Emerging trends and future research on the role of socioeconomic status in chronic illness and multimorbidity

Socioeconomic determinants of myalgic encephalomyelitis/chronic fatigue syndrome in Norway: a registry study

BACKGROUND

Previous research has shown that socioeconomic status (SES) is a strong predictor of chronic disease. However, to the best of our knowledge, there has been no studies of how SES affects the risk of Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) that has not been based upon self-reporting or retrospectively screening of symptoms. As far as we know, this is therefore the first study that isolate and describe socioeconomic determinants of ME/CFS and calculate how these factors relate to the risk of ME/CFS diagnosis by utilizing individual level registry data. This allows for objective operationalization of the ME/CFS population, and makes it possible to model SES affect the risk of ME/CFS diagnosis, relative to control groups.

DATA AND METHODS

We conduct a pooled cross-sectional analysis of registry data from all adult patients diagnosed with ME/CFS from 2016 to 2018 in Norway, coupled with socioeconomic data from statistics Norway from 2011 to 2018. We operationalize SES as household income and educational attainment fixed at the beginning of the study period. We compare the effects of SES on the risk of ME/CFS diagnosis to a population of chronically ill patients with hospital diagnoses that share clinical characteristics of ME/CFS and a healthy random sample of the Norwegian population. Our models are estimated by logistic regression analyses.

RESULTS

When comparing the risk of ME/CFS diagnosis with a population consisting of people with four specific chronic diseases, we find that high educational attainment is associated with a 19% increase (OR: 1.19) in the risk of ME/CFS and that high household income is associated with a 17% decrease (OR:0.83) in risk of ME/CFS. In our second model we compare with a healthy population sample, and found that low educational attainment is associated with 69% decrease (OR:0.31) in the risk of ME/CFS and that low household income is associated with a 53% increase (OR: 1.53).

CONCLUSION

We find statistically significant associations between SES and the risk of ME/CFS. However, our more detailed analyses shows that our findings vary according to which population we compare the ME/CFS patients with, and that the effect of SES is larger when comparing with a healthy population sample, as opposed to controls with selected hospital diagnoses.

Comorbidity patterns in cardiovascular diseases: the role of life-stage and socioeconomic status

Cardiovascular diseases stand as a prominent global cause of mortality, their intricate origins often entwined with comorbidities and multimorbid conditions. Acknowledging the pivotal roles of age, sex, and social determinants of health in shaping the onset and progression of these diseases, our study delves into the nuanced interplay between life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Leveraging data from a cross-sectional survey encompassing Mexican adults, we unearth a robust association between these variables and the prevalence of comorbidities linked to cardiovascular conditions. To foster a comprehensive understanding of multimorbidity patterns across diverse life-stages, we scrutinize an extensive dataset comprising 47,377 cases diagnosed with cardiovascular ailments at Mexico's national reference hospital. Extracting sociodemographic details, primary diagnoses prompting hospitalization, and additional conditions identified through ICD-10 codes, we unveil subtle yet significant associations and discuss pertinent specific cases. Our results underscore a noteworthy trend: younger patients of lower socioeconomic status exhibit a heightened likelihood of cardiovascular comorbidities compared to their older counterparts with a higher socioeconomic status. By empowering clinicians to discern non-evident comorbidities, our study aims to refine therapeutic designs. These findings offer profound insights into the intricate interplay among life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Armed with data-supported approaches that account for these factors, clinical practices stand to be enhanced, and public health policies informed, ultimately advancing the prevention and management of cardiovascular disease in Mexico.

Socioeconomic disparities in diabetes-concordant comorbidity: national health interview survey, 1997-2018

OBJECTIVE

Although social disparities in morbidity and mortality are well-documented, little is known how socioeconomic status (SES) shapes diabetes-concordant comorbidity (DCC). This study examines socioeconomic inequalities in DCC among adults with diabetes in the United States.

STUDY DESIGN

The study incorporated a cross-sectional nationally representative household health survey.

