Association of childhood and adult socioeconomic indicators with cardiovascular risk factors and its modification by age: the CARLA Study 2002-2006

Cardiovascular Health in India - a Report Card from Three Urban and Rural Surveys of 22,144 Adults

Background

Markers of ideal cardiovascular health (CVH) predict cardiovascular events. We estimated the prevalence of ideal CVH markers in two levels of cities and villages in India.

Methods

We did pooled analysis of individual-level data from three cross sectional surveys of adults ≥ 30 years over 2010-14 (CARRS: Centre for cArdiometabolic Risk Reduction in South Asia; UDAY and Solan Surveillance Study) representing metropolitan cities; smaller cities and rural areas in diverse locations of India. We defined ideal CVH using modified American Heart Association recommendations: not smoking, ≥ 5 servings of fruits and vegetables (F&V), high physical activity (PA), body mass index (BMI) <25 Kg/m2, blood pressure (BP) <120/80 mm Hg, fasting plasma glucose (FPG) <100 mg/dl, and total cholesterol (TC) <200 mg/dL. We estimated (1) age-and sex-standardized prevalence of ideal CVH and (2) prevalence of good (≥6 markers), moderate (4-5), and poor CVH (≤3) adjusted for age, sex, education, and stratified by setting and asset tertiles.

Results

Of the total 22,144 participants, the prevalence of ideal CVH markers were: not smoking (76.7% [95% CI 76.1, 77.2]), consumed ≥5 F&V (4.2% [3.9, 4.5]), high PA (67.5% [66.8, 68.2]), optimum BMI (59.6% [58.9, 60.3]), ideal BP (34.5% [33.9, 35.2]), FPG (65.8% [65.1, 66.5]) and TC (65.4% [64.7, 66.1]). The mean number of ideal CVH metrics was 3.7(95% CI: 3.7, 3.8). Adjusted prevalence of good, moderate, and poor CVH, varied across settings: metropolitan (3.9%, 41.0%, and 55.1%), smaller cities (7.8%, 49.2%, and 43%), and rural (10.4%, 60.9%, and 28.7%) and across asset tertiles: Low (11.0%, 55.9%, 33.1%), Middle (6.3%, 52.2%, 41.5%), and High (5.0%, 46.4%, 48.7%), respectively.

Conclusion

Achievement of ideal CVH varied, with higher prevalence in rural and lower asset tertiles. Multi-sectoral and targeted policy and program actions are needed to improve CVH in diverse contexts in India.

Association between Parenthood and Health Behaviour in Later Life-Results from the Population-Based CARLA Study

Previous research has focused on comparing health behaviour between parents and non-parents at younger ages, while little is known about the impact of being a parent on health behaviours in later life. We studied whether parenthood is associated with later physical activity (PA), dietary pattern, smoking status and alcohol consumption in German adults of middle and old age. We used data from the baseline examination of the population-based CARLA-study in Halle (Saale), comprising 1779 adults aged 45-83. Linear and logistic regression analyses assessed the relationship between parenthood and health behaviours while controlling for age, partner status, education, income, occupational position, socioeconomic status in childhood, and number of chronic diseases. Of the participants, 89.1% had biological children. Being a father was associated with higher PA in sports (sport index ß = 0.29, 95% confidence interval [0.14; 0.44]), but not with PA in leisure time (excluding sports), dietary pattern, consumption of alcohol and smoking status. No associations were found between being a mother with all outcome variables. Provided that PA of fathers is typically reduced when the children are young, the development towards higher PA at later age needs to be studied in more detail.

Income disparity and utilization of cardiovascular preventive care services among U.S. adults

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Low income individuals are less likely to receive smoking cessation counseling.

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Low income individuals are less likely to have their blood pressure checked.

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Low income individuals are less likely to be receive exercise counseling.

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Low income individuals are less likely to receive dietary counseling.

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Low income individuals are less likely to have their cholesterol levels checked.

Objective

: Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults.

Methods

: We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200–400% of FPL), low-income (125–200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities.

Results

: The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37–0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33–0.38)] or receive counseling about diet modifications [0.77 (0.74–0.81)], exercise [0.81 (0.77–0.85)], or smoking cessation [0.71 (0.63–0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22–0.46)] or cholesterol [0.33 (0.26–0.42)] checked and receive counseling about exercise [0.84 (0.76–0.93)] or smoking cessation [0.78 (0.61–0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants.

Conclusions

: VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.

