Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany

Poverty Status at Birth Predicts Epigenetic Changes at Age 15

Epigenetic studies have provided new opportunities to better understand the biological effects of poverty and racial/ethnic minority status. However, little is known about sex differences in these processes.

Methods

We used 15 years of follow up of 854 racially and ethnically diverse birth cohort who were followed from birth to age 15. Structural equation modeling (SEM) was used to examine the effects of race/ethnicity, maternal education, and family structure on poverty at birth, as well as the effects of poverty at birth on epigenetic changes at age 15. We also explored variations by sex.

Results

Our findings indicate that Black and Latino families had lower maternal education and married family structure which in turn predicted poverty at birth. Poverty at birth then was predictive of epigenetic changes 15 years later when the index child was 15. This suggested that poverty at birth partially mediates the effects of race/ethnicity, maternal education, and family structure on epigenetic changes of youth at age 15. There was an effect of poverty status at birth on DNA methylation of male but not female youth at age 15. Thus, poverty at birth may have a more salient effect on long term epigenetic changes of male than female youth.

Conclusions

Further studies are needed to understand the mechanisms underlying the observed sex differences in the effects of poverty as a mechanism that connects race/ethnicity, maternal education, and family structure to epigenetic changes later in life.

Race, Poverty Status at Birth, and DNA Methylation of Youth at Age 15

Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future of Families and Child Wellbeing Study (FFCWS) cohort, with GrimAge used as a measure of DNAm levels and epigenetic aging. Our analysis included 854 racially and ethnically diverse participants followed from birth to age 15. Structural equation modeling (SEM) examined the relationships among race, SEP at birth, and epigenetic aging at age 15, controlling for sex, ethnicity, and family structure at birth. Findings indicate that race was associated with lower SEP at birth and faster epigenetic aging. Specifically, income to poverty ratio at birth partially mediated the effects of race on accelerated aging by age 15. The effect of income to poverty ratio at birth on DNAm was observed in male but not female youth at age 15. Thus, SEP partially mediated the effect of race on epigenetic aging in male but not female youth. These results suggest that income to poverty ratio at birth partially mediates the effects of race on biological aging into adolescence. These findings highlight the long-term biological impact of early-life poverty in explaining racial disparities in epigenetic aging and underscore the importance of addressing economic inequalities to mitigate these disparities. Policymakers should focus on poverty prevention in Black communities to prevent accelerated biological aging and associated health risks later in life. Interventions aimed at eliminating poverty and addressing racial inequities could have significant long-term benefits for public health. Future research should explore additional factors contributing to epigenetic aging and investigate potential interventions to slow down the aging process. Further studies are needed to understand the mechanisms underlying these associations and to identify effective strategies for mitigating the impact of SEP and racial disparities on biological aging.

Optimal outcomes from cardiac rehabilitation are associated with longer-term follow-up and risk factor status at 12 months: An observational registry-based study

AIM

The purpose of Cardiac Rehabilitation (CR) is to promote and reduce risk factors in the short and long term, however, the latter has, to date, been poorly evaluated. We explored characteristics associated with provision and outcomes of a long-term assessment in CR.

METHOD

Data from the UK National Audit of CR between April 2015 and March 2020 was used. Programmes were selected if they had an established mechanism and routine methodology to collect the 12-month assessments. Risk factors pre and post phase II CR and at the 12-month assessment were explored; BMI ≤30, ≥150 min of physical activity per week, hospital anxiety and depression scale (HADS) scores <8. The data came from 32 programmes, 24,644 patients with coronary heart disease. Patients being in at least one optimal risk factor stage throughout phase II CR (OR = 1.43 95% CI 1.28 to 1.59) or successfully reaching an optimal stage during phase II CR (OR = 1.61 95% CI 1.44 to 1.80) had an increased likelihood of being assessed at 12 months compared to those who did not. Patients being in the optimal stage upon completion of phase II CR had an increased likelihood of still being in the optimal stage at 12 months. Most prominent was BMI; (OR = 14.6 (95% CI 11.1 to 19.2) for patients reaching an optimal stage throughout phase II CR.

CONCLUSION

Being in an optimal stage upon routine CR completion could be an overlooked predictor in the provision of a long-term CR service and prediction of longer-term risk factor status.

Socioeconomic disparities in endometrial cancer survival in Germany: a survival analysis using population-based cancer registry data

PURPOSE

Area-based socioeconomic deprivation has been established as an important indicator of health and a potential predictor of survival. In this study, we aimed to measure the effect of socioeconomic inequality on endometrial cancer survival.

METHODS

Population-based data on patients diagnosed with endometrial cancer between 2004 and 2014 were obtained from the German Centre for Cancer Registry Data. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. We investigated the association of deprivation and overall survival through Kaplan-Meier curves and Cox proportional regression models.

RESULTS

A total of 21,602 women, with a mean age of 67.8 years, were included in our analysis. The observed 5-year overall survival time for endometrial cancer patients living in the most affluent districts (first quintile) was 78.6%. The overall survival rate decreased as the level of deprivation increased (77.2%, 73.9%, 76.1%, 74.7%, for patients in the second, third, fourth, and fifth quintile (most deprived patients), respectively). Cox regression models showed stage I patients living in the most deprived districts to have a higher hazard of overall mortality when compared to the cases living in the most affluent districts [Hazard ratio: 1.20; 95% Confidence interval (0.99-1.47)] after adjusting for age, tumor characteristics, and treatment.

CONCLUSION

Our results indicate differences in endometrial cancer survival according to socioeconomic deprivation among stage I patients. Considering data limitations, future studies with access to individual-level patient information should be conducted to examine the underlying causes for the observed disparity in cancer survival.

Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana

Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.

Regional living conditions and the prevalence, awareness, treatment, control of hypertension at the individual level in Russia

Background

The objective of our study was to investigate the associations of characteristics inherent in large Russian Federation (RF) regions with prevalence, awareness, treatment and control of hypertension at the individual level.

Methods

Regional characteristics were obtained from the official website of the Federal State Statistics Service of the RF. We employed principal component analysis to reduce the dimensionality of data, which allowed defining five integral regional indices. Prevalence, awareness, treatment and control of hypertension were assessed from the data of the cross-sectional stage of ESSE-RF study conducted in 2013–2014. The final sample included 19,791 patients from 12 RF regions. Generalized estimating equations were used to identify the associations of regional indices with prevalence, awareness, treatment and control of hypertension at the individual level, taking into consideration nested data structures (study subjects in the regions).

