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Bann D, Wright L, Hughes A, Chaturvedi N. Socioeconomic inequalities in cardiovascular disease: a causal perspective. Nat Rev Cardiol 2024; 21:238-249. [PMID: 37821646 DOI: 10.1038/s41569-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK.
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
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Cheon BK, Low X, Wijaya DJ, Lee A. Perceived inequality in society may not motivate increased food intake in the absence of personal socioeconomic disadvantage. BMC Public Health 2023; 23:1237. [PMID: 37365621 PMCID: PMC10294481 DOI: 10.1186/s12889-023-16138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Greater levels of socioeconomic inequality across societies have been associated with higher rates of obesity and cardiometabolic disease. While these relationships could be attributed to poorer quality of health services and lower access to healthier lifestyles among disadvantaged groups in societies with greater economic inequality, this explanation does not account for those who experience relative economic security in such unequal societies (e.g., the middle and upper classes). Here, we tested whether perceptions of greater disparities between social classes in one's society (i.e., perceived societal inequality) may promote eating behaviors that risk excess energy intake. METHODS In two studies, participants completed an experimental manipulation that situated them as middle class within a hypothetical society that was presented to have either large disparities in socioeconomic resources between classes (high inequality condition) or low disparities (low inequality condition), while keeping the participants' objective socioeconomic standing constant across conditions. In Study 1 (pre-registered), participants (n = 167) completed the perceived societal inequality manipulation before a computerized food portion selection task to measure desired portion sizes for a variety of foods. Study 2 (n = 154) involved a similar design as Study 1, but with inclusion of a neutral control condition (no awareness of class disparities) followed by ad libitum consumption of potato chips. RESULTS While the high inequality condition successfully elicited perceptions of one's society as having greater socioeconomic inequalities between classes, it did not generate consistent feelings of personal socioeconomic disadvantage. Across both studies, we observed no differences between conditions in average selected portion sizes or actual energy intake. CONCLUSIONS Taken together with prior research on the effects of subjective socioeconomic disadvantage on increased energy intake, these findings suggest that perceptions of inequality in one's society may be insufficient to stimulate heightened energy intake in the absence of personal socioeconomic disadvantage or inadequacy.
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Affiliation(s)
- Bobby K Cheon
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr., Room 3166, Bethesda, MD, 20817, USA.
| | - Xenia Low
- School of Social Sciences (Psychology), Nanyang Technological University, Singapore, Singapore
| | - Darren Jeffian Wijaya
- School of Social Sciences (Psychology), Nanyang Technological University, Singapore, Singapore
| | - Albert Lee
- School of Social Sciences (Psychology), Nanyang Technological University, Singapore, Singapore
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3
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Cohen SA, Nash CC, Byrne EN, Greaney ML. Income and rural-urban status moderate the association between income inequality and life expectancy in US census tracts. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:24. [PMID: 36978201 PMCID: PMC10045499 DOI: 10.1186/s41043-023-00366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND A preponderance of evidence suggests that higher income inequality is associated with poorer population health, yet recent research suggests that this association may vary based on other social determinants, such as socioeconomic status (SES) and other geographic factors, such as rural-urban status. The objective of this empirical study was to assess the potential for SES and rural-urban status to moderate the association between income inequality and life expectancy (LE) at the census-tract level. METHODS Census-tract LE values for 2010-2015 were abstracted from the US Small-area Life Expectancy Estimates Project and linked by census tract to Gini index, a summary measure of income inequality, median household income, and population density for all US census tracts with non-zero populations (n = 66,857). Partial correlation and multivariable linear regression modeling was used to examine the association between Gini index and LE using stratification by median household income and interaction terms to assess statistical significance. RESULTS In the four lowest quintiles of income in the four most rural quintiles of census tracts, the associations between LE and Gini index were significant and negative (p between < 0.001 and 0.021). In contrast, the associations between LE and Gini index were significant and positive for the census tracts in the highest income quintiles, regardless of rural-urban status. CONCLUSION The magnitude and direction of the association between income inequality and population health depend upon area-level income and, to a lesser extent, on rural-urban status. The rationale behind these unexpected findings remains unclear. Further research is needed to understand the mechanisms driving these patterns.
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Affiliation(s)
- Steven A Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI, 02881, USA.
| | - Caitlin C Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI, 02881, USA
| | - Erin N Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI, 02881, USA
| | - Mary L Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI, 02881, USA
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Qin W, Xu L. Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients. BMC Geriatr 2023; 23:57. [PMID: 36721087 PMCID: PMC9890848 DOI: 10.1186/s12877-023-03769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension. METHODS Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The "KHB-method" was used to perform mediation analysis. RESULTS Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78-7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control. CONCLUSIONS Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.
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Affiliation(s)
- Wenzhe Qin
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012 China
| | - Lingzhong Xu
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012 China
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5
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Xiang G, Liu J, Zhong S, Deng M. Comprehensive metrological and content analysis of the income inequality research in health field: A bibliometric analysis. Front Public Health 2022; 10:901112. [PMID: 36187638 PMCID: PMC9515572 DOI: 10.3389/fpubh.2022.901112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
The association between income inequality in a society and the poor health status of its people has attracted the attention of researchers from multiple disciplines. Based on the ISI Web of Science database, bibliometric methods were used to analyze 546 articles related to income inequality research in health field published between 1997 and 2021. We found that the USA contributed most articles, the Harvard Univ was the most influential institution, Social Science & Medicine was the most influential journal, and Kawachi I was the most influential author; the main hotspots included the income inequality, income, health inequality, mortality, socioeconomic factors, concentration index, social capital, self-rated health, income distribution, infant mortality, and population health in 1997-2021; the cardiovascular disease risk factor, social capital income inequality, individual mortality risk, income-related inequalities, understanding income inequalities, income inequality household income, and state income inequality had been the hot research topics in 1997-2003; the self-assessed health, achieving equity, income-related inequalities, oral health, mental health, European panel, occupational class, and cardiovascular diseases had been the hot research topics in 2004-2011; the adolescent emotional problem, South Africa, avoidable mortality, rising inequalities, results from world health survey, working-age adult, spatial aggregation change, prospective study, and mental health-empirical evidence had been the hot research topics in 2012-2021; there were 11 articles with strong transformation potential during 2012-2021. The research results of this paper are helpful to the scientific understanding of the current status of income inequality research in health field.
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Affiliation(s)
- Guocheng Xiang
- School of Business, Hunan University of Science and Technology, Xiangtan, China,College of Economics and Trade, Hunan University of Technology and Business, Changsha, China
| | - Jingjing Liu
- School of Business, Hunan University of Science and Technology, Xiangtan, China
| | - Shihu Zhong
- Department of Applied Economics, Shanghai National Accounting Institute, Shanghai, China,*Correspondence: Shihu Zhong
| | - Mingjun Deng
- Research Center of Big Data and Intelligent Decision, Hunan University of Science and Technology, Xiangtan, China
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Davenport TE, Griech SF, Deamer KE, Gale LR. Beyond "Exercise as Medicine" in Physical Therapy: Toward the Promotion of Exercise as a Public Good. Phys Ther 2022; 102:6618282. [PMID: 35778932 DOI: 10.1093/ptj/pzac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/11/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022]
Abstract
Physical therapists are uniquely positioned through their knowledge and skills to help people become more physically active, which may reduce the consequences of physical inactivity for health-related quality of life and the global economy. The "Exercise Is Medicine" campaign was introduced in 2007. It holds that exercise may be prescribed like a medicine. Although this analogy doubtlessly has promoted innumerable life-changing conversations between clinicians and patients, there are important shortcomings to considering physical activity and exercise as medicine. In the United States, many of these shortcomings relate to how medical services are provided and remunerated. Medical care is provided in the context of exclusive groups, which are established by insurance, preferred service populations, or other characteristics that determine a basis for providing care. Exclusivity means that medical care is frequently provided in a type of club. The club structure of medical care jeopardizes the ability of nonmembers to benefit. Medical care clubs based on payment create an environment in which nonpaying customers may not benefit in the same manner as paying customers from approaches that consider exercise prescribed as medicine. This clinical perspective reviews the characteristics of exercise as a good, focusing on how it is prescribed by physical therapists. It discusses how physical therapists may become involved in the process of making exercise a public good by reducing its exclusivity. Multiple levels of involvement are recommended at the societal, community, and individual levels. These involvements may be guided by an existing construct proposed by the World Health Organization, which would bring the global physical therapy profession into a common alignment. This Perspective concludes with a discussion that anticipates the shortcomings of conceptualizing exercise as a public good to be addressed in future service delivery models.