METHODS

This study used data from the National Health Interview Survey, 1997-2018. The analysis included 56,192 adults aged 30 or above with diabetes. Multinomial logistic regression was used to obtain relative risk ratios in gender-stratified models after adjusting for sociodemographic covariates.

RESULTS

The multivariable-adjusted analyses suggest that across all SES indicators and in both men and women, individuals with lower SES had greater odds of DCC than individuals with higher SES. The associations of SES indicators with DCC were larger in magnitude among women than in men. For example, compared to individuals with a college or higher degree, men with less than a high school degree were 2.06 times (95% confidence interval = 1.76-2.41) and women with less than a high school degree were 3.19 times (95% confidence interval = 2.67-3.82) more likely to have 3 or more DCCs. Similar associations were observed for other indicators of SES.

CONCLUSION

Study findings suggest strong social status and gender-based patterns in DCC. Identifying population groups with poor social status may be useful for informing interventions aiming to improve healthcare services of diabetes-related complications.

Development and validation of the Socioeconomic Status Composite Scale (SES-C)

BACKGROUND

Socioeconomic status (SES) is a critical multifactorial determinant of health and plays a significant role in shaping an individual's health outcomes. While a composite scale has been proposed to measure SES in children, to our knowledge, limited composite scales were developed for adults in different contexts, highlighting the need for a comprehensive and valid SES measure to elucidate the relationship between SES and health in this population.

OBJECTIVE

This study aimed to develop and validate a composite scale that measures the socioeconomic status in Lebanon and assess its correlates in a socioeconomic crisis context.

METHODS

An online study was carried out between October and November 2022 across all Lebanese regions. Snowball sampling was used to enroll 448 adults living in Lebanon through a questionnaire created on Google Forms and shared by WhatsApp to a first sample from all geographic areas.

RESULTS

The developed composite scale (SES-C) was found to be reliable and valid. It was based on several aspects of socioeconomic status, i.e., participant education level, family head education level, perceived social class, not being in debt, not receiving financial help, crowding index, participant work status, family head work status, monthly household income, and financial well-being. Furthermore, high SES was significantly associated with married status, older age, alcohol consumption, the absence of chronic disease, easy access to healthcare, private insurance coverage, and the number of rooms in the house in the bivariate analysis. In the multivariable analysis, high SES was significantly associated with age (ORa-1.13; p = 0.011) and easy access to healthcare (ORa = 7.81; p = 0.001) and inversely associated with chronic disease (ORa = 0.17; p = 0.002). Similar results with lower magnitude were found for moderate SES.

CONCLUSION

The study successfully developed and validated a composite scale (SES-C) for measuring the socioeconomic status in Lebanon, taking into account the complexities of the Lebanese context. The scale was found to be reliable and valid, and its results showed significant correlations with various factors such as older age, lower risk of chronic disease, and easy access to healthcare.

Oxidative potential of metal-polluted urban dust as a potential environmental stressor for chronic diseases

Oxidative stress (OS) associated with metals in urban dust has become a public health concern. Chronic diseases linked to general inflammation are particularly affected by OS. This research analyzes the spatial distribution of metals associated with OS, the urban dust´s oxidative potential (OP), and the occurrence of diseases whose treatments are affected by OS. We collected 70 urban dust samples during pre- and post-monsoon seasons to achieve this. We analyzed particle size distribution and morphology by scanning electron microscopy, as well as metal(loid)s by portable X-ray fluorescence, and OP of dust in artificial lysosomal fluid by using an ascorbic acid depletion assay. Our results show that the mean concentration of Fe, Pb, As, Cr, Cu, and V in pre-monsoon was 83,984.6, 98.4, 23.5, 165.8, 301.3, and 141.9 mg kg^-1, while during post-monsoon was 50,638.8, 73.9, 16.7, 124.3, 178.9, and 133.5 mg kg^-1, respectively. Impoverished areas with the highest presence of cardiovascular, cancer, diabetes, and respiratory diseases coincide with contaminated areas where young adults live. We identified significant differences in the OP between seasons. OP increases during the pre-monsoon (from 7.8 to 237.5 nmol AA min^-1) compared to the post-monsoon season (from 1.6 to 163.2 nmol AA min^-1). OP values are much higher than measured standards corresponding to contaminated soil and urban particulate matter, which means that additional sources beside metals cause the elevated OP. The results show no risk from chronic exposure to metals; however, our results highlight the importance of studying dust as an environmental factor that may potentially increase oxidative stress.