Results

The index characterizing deterioration of social living conditions and societal marginalization exhibited positive associations with the prevalence of hypertension among men (OR = 1.18; 95% CI: 1.05–1.32) and elderly people (OR = 1.16; 95% CI: 1.02–1.32). Moreover, deterioration in the social environment was associated with a reduction in treatment (OR = 0.76; 95% CI: 0.64–0.90) and control of hypertension (OR = 0.79; 95% CI: 0.69–0.90). Hypertension awareness was directly connected with demographic crisis (OR = 1.13; 95% CI: 1.02–1.25) and augmented industrial development (OR = 1.15; 95% CI: 1.01–1.33) in the regions. The association of regional living conditions with the prevalence of hypertension is relatively weak, compared to predictors at the individual level, but this influence is important for awareness, treatment and control of hypertension.

Conclusion

The study contributed to evaluating the associations of the vital characteristics inherent in population of large RF regions with arterial hypertension prevalence, as well as with awareness, treatment and control of this disease. Our results provided original insights from the standpoint of cardiovascular disease epidemiology in the RF, as well as in the context of investigating the impact of living conditions on population health.

Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study

Background

Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking.

Methods

Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions.

Results

In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts.

Conclusions

Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11629-4.

Ideal cardiovascular health in urban Jamaica: prevalence estimates and relationship to community property value, household assets and educational attainment: a cross-sectional study

OBJECTIVE

Ideal cardiovascular health (ICH) is associated with greater longevity and reduced morbidity, but no research on ICH has been conducted in Jamaica. We aimed to estimate the prevalence of ICH in urban Jamaica and to evaluate associations between ICH and community, household, and individual socioeconomic status (SES).

DESIGN

Cross-sectional study.

SETTING

Urban communities in Jamaica.

PARTICIPANTS

360 men and 665 women who were urban residents aged ≥20 years from a national survey, the Jamaica Health and Lifestyle Survey 2016-2017.

EXPOSURES

Community SES, using median land values (MLV); household SES, using number of household assets; and individual SES, using education level.

PRIMARY OUTCOME

The main outcome variable was ICH, defined as having five or more of seven ICH characteristics (ICH-5): current non-smoking, healthy diet, moderate physical activity, normal body mass index, normal blood pressure, normal glucose and normal cholesterol. Prevalence was estimated using weighted survey design and logistic regression models were used to evaluate associations.

RESULTS

The prevalence of overall ICH (seven characteristics) was 0.51%, while the prevalence of ICH-5 was 22.9% (male 24.5%, female 21.5%, p=0.447). In sex-specific multivariable models adjusted for age, education, and household assets, men in the lower tertiles of community MLV had lower odds of ICH-5 compared with men in the upper tertile (lowest tertile: OR 0.33, 95% CI 0.12 to 0.91, p=0.032; middle tertile: OR 0.46, 95% CI 0.20 to 1.04, p=0.062). Women from communities in the lower and middle tertiles of MLV also had lower odds of ICH-5, but the association was not statistically significant. Educational attainment was inversely associated with ICH-5 among men and positively associated among women.

CONCLUSION

Living in poorer communities was associated with lower odds of ICH-5 among men in Jamaica. The association between education level and ICH-5 differed in men and women.

Geographic variation in cardiometabolic risk factor prevalence explained by area-level disadvantage in the Illawarra-Shoalhaven region of the NSW, Australia

Cardiometabolic risk factors (CMRFs) demonstrate significant geographic variation in their distribution. The study aims to quantify the general contextual effect of the areas on CMRFs; and the geographic variation explained by area-level socioeconomic disadvantage. A cross sectional design and multilevel logistic regression methods were adopted. Data included objectively measured routine pathology test data between years 2012 and 2017 on: fasting blood sugar level; glycated haemoglobin; total cholesterol; high density lipoprotein; urinary albumin creatinine ratio; estimated glomerular filtration rate; and body mass index. The 2011 Australian census based Index of Relative Socioeconomic Disadvantage (IRSD) were the area-level study variables, analysed at its smallest geographic unit of reporting. A total of 1,132,029 CMRF test results from 256,525 individuals were analysed. After adjusting for individual-level covariates, all CMRFs significantly associated with IRSD and the probability of higher risk CMRFs increases with greater area-level disadvantage. Though the specific contribution of IRSD in the geographic variation of CMRF ranged between 57.8 and 14.71%, the general contextual effect of areas were found minimal (ICCs 0.6-3.4%). The results support universal interventions proportional to the need and disadvantage level of populations for the prevention and control of CMRFs, rather than any area specific interventions as the contextual effects were found minimal in the study region.

Socioeconomic position in childhood and depressive symptoms in later adulthood in the Czech Republic

BACKGROUND

Depression risk may partly originate from socioeconomic hardship in childhood. We investigated the association of childhood socioeconomic position with depressive symptoms in later adulthood in a Central and Eastern European country.

METHODS

We analyzed data from the Czech arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. We estimated the associations of three indicators of childhood socioeconomic position (access to household amenities at age of 10 years, father´s education and mother´s education) with high depressive symptoms, operationalized as ≥16 points on the Center for Epidemiological Studies - Depression 20 scale, controlling for age and sex, current socioeconomic position and other social and health-related factors.

RESULTS

The analytical sample included 4,213 individuals (mean age 58 years, 54% women). All three indicators of childhood socioeconomic position were inversely associated with depressive symptoms in age-sex adjusted models (p for trends: access to household amenities p<0.001; mother´s education p<0.001; father´s education p=0.03). Adjustment for current socioeconomic position attenuated the associations of depressive symptoms with access to household amenities (p for trend 0.04) and mother´s education (p for trend 0.05) and virtually eliminated the association with father´s education (p for trend 0.82).

LIMITATIONS

Individuals with higher depressive symptoms and more adverse socioeconomic position are likely to be underrepresented in the study sample. Data on childhood socioeconomic position may be reported inaccurately.

CONCLUSIONS

Socioeconomic hardship in childhood may have long-lasting consequences on mental health in later adulthood.

Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra-Shoalhaven Region of NSW, Australia

BACKGROUND

Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs.

METHODS

Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region.

RESULTS

Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91-0.96) and obesity (OR 0.91, CI 0.88-0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4-1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%.

CONCLUSION

The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.

Clinical complexity and hospital admissions in the December holiday period

Background

Christmas and New Year’s holidays are risk factors for hospitalization, but the causes of this “holiday effect” are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period.

Methods

This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017–2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed.

Results

Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10–3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.