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Affiliation(s)
- Todd E Davenport
- Department of Physical Therapy, School of Health Sciences, University of the Pacific, Stockton, California, USA
| | - Sean F Griech
- Department of Physical Therapy, DeSales University, Center Valley, Pennsylvania, USA
| | | | - Lewis R Gale
- Eberhardt School of Business, University of the Pacific, Stockton, California, USA
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Lee J, Kim H, Moon J, Shin J, Jeong H, Kim Y. Temporal trend of first-ever ischaemic stroke incidence from 2010 to 2019 in South Korea: a nationwide retrospective cohort study. BMJ Open 2022; 12:e059956. [PMID: 36002224 PMCID: PMC9413172 DOI: 10.1136/bmjopen-2021-059956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Ischaemic stroke incidence is on the decline globally, but the trend in South Korea is unknown. In this study, the 10-year incidence trends of first-ever ischaemic stroke in South Korea were evaluated. DESIGN, SETTING AND PARTICIPANTS The National Health Insurance Services medical claim data were used to construct 10 annual cohorts of adults aged 20 years and older, who had not been diagnosed with stroke, to find out the incidence trends of first-ever ischaemic stroke from 2010 to 2019. OUTCOME MEASURES The primary outcomes were crude and age-adjusted incidence rates for 10 years. Crude incidence rates of the age groups and incidence age statistics were calculated. For comparison among the income groups, age-adjusted incidence rates were used. Incidence rates in all the groups were analysed separately by sex. RESULTS Age-standardised incidence rates of ischaemic stroke per 100 000 were 101.0 in men, and 67.6 in women in 2010; and 92.2 in men, and 55.0 in women in 2019. By age group, there was a decrease in women over 40 years of age, and men over 60 years of age. The relative difference in stroke incidence rates between medical aid beneficiaries and the highest income group increased from 1.5 to 1.87 over 10 years. CONCLUSIONS Age-standardised incidence rate of ischaemic stroke has decreased from 2010 to 2019 for both man and women. The incidence rate was stable in the younger age groups and decreased in the older age groups, and the disparities between income groups have widened over the past decade. Stroke prevention strategies are needed for the younger age group and the low-income group. Further research is needed to study the risk factors contributing to the incidence of ischaemic stroke in different groups.
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Affiliation(s)
- Jeehye Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hojin Jeong
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Youngtaek Kim
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Korea
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Alizadeh G, Gholipour K, Azami-Aghdash S, Dehnavieh R, JafarAbadi MA, Azmin M, Khodayari-Zarnaq R. Social, Economic, Technological, and Environmental Factors Affecting Cardiovascular Diseases: A Systematic Review and Thematic Analysis. Int J Prev Med 2022; 13:78. [PMID: 35706860 PMCID: PMC9188896 DOI: 10.4103/ijpvm.ijpvm_105_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022] Open
Abstract
Background Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD. Methods Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data. Results A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster. Conclusions Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors.
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Affiliation(s)
- Gisoo Alizadeh
- Department of Health policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Asghari JafarAbadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Azmin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Dunn JR, Park GR, Brydon R, Wolfson M, Veall M, Rolheiser L, Siddiqi A, Ross NA. Income inequality and population health: a political-economic research agenda. J Epidemiol Community Health 2022; 76:jech-2022-219252. [PMID: 35676074 DOI: 10.1136/jech-2022-219252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/03/2022]
Abstract
There is more than 30 years of research on relationships between income inequality and population health. In this article, we propose a research agenda with five recommendations for future research to refine existing knowledge and examine new questions. First, we recommend that future research prioritise analyses with broader time horizons, exploring multiple temporal aspects of the relationship. Second, we recommend expanding research on the effect of public expenditures on the inequality-health relationship. Third, we introduce a new area of inquiry focused on interactions between social mobility, income inequality and population health. Fourth, we argue the need to examine new perspectives on 21st century capitalism, specifically the population health impacts of inequality in income from capital (especially housing), in contrast to inequality in income from labour. Finally, we propose that this research broaden beyond all-cause mortality, to cause-specific mortality, avoidable mortality and subcategories thereof. We believe that such a research agenda is important for policy to respond to the changes following the COVID-19 pandemic.
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Affiliation(s)
- James R Dunn
- Department of Health, Aging and Society, McMaster University Faculty of Social Sciences, Hamilton, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Robbie Brydon
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
| | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Veall
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Lyndsey Rolheiser
- Center for Real Estate and Urban Economic Studies, University of Connecticut School of Business, Storrs, Connecticut, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, Montreal, Quebec, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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10
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Rising childhood income inequality and declining Americans' health. Soc Sci Med 2022; 303:115016. [PMID: 35567904 PMCID: PMC9750155 DOI: 10.1016/j.socscimed.2022.115016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 12/16/2022]
Abstract
Morbidity and mortality are on the rise among Baby Boomers and younger cohorts. This study investigates whether this unfavorable health trend across birth cohorts 1925-1999 is related to rising income inequality Americans face during childhood. We use two nationally representative datasets: National Health and Nutrition Examination Surveys (NHANES) 1988-2018 and Panel Studies of Income Dynamics (PSID) 1968-2013, and two health outcomes: biomarkers of physiological dysregulation, and a chronic disease index. Childhood income inequality is measured by the average of the Gini index at the national level each birth cohort is exposed to between birth and age 18, where the Gini index from 1925 to 2016 is computed based on Internal Revenue Service income data. By merging childhood income inequality to individual level data from NHANES or PSID based on birth cohort, we find childhood income inequality is positively associated with the risk of physiological dysregulation in adulthood for all gender and racial groups in the NHANES data. It is also significantly related to the risk of chronic disease in the PSID data. This association is robust to controls for individual level childhood health and family background, adulthood socioeconomic and marital status, and contemporary macro socioeconomic factors. More importantly, childhood income inequality exposure explains a substantial amount of variation in these two health outcomes across cohorts, a pattern not observed for other early life exposures that display negative temporal trends similar to those for childhood income inequality. This study provides important evidence that income inequality experienced during childhood may have a long-lasting negative consequence for adult health, which partially explains the adverse health trends experienced by Baby Boomers and younger cohorts in the United States.
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11
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Kempel MK, Winding TN, Böttcher M, Andersen JH. Subjective social status and cardiometabolic risk markers in young adults. Psychoneuroendocrinology 2022; 137:105666. [PMID: 35038663 DOI: 10.1016/j.psyneuen.2022.105666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Low subjective social status (SSS), the perceived status in the social hierarchy, is associated with cardiometabolic risk in middle-aged and older adults. However, most studies are cross-sectional and very little is known about the association in adolescence and young adulthood. The aims of this study were; a) to prospectively investigate the association between SSS at ages 15 and 28 and cardiometabolic risk at age 28-30 and b) to examine if such an association was independent of smoking, physical activity and objective measures of social position. METHODS The study used questionnaire information at ages 15 and 28 from the West Jutland Cohort Study (N = 3681), health measurements from a sub-sample of the cohort (N = 264, age 28-30, 50% women) and information from population-based national registers. The independent variable was a measure of SSS evaluated by a 10-rung ladder scale and dichotomized at the 25th percentile of data from the cohort study population. The outcome measure was a composite score of cardiometabolic risk including measures of lipids, inflammation, blood pressure and glucose-metabolism. Co-variates included smoking, physical activity, childhood and adulthood socioeconomic position. Sex-stratified linear regression analyses were performed to evaluate the associations between SSS and cardiometabolic risk. RESULTS In both sexes, low SSS at age 28, but not at age 15, was significantly associated with increased cardiometabolic risk at age 28-30. Neither smoking, physical activity, childhood or adulthood objective socioeconomic position fully explained the associations. CONCLUSION In young adulthood, SSS was inversely related to cardiometabolic risk after accounting for smoking, physical activity and objective measures of socioeconomic position. These findings suggest that SSS could play a role in the social disparities in cardiometabolic risk in addition to traditional measures of socioeconomic position.
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Affiliation(s)
- Mia Klinkvort Kempel
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark.