Hand transplantation: can we balance the risks and benefits?

Asking 'can we balance the risks and benefits?' implies that a quantification of both risk and benefit in hand transplantation (here the terms hand transplant and hand transplantation refer to allotransplantation of the human hand or hand and part or all of the upper limb or limbs) is possible. Despite all we have learned in recent years about hand transplantation, much remains unknown. Even if reliable methods for quantification of risk and benefit were available, fundamental issues relating to effective communication across the gulf of lived experience between the (presumably) handed surgeon and the handless patient remain. Inherent complexities mean some consider hand transplantation an unsolved problem, but we believe the medical and technical considerations fall within the ambit of a competent multidisciplinary team, and that psychosocial and ethical challenges are open to management through robust frameworks for assessment and decision making, underpinned by an extended period of assessment and dialogue, with candid acknowledgement where uncertainty remains. This respects the patient's autonomy while addressing the need for a prolonged period of informing consent.Level of evidence: V.

The end of life experiences of people living with socio-economic deprivation in the developed world: an integrative review

Background

Those experiencing socioeconomic deprivation have poorer quality of health throughout their life course which can result in poorer quality of death – with decreased access to palliative care services, greater use of acute care, and reduced access to preferred place of care compared with patients from less deprived populations.

Aim

To summarise the current global evidence from developed countries on end-of-life experience for those living with socio-economic deprivation.

Design

Integrative review in accordance with PRISMA. A thorough search of major databases from 2010–2020, using clear definitions of end-of-life care and well-established proxy indicators of socio-economic deprivation. Empirical research describing experience of adult patients in the last year of life care were included.

Results

Forty studies were included from a total of 3508 after screening and selection. These were deemed to be of high quality; from a wide range of countries with varying healthcare systems; and encompassed all palliative care settings for patients with malignant and non-malignant diagnoses. Three global themes were identified: 1) multi-dimensional symptom burden, 2) preferences and planning and 3) health and social care interactions at the end of life.

Conclusions

Current models of healthcare services are not meeting the needs of those experiencing socioeconomic deprivation at the end-of-life. Further work is needed to understand the disparity in care, particularly around ensuring patients voices are heard and can influence service development and delivery.

The impact of socioeconomic status and sleep quality on the prevalence of multimorbidity in older adults

Introduction

Multimorbidity has become a global public health concern that can cause serious damage to the health status of older adults. This study aimed to investigate the impact of socioeconomic status (SES) and sleep quality on the prevalence of multimorbidity in older adults, thus providing a reference for reducing the risk of the prevalence of multimorbidity and improving the health of older adults.

Methods

A multi-stage random sampling method was used to conduct a questionnaire survey on 3,250 older adults aged 60 years and above in Shanxi Province, China. The chi-square test and multiple logistic regression models were used to analyze the association of SES and sleep quality with the prevalence of multimorbidity of older adults.

Results

The prevalence of multimorbidity was 30.31% in older adults aged 60 years and above in Shanxi Province, China. After adjusting for confounders, very low SES (OR = 1.440, 95% CI: 1.083-1.913) and poor sleep quality (OR = 2.445, 95% CI: 2.043-2.927) were associated with the prevalence of multimorbidity. Older adults with low SES and poor sleep quality had the highest risk of the prevalence of multimorbidity (OR = 3.139, 95% CI: 2.288-4.307).

Conclusions

SES and sleep quality are associated with the prevalence of multimorbidity in older adults, and older adults with lower SES and poorer sleep quality are at higher risk for the prevalence of multimorbidity.