Conclusions

Patients hospitalized during the December holiday period had worse health outcomes, and this could be attributable to the grater CC, especially related to socioeconomic (social deprivation, low income) and behavioral factors (inappropriate diet). The evaluation of all CC components could potentially represent a useful tool for a more rational resource allocation over this time of the year.

Gentrification, Neighborhood Change, and Population Health: a Systematic Review

Despite a proliferation of research on neighborhood effects on health, how neighborhood economic development, in the form of gentrification, affects health and well-being in the USA is poorly understood, and no systematic assessment of the potential health impacts has been conducted. Further, we know little about whether health impacts differ for residents of neighborhoods undergoing gentrification versus urban development, or other forms of neighborhood socioeconomic ascent. We followed current guidelines for systematic reviews and present data on the study characteristics of the 22 empirical articles that met our inclusion criteria and were published on associations between gentrification, and similar but differently termed processes (e.g., urban regeneration, urban development, neighborhood upgrading), and health published between 2000 and 2018. Our results show that impacts on health vary by outcome assessed, exposure measurement, the larger context-specific determinants of neighborhood change, and analysis decisions including which reference and treatment groups to examine. Studies of the health impacts of gentrification, urban development, and urban regeneration describe similar processes, and synthesis and comparison of their results helps bridge differing theoretical approaches to this emerging research. Our article helps to inform the debate on the impacts of gentrification and urban development for health and suggests that these neighborhood change processes likely have both detrimental and beneficial effects on health. Given the influence of place on health and the trend of increasing gentrification and urban development in many American cities, we discuss how future research can approach understanding and researching the impacts of these processes for population health.

30 years after the fall of the Berlin Wall: Regional health differences in Germany

Following the fall of the Berlin Wall in November 1989, considerable effort was made to bring the living conditions and levels of social participation in the former East German federal states into line with the former West German federal states. As a result, differences in health between the East and the West diminished significantly, in many cases as early as the 1990s, examples being life expectancy and cardiovascular mortality. In regard to health behaviour, the overall tendency has also clearly been one of convergence. Thus, only very small differences can be observed today, for example in the use of tobacco or in the prevalence of obesity. Yet the results also highlight the insufficiency of regarding the remaining differences as a simple comparison between East and West. Instead, the focus should shift towards smaller-scale approaches that take regional differences in living conditions into account.

Study of Consumer Acceptance by Means of Questionnaire Survey Towards Newly Developed Yogurts with Functional Ingredients

Background:

Presently, consumers are becoming very much aware of the benefits of allying the concepts of pleasant food with health promoting properties. Hence, the market for healthier foods, functional foods or even nutraceuticals has risen in the past decades.

Objective:

This work was designed to assess the consumers’ possible acceptance of newly developed yogurts with functional ingredients.

Methods:

A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 347 participants. The data were collected from October to December 2015 in the Central Region of Portugal. The questionnaires were applied by direct interview after verbally informed consent only to participants aged 18 or over.

Results:

The results obtained showed that more than 90% of the participants liked yogurts and consumed yogurts regularly (∼73%), either in the solid or liquid forms. The participants consumed functional yogurts, specifically for regulation of intestinal transit (∼46%) and for weight control (∼44%). When asked about the new yogurts with functional and detox properties, the participants indicated that they might be potential consumers of yogurts with the ability to eliminate toxins from the body (∼69%). In spite of recognizing the importance of adding ingredients with certain functionalities, like parsley, watercress or celery, the consumers manifested some doubts that those ingredients might combine well in yogurts. A regression model was deduced relating the possible consumption of detox yogurts with some behavioural aspects like physical exercise, consumption of functional foods and detox products.

Conclusion:

This work showed that selling yogurts with detox properties might be a good strategy because there might be a market for that type of product. However, without trying the samples and verifying the real taste of the products, the possible consumers have some doubts about the incorporation of certain ingredients, even though recognizing their roles as important.

Health Disparities in Czechia and Portugal at Country and Municipality Levels

This article investigates the health outcomes and determinants between two different European populations, Portuguese and Czech, on two hierarchical levels: country and metropolitan area. At first, the decomposition method of age and cause of death were compared on the country level, and then health was examined based on a factor analysis at the municipality level of Prague and Lisbon. The results clearly indicate problematic diabetes mortality among the Portuguese population, and especially in the Lisbon Metropolitan Area, and confirm the dominant role of circulatory mortality and cancer mortality among Czech, especially the Prague population. The social and economic deprivations were revealed as the major drivers for both metropolitan areas, although with differences between them, requiring interventions that go beyond the health sector.

Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index

The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas.

Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature

INTRODUCTION

A growing number of publications report variation in the distribution of cardiometabolic risk factors (CMRFs) at different geographic scales. A review of these variations may help inform policy and health service organisation.

AIM

To review studies reporting variation in the geographic distribution of CMRFs and its association with various proxy measures of area-level socioeconomic disadvantage (ASED) among the adult ( ≥ 18 years) population across the world.

METHODS

A systematic search for published articles was conducted in four databases (MEDLINE (Ovid), PubMed, Scopus and Web of Science) considering the interdisciplinary nature of the review question. Population-based cross-sectional and cohort studies on geographic variations of one or more biological proxies of CMRFs with/without an analysed contextual association with ASED were included. Two independent reviewers screened the studies and PRISMA guidelines were followed in the study selection and reporting.

RESULT

A total of 265 studies were retrieved and screened, resulting in 24 eligible studies. The review revealed reports of variation in the distribution of CMRFs, at varying geographic scales, in multiple countries. In addition, consistent associations between ASED and higher prevalence of CMRFs were demonstrated. The reports were mainly from industrialised nations and small area geographic units were frequently used.

CONCLUSION

Geographic variation in cardiometabolic risk exists across multiple spatial scales and is positively associated with ASED. This association is independent of individual-level factors and provides an imperative for area-based approaches to informing policy and health service organisation. The study protocol is registered in International prospective register of systematic reviews (Register No: CRD42018115294) PROSPERO 2018.