| | - Trine Nøhr Winding
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | - Morten Böttcher
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Cardiovascular Research Unit - University Research Clinic, Department of Cardiology, Goedstrup Hospital, Herning, Denmark
| | - Johan Hviid Andersen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
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12
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Ryan M, Muldoon OT, Gallagher S, Jetten J. Physiological stress responses to inequality across income groups in a virtual society. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1111/jasp.12807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Megan Ryan
- Department of Psychology Centre for Social Issues Research University of Limerick Limerick Ireland
- Department of Psychology Centre for Social Issues Research Study of Anxiety, Stress and Health Laboratory University of Limerick Limerick Ireland
| | - Orla T. Muldoon
- Department of Psychology Centre for Social Issues Research University of Limerick Limerick Ireland
| | - Stephen Gallagher
- Department of Psychology Centre for Social Issues Research University of Limerick Limerick Ireland
- Department of Psychology Centre for Social Issues Research Study of Anxiety, Stress and Health Laboratory University of Limerick Limerick Ireland
| | - Jolanda Jetten
- School of Psychology University of Queensland Brisbane QLD Australia
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Jaeggi AV, Blackwell AD, von Rueden C, Trumble BC, Stieglitz J, Garcia AR, Kraft TS, Beheim BA, Hooper PL, Kaplan H, Gurven M. Do wealth and inequality associate with health in a small-scale subsistence society? eLife 2021; 10:59437. [PMID: 33988506 PMCID: PMC8225390 DOI: 10.7554/elife.59437] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
In high-income countries, one’s relative socio-economic position and economic inequality may affect health and well-being, arguably via psychosocial stress. We tested this in a small-scale subsistence society, the Tsimane, by associating relative household wealth (n = 871) and community-level wealth inequality (n = 40, Gini = 0.15–0.53) with a range of psychological variables, stressors, and health outcomes (depressive symptoms [n = 670], social conflicts [n = 401], non-social problems [n = 398], social support [n = 399], cortisol [n = 811], body mass index [n = 9,926], blood pressure [n = 3,195], self-rated health [n = 2523], morbidities [n = 1542]) controlling for community-average wealth, age, sex, household size, community size, and distance to markets. Wealthier people largely had better outcomes while inequality associated with more respiratory disease, a leading cause of mortality. Greater inequality and lower wealth were associated with higher blood pressure. Psychosocial factors did not mediate wealth-health associations. Thus, relative socio-economic position and inequality may affect health across diverse societies, though this is likely exacerbated in high-income countries. Poverty is bad for health. People living in poverty are more likely to struggle to afford nutritious food, lack access to health care, or be overworked or stressed. This may make them susceptible to chronic diseases, contribute to faster aging, and shorten their lifespans. In high-income countries, there is growing evidence to suggest that a person’s ‘rank’ in society also impacts their health. For example, individuals who have a lower position in the social hierarchy report worse health outcomes, regardless of their incomes. But it is unclear why living in an unequal society or having a lower social status contributes to poorer health. One possibility is that inequalities in society are creating a stressful environment that leads to worse physical and mental outcomes. It is thought that this stress largely comes from how humans evolved to prioritize reaching a higher social status over having a long and healthy life. If this is the case, this would mean that the link between social status and health would also be present in non-industrialized communities where social hierarchies tend to be less pronounced. To test this, Jaeggi, Blackwell et al. studied the Indigenous Tsimane population in Bolivia who live in small communities and forage and farm their own food. The income and relative wealth of 870 households from 40 Tsimane communities were compared against various outcomes, including symptoms associated with depression, stress hormone levels, blood pressure, self-rated health and several diseases. Jaeggi, Blackwell et al. found poverty and inequality did not negatively impact all of the health outcomes measured as has been previously reported for industrialized societies. However, blood pressure was higher among people with lower incomes or those who lived in more unequal communities. But because the Tsimane people generally have low blood pressure, the differences were too small to have much effect on their health. People who lived in more unequal communities were also three times more likely to have respiratory infections, but the reason for this was unclear. This shows that social determinants such as a person’s wealth or inequality can affect health, even in communities with less rigid social hierarchies. In industrial societies the effect may be worse in part because they are compounded by lifestyle factors, such as diets rich in fat and sugar, and physical inactivity which can also increase blood pressure. This information may help policy makers reduce health disparities by addressing some of the social determinants of health and the lifestyle factors that cause them.
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Affiliation(s)
- Adrian V Jaeggi
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,Department of Anthropology, Emory University, Atlanta, United States
| | - Aaron D Blackwell
- Department of Anthropology, Washington State University, Pulman, United States
| | | | - Benjamin C Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, United States.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, United States
| | | | - Angela R Garcia
- Department of Anthropology, Emory University, Atlanta, United States.,School of Human Evolution and Social Change, Arizona State University, Tempe, United States.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, United States
| | - Thomas S Kraft
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
| | - Bret A Beheim
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Paul L Hooper
- Economic Science Institute, Chapman University, Irvine, United States.,Department of Anthropology, University of New Mexico, Albuquerque, United States
| | - Hillard Kaplan
- Economic Science Institute, Chapman University, Irvine, United States
| | - Michael Gurven
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
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14
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The sociospatial factors of death: Analyzing effects of geospatially-distributed variables in a Bayesian mortality model for Hong Kong. PLoS One 2021; 16:e0247795. [PMID: 33760852 PMCID: PMC7990297 DOI: 10.1371/journal.pone.0247795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
Human mortality is in part a function of multiple socioeconomic factors that differ both spatially and temporally. Adjusting for other covariates, the human lifespan is positively associated with household wealth. However, the extent to which mortality in a geographical region is a function of socioeconomic factors in both that region and its neighbors is unclear. There is also little information on the temporal components of this relationship. Using the districts of Hong Kong over multiple census years as a case study, we demonstrate that there are differences in how wealth indicator variables are associated with longevity in (a) areas that are affluent but neighbored by socially deprived districts versus (b) wealthy areas surrounded by similarly wealthy districts. We also show that the inclusion of spatially-distributed variables reduces uncertainty in mortality rate predictions in each census year when compared with a baseline model. Our results suggest that geographic mortality models should incorporate nonlocal information (e.g., spatial neighbors) to lower the variance of their mortality estimates, and point to a more in-depth analysis of sociospatial spillover effects on mortality rates.
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15
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Teng THK, Tay WT, Richards AM, Chew TSM, Anand I, Ouwerkerk W, Chandramouli C, Huang W, Lawson CA, Kadam UT, Yap J, Lim S, Hung CL, MacDonald MR, Loh SY, Shimizu W, Tromp J, Lam CSP. Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia. Circ Cardiovasc Qual Outcomes 2021; 14:e006962. [PMID: 33757307 DOI: 10.1161/circoutcomes.120.006962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. METHODS We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). RESULTS Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status (Pinteraction <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. CONCLUSIONS These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT01633398.
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Affiliation(s)
- Tiew-Hwa K Teng
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,School of Population & Global Health, University of Western Australia (T.-H.K.T.)
| | - Wan Ting Tay
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Arthur Mark Richards
- National University Heart Centre, Singapore (A.M.R., S.L.).,University of Otago, New Zealand (A.M.R.)
| | | | - Inder Anand
- Veterans Affairs Medical Center, University of Minnesota, Minneapolis (I.A.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Department of Dermatology, Amsterdam Medical Center, the Netherlands (W.O.)
| | - Chanchal Chandramouli
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Weiting Huang
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | | | - Umesh T Kadam
- University of Leicester, United Kingdom (C.A.L., U.T.K.)
| | - Jonathan Yap
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Shirlynn Lim
- National University Heart Centre, Singapore (A.M.R., S.L.)
| | | | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Jasper Tromp
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands (J.T., C.S.P.L.)
| | - Carolyn Su Ping Lam
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands (J.T., C.S.P.L.)
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16
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Morar M, Vandevijvere S, Swinburn B. The potential impact of an implemented income redistribution package on obesity prevalence in New Zealand. Soc Sci Med 2020; 268:113483. [PMID: 33243526 DOI: 10.1016/j.socscimed.2020.113483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
AIM This study quantified associations between (absolute and relative) individual income and obesity prevalence. These associations were then used to model the potential effect of a New Zealand (NZ) Government's income redistributive policy (the Families Package) on adult obesity prevalence. METHODS Logistic regressions were used to investigate associations between absolute individual income and adult obesity prevalence in NZ. Linear regressions were used to assess associations between relative income (income inequality measured by Gini) and obesity prevalence (from the NCD-RisC) for OECD countries. Potential impact fractions were calculated to determine how income redistribution might affect obesity prevalence. FINDINGS Absolute individual disposable income was significantly associated with obesity in NZ females (but not males) in a shallow, inverted J-shaped fashion. Income inequality was significantly positively associated with obesity prevalence in NZ females but not in males. The Families Package had a modest effect on income distribution and reduced Gini in NZ by 1.43%. Female obesity prevalence in NZ was modelled to decrease by 0.12 percentage points and 0.98 percentage points due to changes to absolute income and income inequality, respectively. CONCLUSIONS Despite being the most substantial income tax package in New Zealand since the 1990s, this policy had a modest effect on income redistribution, and its expected impact on reducing obesity in females was also modest, with no effect in males. The J-shaped curve indicates that income redistribution could even increase obesity prevalence among low-income women.
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Affiliation(s)
- Manisha Morar
- School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Stefanie Vandevijvere
- School of Population Health, University of Auckland, Auckland, New Zealand; Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand; Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia
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17
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Sfm C, Van Cauwenberg J, Maenhout L, Cardon G, Lambert EV, Van Dyck D. Inequality in physical activity, global trends by income inequality and gender in adults. Int J Behav Nutr Phys Act 2020; 17:142. [PMID: 33239036 PMCID: PMC7690175 DOI: 10.1186/s12966-020-01039-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background Physical inactivity is a global pandemic associated with a high burden of disease and premature mortality. There is also a trend in growing economic inequalities which impacts population health. There is no global analysis of the relationship between income inequality and population levels of physical inactivity. Methods Two thousand sixteen World Health Organisation’s country level data about compliance with the 2010 global physical activity guidelines were analysed against country level income interquantile ratio data obtained from the World Bank, OECD and World Income Inequality Database. The analysis was stratified by country income (Low, Middle and High) according to the World Bank classification and gender. Multiple regression was used to quantify the association between physical activity and income inequality. Models were adjusted for GDP and percentage of GDP spent on health care for each country and out of pocket health care spent. Results Significantly higher levels of inactivity and a wider gap between the percentage of women and men meeting global physical activity guidelines were found in countries with higher income inequality in high and middle income countries irrespective of a country wealth and spend on health care. For example, in higher income countries, for each point increase in the interquantile ratio data, levels of inactivity in women were 3.73% (CI 0.89 6.57) higher, levels of inactivity in men were 2.04% (CI 0.08 4.15) higher and the gap in inactivity levels between women and men was 1.50% larger (CI 0.16 2.83). Similar relationships were found in middle income countries with lower effect sizes. These relationships were, however, not demonstrated in the low-income countries. Conclusions Economic inequalities, particularly in high- and middle- income countries might contribute to physical inactivity and might be an important factor to consider and address in order to combat the global inactivity pandemic and to achieve the World Health Organisation target for inactivity reduction. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-020-01039-x.