Healthcare utilisation and unmet health needs in children with intellectual disability: a propensity score matching approach using longitudinal cohort data

BACKGROUND

Health disparities for children with intellectual disabilities can be challenging to measure due to many other factors that can impact health and healthcare use. The aim of the current study was to use longitudinal cohort data to compare children with intellectual disability (ID) in Ireland between 2006 and 2014 on healthcare utilisation and unmet need, at ages 9 and 13, using a propensity score matching (PSM) approach.

METHODS

Using data from the Growing up in Ireland study, PSM was used to identify an appropriate control sample to compare with a sample of children with ID (n = 124). Participants were matched on variables that are known to influence healthcare utilisation to reduce the impact of confounding variables between groups so that differences between the groups can be estimated. Logistic regression was used to estimate effects at ages 9 and 13.

RESULTS

Children with ID were no more likely to have visited a general practitioner or emergency department in the past 12 months than children without ID. They did have a greater likelihood of visiting a doctor in a hospital in the past 12 months and of having an overnight stay in hospital by age 9. Primary caregivers of children with ID were more likely to report unmet health needs at ages 9 and 13.

CONCLUSIONS

This approach is a novel means of comparing healthcare use in this population by balancing the impact of other factors that may result in inequities, to which children with ID may be more vulnerable.

Targeting population groups with heavier burden of hepatocellular carcinoma incidence: a nationwide descriptive epidemiological study in Sweden

Contemporary European studies examining associations between socioeconomic status and hepatocellular carcinoma (HCC) incidence are scarce. We aimed to target population groups with a heavier burden of HCC by assessing associations of individual‐level sociodemographic variables and neighbourhood deprivation with all‐stage and stage‐specific HCC incidence rates (IR). Patient and population data stratified by calendar year (2012‐2018), sex, age (5‐year groups), household income (low, medium and high), country of birth (Nordic, non‐Nordic) and neighbourhood deprivation (national quintiles Q1‐Q5) were retrieved from Swedish registers. HCC stages were defined by Barcelona Clinic Liver Cancer stages 0 to A (early‐stage) and B to D (late‐stage). IR (per 100 000 person‐years) were estimated by Poisson regression models. Men had four times higher IR than women. IRs increased markedly with lower household income as well as with neighbourhood deprivation. Seven times higher IR was observed among people with a low household income living in the most deprived neighbourhoods (IR 3.90, 95% confidence interval [CI] 3.28‐4.64) compared to people with a high household income living in the least deprived neighbourhoods (IR 0.58, 95% CI 0.46‐0.74). The gradient across income categories was more pronounced for late‐stage than early‐stage HCC. IR reached 30 (per 100 000 person‐years) for people in the age span 60 to 79 years with low income and 20 for 60 to 79 year old people living in the most deprived neighbourhoods (regardless of income). Men with low household income and/or living in the most deprived neighbourhoods might be considered as primary targets in studies evaluating the cost‐effectiveness of screening for early‐stage HCC detection.

COVID-19 mortality in Istanbul in association with air pollution and socioeconomic status: an ecological study

This study aims to reveal the relationship between the COVID-19 mortality indicators and socioeconomic status (SES) and air pollution. In this ecological study, the focus was put on the relationship between COVID-19 mortality and both air quality and socioeconomic status at the district level in Istanbul. The mortality variables of the study are the excess deaths due to the pandemic, the proportion of deaths due to the pandemic among all deaths, COVID-19 mortality rate (per 100,000), and the proportion of COVID-19 deaths among older people (above the age of 65). The daily air quality measurements of PM₁₀, SO₂, NO₂, and NO_x of the pre-pandemic term were included in the research to avoid bias due to decreasing traffic burden during the pandemic. Partial correlation was applied to analyze the relationship between air quality and mortality measures by controlling socioeconomic status, the percentage of the older population, and household size. Every 20% deterioration in the SES stratum has contributed to a 4% increase in excess mortality at the district level. The elderly population ratio of over 10% in the districts was found to increase the COVID-19 deaths in the total population by 35% and the deaths in the population over 65 years old by 3%. Average household size was correlated with COVID-19 deaths in the population over 65. A moderate correlation was found between the COVID-19 mortality rate per 100,000 population and PM₁₀, SO₂, and NO₂ (r = 0.413, 0.421, and 0.431, respectively). Mortality during the COVID-19 pandemic in Istanbul is related to an interaction of socioeconomic characteristics and air pollution as an environmental issue.