Are area-level and individual-level socioeconomic factors associated with self-rated health in adult urban citizens? Evidence from Slovak and Dutch cities

Background

Evidence shows that living in disadvantaged areas is associated with poor health. This may be due to the socioeconomic (SE) characteristics of both these residents and the areas where they live. Evidence regarding this on Central European (CE) countries is scarce. Our aim was to assess whether the prevalence of poor self-rated health (SRH) was higher in deprived urban areas, whether this can be explained by individual SE status (SES) and whether this differed between Slovakia and the Netherlands per age group. We examined the association of urban-level data and individual-level SE factors from different urban areas in different countries (Slovakia, the Netherlands) using comparable urban health indicators and area indicators. We also obtained unique data from the EU-FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that poor SRH was associated with area deprivation in both countries. Regarding age by country, poor SRH occurred more frequently in the more deprived areas for the younger age group (≤64) in the Netherlands but for the older age group (≥65 years) in Slovakia. Moreover, Slovak citizens reported poor SRH significantly more often than Dutch residents. Individual SES was significantly associated with poor SRH in both age groups and both countries for most area-level SE measures. Individual SES is associated with SRH more strongly than area deprivation. Therefore, it is important to account for relative deprivation at an individual level when considering health-enhancing activities. Moreover, the effect of urban-area deprivation seems to differ between CE and WE countries.

Association of individual and neighbourhood socioeconomic status with physical activity and screen time in seventh-grade boys and girls in Berlin, Germany: a cross-sectional study

OBJECTIVES

Few studies have explored the impact of neighbourhood socioeconomic status (SES) on health behaviours in youths in Germany. Our aim was to investigate the association of individual and neighbourhood SES with physical activity (PA) and screen time (ST) in students aged 12-13 years in Berlin.

DESIGN

Cross-sectional study.

SETTING

Secondary schools (high schools and integrated secondary schools) in Berlin, Germany.

PARTICIPANTS

A total of 2586 students aged 12-13 years (seventh grade).

MAIN OUTCOME MEASURES

Sociodemographics, anthropometric data and health behaviours were assessed by self-report during classes. Primary outcome was the association of individual and neighbourhood SES with meeting daily PA and exceeding daily ST recommendations. Students' characteristics were described with means or percentages. Comparisons were performed using generalised linear mixed model yielding ORs with 95% CIs.

RESULTS

Mean (±SD) age was 12.5±0.5 years, 50.5% were girls and 34.1% had a migrant background. When adjusting for individual covariates, associations of low versus high individual SES were 0.85 (0.48; 1.52) for PA and 2.08 (1.26; 3.43) for ST. Associations of low versus high neighbourhood SES were 1.76 (1.12; 2.75) for PA and 1.54 (1.10; 2.17) for ST. After additional adjustment for school type and school neighbourhood SES, associations comparing low versus high individual and neighbourhood SES were attenuated for PA (individual SES 0.74 (0.41; 1.33) and neighbourhood SES 1.51 (0.93; 2.46)) and ST (individual SES 1.88 (1.12; 3.14) and neighbourhood SES 1.40(0.98; 2.00).

CONCLUSIONS

Lower individual and neighbourhood SES were associated with higher ST. Lower neighbourhood but not individual SES was associated with higher PA. After consideration of school type and school neighbourhood SES associations were attenuated and became insignificant for the relationship between neighbourhood SES, PA and ST. Further research is warranted to unravel the complex relationships between individual SES, neighbourhood SES and school environment to develop more targeted health promotion strategies in the future.

Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education)

OBJECTIVE

To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS).

METHODS

We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 36-item short-form health survey (SF-36) (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-month postdischarge. We categorized participants by tertiles of the neighborhood deprivation index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual socioeconomic status (SES) and clinical characteristics.

RESULTS

Participants had mean age 61.3 (SD, 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months postdischarge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. NSES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above.

CONCLUSIONS

Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual SES and NSES may unfairly penalize safety-net hospitals.

Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort

Both low socioeconomic status (SES) and behavioural problems in childhood are associated with cardiovascular disease (CVD) in adulthood, but their combined effects on CVD are unknown. Study objectives were to investigate the effect of neighbourhood level SES and behavioural problems during childhood on the development of CVD risk factors and events during adulthood. Participants were from a longitudinal cohort (n = 3792, baseline: 6-13 years of age) of Montreal children, followed from 1976 to 2010. SES was a composite measure of neighbourhood income, employment, education, and single-parent households separately assessed from census micro data sets in 1976, 2001, and 2006. Behavioural problems were assessed based on sex-specific peer assessments. CVD events were from medical records. Sex-stratified multivariable Cox regression models adjusted for age, frequency of medical visits, and parental history of CVD. Males from disadvantaged neighbourhoods during childhood were 2.06 (95% CI: 1.09-3.90, p = 0.03) and 2.51 (95% CI: 1.49-4.22, p = 0.0005) times more likely to develop a CVD risk factor or an event, respectively, than males not from disadvantaged neighbourhoods. Aggressive males were also 50% more likely to develop a CVD risk factor or event. Females from disadvantaged neighbourhoods during childhood were 1.85 (95% CI: 1.33-2.59, p = 0.0003) times more likely to develop a CVD risk factor. Future studies should aim to disentangle the interpersonal from the socioeconomic effects on CVD incidence.

Standardised mortality rate for cerebrovascular diseases in the Slovak Republic from 1996 to 2013 in the context of income inequalities and its international comparison

Non-communicable diseases represent one of the greatest challenges for health policymakers. The main objective of this study is to analyse the development of standardised mortality rates for cerebrovascular disease, which is one of the most common causes of deaths, in relation to income inequality in individual regions of the Slovak Republic. Direct standardisation was applied using data from the Slovak mortality database, covering the time period from 1996 to 2013. The standardised mortality rate declined by 4.23% in the Slovak Republic. However, since 1996, the rate has been higher by almost 33% in men than in women. Standardised mortality rates were lower in the northern part of the Slovak Republic than in the southern part. The regression models demonstrated an impact of the observed income-related dimensions on these rates. The income quintile ratio and Gini coefficient appeared to be the most influencing variables. The results of the analysis highlight valuable baseline information for creating new support programmes aimed at eliminating health inequalities in relation to health and social policy.

[What potential do geographic information systems have for population-wide health monitoring in Germany? : Perspectives and challenges for the health monitoring of the Robert Koch Institute]

Geographic information systems (GISs) are computer-based systems with which geographical data can be recorded, stored, managed, analyzed, visualized and provided. In recent years, they have become an integral part of public health research. They offer a broad range of analysis tools, which enable innovative solutions for health-related research questions. An analysis of nationwide studies that applied geographic information systems underlines the potential this instrument bears for health monitoring in Germany. Geographic information systems provide up-to-date mapping and visualization options to be used for national health monitoring at the Robert Koch Institute (RKI). Furthermore, objective information on the residential environment as an influencing factor on population health and on health behavior can be gathered and linked to RKI survey data at different geographic scales. Besides using physical information, such as climate, vegetation or land use, as well as information on the built environment, the instrument can link socioeconomic and sociodemographic data as well as information on health care and environmental stress to the survey data and integrate them into concepts for analyses. Therefore, geographic information systems expand the potential of the RKI to present nationwide, representative and meaningful health-monitoring results. In doing so, data protection regulations must always be followed. To conclude, the development of a national spatial data infrastructure and the identification of important data sources can prospectively improve access to high quality data sets that are relevant for the health monitoring.