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Affiliation(s)
- Chastin Sfm
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. .,Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
| | - J Van Cauwenberg
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - L Maenhout
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - G Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - E V Lambert
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - D Van Dyck
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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18
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Punnoose LR, Lindenfeld J. Sex-specific differences in access and response to medical and device therapies in heart failure: State of the art. Prog Cardiovasc Dis 2020; 63:640-648. [PMID: 32987026 DOI: 10.1016/j.pcad.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022]
Abstract
Women with heart failure (HF) are more symptomatic than their male counterparts. Despite deriving similar benefits from both medical and devices therapies, women continue to be underrepresented in clinic trials. Important sex-based disparities exist in enrollment in clinical trials and access to medical and device-based therapies, in part stemming from differences in medical and psychosocial comorbidities. Disparities in access to beneficial interventions likely contribute to the greater symptom burden identified in women with HF. Improved focus on the enrollment of women in clinical trials will allow a better understanding of the underpinnings of these disparities and improve the care of women with HF.
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Affiliation(s)
- Lynn R Punnoose
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, United States of America.
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, United States of America
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19
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Horino M, Liu SY, Lee EY, Kawachi I, Pabayo R. State-level income inequality and the odds for meeting fruit and vegetable recommendations among US adults. PLoS One 2020; 15:e0238577. [PMID: 32903265 PMCID: PMC7480846 DOI: 10.1371/journal.pone.0238577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Previous research indicates that income inequality is associated with risk for mortality, self-rated health status, chronic conditions, and health behavior, such as physical activity. However, little is known about the relationship between income inequality and dietary intake, which is a major risk factor for common chronic diseases including heart disease, stroke, diabetes, and certain types of cancers. The objective of this study is to determine the association between US state income inequality and fruit and vegetable consumption among adults. Methods Cross-sectional data on 270,612 U.S. adults from the U.S. 2013 Behavioral Risk Factor Surveillance System was used. Fruit and vegetable consumption was assessed from the six-item fruit and vegetable frequency questionnaire, which is part of the Behavioral Risk Factor Surveillance System. Multilevel modeling was used to determine whether US state-level income inequality (measured by the z-transformation of the Gini coefficient) was associated with fruit and vegetable consumption adjusting for individual-level and state-level covariates. Results In comparison to men, women were more likely to consume fruits and vegetables ≥5 times daily, fruits ≥2 times daily, vegetables ≥3 times of daily, and less likely to consume fruit juice daily. Among both men and women, a standard deviation increase in Gini coefficient was associated with an increase in consuming fruit juice daily (OR = 1.07, 95% CI = 1.03, 1.11). However, among women, a standard deviation increase in Gini coefficient was associated with a decreased likelihood in meeting daily recommended levels of both fruits and vegetables (OR = 0.93; 0.87–0.99), fruits only (OR = 0.95; 95% CI, 0.92–0.99) and vegetables only (OR = 0.92; 95% CI, 0.89–0.96). Conclusions This study is one of the first to show the relationship between income inequality and fruit and vegetable consumption among U.S. adults empirically. Women’s health is more likely to be detrimentally affected when living in a state with higher income inequality.
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Affiliation(s)
- Masako Horino
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- School of Community Health Sciences, University of Nevada, Reno, Reno, NV, United States of America
| | - Sze Yan Liu
- Public Health Department, Montclair State University, New York, NY, United States of America
- Weill Cornell Medical College, New York City, NY, United States of America
| | - Eun-Young Lee
- School of Kinesiology & Health and Department of Gender Studies, Queen's University Kingston, ON, Canada
| | - Ichiro Kawachi
- Department of Social Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- * E-mail:
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20
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Vernon F, Morrow M, MaWhinney S, Coyle R, Coleman S, Ellison L, Zheng JH, Bushman L, Kiser JJ, Galárraga O, Anderson PL, Castillo-Mancilla J. Income Inequality Is Associated With Low Cumulative Antiretroviral Adherence in Persons With Human Immunodeficiency Virus. Open Forum Infect Dis 2020; 7:ofaa391. [PMID: 33072812 PMCID: PMC7539687 DOI: 10.1093/ofid/ofaa391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background The adherence biomarker tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is associated with viral suppression and predicts future viremia. However, its association with social determinants of health (SDoH) in people with human immunodeficiency virus (PWH) remains unknown. Methods Dried blood spots for TFV-DP were longitudinally collected from a clinical cohort of PWH receiving tenofovir disoproxil fumarate-based therapy (up to 3 visits over 48 weeks) residing in 5 Colorado counties. To assign SDoH, zip codes at enrollment were matched with SDoH data from AIDSVu (https://aidsvu.org/). The SDoH included household income, percentage living in poverty, education level, and income inequality (quantified using Gini coefficient, where 0 and 1 represent perfect income equality and inequality, respectively). Log-transformed TFV-DP concentrations were analyzed using a mixed-effects model to estimate percentage change (95% confidence interval) in TFV-DP for every significant change in the SDoH and adjusted for relevant covariates including age, gender, race, estimated glomerular filtration rate, body mass index, hematocrit, CD4+ T-cell count, antiretroviral drug class, and 3-month self-reported adherence. Results Data from 430 PWH totaling 950 person-visits were analyzed. In an adjusted analysis, income inequality was inversely associated with TFV-DP in DBS. For every 0.1 increase in the Gini coefficient, TFV-DP concentrations decreased by 9.2% (−0.5 to −17.1; P = .039). This remained significant after adjusting for human immunodeficiency virus viral suppression, where a 0.1 increase in Gini was associated with a decrease of 8.7% (−0.3 to −17.9; P = .042) in TFV-DP. Conclusions Higher income inequality was associated with lower cumulative antiretroviral adherence. These findings support the need for further research on how SDoH impact adherence and clinical care.
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Affiliation(s)
- Frances Vernon
- School of Medicine, University of Colorado-Anschutz Medical Campus (AMC), Aurora, Colorado, USA
| | - Mary Morrow
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ryan Coyle
- Division of Infectious Diseases, School of Medicine, University of Colorado-AMC, Aurora, Colorado, USA
| | | | - Lucas Ellison
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, Colorado, USA
| | - Jia-Hua Zheng
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, Colorado, USA
| | - Lane Bushman
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, Colorado, USA
| | - Jennifer J Kiser
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, Colorado, USA
| | - Omar Galárraga
- Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Peter L Anderson
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, Colorado, USA
| | - Jose Castillo-Mancilla
- Division of Infectious Diseases, School of Medicine, University of Colorado-AMC, Aurora, Colorado, USA
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Nagano H, Puppim de Oliveira JA, Barros AK, Costa Junior ADS. The 'Heart Kuznets Curve'? Understanding the relations between economic development and cardiac conditions. WORLD DEVELOPMENT 2020; 132:104953. [PMID: 32362711 PMCID: PMC7190509 DOI: 10.1016/j.worlddev.2020.104953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 05/23/2023]
Abstract
As countries turn wealthier, some health indicators, such as child mortality, seem to have well-defined trends. However, others, including cardiovascular conditions, do not follow clear linear patterns of change with economic development. Abnormal blood pressure is a serious health risk factor with consequences for population growth and longevity as well as public and private expenditure in health care and labor productivity. This also increases the risk of the population in certain pandemics, such as COVID-19. To determine the correlation of income and blood pressure, we analyzed time-series for the mean systolic blood pressure (SBP) of men's population (mmHg) and nominal Gross Domestic Product per capita (GDPPC) for 136 countries from 1980 to 2008 using regression and statistical analysis by Pearson's correlation (r). Our study finds a trend similar to an inverted-U shaped curve, or a 'Heart Kuznets Curve'. There is a positive correlation (increase GDPPC, increase SBP) in low-income countries, and a negative correlation in high-income countries (increase GDPPC, decrease SBP). As country income rises people tend to change their diets and habits and have better access to health services and education, which affects blood pressure. However, the latter two may not offset the rise in blood pressure until countries reach a certain income. Investing early in health education and preventive health care could avoid the sharp increase in blood pressure as countries develop, and therefore, avoiding the 'Heart Kuznets Curve' and its economic and human impacts.
