Socioeconomic status and health: a neurobiological perspective

Relationship between socioeconomic status and myopia in school children: CISViT project

PURPOSE

Evidence indicates the existence of an association between socioeconomic status (SES) and the prevalence of myopia in the adult population. In contrast, there are limited studies investigating this association in children. The purpose of this study was to investigate the association between the presence of myopia in 8-year-old children from southern Europe and SES defined as parental educational level and employment status.

METHODS

Participants aged 8 years old were recruited from 16 schools located in Terrassa, Spain (n = 813). Ten of these schools were classified as "high complexity" schools (low SES). Refractive error was assessed using non-cycloplegic retinoscopy. Parental questionnaires were used to gather socioeconomic information such as parental education level and employment status. Non-parametric Kruskal Wallis, Mann Whitney and Chi-square tests were used to evaluate the association between spherical equivalent (SE) and parental educational level and employment status as well as differences in the SE distribution between high-complexity and regular schools.

RESULTS

Myopia was more prevalent than hyperopia in the population sample (11.1% vs 5.1 %). Chi-square tests revealed a significant association between attending "high-complexity" schools and the presence of myopia (p = 0.014). In contrast, no significant associations were found between SE and SES. A trend for higher prevalence of myopia in children whose mothers had low educational level and were unemployed was observed.

CONCLUSIONS

While no significant associations are found between SE and parental education or employment status, myopia is more frequently found in schools with low SES ("high-complexity" schools), suggesting a potential link between SES and childhood myopia.

Perceived classism and its relation with socioeconomic status, health, health behaviours and perceived inferiority: the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) panel

OBJECTIVES

Classism might be the downside of the prevailing ideologies of individual responsibility for success. However, since studies into perceived classism have mainly been qualitative, little is known about its association with socioeconomic status, health, health behaviours and perceived inferiority, especially in more egalitarian countries. This study, therefore, examined the associations of perceived classism with socioeconomic status, health, health behaviours and perceived inferiority.

METHODS

We used cross-sectional data (2012/2013) from the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) (n = 1540; age 16-90; 46.9 % men).

RESULTS

We found that classism was perceived by 18.2 % of the participants, with the lowest income and occupation group most likely to perceive classism (22.0 and 27.5 %, respectively). Perceived classism was significantly associated with poor health (e.g. self-rated health OR = 2.44, 95 % CI = 1.76-3.38) and feelings of inferiority (e.g. shame OR = 4.64, 95 % CI = 3.08-6.98). No significant associations were found with health behaviours.

CONCLUSIONS

To further examine the role of perceived classism for socioeconomic differences in health and its association with country-level socioeconomic inequalities, prevailing ideologies, and objective opportunities for social mobility, we recommend more longitudinal and international studies with comparable measures of perceived classism.

Leveraging geotagged Twitter data to examine neighborhood happiness, diet, and physical activity

OBJECTIVES

Using publicly available, geotagged Twitter data, we created neighborhood indicators for happiness, food and physical activity for three large counties: Salt Lake, San Francisco and New York.

METHODS

We utilize 2.8 million tweets collected between February-August 2015 in our analysis. Geo-coordinates of where tweets were sent allow us to spatially join them to 2010 census tract locations. We implemented quality control checks and tested associations between Twitter-derived variables and sociodemographic characteristics.

RESULTS

For a random subset of tweets, manually labeled tweets and algorithm labeled tweets had excellent levels of agreement: 73% for happiness; 83% for food, and 85% for physical activity. Happy tweets, healthy food references, and physical activity references were less frequent in census tracts with greater economic disadvantage and higher proportions of racial/ethnic minorities and youths.

CONCLUSIONS

Social media can be leveraged to provide greater understanding of the well-being and health behaviors of communities-information that has been previously difficult and expensive to obtain consistently across geographies. More open access neighborhood data can enable better design of programs and policies addressing social determinants of health.

Distributional Orientation and Health Outcomes in OECD Countries

This study uses data from the Organisation for Economic Co-operation and Development countries over the 2008-2010 period to construct indicators of "pro-primary" and "pro-secondary" distributions. The former is concerned with the original distribution of income through the market, whereas the latter is concerned with the redistribution efforts of the government. The study ranks these countries along these dimensions to create a distributional orientation map for such countries. It finds that the Scandinavian countries occupy the top rankings in terms of equity in pro-primary distribution, followed by countries with a Bismarckian welfare state regime. The Scandinavian countries also rank very high on equity in pro-secondary distribution, along with some of the top-ranking Bismarckian countries. More significantly, the study finds that the countries' health outcomes are associated more strongly with the pro-primary distributional stance than with the pro-secondary distributional stance. A key policy implication is that to achieve better and more equitable health, it is more effective to design a level playing field for market participants in the first place, than to try to mend inequities after the fact through remedial social policy.