Association of workplace and population characteristics with prevalence of hypertension among Brazilian industry workers: a multilevel analysis

BACKGROUND

Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time.

OBJECTIVES

To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension.

MATERIAL AND METHODS

This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI (Serviço Social da Indústria-Social Service of Industries) study and population-based data from the national census statistics. Workers aged ≥15 years were randomly selected from small (20-99), medium (100-499) and large (≥500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95% CI) adjusted for three-level variables.

RESULTS

4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics-being male, ageing, low schooling, alcohol abuse and higher BMI-a workplace with no staff canteen (OR=1.28; 95% CI 1.08 to 1.52), small companies (OR=1.31; 95% CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95% CI 1.23 to 1.76) were associated with a higher risk for hypertension.

CONCLUSION

Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries.

Regional health differences - developing a socioeconomic deprivation index for Germany

For Germany, regional differences for various health indicators, which are also associated with socioeconomic factors, have been documented. This article aims to develop a regional socioeconomic deprivation index for Germany that (1) can be used to analyse regional socioeconomic inequalities in health and (2) provides a basis for explaining regional health differences in Germany. The core data stem from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database compiled by Germany's Federal Institute for Research on Building, Urban Affairs and Spatial Development. Factor analysis is used for indexing and the weighting of indicators for the three dimensions of education, occupation and income. The German Index of Socioeconomic Deprivation (GISD) is generated at the levels of associations of municipalities, administrative districts and administrative regions for the years 1998, 2003, 2008 and 2012. Aggregate data and individual data from the German Health Update 2014/2015-EHIS (GEDA 2014/2015-EHIS) study are used to analyse associations between the index and selected health indicators. For around two thirds of the causes of death, the German Index of Socioeconomic Deprivation reveals significant socioeconomic inequalities at the level of Germany's administrative regions. At district level, life expectancy in the bottom fifth of districts presenting the highest levels of deprivation is, depending on the observation period, 1.3 years lower for women and 2.6 years lower for men in comparison to the upper fifth of districts presenting the lowest levels of deprivation. The index can explain 45.5% and 62.2% of regional differences in life expectancy for women and men, respectively. Moreover, the population in regions characterised by high levels of deprivation has significantly higher rates of smokers, engages less frequently in leisure-time physical activities and is more often obese. The German Index of Socioeconomic Deprivation illustrates regional socioeconomic differences at different spatial levels and contributes to explaining regional health differences. This index is intended for use in research as well as by federal and federal state health reporting systems and should enable access to new sources of data for investigating the links between social inequalities and health in Germany.

Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study

This study compares health-risk behaviours (including the co-occurrence of health-risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health-risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health-risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health-risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people

BACKGROUND AND AIM

Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS

Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS

The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION

Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Effects of neighborhood socioeconomic status on blood pressure in older adults

OBJECTIVE

To test if the neighborhood socioeconomic status is associated with systolic blood pressure and hypertension in older adults.

METHODS

A cross-sectional population-based study with a sample of 1,705 older adults from Florianópolis, SC, Southern Brazil. The contextual variable used was the average years of schooling of the head of the household in census tracts. Participants were considered hypertensive when the systolic blood pressure was ≥ 140 mmHg, diastolic ≥ 90 mmHg, or both. Additionally, the use of antihypertensive medication was also considered. Data were analyzed by using multilevel models of logistic and linear regression.

RESULTS

The average age of the sample was 70.7 years and the average of systolic and diastolic blood pressure was 133.5 mmHg (SD = 20.5 mmHg) and 81.9 mmHg (SD = 12.5 mmHg), respectively. The systolic blood pressure was 4.46 mmHg (95%CI 1.00-7.92) higher and the chance of hypertension was 1.80 (95%CI 1.26-2.57) among those who lived in census tracts with lower level of schooling. When the use of antihypertensive medication was combined with blood pressure levels, none association was found between the outcome and the level of schooling of the census tract.

CONCLUSIONS

Analytical models more robust (such as multilevel analysis) in Brazil are still little used, with a small number of articles published. Neighborhood socioeconomic status is associated with systolic blood pressure and the chance of hypertension, regardless of individual characteristics.

Family Affluence and the Eating Habits of 11- to 15-Year-Old Czech Adolescents: HBSC 2002 and 2014

Socioeconomic inequalities in eating habits have a profound impact on the health of adolescents. The aim of the present study was to evaluate socioeconomic disparities in the eating habits of Czech adolescents and to compare their change between 2002 and 2014. The data from the Czech Health Behavior in School-aged Children (HBSC) study conducted in 2002 and 2014 was utilized. The Family Affluence Scale (FAS) was used to assess socioeconomic disparities. Higher odds of daily consumption of fruit (2002: OR = 1.67; 2014: OR = 1.70, p < 0.001) and vegetables (2002: OR = 1.54; 2014: OR = 1.48, p < 0.001) were associated with high FAS in both genders. Adolescents with higher FAS were less likely to consume sweets (2002: OR = 0.72, p < 0.05) and more likely to eat breakfast on weekdays (2014: OR = 1.19, p < 0.05). In 2002 and 2014, the data showed lower odds of daily consumption of soft drinks (Low: OR = 0.47; Medium: OR = 0.43; High: OR = 0.41, p < 0.001), fruit (Low: OR = 0.73; Medium: OR = 0.74, p < 0.001; High: OR = 0.75, p < 0.05), sweets (Low: OR = 0.71; Medium: OR = 0.79, p < 0.001) and breakfast on weekends (High: OR = 0.70, p < 0.05), and a higher likelihood of eating breakfast on weekdays (Low: OR = 1.26, p < 0.01; Medium: OR = 1.13, p < 0.05). These findings play an important role in future public measures to improve dietary habits and decrease social inequalities in youth.

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.