Educational inequality in the Dietary Approach to Stop Hypertension diet in the UK: evaluating the mediating role of income

Apparent differences in the adoption of the Dietary Approach to Stop Hypertension (DASH) diet have been reported between less and more educated individuals. However, the mediating role of income has not been clarified. In this study, we aimed at quantifying the mediating effect of income on the relationship between education and the DASH score in the UK population. We analysed data on 4864 subjects aged 18 years and older collected in three waves of the National Diet and Nutrition Survey (2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. We carried out a counterfactual-based mediation analysis to decompose the total effect of education on DASH score into average direct effect and average causal mediation effect mediated by income. We found that the overall mediating effect of income on the relationship between education and the DASH score was only partial, with an estimated proportion mediated ranging between 6 and 9 %. The mediating effect was higher among females (11·6 %) and younger people (17·9 %). Further research is needed to investigate which other factors may explain the socio-economic inequality in the adoption of the DASH diet in the UK.

Socioeconomic status in childhood and obesity in adults: a population-based study

OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

Prevalence of cardio-metabolic risk factors in a nationally representative sample of Iranian adolescents: The CASPIAN-III Study

Introduction: The aim of the present study is to explore the prevalence and mean of cardiometabolic risk factors and liver enzymes of Iranian adolescents living in regions with different socioeconomic status (SES). To the best of our knowledge this is the first study reporting these data at sub-national level in Iran.

Methods: This multi-centric study was performed in 2009-2010 on a stratified multi-stage probability sample of 5940 students aged 10-18 years, living in urban and rural areas of 27 provinces of Iran. Trained healthcare professionals measured anthropometric indices, systolic and diastolic blood pressures (SBP, DBP) according to standard protocols. Fasting venous blood was examined for fasting blood sugar (FBS), lipid profile and liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We classified the country into four sub-national regions based on criteria of the combination of geography and SES. Mean and frequency of risk factors were compared across these regions.

Results: The mean of body mass index had linear rise with increase in the regions’ SES (P for trend <0.001). The mean levels of DBP, total cholesterol (TC), high-density lipoproteincholesterol (HDL-C), triglycerides (TG), FBS, ALT, and AST had linear association with regions’ SES in the whole population and in both genders (P for trend < 0.05), whereas the corresponding figure was statistically significant for the mean SBP only in girls (P for trend: 0.03) and for the mean of LDL-C in the whole population and in boys (P for trend <0.001). In total and in both genders, there was an escalating trend in the prevalence of elevated FBS, TC and liver enzymes, low HDL-C, and metabolic syndrome by increase in the SES of the region(P for trend <0.01).

Conclusion: This study proposes that in addition to national health policies on preventing cardiometabolic risk factors, specific interventions should be considered according to the regional SES level.

Receipt of public assistance during childhood and hypertension risk in adulthood

PURPOSE

We examined if receipt of public assistance during childhood lowered risk for hypertension by mid-life in a cohort of African Americans in the Southeastern United States.

METHODS

We used multiple logistic regression models to assess the relationship between receipt of public assistance during childhood and adult hypertension among 405 male and 737 female adult participants enrolled between 1988 and 2001 in the Pitt County Study, a community-based prospective cohort study of African Americans in North Carolina. Statistical analyses were adjusted for child and adult sociodemographic measures as well as adult psychosocial and lifestyle factors.

RESULTS

Women who grew up in economically disadvantaged families and who received public assistance during childhood had a 66% decreased odds of hypertension by mid-life compared with women similarly disadvantaged in childhood but who did not receive public assistance, odds ratio = 0.34; 95% confidence interval: 0.14-0.83. No association was observed for African American men.

CONCLUSIONS

Receipt of anti-poverty federal assistance during childhood was associated with reduced risk for hypertension by mid-life among African American women. It is possible that social expenditures on public assistance programs for families in need could produce long-term health benefits for children.

Educational status and differences in left ventricular mass and ejection fraction - The role of BMI and parameters related to the metabolic syndrome: A longitudinal analysis from the population-based CARLA cohort

BACKGROUND AND AIMS

Higher ventricular mass has been reported in non-white US-Americans with low educational status and in socially isolated people. To assess the impact of education on cardiac mass and function in the general population and to identify mediators.