The COVID-19 Pandemic and Access to Healthcare in People with Chronic Kidney Disease: a Systematic Review and Meta-analysis

The Coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on healthcare systems worldwide. The effect of the pandemic on those with chronic kidney disease (CKD) has yet to be defined.

AIMS

This systematic review aims to evaluate the effect of the COVID-19 pandemic on access to healthcare for patients with CKD.

METHODS

MEDLINE and EMBASE databases were searched up to July 2021 (PROSPERO CRD42021230831). Data relevant to access to healthcare before and during the COVID-19 pandemic were extracted, including outcomes related to access to general nephrology consultations, telehealth, dialysis services and kidney transplantations. Relative and absolute effects were pooled using a random effects model to account for between-study heterogeneity. Risk of bias was assessed using a modified Quality in Prognostic Studies tool. The certainty of the evidence was rated using the GRADE approach.

RESULTS

Twenty-three studies across five WHO regions were identified. Reductions in transplantation surgeries were observed during the COVID-19 pandemic compared to the pre-COVID-19 era (risk ratio = 2.15, 95%CI = 1.51-3.06, I²  = 90%, P < 0.001). Additionally, six studies reported increased use of telehealth services compared to pre-COVID-19 times. Four studies found reduced access to in-person general nephrology services and six studies reported interruptions to dialysis services during the COVID-19 pandemic.

CONCLUSION

Our findings suggest COVID-19 pandemic may have led to reductions in access to kidney transplantation, dialysis and in-person nephrology care. Meanwhile, whilst the use of telehealth has emerged as a promising alternate mode of healthcare delivery, its utility during the pandemic warrants further investigation. This study has highlighted major barriers to accessing care in a highly vulnerable chronic disease group. This article is protected by copyright. All rights reserved.

Living with a chronic disease: insights from patients with a low socioeconomic status

Background

Little is known about how patients with low socioeconomic status (SES) experience their chronic disease, and how it impacts health-related quality of life (HRQoL). Compared to their more affluent counterparts, worse outcomes have been reported. A better understanding of the domains of HRQoL that are relevant to these specific populations is therefore needed. We explored the experiences of living with a chronic disease in low SES persons.

Methods

A qualitative interview study was performed in Flanders, Belgium. Semi-structured interviews were conducted in chronically ill patients, selected through purposive sampling. Interviews were audio-recorded and transcribed verbatim. Analysis followed an inductive and iterative approach.

Results

Fifteen patients were interviewed. Six major themes were identified: a heavy bag to carry, loss of autonomous life, inner and outer loneliness, emotional imbalance, unmet need for support, and coping strategies. Patients experienced their illness as an additional problem on top of all other problems (i.e. financial/social problems, traumatic life events). In general, the disease burden and non-disease burden were mutually reinforcing, resulting in greater dependency, greater risk of social isolation, greater psychological distress, and greater risk of impaired HRQoL.

Conclusions

This study is the first to provide detailed insight into the experiences of living with a chronic disease in low SES persons. A conceptual model is proposed that can be used in daily clinical practice to raise awareness among clinicians and health care providers that the patient’s needs go beyond the disease itself. Future research is needed to validate and test the model.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01578-7.

The long shadow of socioeconomic deprivation over the modern management of acute myeloid leukemia: time to unravel the challenges

Biological and non-biological variables unrelated to acute myeloid leukemia (AML) preclude standard therapy in many settings, with "real world" patients under-represented in clinical trials and prognostic models. Here, using a case-based format, we illustrate the impact that socioeconomic and anthropogeographical constraints can have on optimally managing AML in 4 different healthcare systems. The granular details provided, emphasize the need for the development and targeting of socioeconomic interventions that are commensurate with the changing landscape of AML therapeutics, in order to avoid worsening the disparity in outcomes between patients with biologically similar disease.