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Affiliation(s)
| | - Jose A. Puppim de Oliveira
- Fundação Getulio Vargas (FGV/EAESP and FGV/EBAPE), Brazil
- Institute for Global Public Policy and School of International Relations and Public Affairs (SIRPA), Fudan University, China
| | | | - Altair da Silva Costa Junior
- SURGP&D – Company for Research and Development in Medicine/Surgery, Brazil
- Paulista School of Medicine/Sao Paulo University Hospital – Federal University of Sao Paulo, Brazil
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22
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Ferreira JP, Rossignol P, Dewan P, Lamiral Z, White WB, Pitt B, McMurray JJ, Zannad F. Income level and inequality as complement to geographical differences in cardiovascular trials. Am Heart J 2019; 218:66-74. [PMID: 31707330 DOI: 10.1016/j.ahj.2019.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Analyses of country or regional differences in cardiovascular (CV) trials are based on geographical subgroup analyses. However, apart from map location and related racial, ethnic, and genetic variations, identified differences may also depend on social structure and provision and access to health care, for which country income and income inequality are indicators. The aim of the study was to examine the association between country per capita income and income inequality and prognosis in patients with heart failure or an acute coronary syndrome in 3 international trials (EMPHASIS-HF, EPHESUS, and EXAMINE). METHODS Countries were classified into high income or low-middle income (LMICs) and into low, middle, or high inequality using the Gini index. The main outcome measures were all-cause and CV death. RESULTS Patients from LMICs and countries with higher inequality were younger, were less often white, had fewer comorbid conditions, and were less often treated with guideline-recommended therapies, including devices. These patients had higher adjusted mortality rates (+15% to +70%) compared with patients from high-income countries and countries with less inequality. Patients from countries with the combination of greater inequality and low-middle income had particularly high mortality rates (+80% to +190%) compared with those that did not have both characteristics. Living in a country that is poor and has inequality had more impact on death rates than any comorbidity. These findings were reproduced in 3 trials. CONCLUSIONS Patients from LMICs and countries with greater inequality had the highest mortality rates. The prognostic impact of income and inequality is substantial and should be considered when looking into subgroup differences in CV trials.
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Pearce J, Rafiq S, Simpson J, Varese F. Perceived discrimination and psychosis: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1023-1044. [PMID: 31236631 DOI: 10.1007/s00127-019-01729-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Higher rates of psychosis have been reported in minority groups. Since individuals belonging to such groups are vulnerable to the experiences of discrimination, and in line with models proposing that social and life adversity may play a causal role in development and maintenance of psychotic experiences, it has been proposed that perceived discrimination may represent an important determinant of psychotic experiences. This paper reviews the literature examining the relationship between perceived discrimination and psychosis, examining whether discrimination is associated with an increased risk of psychosis, the severity of psychotic symptoms and whether there is an association with specific psychotic symptoms. METHODS A systematic database search of PsycINFO, Embase and PubMed was conducted to identify quantitative cross-sectional and prospective studies that examined the association between discrimination and psychosis. RESULTS Twenty-four studies met the inclusion criteria, four of which used prospective designs and twenty used cross-sectional designs. The main findings indicated that discrimination may be associated with an increased risk of psychosis (too few studies to determine whether discrimination is associated with severity). Some studies found associations between discrimination and positive psychotic experiences and/or specific psychotic experiences such as paranoia. A small number of studies found that greater exposure to discrimination was associated with a greater likelihood of reporting psychotic experiences, tentatively indicating a dose-response relationship. CONCLUSIONS This review indicates that discrimination plays an important role in the experience of psychosis; however, future research is required to clarify the nature of this relationship. Avenues for further research and clinical implications are proposed.
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Affiliation(s)
- Josie Pearce
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sonya Rafiq
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK. .,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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24
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Cyrus T. Pathways from trade to health. Rev Panam Salud Publica 2019; 42:e51. [PMID: 31093079 PMCID: PMC6386062 DOI: 10.26633/rpsp.2018.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/05/2018] [Indexed: 11/24/2022] Open
Abstract
International trade has increased over time, both in volume and as a share of gross domestic product, and international trade agreements have proliferated. This rise in trade has many potential impacts on health outcomes. Trade raises living standards, allowing for greater spending on education and medical care, which improves health. However, trade may worsen intranational inequality, leading to increased stress and adverse impacts on mortality. Labor markets are affected by international trade, and the resulting changes in unemployment, working hours, and injury rates have an impact on health outcomes. Trade may induce adverse environmental impacts, such as increased pollution, leading to worsened health. Reductions in prices as a result of changes to trade policy may increase the consumption of unhealthy goods, including tobacco and processed foods, thus worsening the prevalence of noncommunicable diseases. Trade agreements may affect the ability of governments to legislate health-improving policies. Overall, international trade and trade agreements may have both positive and negative effects on health outcomes; government policy may be used to ameliorate any adverse effects of trade.
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Affiliation(s)
- Teresa Cyrus
- Dalhousie University, Halifax, Nova Scotia, Canada
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Kim JH, Lewis TT, Topel ML, Mubasher M, Li C, Vaccarino V, Mujahid MS, Sims M, Quyyumi AA, Taylor HA, Baltrus PT. Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Prev Chronic Dis 2019; 16:E57. [PMID: 31074715 PMCID: PMC6513475 DOI: 10.5888/pcd16.180505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite the growing interest in place as a determinant of health, areas that promote rather than reduce cardiovascular disease (CVD) in blacks are understudied. We performed an ecologic analysis to identify areas with high levels of CVD resilience and risk among blacks from a large southern, US metropolitan area. METHODS We obtained census tract-level rates of cardiovascular deaths, emergency department (ED) visits, and hospitalizations for black adults aged 35 to 64 from 2010 through 2014 for the Atlanta, Georgia, metropolitan area. Census tracts with substantially lower rates of cardiovascular events on the basis of neighborhood socioeconomic status were identified as resilient and those with higher rates were identified as at risk. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) of being classified as an at-risk versus resilient tract for differences in census-derived measures. RESULTS We identified 106 resilient and 121 at-risk census tracts, which differed in the rates per 5,000 person years of cardiovascular outcomes (mortality, 8.13 vs 13.81; ED visits, 32.25 vs 146.3; hospitalizations, 26.69 vs 130.0), despite similarities in their median black income ($46,123 vs $45,306). Tracts with a higher percentage of residents aged 65 or older (odds ratio [OR], 2.29; 95% CI, 1.41-3.85 per 5% increment) and those with incomes less than 200% of the federal poverty level (OR, 1.19; 95% CI, 1.02-1.39 per 5% increment) and greater Gini index (OR, 1.56; 95% CI, 1.19- 2.07 per 0.05 increment) were more likely to be classified as at risk than resilient neighborhoods. DISCUSSION Despite matching on median income level, at-risk neighborhoods for CVD among black populations were associated with a higher prevalence of socioeconomic indicators of inequality than resilient neighborhoods.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew L Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Peter T Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia.,Morehouse School of Medicine, National Center for Primary Care, Room 310, 720 Westview Dr, Atlanta, GA 30310.
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Towne SD, Lopez ML, Li Y, Smith ML, Warren JL, Evans AE, Ory MG. Examining the Role of Income Inequality and Neighborhood Walkability on Obesity and Physical Activity among Low-Income Hispanic Adults. J Immigr Minor Health 2019; 20:854-864. [PMID: 28735455 DOI: 10.1007/s10903-017-0625-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Obesity is a major public health issue affecting rising medical costs and contributing to morbidity and premature mortality. We aimed to identify factors that may play a role in obesity and physical activity at the individual and environmental/neighborhood levels. We analyzed data from an adult sample who were parents of students enrolled in a school-based health and wellness program. The sample was restricted to those who were Hispanic and whose children were on free/reduced lunch (n = 377). Dependent variables: body mass index (BMI); neighborhood walkability. Walk Score® was used to assess neighborhood walkability. Overall, 46% of participants were obese and 31% were overweight. The median age of respondents was 34 years, and the majority were female (88%) and married (59%). Participants who resided in a census tract with a higher relative income inequality (high, OR 2.54, 90% CI 1.154-5.601; moderate-high OR 2.527, 90% CI 1.324-4.821) and those who were unmarried (OR 1.807, 90% CI 1.119-2.917) were more likely to be obese versus normal weight. Overweight individuals that resided in areas that were walkable versus car-dependent averaged more days engaging in walking for at least 30-min (p <.05). Identifying individual and neighborhood factors associated with obesity can inform more targeted approaches to combat obesity at multiple ecological levels. The importance of understanding how neighborhood characteristics influence health-related and behavioral outcomes is further reinforced with the current findings. Identifying effective strategies to engage communities and organizations in creating, implementing, adopting, evaluating, and sustaining policy and/or environmental interventions will be needed to combat the obesity epidemic.