METHODS AND RESULTS

Data from a German population-based sample were used (CARLA cohort, n = 1779 at baseline, n = 1436 at the four-year follow-up). Ventricular mass indexed on height (LVMI) and ejection fraction, using Teichholz's formula (EFTZ), were measured. Education was assessed using the ISCED classification. Mediator analyses were performed using the R-macro 'mediation' to compute the average direct effect and the average causal mediated effect after confounder adjustment. Sensitivity analyses for unobserved confounders were performed. Considered mediators were BMI, waist-to-hip ratio, HbA1c, and systolic and diastolic blood pressures. We found differences in LVMI and EFTZ, both at baseline and follow-up, between educational levels in women (lowest vs highest educational level: 15.6 g, 95% CI: -25.7, -5.6), but not in men. Similarly, women (lowest vs highest educational level at baseline: 3.3%, 95% CI: 0.8-5.7), but not men, of higher educational levels had a higher EFTZ of comparable magnitude at baseline and follow-up. Of the considered mediators, BMI explained 55.9% at baseline and 54.1% at follow-up of the educational effect, while other potential mediators had no significant effect. Relations remained constant between baseline and follow-up.

CONCLUSIONS

Women with low educational levels tend to have a higher ventricular mass and lower EF, which can be explained by a higher BMI in this group.

Social Inequalities in Cardiovascular Risk Factors Among Older Adults in Spain: The Seniors-ENRICA Study

INTRODUCTION AND OBJECTIVES

To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain.

METHODS

A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions.

RESULTS

In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men.

CONCLUSIONS

There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population.

Child Poverty and the Promise of Human Capacity: Childhood as a Foundation for Healthy Aging

The effect of child poverty and related early life experiences on adult health outcomes and patterns of aging has become a central focus of child health research and advocacy. In this article a critical review of this proliferating literature and its relevance to child health programs and policy are presented. This literature review focused on evidence of the influence of child poverty on the major contributors to adult morbidity and mortality in the United States, the mechanisms by which these associations operate, and the implications for reforming child health programs and policies. Strong and varied evidence base documents the effect of child poverty and related early life experiences and exposures on the major threats to adult health and healthy aging. Studies using a variety of methodologies, including longitudinal and cross-sectional strategies, have reported significant findings regarding cardiovascular disorders, obesity and diabetes, certain cancers, mental health conditions, osteoporosis and fractures, and possibly dementia. These relationships can operate through alterations in fetal and infant development, stress reactivity and inflammation, the development of adverse health behaviors, the conveyance of child chronic illness into adulthood, and inadequate access to effective interventions in childhood. Although the reviewed studies document meaningful relationships between child poverty and adult outcomes, they also reveal that poverty, experiences, and behaviors in adulthood make important contributions to adult health and aging. There is strong evidence that poverty in childhood contributes significantly to adult health. Changes in the content, financing, and advocacy of current child health programs will be required to address the childhood influences on adult health and disease. Policy reforms that reduce child poverty and mitigate its developmental effects must be integrated into broader initiatives and advocacy that also attend to the health and well-being of adults.

How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study

INTRODUCTION

Several studies have identified that socioeconomic inequalities in coronary artery disease (CAD) morbidity and mortality lead to a disadvantage in patients with low socioeconomic status (SES). International studies have shown that socioeconomic inequalities also exist in terms of access, utilisation and quality of cardiac care. The aim of this qualitative study is to provide information on the impact of socioeconomic inequalities on the pathway of care for CAD, and to establish which factors lead to socioeconomic inequality of care to form and expand existing scientific theories.

METHODS AND ANALYSIS

A longitudinal qualitative study with 48 patients with CAD, aged 60-80 years, is being conducted. Patients have been recruited consecutively at the University Hospital in Halle/Saale, Germany, and will be followed for a period of 6 months. Patients are interviewed two times face-to-face using semistructured interviews. Data are transcribed and analysed based on grounded theory.

ETHICS AND DISSEMINATION

Only participants who have been informed and who have signed a declaration of consent have been included in the study. The study complies rigorously with data protection legislation. Approval of the Ethical Review Committee at the Martin-Luther University Halle-Wittenberg, Germany was obtained. The results of the study will be presented at several congresses, and will be published in high-quality peer-reviewed international journals.

TRIAL REGISTRATION NUMBER

This study has been registered with the German Clinical Trials Register and assigned DRKS00007839.

Social capital, mortality, cardiovascular events and cancer: a systematic review of prospective studies

BACKGROUND

Social capital is considered to be an important determinant of life expectancy and cardiovascular health. Evidence on the association between social capital and all-cause mortality, cardiovascular disease (CVD) and cancer was systematically reviewed.