Low socioeconomic status and perceptions of social inadequacy and shame: findings from the Dutch SMILE study

BACKGROUND

Based on presumed negative social comparisons in lower socioeconomic status groups, we set out to examine whether notions of 'internalized inferiority' are more common in these groups.

METHODS

Dutch Studie naar Medische Informatie en Leefwijzen in Eindhoven (SMILE) data on 1323 participants, aged 58-94 in 2008, were used to estimate odds ratios (ORs) of internalized inferiority by childhood and adulthood socioeconomic indicators. Questionnaires for social inadequacy and shame were used to measure internalized inferiority.

RESULTS

Both adulthood low educational level [OR 1.58; 95% confidence interval (CI): 1.04-2.40] and low income level (OR 1.88; 95% CI: 1.23-2.88) had substantial associations with reports of social inadequacy. Recalled childhood poverty was strongly associated with reports of shame (OR 2.20; 95% CI: 1.39-3.48).

CONCLUSIONS

The socioeconomic patterning of social inadequacy and shame suggests that notions of internalized inferiority in the individual, psychological makeup might be important in the generation and maintenance of socioeconomic inequalities in health.

When overweight is the normal weight: an examination of obesity using a social media internet database

Using a large social media database, Yahoo Answers, we explored postings to an online forum in which posters asked whether their height and weight qualify themselves as "skinny," "thin," "fat," or "obese" over time and across forum topics. We used these data to better understand whether a higher-than-average body mass index (BMI) in one's county might, in some ways, be protective for one's mental and physical health. For instance, we explored whether higher proportions of obese people in one's county predicts lower levels of bullying or "am I fat?" questions from those with a normal BMI relative to his/her actual BMI. Most women asking whether they were themselves fat/obese were not actually fat/obese. Both men and women who were actually overweight/obese were significantly more likely in the future to ask for advice about bullying than thinner individuals. Moreover, as mean county-level BMI increased, bullying decreased and then increased again (in a U-shape curve). Regardless of where they lived, posters who asked "am I fat?" who had a BMI in the healthy range were more likely than other posters to subsequently post on health problems, but the proportions of such posters also declined greatly as county-level BMI increased. Our findings suggest that obese people residing in counties with higher levels of BMI may have better physical and mental health than obese people living in counties with lower levels of BMI by some measures, but these improvements are modest.

Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease

The brain is the key organ of stress reactivity, coping, and recovery processes. Within the brain, a distributed neural circuitry determines what is threatening and thus stressful to the individual. Instrumental brain systems of this circuitry include the hippocampus, amygdala, and areas of the prefrontal cortex. Together, these systems regulate physiological and behavioral stress processes, which can be adaptive in the short-term and maladaptive in the long-term. Importantly, such stress processes arise from bidirectional patterns of communication between the brain and the autonomic, cardiovascular, and immune systems via neural and endocrine mechanisms underpinning cognition, experience, and behavior. In one respect, these bidirectional stress mechanisms are protective in that they promote short-term adaptation (allostasis). In another respect, however, these stress mechanisms can lead to a long-term dysregulation of allostasis in that they promote maladaptive wear-and-tear on the body and brain under chronically stressful conditions (allostatic load), compromising stress resiliency and health. This review focuses specifically on the links between stress-related processes embedded within the social environment and embodied within the brain, which is viewed as the central mediator and target of allostasis and allostatic load.

Coping with competition: neuroendocrine responses and cognitive variables

Confronting another individual or group motivated by the same goal is a very frequent situation in human communities that occurs in many other species. Competitive interactions emerge as critical situations that shed light on the effects and consequences of social stress on health. But more important than the situation itself is the way it is interpreted by the subject. This "appraisal" involves cognitive processes that contribute to explaining the neuroendocrine response to these interactions, helping to understanding the vulnerability or resistance to their effects. In this review, we defend the need to study human competition within the social stress framework, while maintaining an evolutionary perspective, and taking advantage of the theoretical and methodological advances in psychology and psychophysiology in order to better understand the cognitive processes underlying the social stress response in humans.

Long-term employment and health inequalities in Canadian communities

OBJECTIVES

This study examines the long-term unemployment rate and various health outcomes across Canadian communities to estimate employment-related health inequalities in these communities.

METHODS

The study uses cross-sectional community-level health data along with data on the long-term employment rate for various communities across Canada to quantify health inequalities among these communities. The health outcomes that are considered in this study include total and disease specific mortality rates; health conditions such as high blood pressure, diabetes, injuries, and self rated health; and life expectancies at birth and at age 65. Health inequalities are estimated using the concentration index, which is used to measure health inequalities along socioeconomic dimensions. The concentration index is estimated by a regression of weighted relative health (ill health) over weighted cumulative relative rank of the populations. All the estimates are provided separately for males and females.

RESULTS

The findings of the study support the existence of inequalities in community health outcomes as related to the long-term employment rates in those communities. Communities with lower long term employment rates (higher unemployment rates) have poorer health outcomes in terms of higher mortality rates, worse health conditions, and shorter life expectancies.