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Affiliation(s)
- Samuel D Towne
- Texas A&M School of Public Health, 1266 TAMU, College Station, TX, 77843-1266, USA.
| | - Michael L Lopez
- Texas A&M AgriLife Extension, Texas A&M University, College Station, TX, 77843, USA
| | - Yajuan Li
- Department of Agricultural Economics, Texas A&M University, College Station, TX, 77843, USA
| | - Matthew Lee Smith
- Texas A&M School of Public Health, 1266 TAMU, College Station, TX, 77843-1266, USA.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, 30602, USA
| | - Judith L Warren
- Texas A&M AgriLife Extension, Texas A&M University, College Station, TX, 77843, USA
| | - Alexandra E Evans
- Michael & Susan Dell Center for Healthy Living Division of Health Promotion and Behavioral Science School of Public Health, University of Texas, Austin, TX, 78701, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M School of Public Health, 1266 TAMU, College Station, TX, 77843-1266, USA
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27
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Income Inequality and Outcomes in Heart Failure. JACC-HEART FAILURE 2019; 7:336-346. [DOI: 10.1016/j.jchf.2018.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 11/18/2022]
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Peterson RL, Carvajal SC, McGuire LC, Fain MJ, Bell ML. State inequality, socioeconomic position and subjective cognitive decline in the United States. SSM Popul Health 2019; 7:100357. [PMID: 30886886 PMCID: PMC6402371 DOI: 10.1016/j.ssmph.2019.100357] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 01/08/2023] Open
Abstract
Background Social gradients in health have been observed for many health conditions and are suggested to operate through the effects of status anxiety. However, the gradient between education and Alzheimer’s disease is presumed to operate through cognitive stimulation. We examined the possible role of status anxiety through testing for state-level income inequality and social gradients in markers of socioeconomic position (SEP) for Alzheimer’s disease risk. Methods Using data from the cross-sectional 2015 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey, we tested for the association between U.S. state-level income inequality and individual SEP on subjective cognitive decline (SCD) – a marker of dementia risk – using a generalized estimating equation and clustering by state. Results State income inequality was not significantly associated with SCD in our multivariable model (OR 1.2; 95% CI: 0.9, 1.6; p=0.49). We observed a clear linear relationship between household income and SCD where those with an annual household income of 50k to 75k had 1.4 (95% CI: 1.3, 1.6) times the odds and those with household incomes of less than $10,000 had 4.7 (95% CI: 3.8, 5.7) times the odds of SCD compared to those with household income of more than $75,000. We also found that college graduates (ref.) and those who completed high school (OR: 1.1; 95% CI 1.04, 1.2) fared better than those with some college (OR: 1.3, 95% CI 1.2, 1.4) or less than a high school degree (OR: 1.5; 95% CI: 1.4, 1.7). Conclusions Income inequality does not play a dominant role in SCD, though a social gradient in individual income for SCD suggests the relationship may operate in part via status anxiety. Research suggests education impacts cognitive decline via cognitive stimulation Associations with income and inequality may suggest a “status anxiety” mechanism Income inequality was not statistically associated with cognitive decline We found a dose-response effect of individual income on cognitive decline Status anxiety may contribute to disparities in dementia risk
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Affiliation(s)
- Rachel L Peterson
- University of Arizona Center on Aging, 1500 N. Campbell Ave, PO Box 245027, Tucson, AZ 85724-5027, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Scott C Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | | | - Mindy J Fain
- University of Arizona Center on Aging, 1500 N. Campbell Ave, PO Box 245027, Tucson, AZ 85724-5027, USA.,Division of Geriatrics, General Internal Medicine and Palliative Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Melanie L Bell
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
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29
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Curran M, Mahutga MC. Income Inequality and Population Health: A Global Gradient? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:536-553. [PMID: 30381957 DOI: 10.1177/0022146518808028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cross-national empirical research about the link between income inequality and population health produces conflicting conclusions. We address these mixed findings by examining the degree to which the income inequality and health relationship varies with economic development. We estimate fixed-effects models with different measures of income inequality and population health. Results suggest that development moderates the association between inequality and two measures of population health. Our findings produce two generalizations. First, we observe a global gradient in the relationship between income inequality and population health. Second, our results are consistent with income inequality as a proximate or conditional cause of lower population health. Income inequality has a 139.7% to 374.3% more harmful effect on health in poorer than richer countries and a significantly harmful effect in 2.1% to 53.3% of countries in our sample and 6.6% to 67.6% of the world's population but no significantly harmful effect in richer countries.
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30
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Kim D, Wang F, Arcan C. Geographic Association Between Income Inequality and Obesity Among Adults in New York State. Prev Chronic Dis 2018; 15:E123. [PMID: 30316306 PMCID: PMC6198674 DOI: 10.5888/pcd15.180217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction In addition to economic factors and geographic area poverty, area income inequality — the extent to which income is distributed in an uneven manner across a population — has been found to influence health outcomes and obesity. We used a spatial-based approach to describe interactions between neighboring areas with the objective of generating new insights into the relationships between county-level income inequality, poverty, and obesity prevalence across New York State (NYS). Methods We used data from the 2015 American Community Survey and 2013 obesity estimates from the Centers for Disease Control and Prevention for NYS to examine correlations between county-level economic factors and obesity. Spatial mapping and analysis were conducted with ArcMap. Ordinary least squares modeling with adjusting variables was used to examine associations between county-level obesity percentages and county-level income inequality (Gini index). Univariate spatial analysis was conducted between obesity and Gini index, and globally weighted regression and Hot Spot Analysis were used to view spatial clustering. Results Although higher income inequality was associated with lower obesity rates, a higher percentage of poverty was associated with higher obesity rates. A higher percentage of Hispanic population was associated with lower obesity rates. When tested spatially, higher income inequality was associated with a greater decrease in obesity in southern and eastern NYS counties than in the northern and western counties, with some differences by sex present in this association. Conclusion Increased income inequality and lower poverty percentage were significantly linked to lower obesity rates across NYS counties for men. Income inequality influence differed by geographic location. These findings indicate that in areas with high income inequality, currently unknown aspects of the environment may benefit low-income residents. Future studies should also include environmental factors possibly linked to obesity.
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Affiliation(s)
- Daniel Kim
- Department of Biomedical Informatics and Department of Computer Science, Stony Brook University, Stony Brook, New York.,56 Ridgewood Dr, Randolph, NJ 07869.
| | - Fusheng Wang
- Department of Biomedical Informatics and Department of Computer Science, Stony Brook University, Stony Brook, New York
| | - Chrisa Arcan
- Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
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31
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Bae JH, Obounou BWO. Presence of Dental Caries Is Associated with Food Insecurity and Frequency of Breakfast Consumption in Korean Children and Adolescents. Prev Nutr Food Sci 2018; 23:94-101. [PMID: 30018886 PMCID: PMC6047872 DOI: 10.3746/pnf.2018.23.2.94] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/01/2018] [Indexed: 02/04/2023] Open
Abstract
Dental caries remains one of the most common chronic diseases affecting children worldwide with a multi-factorial etiology. The objective of the study was to evaluate the association between socioeconomic status (SES), dietary intake, food insecurity (FI), and dental caries in Korean children and adolescents. The study utilized data from the 2-year Korean National Health and Nutrition Examination Survey (KNHANES) conducted with 1,559 Korean boys and 1,391 girls aged 2 to 18 years from 2012 to 2013. Fathers' education (P=0.017), mothers' education (P<0.001), and household income (P=0.049) were all significantly associated with dental caries among Korean boys. As for dietary practices, both eating breakfast (P<0.001) and frequency of eating out (P<0.001) were strongly associated with dental caries (P<0.001). Three models of FI were used and no differences were found regarding genders. In model 3, both food insecure male [odds ratio (OR)=1.682, 95% confidence interval (CI): 0.999~2.832] and female (OR=1.900, 95% CI: 1.094~3.299) subjects had higher odds of developing dental caries than food secure subjects after adjusting the confounding factors. The present study showed a strong association between FI mediated by SES and dental caries. Nutrition education programs targeting low-socioeconomic families are necessary as a tool to prevent dental caries in Korea.
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Affiliation(s)
- Ji-Hyun Bae
- Department of Food Science and Nutrition, Keimyung University, Daegu 41566, Korea
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32
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Adjaye-Gbewonyo K, Kawachi I, Subramanian SV, Avendano M. Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa. Int J Equity Health 2018; 17:31. [PMID: 29510733 PMCID: PMC5839065 DOI: 10.1186/s12939-018-0741-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 02/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background Chronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally. Methods We linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes. Results Both income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors. Conclusions Our findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa. Electronic supplementary material The online version of this article (10.1186/s12939-018-0741-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kafui Adjaye-Gbewonyo
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - Mauricio Avendano
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA. .,Department of Global Health and Social Medicine, King's College London, Strand Campus, Strand, London, WC2R2LS, UK.
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Pabayo R, Fuller D, Lee EY, Horino M, Kawachi I. State-level income inequality and meeting physical activity guidelines; differential associations among US men and women. J Public Health (Oxf) 2017; 40:229-236. [DOI: 10.1093/pubmed/fdx082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel Fuller
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Eun Young Lee
- Faculty of Physical Education & Recreation, University of Alberta, Edmonton, AB, Canada
| | - Masako Horino
- State of Nevada, Health & Human Services, Nevada Division of Public Health and Behavioral Health, Carson City, NV, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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34
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Mendoza W, Miranda JJ. Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology. Cardiol Clin 2017; 35:1-12. [PMID: 27886780 DOI: 10.1016/j.ccl.2016.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades.
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Affiliation(s)
- Walter Mendoza
- United Nations Population Fund, Peru Country Office, Av. Guardia Civil 1231, San Isidro, Lima 27, Peru
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima 31, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
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35
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Gender Differences in Vulnerability to Socioeconomic Status on Self-Rated Health in 15 Countries. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.5812/whb.45280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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36
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Gender Differences in Vulnerability to Socioeconomic Status on Self-Rated Health in 15 Countries. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.5812/whb-45280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Adjaye-Gbewonyo K, Avendano M, Subramanian SV, Kawachi I. Income inequality and depressive symptoms in South Africa: A longitudinal analysis of the National Income Dynamics Study. Health Place 2016; 42:37-46. [PMID: 27639104 DOI: 10.1016/j.healthplace.2016.08.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/23/2016] [Accepted: 08/25/2016] [Indexed: 11/15/2022]
Abstract
Research suggests that income inequality may detrimentally affect mental health. We examined the relationship between district-level income inequality and depressive symptoms among individuals in South Africa-one of the most unequal countries in the world-using longitudinal data from Wave 1 (2008) and Wave 3 (2012) of the National Income Dynamics Study. Depressive symptoms were measured using the Center for Epidemiological Studies of Depression Short Form while district Gini coefficients were estimated from census and survey sources. Age, African population group, being single, being female, and having lower household income were independently associated with higher depressive symptoms. However, in longitudinal, fixed-effects regression models controlling for several factors, district-level Gini coefficients were not significantly associated with depressive symptoms scores. Our results do not support the hypothesis of a causal link between income inequality and depressive symptoms in the short-run. Possible explanations include the high underlying levels of inequality in all districts, or potential lags in the effect of inequality on depression.