METHODS

Prospective studies examining the association of social capital with these outcomes were systematically sought in Medline, Embase and PsycInfo, all from inception to 8 October 2012. We categorized the findings from studies according to seven dimensions of social capital, including social participation, social network, civic participation,social support, trust, norm of reciprocity and sense of community, and pooled the estimates across studies to obtain summary relative risks of the health outcomes for each social capital dimension. We excluded studies focusing on children, refugees or immigrants and studies conducted in the former Soviet Union.

RESULTS

Fourteen prospective studies were identified. The pooled estimates showed no association between most social capital dimensions and all-cause mortality, CVD or cancer. Limited evidence was found for association of increased mortality with social participation and civic participation when comparing the most extreme risk comparisons.

CONCLUSIONS

Evidence to support an association between social capital and health outcomes is limited. Lack of consensus on measurements for social capital hinders the comparability of studies and weakens the evidence base.

Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany

Background

The objective of this study was to analyse the association between area deprivation at municipality level and the prevalence of type 2 diabetes (T2D) and obesity across Germany, controlling for individual socioeconomic status (SES).

Methods

The analyses are based on a large survey conducted in 2006. Information was included from 39,908 adults aged 20 years or above. Area deprivation was assessed using the German Index of Multiple Deprivation (GIMD) at municipality level. About 4,700 municipalities could be included and assigned to a deprivation quintile. Individual SES was assessed by income and educational level. Multilevel logistic models were used to control for individual SES and other potential confounders such as age, sex and physical activity.

Results

We found a positive association of area deprivation with T2D and obesity. Controlling for all individual-level variables, the odds ratios for municipalities in the most deprived quintile were significantly increased for T2D (OR 1.35; 95% CI 1.12–1.64) as well as for obesity (OR 1.14; 95% CI 1.02–1.26). Further analyses showed that these associations were relatively similar for both men and women.

Conclusions

Based on a nationwide dataset, we were able to show that area deprivation at municipality level is significantly associated with the prevalence of T2D and obesity. It will be important to focus preventive efforts on very deprived municipalities.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.

Impact of health counselling on cardiovascular disease risk in middle aged men: influence of socioeconomic status

BACKGROUND

The inverse association between socioeconomic status and cardiovascular disease is well documented. We examined whether the impact of health counselling on cardiovascular risk factors in middle-aged men differed according to socioeconomic status.

METHODS

We used data from a community based study assessing the risk for cardiovascular disease among middle-aged men in Helsinki, Finland. Traditional cardiovascular disease risk factors were measured and cardiovascular disease risk was assessed by a modified risk tool used in the North Karelia project (CVD Risk Score). Those men with increased risk for cardiovascular disease at their baseline visit in 2006 received lifestyle counselling. After two years these high-risk men were invited to a follow-up visit. The same measurements and risk assessments were repeated.

RESULTS

Based on the CVD Risk Score there were significant differences between the groups at baseline (p = 0.001) and at follow-up (p<0.001) with the highest scores in the lowest educational group. There were no significant differences in traditional cardiovascular risk factors according to educational attainment between groups either at baseline or at follow-up. Baseline lifestyle characteristics differed between the groups regarding use of soft fat (p = 0.019). All groups responded positively to lifestyle counselling.

CONCLUSIONS

The present study showed that lifestyle counselling is feasible in high-risk middle-aged men and lifestyle intervention works in all educational groups. Interestingly the traditional risk factors did not show improvement, but the risk score improved. From a practical point of view our findings stress the importance of using risk score calculators in health counselling instead of looking at individual cardiovascular disease risk factors.

Socioeconomic inequalities in abdominal obesity in Brazilian female adolescents: a national-based study

The aim of the present study was to identify the prevalence of abdominal obesity and verify the socioeconomic inequities in abdominal obesity among female adolescents from all regions of Brazil. A cross sectional nationwide study was carried out on abdominal obesity with 2,488 women aged 15 to 19 years in the National Survey on Demography and Health of Women and Children (PNDS), 2006. Abdominal obesity was identified based on waist circumference (WC). Demographic and socioeconomic data (age, skin color, schooling level, socioeconomic status, area of residence, geographic region, marital status, and private health insurance) were collected. Poisson regression was used for multivariate analysis. The prevalence of abdominal obesity was 24.7 % (95 % confidence intervals; 20.9, 28.3). The mean WC value was 74.1 cm (SD=9.3). Adolescents who studied fewer years, those living in a socially and economically more developed region and those who had a partner, showed higher prevalence of abdominal obesity. Effective actions to reduce abdominal obesity include equitable early childhood development programs and education and interventions within the health systems should be complemented with population-based policies specifically designed to reduce socioeconomic inequalities.