Neighborhood features and physiological risk: An examination of allostatic load

Poor neighborhoods may represent a situation of chronic stress, and may therefore be associated with health-related correlates of stress. We examined whether lower neighborhood income would relate to higher allostatic load, or physiological well-being, through psychological, affective, and behavioral pathways. Using data from the Biomarker Project of the Midlife in the United States (MIDUS) study and the 2000 Census, we demonstrated that people living in lower income neighborhoods have higher allostatic load net of individual income. Moreover, findings indicate that this relation is partially accounted for by anxious arousal symptoms, fast food consumption, smoking, and exercise habits.

Current and past smoking patterns in a Central European urban population: a cross-sectional study in a high-burden country

BACKGROUND

Many studies have examined the socioeconomic variations in smoking and quitting rates across the European region; however, data from Central and East European countries, where the tobacco burden is especially high, are sparse. This study aimed to assess the patterns in current and past smoking prevalence based on cross-sectional data from a Central European urban population sample.

METHODS

Data from 2160 respondents aged 25-64 years in Brno, Czech Republic were collected in 2013-2014 using the Czech post-MONICA survey questionnaire to assess the prevalence of cardiovascular risk factors, including smoking status. The age- and sex-stratified randomized sample was drawn using health insurance registries. Descriptive statistics and quit ratios were calculated, and chi-square and multivariate logistic analyses conducted to examine relationships between current and past smoking and demographic (age, gender, marital status) and socioeconomic variables (education, income, occupation).

RESULTS

The prevalence of current and past smoking was 23.6 and 31.3 % among men and 20.5 and 23.2 % among women, respectively. Education reliably predicted smoking and quitting rates in both genders. Among men, being unemployed was associated with greater odds of smoking (OR 3.6; 1.6-8.1) and lower likelihood of quitting (OR 0.2: 0.1-0.6); the likelihood of quitting also increased with age (OR 1.8; 1.2-2.8). Among women, marital status (being married) decreased the odds of current smoking (OR 0.6; 0.4-0.9) and increased the odds of quitting (OR 2.2; 1.2-3.9). Quit ratios were the lowest in the youngest age group (25-34 years) where quitting was more strongly associated with middle income (OR 2.7; 95 % CI 1.2-5.9) than with higher education (OR 2.9; 95 % CI 0.9-8.2).

CONCLUSIONS

Interventions to increase cessation rates and reduce smoking prevalence need to be gender-specific and carefully tailored to the needs of the disadvantaged groups of the population, especially the less well-off young adults. Future studies should examine the equity impact of the tobacco control policies and be inclusive of the Central and East European countries.

Expansion or compression of long-term care in Germany between 2001 and 2009? A small-area decomposition study based on administrative health data

Background

Studies state profound cross-country differences in healthy life years and its time trends, suggesting either the health scenario of expansion or compression of morbidity. A much-discussed question in public health research is whether the health scenarios are heterogeneous or homogeneous on the subnational level as well. Furthermore, the question arises whether the morbidity trends or the mortality trends are the decisive drivers of the care need-free life years (CFLY), the life years with care need (CLY), and, ultimately, the health scenarios.

Methods

This study uses administrative census data of all beneficiaries in Germany from the Statutory Long-Term Care Insurance 2001–2009. We compute the CFLY and CLY at age 65+ for 412 counties. The CFLY and CLY gains are decomposed into the effects of survival and of the prevalence of care need, and we investigate their linkages with the health scenarios by applying multinomial regression models.

Results

We show an overall increase in CFLY, which is higher for men than for women and higher for severe than for any care need. However, spatial variation in CFLY and in CLY has increased. In terms of the health scenarios, a majority of counties show an expansion of any care need but a compression of severe care need. There is high spatial heterogeneity, with expansion-counties surrounding compression-counties and vice versa, which is mainly caused by divergent trends in the prevalence of care need. We show that mortality is responsible for the absolute changes in CFLY and CLY, while morbidity is the decisive driver that determines the health scenario of a county.

Conclusion

Combining regionalized administrative data and advanced statistical methods permits a deeper insight into the complex relationship between health and mortality. Our findings demonstrate a compression of life years with severe care need, which however, depends on the region of residence. To attenuate regional inequalities, more efforts are needed that improve health by medical and infrastructural interventions and by the exchange of insights in the efficiency of small- and large-area policy measures between the vanguard and the rearguard counties. In future research, the underlying latent mechanisms should be investigated in more detail.

Electronic supplementary material

The online version of this article (doi:10.1186/s12963-016-0093-1) contains supplementary material, which is available to authorized users.

Neighbourhood effects on body constitution-A case study of Hong Kong

Traditional Chinese Medicine (TCM) has long perceived environment as an integral part of the development of body constitution, which is a personal state of health closely related to disease presence. Despite of the ever-growing studies on the clinical effectiveness of TCM and the scientific linking between body constitution and diseases, the geographical influence on body constitution has yet remained an unexplored territory. This study sought to investigate whether the neighbourhood environment is relevant to the composition of body type of a population through statistical multilevel and Geographic Information Systems modelling. The analysis comprised 3277 participants who had completed their body type assessment between 2009 and 2012 inclusive. The multilevel analysis also took simultaneous accounts of both individual-level (gender, age, BMI, type of housing) and area-level (percent greenery, percent road surface, total road intersection, sky view factor, temperature, relative humidity, rainfall and social deprivation index) characteristics to explain geographical variation by body types. Significant random or place effects (p < 0.001) were identified in the multilevel models. The spatial variation of body constitution involved the dynamic interplay between individual and environmental factors. The findings amassed the first scientific indications to back the common belief that place does play a role in the development of body constitution and is worthy of further investigation. By considering spatial and personal attributes simultaneously, the study can yield valuable insights into the patterning of area variation in body constitution and disease presence.

Assessment of Environmental Determinants of Physical Activity: a Study of Built Environment Indicators in Brno, Czech Republic

BACKGROUND

Research on physical activity in relation to obesity gradually becomes more focused on environmental determinants, which can potentially influence people's health choices. The present article addresses the topic of physical activity from a wider sociological perspective. Our pilot study was designed with the objective of testing the applicability of a method included in the EC 6th Framework Programme EURO-PREVOB, in the Czech context. The method examines specific determinants of the built environment that can have an impact on physical activity at the population level. In addition, the study aims to analyze possible differences in built environment indicators and their relation to the physical activity of people living in neighbourhoods with areas of varying socioeconomic status.

METHODS

The field study was carried out in the city of Brno, Czech Republic, in 5 neighbourhood quintiles, i.e. areas divided according to the socioeconomic status of local residents. In each quintile, we evaluated the quality of the built environment according to the quality, aesthetics and safety of segregated cycle facilities, playgrounds/playing areas, public open spaces, marked road crossings and pavements as well as signs of incivilities and devastation.