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Affiliation(s)
- Kafui Adjaye-Gbewonyo
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115, USA.
| | - Mauricio Avendano
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115, USA; Department of Global Health and Social Medicine, King's College London, Strand Campus, Strand, London WC2R 2LS, United Kingdom.
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115, USA.
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38
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Sliwa K, Acquah L, Gersh BJ, Mocumbi AO. Impact of Socioeconomic Status, Ethnicity, and Urbanization on Risk Factor Profiles of Cardiovascular Disease in Africa. Circulation 2016; 133:1199-208. [PMID: 27002082 DOI: 10.1161/circulationaha.114.008730] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Africa is a continent characterized by marked ethnic, sociodemographic, and economic diversity, with profound changes in many regions over the past 2 decades. This diversity has an impact on cardiovascular disease presentation and outcomes. Within Africa and within the individual countries, one can find regions having predominantly communicable diseases such as rheumatic heart disease, tuberculous pericarditis, or cardiomyopathy and others having a marked increase in noncommunicable disease such as hypertension and hypertensive heart disease. Ischemic heart disease remains rare in most countries. Difficulties in the planning and implementation of effective health care in most African countries are compounded by a paucity of studies and a low rate of investment in research and data acquisition. The fiduciary responsibilities of companies working in Africa should include the effective and efficient use of natural resources to promote the overall health of populations.
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Affiliation(s)
- Karen Sliwa
- From Hatter Institute for Cardiovascular Research in Africa & IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa (K.S.); Medical Research Council of South Africa, Inter-Cape Heart Group, Cape Town, South Africa (K.S.); Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Hospitals, Rochester, MN (L.A.); Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN (B.J.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); and Universidade Eduardo Mondlane, Maputo, Mozambique (A.O.M.).
| | - Letitia Acquah
- From Hatter Institute for Cardiovascular Research in Africa & IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa (K.S.); Medical Research Council of South Africa, Inter-Cape Heart Group, Cape Town, South Africa (K.S.); Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Hospitals, Rochester, MN (L.A.); Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN (B.J.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); and Universidade Eduardo Mondlane, Maputo, Mozambique (A.O.M.)
| | - Bernard J Gersh
- From Hatter Institute for Cardiovascular Research in Africa & IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa (K.S.); Medical Research Council of South Africa, Inter-Cape Heart Group, Cape Town, South Africa (K.S.); Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Hospitals, Rochester, MN (L.A.); Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN (B.J.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); and Universidade Eduardo Mondlane, Maputo, Mozambique (A.O.M.)
| | - Ana Olga Mocumbi
- From Hatter Institute for Cardiovascular Research in Africa & IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa (K.S.); Medical Research Council of South Africa, Inter-Cape Heart Group, Cape Town, South Africa (K.S.); Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Hospitals, Rochester, MN (L.A.); Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN (B.J.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); and Universidade Eduardo Mondlane, Maputo, Mozambique (A.O.M.)
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Harris D, Klyushnenkova E, Kalsi R, Garrido D, Bhardwaj A, Rabin J, Toursavadkohi S, Diaz J, Crawford R. Non-White Race is an Independent Risk Factor for Hospitalization for Aortic Dissection. Ethn Dis 2016; 26:363-8. [PMID: 27440976 DOI: 10.18865/ed.26.3.363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate racial differences in the burden of aortic dissection. DESIGN Retrospective analysis of a comprehensive state-wide inpatient database. SETTING Acute care hospitals in the state of Maryland, 2009 - 2014. PARTICIPANTS All hospitalized adults with aortic dissection (AD), stratified by race. MAIN OUTCOME MEASURES Statewide and county-level population adjusted hospitalization rates, access to specialty aortic care, and mortality. RESULTS Of 3,719,412 admissions to Maryland hospitals during the study period, 3,190 had AD (.09%; 1665 White, 1525 non-White). Non-White race was more common in patients with AD than without (48% vs. 41%, P<.0001). Adjusted for statewide demographics, admission for AD was 1.4 times more common among non-Whites (11 vs. 8 per 100,000, P<.0001). Non-White race was an independent risk factor for AD admission (OR 1.5, 95% CI 1.4 - 1.7). Among patients with AD, non-Whites were younger and more often female, but had similar or lower rates of cardiovascular comorbidities. Non-White race was not associated with decreased access to care or increased mortality. CONCLUSION Hospitalization for AD is more common among non-Whites, who develop AD at younger ages despite fewer comorbidities. While clinical correlates are limited from this dataset, this may reflect more severe pathophysiology related to clinical or socioeconomic factors among non-Whites. Further study is warranted to better define this disparity and identify high-risk subgroups who may benefit from aggressive primary prevention.
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Affiliation(s)
- Donald Harris
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
| | - Elena Klyushnenkova
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
| | - Richa Kalsi
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
| | - Danon Garrido
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
| | - Abhishek Bhardwaj
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
| | - Joseph Rabin
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | - Shahab Toursavadkohi
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
| | - Jose Diaz
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | - Robert Crawford
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine
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Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study. PLoS One 2016; 11:e0157327. [PMID: 27332986 PMCID: PMC4917220 DOI: 10.1371/journal.pone.0157327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/28/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function. Methods In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8–20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors. Results Higher MSA-level income inequality predicted lower cognitive function 16–18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods. Conclusions Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States.
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Tang KL, Rashid R, Godley J, Ghali WA. Association between subjective social status and cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis. BMJ Open 2016; 6:e010137. [PMID: 26993622 PMCID: PMC4800117 DOI: 10.1136/bmjopen-2015-010137] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine the association between subjective social status (SSS), or the individual's perception of his or her position in the social hierarchy, and the odds of coronary artery disease (CAD), hypertension, diabetes, obesity and dyslipidaemia. STUDY DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, SocINDEX, Web of Science and reference lists of all included studies up to October 2014, with a verification search in July 2015. Inclusion criteria were original studies in adults that reported odds, risk or hazard ratios of at least one outcome of interest (CAD, hypertension, diabetes, obesity or dyslipidaemia), comparing 'lower' versus 'higher' SSS groups, where SSS is measured on a self-anchoring ladder. ORs were pooled using a random-effects model. RESULTS 10 studies were included in the systematic review; 9 of these were included in the meta-analysis. In analyses unadjusted for objective socioeconomic status (SES) measures such as income, education or occupation, the pooled OR comparing the bottom versus the top of the SSS ladder was 1.82 (95% CI 1.10 to 2.99) for CAD, 1.88 (95% CI 1.27 to 2.79) for hypertension, 1.90 (95% CI 1.25 to 2.87) for diabetes, 3.68 (95% CI 2.03 to 6.64) for dyslipidaemia and 1.57 (95% CI 0.95 to 2.59) for obesity. These associations were attenuated when adjusting for objective SES measures, with the only statistically significant association remaining for dyslipidaemia (OR 2.10, 95% CI 1.09 to 4.06), though all ORs remained greater than 1. CONCLUSIONS Lower SSS is associated with significantly increased odds of CAD, hypertension, diabetes and dyslipidaemia, with a trend towards increased odds of obesity. These trends are consistently present, though the effects attenuated when adjusting for SES, suggesting that perception of one's own status on a social hierarchy has health effects above and beyond one's actual income, occupation and education.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruksana Rashid
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
- O’ Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’ Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Kim D. The associations between US state and local social spending, income inequality, and individual all-cause and cause-specific mortality: The National Longitudinal Mortality Study. Prev Med 2016; 84:62-8. [PMID: 26607868 PMCID: PMC5766344 DOI: 10.1016/j.ypmed.2015.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate government state and local spending on public goods and income inequality as predictors of the risks of dying. METHODS Data on 431,637 adults aged 30-74 and 375,354 adults aged 20-44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables. RESULTS Each additional $250 per capita per year spent on welfare predicted a 3-percentage point (-0.031, 95% CI: -0.059, -0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (-0.016, 95% CI: -0.031, -0.0011) and 0.8-percentage point (-0.008, 95% CI: -0.0156, -0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively. CONCLUSIONS Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, United States; EHESP School of Public Health, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
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Fan JX, Wen M, Kowaleski-Jones L. Tract- and county-level income inequality and individual risk of obesity in the United States. SOCIAL SCIENCE RESEARCH 2016; 55:75-82. [PMID: 26680289 PMCID: PMC4684591 DOI: 10.1016/j.ssresearch.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/16/2015] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES We tested three alternative hypotheses regarding the relationship between income inequality and individual risk of obesity at two geographical scales: U.S. Census tract and county. METHODS Income inequality was measured by Gini coefficients, created from the 2000 U.S. Census. Obesity was clinically measured in the 2003-2008 National Health and Nutrition Examination Survey (NHANES). The individual measures and area measures were geo-linked to estimate three sets of multi-level models: tract only, county only, and tract and county simultaneously. Gender was tested as a moderator. RESULTS At both the tract and county levels, higher income inequality was associated with lower individual risk of obesity. The size of the coefficient was larger for county-level Gini than for tract-level Gini; and controlling income inequality at one level did not reduce the impact of income inequality at the other level. Gender was not a significant moderator for the obesity-income inequality association. CONCLUSIONS Higher tract and county income inequality was associated with lower individual risk of obesity, indicating that at least at the tract and county levels and in the context of cross-sectional data, the public health goal of reducing the rate of obesity is in line with anti-poverty policies of addressing poverty through mixed-income development where neighborhood income inequality is likely higher than homogeneous neighborhoods.