The influence of seasonal climate variability on mortality in pre-industrial Sweden

Background

Recent studies have shown an association between weather and climatic factors with mortality, cardiovascular and infectious diseases. We used historical data to investigate the impact of seasonal temperature and precipitation on total mortality in Uppsala, Sweden, during the first two stages of the demographic transition, 1749–1859.

Design

We retrieved mortality and population numbers of the Uppsala Domkyrka parish from digitised parish records and obtained monthly temperature and precipitation measures recorded in Uppsala during that time. Statistical models were established for year-to-year variability in deaths by annual and seasonal temperature and precipitation, adjusting for longer time trends. In a second step, a model was established for three different periods to study changes in the association of climate variability and mortality over time. Relative risks (RR) with 95% confidence intervals (CI) were calculated.

Results

Precipitation during spring and autumn was significantly associated with annual mortality (spring RR 0.982, CI 0.965–1.000; autumn RR 1.018, CI 1.004–1.032, respectively, per centimetre increase of precipitation). Higher springtime temperature decreased annual mortality, while higher summer temperature increased the death toll; however, both were only borderline significant (p=0.07). The significant effect of springtime precipitation for mortality was present only in the first two periods (1749–1785 and 1786–1824). On the contrary, the overall effect of autumn precipitation was mainly due to its relevance during the last period, 1825–1859 (RR 1.024, CI 0.997–1.052). At that time, higher winter precipitation was found to decrease mortality.

Conclusions

In urban Uppsala, during the 18th and 19th century, precipitation appeared to be a stronger predictor for mortality than temperature. Higher spring precipitation decreased and higher autumn precipitation increased the number of deaths. However, this association differed before and during the early stages of industrialisation. Further research shall take age-specific differences into account, as well as changes in socio-economic conditions during that time.

Socioeconomic status is significantly associated with dietary salt intakes and blood pressure in Japanese workers (J-HOPE Study)

The association of socioeconomic status (SES) with nutrients intakes attracts public attention worldwide. In the current study, we examined the associations of SES with dietary salt intake and health outcomes in general Japanese workers (2,266) who participated in this Japanese occupational cohort. SES was assessed by a self-administered questionnaire. Dietary intakes were assessed with a validated, brief, self-administered diet history questionnaire (BDHQ). Multiple linear regression and stratified analysis were used to evaluate the associations of salt intake with the confounding factors. Education levels and household incomes were significantly associated with salt intake, as well as blood pressures (P < 0.05). After adjusting for age, sex and total energy intake, both years of education and household income significantly affect the salt intake (for education, β = −0.031, P = 0.040; for household income, β = −0.046, P = 0.003). SES factors also affect the risk of hypertension, those subjects with higher levels of education or income had lower risk to become hypertensive (ORs for education was 0.904, P < 0.001; ORs for income was 0.956, P = 0.032). Our results show that SES is an independent determinant of salt intake and blood pressure, in order to lower the risk of hypertension, the efforts to narrow the social status gaps should be considered by the health policy-makers.

Socioeconomic status is significantly associated with the dietary intakes of folate and depression scales in Japanese workers (J-HOPE Study)

The association of socioeconomic status (SES) with nutrient intake attracts public attention worldwide. In the current study, we examined the associations of SES with dietary intake of folate and health outcomes in general Japanese workers. This Japanese occupational cohort consisted off 2266 workers. SES was assessed by a self-administered questionnaire. Intakes of all nutrients were assessed with a validated, brief and self-administered diet history questionnaire (BDHQ). The degree of depressive symptoms was measured by the validated Japanese version of the K6 scale. Multiple linear regression and stratified analysis were used to evaluate the associations of intake with the confounding factors. Path analysis was conducted to describe the impacts of intake on health outcomes. Education levels and household incomes were significantly associated with intake of folate and depression scales (p < 0.05). After adjusting for age, sex and total energy intake, years of education significantly affect the folate intake (β = 0.117, p < 0.001). The structural equation model (SEM) shows that the indirect effect of folate intake is statistically significant and strong (p < 0.05, 56% of direct effect) in the pathway of education level to depression scale. Our study shows both education and income are significantly associated with depression scales in Japanese workers, and the effort to increase the folate intake may alleviate the harms of social disparities on mental health.