RESULTS

Between the five quintiles, significant differences were found in the quality of parks and playgrounds/playing areas, pavements, marking of pedestrian crossings, and in general aesthetics, i.e. signs of incivilities and devastation of the built environment. No differences were found in the quality and use of cycle facilities.

CONCLUSIONS

The method we used for the evaluation of the built environment proved highly applicable in Czech populated areas. Monitoring of built environment indicators in the Czech Republic should provide a basis for health maps, showing potential associations between the prevalence of high-incidence, non-infectious diseases and various social determinants of physical activity. This information might help in achieving an improvement in these determinants at a community level and promoting an increase in physical activity at the population level.

Social deprivation and hospital admission rates, length of stay and readmissions in emergency medical admissions

BACKGROUND

Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission. How deprivation relates to the admission or readmission incidence rates, episode length of stay (LOS) and ancillary resource utilization is less clear.

METHODS

All emergency medical admissions (66,861 episodes in 36,214 patients) between 2002 and 2013, categorized by quintile of Irish National Deprivation Index were assessed against admission or readmission incidence rates (/1000 local population by electoral division), LOS and utilization of five ancillary services. Univariate and multi-variable risk estimates (odds ratios (OR) or incidence rate ratios (IRR)) were calculated, using truncated Poisson regression.

RESULTS

The deprivation index quintile was strongly correlated with the emergency medical admission rate with IRR (as compared with quintile 1) as follows: Q2 1.99 (95% CI: 1.96, 2.01), Q3 3.45 (95% CI: 3.41, 3.49), Q4 3.27 (95% CI: 3.23, 3.31) and Q5 4.29 (95% CI: 4.23, 4.35). LOS was not influenced by deprivation status; although increasing deprivation resulted in increased utilization of social services (OR 1.04: 95% CI: 1.03, 1.06), with a lower requirement for occupational therapy (OR 0.94: 95% CI: 0.93, 0.96) and speech/language services (OR 0.83: 95% CI: 0.80, 0.86). There was a rather decreased use of ancillary services with increasing deprivation; however, the readmission rate was strongly predicted by deprivation status.

CONCLUSION

Deprivation status strongly influenced the admission and readmission rates for medical patients admitted as emergencies; however, ancillary resource utilization was not increased. Deprivation index will increase demand on hospital resources due to the aggregate effect on both admission and readmission incidence rates.

Health-Risk Behaviour in Deprived Neighbourhoods Compared with Non-Deprived Neighbourhoods: A Systematic Literature Review of Quantitative Observational Studies

BACKGROUND

There has been increasing interest in neighbourhoods' influence on individuals' health-risk behaviours, such as smoking, alcohol consumption, physical activity and diet. The aim of this review was to systematically review recent studies on health-risk behaviour among adults who live in deprived neighbourhoods compared with those who live in non-deprived neighbourhoods and to summarise what kind of operationalisations of neighbourhood deprivation that were used in the studies.

METHODS

PRISMA guidelines for systematic reviews were followed. Systematic searches were performed in PubMed, Embase, Web of Science and Sociological Abstracts using relevant search terms, Boolean operators, and truncation, and reference lists were scanned. Quantitative observational studies that examined health-risk behaviour in deprived neighbourhoods compared with non-deprived neighbourhoods were eligible for inclusion.

RESULTS

The inclusion criteria were met by 22 studies. The available literature showed a positive association between smoking and physical inactivity and living in deprived neighbourhoods compared with non-deprived neighbourhoods. In regard to low fruit and vegetable consumption and alcohol consumption, the results were ambiguous, and no clear differences were found. Numerous different operationalisations of neighbourhood deprivation were used in the studies.

CONCLUSION

Substantial evidence indicates that future health interventions in deprived neighbourhoods should focus on smoking and physical inactivity. We suggest that alcohol interventions should be population based rather than based on the specific needs of deprived neighbourhoods. More research is needed on fruit and vegetable consumption. In future studies, the lack of a uniform operationalisation of neighbourhood deprivation must be addressed.

The role of theory-driven graphic warning labels in motivation to quit: a qualitative study on perceptions from low-income, urban smokers

BACKGROUND

Use of communication theories in the development of pictorial health warning labels (graphic warning labels) for cigarette packaging might enhance labels' impact on motivation to quit, but research has been limited, particularly among low socioeconomic status (SES) populations in the U.S. This qualitative study explored perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income smokers.

METHODS

A cross-sectional qualitative study was conducted with 25 low-income adult smokers in Baltimore, Maryland, who were purposively sampled from a community-based source population. Semi-structured, in-depth interviews were conducted from January to February 2014. Participants were asked about the motivational impact of 12 labels falling into four content categories: negative depictions of the health effects of smoking to smokers and others, and positive depictions of the benefits of quitting to smokers and others. Data were coded using a combined inductive/deductive approach and analyzed thematically through framework analysis.

RESULTS

Labels depicting negative health effects to smokers were identified as most motivational, followed by labels depicting negative health effects to others. Reasons included perceived severity of and susceptibility to the effects, negative emotional reactions (such as fear), and concern for children. Labels about the benefits of quitting were described as motivational because of their hopefulness, characters as role models, and desire to improve family health. Reasons why labels were described as not motivational included lack of impact on perceived severity/susceptibility, low credibility, and fatalistic attitudes regarding the inevitability of disease.

CONCLUSIONS

Labels designed to increase risk perceptions from smoking might be significant sources of motivation for low SES smokers. Findings suggest innovative theory-driven approaches for the design of labels, such as using former smokers as role models, contrasting healthy and unhealthy characters, and socially-oriented labels, might motivate low SES smokers to quit.

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.

Are effort-reward imbalance and social isolation mediating the association between education and depressiveness? Baseline findings from the lidA(§)-study

OBJECTIVES

To investigate multiple mediations of the association between education and depressive symptoms (BDI-V) by work-related stress (ERI) and social isolation, the regional variation of the first mediation and a potential moderating effect of regional unemployment rate.

METHODS

6339 employees born in 1959 and 1965 were randomly recruited from 222 sample points in a German cohort study on work, age, health and work participation. A multilevel model of moderated lower-level mediation was used to investigate the confirmatory research question. Multiple mediations were tested corresponding to Baron and Kenny. These analyses were stratified for age and adjusted for sex, negative affectivity and overcommitment.