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Affiliation(s)
- Jessie X Fan
- Department of Family and Consumer Studies, University of Utah, 225 S 1400 E, AEB 228, Salt Lake City, UT 84112-0080, USA.
| | - Ming Wen
- Department of Sociology, University of Utah, 380 S 1530 E, Rm 301, Salt Lake City, UT 84112-0250, USA.
| | - Lori Kowaleski-Jones
- Department of Family and Consumer Studies, University of Utah, 225 S 1400 E, AEB 228, Salt Lake City, UT 84112-0080, USA.
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Kobza J, Geremek M. Exploring the Life Expectancy Increase in Poland in the Context of CVD Mortality Fall: The Risk Assessment Bottom-Up Approach, From Health Outcome to Policies. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2015; 52:0046958015613091. [PMID: 26546595 PMCID: PMC5813646 DOI: 10.1177/0046958015613091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries' decision-making process and in EU public health strategy.
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Affiliation(s)
- Joanna Kobza
- Public Health Department, Medical University of Silesia, Bytom, Poland
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Assari S, Lankarani MM. Does Multi-morbidity Mediate the Effect of Socioeconomics on Self-rated Health? Cross-country Differences. Int J Prev Med 2015; 6:85. [PMID: 26445632 PMCID: PMC4587073 DOI: 10.4103/2008-7802.164413] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 01/03/2015] [Indexed: 11/04/2022] Open
Abstract
Background: This study explored cross-country differences in how multi-morbidity explains the effects of socioeconomic characteristics on self-rated health. Methods: The study borrowed data from the Research on Early Life and Aging Trends and Effects. Participants were 44,530 individuals (age > 65 years) who were sampled from 15 countries (i.e. United States, China, India, Russia, Costa Rica, Puerto Rico, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana and South Africa). Multi-morbidity was measured as number of chronic medical conditions. In Model I, main effects of socioeconomic factors on self-rated health were calculated using country-specific logistic regressions. In Model II, number of chronic conditions were also added to the models to find changes in coefficients for demographic and socioeconomic factors. Results: In the United States, number of chronic medical conditions explained the effect of income on subjective health. In Puerto Rico, number of chronic medical conditions explained the effect of marital status on subjective health. In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, number of chronic medical conditions explained gender disparities in subjective health. In China, Mexico, Brazil, Russia, Chile, India, Ghana and South Africa, number of chronic medical conditions did not explain the effect of demographic or socioeconomic factors on subjective health. Conclusions: Multi-morbidity explains the effect of demographic and socioeconomic factors on subjective health in some but not other countries. Further research is needed.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, School of Medicine, University of Michigan, Michigan, USA ; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Michigan, USA
| | - Maryam Moghani Lankarani
- Department of Psychiatry, School of Medicine, University of Michigan, Michigan, USA ; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Michigan, USA
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Pabayo R, Kawachi I, Gilman SE. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings. Int J Public Health 2015; 60:573-88. [PMID: 25981210 PMCID: PMC4517572 DOI: 10.1007/s00038-015-0678-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To examine prospectively the association between US state income inequality and incidence of heart attack. METHODS We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. RESULTS In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. CONCLUSIONS This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.
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Affiliation(s)
- Roman Pabayo
- Department of Community Health Sciences, University of Nevada, Reno, Lombardi Building, 203, MS 0274, 1664 North Virginia Street, Reno, NV, 89557, USA,
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Prevalence and determinants of cardiovascular disease risk factors among the residents of urban community housing projects in Malaysia. BMC Public Health 2014; 14 Suppl 3:S3. [PMID: 25436515 PMCID: PMC4251129 DOI: 10.1186/1471-2458-14-s3-s3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia. Method By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor. Results As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93). Conclusion In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes.
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The impact of social deprivation on paranoia, hallucinations, mania and depression: the role of discrimination social support, stress and trust. PLoS One 2014; 9:e105140. [PMID: 25162703 PMCID: PMC4146475 DOI: 10.1371/journal.pone.0105140] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/19/2014] [Indexed: 12/20/2022] Open
Abstract
The negative implications of living in a socially unequal society are now well documented. However, there is poor understanding of the pathways from specific environmental risk to symptoms. Here we examine the associations between social deprivation, depression, and psychotic symptoms using the 2007 Adult Psychiatric Morbidity Survey, a cross-sectional dataset including 7,353 individuals. In addition we looked at the mediating role of stress, discrimination, trust and lack of social support. We found that the participants' neighbourhood index of multiple deprivation (IMD) significantly predicted psychosis and depression. On inspection of specific psychotic symptoms, IMD predicted paranoia, but not hallucinations or hypomania. Stress and trust partially mediated the relationship between IMD and paranoid ideation. Stress, trust and a lack of social support fully mediated the relationship between IMD and depression. Future research should focus on the role deprivation and social inequalities plays in specific manifestations of psychopathology and investigate mechanisms to explain those associations that occur. Targeting the mediating mechanisms through appropriate psychological intervention may go some way to dampen the negative consequences of living in an unjust society; ameliorating economic injustice may improve population mental health.
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Assari S. Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes. J Diabetes Metab Disord 2014; 13:36. [PMID: 24559091 PMCID: PMC3984018 DOI: 10.1186/2251-6581-13-36] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/06/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE This study explored cross-country differences in the additive effects of socio-economic characteristics, health behaviors and medical comorbidities on subjective health of patients with diabetes. METHODS The study analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE). The participants were 9,179 adults with diabetes who were sampled from 15 countries (i.e. China, Costa Rica, Puerto Rico, United States, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, India, Ghana, South Africa, and Russia). We fitted three logistic regressions to each country. Model I only included socio-economic characteristics (i.e. age, gender, education and income). In Model II, we also included health behaviors (i.e. smoking, drinking, and exercise). Model III included medical comorbidities (i.e. hypertension, respiratory disease, heart disease, stroke, and arthritis), in addition to the previous blocks. RESULTS Our models suggested cross-country differences in the additive effects of socio-economic characteristics, health behaviors and comorbidities on perceived health of patients with diabetes. Comorbid heart disease was the only condition that was consistently associated with poor subjective health regardless of country. CONCLUSION Countries show different profiles of social and behavioral determinants of subjective health among patients with diabetes. Our study suggests that universal programs that assume that determinants of well-being are similar across different countries may be over-simplistic. Thus instead of universal programs that use one protocol for health promotion of patients in all countries, locally designed interventions should be implemented in each country.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, 2847-SPH I, Ann Arbor, MI 48109-2029, USA.
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Assari S, Lankarani RM, Lankarani MM. Cross-country differences in the association between diabetes and disability. J Diabetes Metab Disord 2014; 13:3. [PMID: 24393171 PMCID: PMC3927767 DOI: 10.1186/2251-6581-13-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/14/2013] [Indexed: 11/22/2022]
Abstract
Purpose This study tested possible cross-country differences in the associations between diabetes and activities of daily living (ADLs), and possible confounding / mediating effects of socio-economic status, obesity, and exercise. Methods Data came from Research on Early Life and Aging Trends and Effects (RELATE). The study included a total number of 25,372 community sample of adults who were 40 years or older. We used data from community based surveys in seven countries including China, Mexico, Barbados, Brazil, Chile, Cuba, and Uruguay. Demographics (age and gender), socio-economic status (education and income), obesity, exercise, and ADL (bath, dress, toilet, transfer, heavy, shopping, meals) were measured. Self-reported data on physician diagnosis of diabetes was the independent variable. We tested if diabetes is associated with ADL, before and after adjusting for socio-economics, obesity, and exercise in each country. Results Based on Model I (age and gender adjusted model), diabetes was associated with limitation in at least one ADL in Mexico, Barbados, Brazil, Chile, Cuba, and Uruguay, but not China. Based on Model II that also controlled for education and income, education explained the association between diabetes and limitation in ADL in Mexico and Uruguay. Based on Model III that also controlled for exercise and obesity, in Cuba and Brazil, exercise explained the link between diabetes and limitation in performing ADLs. Thus, the link between diabetes and ADL was independent of our covariates only in Chile and Barbados. Conclusions There are cross-country differences in the link between diabetes and limitation in ADL. There are also cross-country differences in how socio-economic status, obesity, and exercise explain the above association.
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Affiliation(s)
- Shervin Assari
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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