CONCLUSION

Health inequalities related to long-term employment have important policy implications. They call for policies that would increase and maintain long term employment rates as part of a broader socioeconomic approach to health. Long term employment ensures income security and prevents the psychosocial experiences leading to mental and physical ill health.

Hypertension and happiness across nations

In surveys of well-being, countries such as Denmark and the Netherlands emerge as particularly happy while nations like Germany and Italy report lower levels of happiness. But are these kinds of findings credible? This paper provides some evidence that the answer is yes. Using data on 16 countries, it shows that happier nations report systematically lower levels of hypertension. As well as potentially validating the differences in measured happiness across nations, this suggests that blood-pressure readings might be valuable as part of a national well-being index. A new ranking of European nations' GHQ-N6 mental health scores is also given.

Is democracy good for health?

Studies of health have recognized the influence of socioeconomic position on health outcomes. People with higher socioeconomic ranking, in general, tend to be healthier than those with lower socioeconomic rankings. The effect of political environment on population health has not been adequately researched, however. This study investigates the effect of democracy (or lack thereof) along with socioeconomic factors on population health. It is maintained that democracy may have an impact on health independent of the effects of socioeconomic factors. Such impact is considered as the direct effect of democracy on health. Democracy may also affect population health indirectly by affecting socioeconomic position. To investigate these theoretical links, some broad measures of population health (e.g., mortality rates and life expectancies) are empirically examined across a spectrum of countries categorized as autocratic, incoherent, and democratic polities. The regression findings support the positive influence of democracy on population health. Incoherent polities, however, do not seem to have any significant health advantage over autocratic polities as the reference category. More rigorous tests of the links between democracy and health should await data from multi-country population health surveys that include specific measures of mental and physical morbidity.

Do patients with diabetes and low socioeconomic status receive less care and have worse outcomes? A national study

PURPOSE

The objective of the study was to assess the influence of socioeconomic status (SES) on the care of patients with diabetes.

METHODS

Quality indicators for patients who were taking medication for diabetes were established. Overall compliance with the quality indicators, as well as prevalence of diabetes by age, were obtained from a national database. Patients with national tax exemptions (used as a marker for low SES) were compared to those without.

RESULTS

Of 4,110,852 citizens aged 18-74, 210,988 (5.1%) were receiving medication for diabetes. The prevalence of diabetes reached 19.9% in people aged 65-74. 495,392 citizens had an exemption, and they had a higher prevalence of diabetes that those who did not (15.4% vs. 3.7%). Patients with an exemption had a higher rate of having a yearly HbA1c done, a yearly LDL level done, a yearly eye exam, a yearly urinary protein exam, of being treated with insulin for an elevated HbA1c than those without an exemption. In patients with an exemption there was a lower percentage with an HbA1c less than 7%, a higher percentage with an HbA1c greater than 9%, and a lower percentage with an LDL less than 130. Multivariate analysis showed that exemption status was a predictor of better performance on process measures (LDL test done, OR-1.03, 95% CI 1.01-1.06, HbA1c test done, OR 1.03, 95% CI- 1.01-1.05) and of worse outcomes (high LDL, OR 0.92, 95% CI, 0.90-0.95 and high HbA1c, OR, 0.85, 95% CI, 0.83-0.87).

CONCLUSIONS

In a country with universal healthcare, patients from a lower SES had an increased prevalence of diabetes and had greater adherence to preventive healthcare measures However, they were less successful in meeting target treatment goals.

Racial disparities in health outcomes after spinal cord injury: mediating effects of education and income

OBJECTIVE

The purpose of this study was to investigate heath disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among participants with spinal cord injury.

DESIGN

Survey methodology. Cross-sectional data.

SETTING

A large Southeastern specialty hospital.

PARTICIPANTS

There were 1342 participants in the current analysis, all of whom were identified from patient records. There were 3 inclusion criteria: (a) traumatic SCI, (b) at least 18 years of age at the time of study, and (c) injury duration of more than 1 year.

MAIN OUTCOME MEASURES

Six outcomes were measured, including 3 general outcomes (self-ratings, days impacted by poor health, days impacted by poor mental health) and 3 that reflect utilization of services (hospitalizations, days hospitalized, and nonroutine physician visits in the past 2 years).

RESULTS

RESULTS of multivariate analysis of variance (MANOVA) indicated significant main effects for both race and gender. Follow-up tests identified racial disparities on 3 of the 6 outcomes, whereas gender disparities were observed for a single outcome. Years of education and household income mediated interrelationships between race and health (but not gender) as racial disparities disappeared after consideration of these factors.

CONCLUSIONS

These findings suggest the need to work more diligently to promote better health outcomes among African Americans and to further investigate how socioeconomic factors and access to health care related to diminished health outcomes among African Americans with spinal cord injury.