Rethinking the relationship between socioeconomic status and health: Challenging how socioeconomic status is currently used in health inequality research

Instrumental, Affective, and Patient-Centered Communication Between Cardiologists and Patients with Low Socioeconomic Status: An Observational Study

One of the essential elements in managing health is having adequate communication with health care providers. Unfortunately, patients with a low socioeconomic status (SES) often experience less adequate communication with their doctor. In the current study, we explore and compare the communication of both doctors and patients from lower and higher sociodemographic backgrounds on three factors: instrumental, affective, and patient-centered communication. In total, 45 cardiology consultations were observed, transcribed, and coded (16 low-SES, 16 middle-SES, 13 high-SES). Our analyses showed that, compared to higher-SES patients, low-SES patients voiced less of their concerns, answered questions of the doctor more often with one word, and expressed less utterances overall. Naturally, we found that doctors expressed more utterances overall toward low-SES patients. For doctors, no differences regarding instrumental, affective, or patient-centered communication were found. These findings suggest that low-SES patients are more passive communicators and communication differences based on SES exist predominantly for patients' communication. The revealed communication differences may lead to a less adequate interaction and potentially worse patient outcomes, further increasing the socioeconomic health gap. Hence, doctors should become even more aware of socioeconomic patient communication differences so that they can appropriately encourage low-SES patients to become more active communicators.

Socioeconomic representativeness of Australian, Canadian and British cohorts from the paediatric diabetes AdDIT study: comparisons to regional and national data

BACKGROUND

Given limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations.

METHODS

Retrospective, cross-sectional evaluation of a subset of adolescent type 1 diabetes cardiorenal intervention trial (AdDIT) participants from Australia (n = 144), Canada (n = 312) and the UK (n = 173). Validated national measures of deprivation were used: the Index of Relative Socioeconomic Disadvantage (IRSD) 2016 (Australia), the Material Resources (MR) dimension of the Canadian Marginalisation index 2016 (Canada) and the Index of Multiple Deprivation (IMD) 2015 (UK). Representativeness was assessed by comparing the AdDIT cohort's distribution of deprivation quintiles with that of the local paediatric type 1 diabetes population (regional), and the broader type 1 diabetes population for which the trial's intervention was targeted (national).

RESULTS

Recruited study cohorts from each country had higher proportions of participants with higher SES, and significant underrepresentation of lower SES, in relation to their national references. The socioeconomic make-up in Australia mirrored that of the regional population (p = 0.99). For Canada, the 2nd least deprived (p = 0.001) and the most deprived quintiles (p < 0.001) were over- and under-represented relative to the regional reference, while the UK featured higher regional and national SES bias with over-representation and under-representation from the least-deprived and most-deprived quintiles (p < 0.0001).

CONCLUSIONS

Significant national differences in trial participation of low SES participants were observed, highlighting limitations in access to clinical research and the importance of reporting sociodemographic representation in diabetes clinical trials.

TRIAL REGISTRATION

NCT01581476. Registered on 20 April 2012.

Bibliometric analysis of the association between drinking water pollution and bladder cancer

Background

Bladder cancer has become an increasingly intractable health problem worldwide. Long-term drinking water pollution is known to promote its occurrence. This study aimed to analyze the research status, hot spots, and future trends of drinking water pollution and bladder cancer through extensive bibliometric examination to provide reference data for better prevention and management of bladder cancer.

Methods

The Scopus database developed by Elsevier was browsed for articles that met the predefined criteria using the search terms related to drinking water and bladder cancer. Included articles were further evaluated by year of publication, subject category, institution, article type, source journal, authors, co-authorship networks, and text mining of titles by R software packages tm, ggplot2 and VOSviewer software.

Results

In total, 687 articles were selected after a comprehensive literature search by the Scopus database, including 491 research articles, 98 review articles, 26 conference papers, 23 letters and 49 other documents. The total number of articles published showed an upward trend. The United States has the largest number of published articles (345 articles), institutions (7/10) and funding sponsors (top 5). The journal with the most publications was Environmental Health Perspectives, with 46 published. The highest number of citations up to 2330 times for a single article published in 2007 on the journal of Mutation Research. Professor Cantor K.P. was the highest number of publications with 35 articles and Smith A.H. was the most cited author with the number of citations reaching 6987 times overall and 225 times per article. The most frequent keywords excluding the search subject were "arsenic", "chlorination", "trihalomethane", and "disease agents".

Conclusion

This study is the first systematic bibliometric study of the literature publications on drinking water pollution and bladder cancer. It offers an overall and intuitive understanding of this topic in the past few years, and points out a clear direction research hotspots and reveals the trends for further in-depth study in future.

Maternal characteristics as indications for routine induction of labor: A nationwide retrospective cohort study

BACKGROUND

Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality.

METHODS

We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses.

RESULTS

The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included.

CONCLUSIONS

Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.

Do Social Inequalities in Smoking Differ by Immigration Status in Young Adults Living in an Urban Setting? Findings From the Interdisciplinary Study of Inequalities in Smoking

Objectives:

We assessed whether social inequalities in smoking observed among young adults born in Canada were also apparent in same-age immigrants.

Methods:

Data were drawn from an investigation of social inequalities in smoking conducted in an urban setting (Montreal, Canada). The sample included 2077 young adults age 18 to 25 (56.6% female; 18.9% immigrants who had lived in Canada 11.6 (SD 6.4) years on average). The association between education and current smoking was examined in multivariable logistic regression analyses conducted separately in young adults born in Canada and in immigrants.

Results:

About 19.5% of immigrants were current smokers compared to 23.8% of young adults born in Canada. In immigrants, relative to those with university education, the adjusted odds ratios (OR) (95% confidence interval) for current smoking were 1.2 (0.6, 2.3) among those with pre-university/vocational training and 1.5 (0.7, 2.9) among those with high school education. In non-immigrants, the adjusted ORs were 1.9 (1.4, 2.5) among those with pre-university/vocational training and 4.0 (2.9, 5.5) among those with high school.

Conclusion:

Young adults who had immigrated to Canada did not manifest the strong social gradient in smoking apparent in young adults born in Canada. Increased understanding of the underpinnings of this difference could inform development of interventions that aim to reduce social inequalities in smoking.