RESULTS

In the association between education and depressive symptoms, indirect effects of work-related stress and social isolation were significant in both age cohorts whereas a direct association was observable in the younger cohort, only. The significant regional variation in the association between work-related stress and depressive symptoms was not statistically explained by regional unemployment rate.

CONCLUSIONS

Our findings point out that work-related stress and social isolation play an intermediary role between education and depressive symptoms in middle-aged employees.

Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study

BACKGROUND

In Germany, adult health checks are carried out in the primary care setting for early detection of chronic conditions, such as cardiovascular diseases, diabetes, and kidney disease. This study aims to examine the social, behavioural, and health-related determinants of health check attendance among eligible adults in Germany.

METHODS

Data were derived from the cross-sectional German Health Update (GEDA) study, a national health survey among adults in Germany carried out by the Robert Koch Institute. Analyses were restricted to respondents with statutory health insurance aged 35 years or older (n = 26,555). Logistic regression models were fitted to estimate associations between health check attendance and factors selected on the basis of Andersen's Behavioral Model of Health Services Use.

RESULTS

After mutual adjustment, higher health check attendance was associated with a higher age, higher socioeconomic status, being married, stronger social support, physical activity, non-smoking, greater fruit and vegetable consumption, and higher use of outpatient care in both sexes. In women, higher attendance was related to alcohol consumption and having company health insurance (BKK) after multiple adjustment. In men, higher attendance was associated with better self-rated health after adjusting for all other factors.

CONCLUSIONS

The findings of this study suggest that people with an unfavourable risk factor profile, such as socioeconomically disadvantaged groups, smokers, physically inactive people, and persons with a low fruit and vegetable intake, are less likely to have health checks than those with a more favourable risk profile. Health checks carried out in the primary care setting should be evaluated for their effects on population health and health inequality.

The effect of neighbourhood unemployment on health-risk behaviours in elderly differs between Slovak and Dutch cities

BACKGROUND

Health-risk behaviours (HRB) increase the risk of disability and chronic diseases at an older age. This study aimed to compare Slovakia and the Netherlands regarding differences in the prevalence of HRB by neighbourhood and individual deprivation and to determine whether area differences could be explained by the socio-economic position (SEP) of the residents.

METHODS

We obtained data on non-institutionalized residents aged ≥ 65 years from the EU-FP7: EURO-URHIS 2 project from Slovak (N = 665, response rate 44.0%) and Dutch cities (N = 795, response rate 50.2%). HRB concerned daily smoking, binge drinking, physical activity, consumption of fruits and vegetables and body mass index. Area deprivation was measured by the neighbourhood unemployment rate. Individual SEP was measured by education and household income with financial strain. We used multilevel logistic regression.

RESULTS

In Slovakia, no HRB was associated with either neighbourhood unemployment or individual SEP. The elderly in the Netherlands from the least favourable neighbourhoods were more likely to be daily smokers [odds ratio (OR) 2.32; 95% confidence interval (CI) 1.25, 4.30] and overweight (OR 1.84; 95% CI 1.24, 2.75) than residents from the most favourable ones. For the Dutch elderly the gradients varied per HRB and per individual-level SEP indicator. Individual SEP explained country differences in the association of area unemployment with smoking and lack of physical activity but not that with overweight.

CONCLUSION

Countries differed in the associations with HRB of both neighbourhood unemployment and individual SEP among the elderly urban residents. The local importance of socio-economic factors on both levels should be considered when developing health-promotion activities for the elderly.

The influence of neighborhood unemployment on mortality after stroke

BACKGROUND

Few studies have investigated the impact of neighborhood characteristics on mortality after stroke. Aim of our study was to analyze the influence of district unemployment as indicator of neighborhood socioeconomic status (SES-NH) on poststroke mortality, and to compare these results with the mortality in the underlying general population.

METHODS

Our analyses involve 2 prospective cohort studies from the city of Dortmund, Germany. In the Dortmund Stroke Register (DOST), consecutive stroke patients (N=1883) were recruited from acute care hospitals. In the Dortmund Health Study (DHS), a random general population sample was drawn (n=2291; response rate 66.9%). Vital status was ascertained in the city's registration office and information on district unemployment was obtained from the city's statistical office. We performed multilevel survival analyses to examine the association between district unemployment and mortality.

RESULTS

The association between neighborhood unemployment and mortality was weak and not statistically significant in the stroke cohort. Only stroke patients exposed to the highest district unemployment (fourth quartile) had slightly higher mortality risks. In the general population sample, higher district unemployment was significantly associated with higher mortality following a social gradient. After adjustment for education, health-related behavior and morbidity was made the strength of this association decreased.

CONCLUSIONS

The impact of SES-NH on mortality was different for stroke patients and the general population. Differences in the association between SES-NH and mortality may be partly explained by disease-related characteristics of the stroke cohort such as homogeneous lifestyles, similar morbidity profiles, medical factors, and old age.

Factors associated with the prevalence of hypertension in the southeastern United States: insights from 69,211 blacks and whites in the Southern Community Cohort Study

BACKGROUND

Lifestyle and socioeconomic status have been implicated in the prevalence of hypertension; thus, we evaluated factors associated with hypertension in a cohort of blacks and whites with similar socioeconomic status characteristics.

METHODS AND RESULTS

We evaluated the prevalence and factors associated with self-reported hypertension (SR-HTN) and ascertained hypertension (A-HTN) among 69,211 participants in the Southern Community Cohort Study. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with hypertension. The prevalence of SR-HTN was 57% overall. Body mass index was associated with SR-HTN in all race-sex groups, with the OR rising to 4.03 (95% CI, 3.74-4.33) for morbidly obese participants (body mass index, >40 kg/m(2)). Blacks were more likely to have SR-HTN than whites (OR, 1.84; 95% CI, 1.75-1.93), and the association with black race was more pronounced among women (OR, 2.08; 95% CI, 1.95-2.21) than men (OR, 1.47; 95% CI, 1.36-1.60). Similar findings were noted in the analysis of A-HTN. Among those with SR-HTN and A-HTN who reported use of an antihypertensive agent, 94% were on at least one of the major classes of antihypertensive agents, but only 44% were on ≥2 classes and only 29% were on a diuretic. The odds of both uncontrolled hypertension (SR-HTN and A-HTN) and unreported hypertension (no SR-HTN and A-HTN) were twice as high among blacks as whites (OR, 2.13; 95% CI, 1.68-2.69; and OR, 1.99; 95% CI, 1.59-2.48, respectively).

CONCLUSIONS

Despite socioeconomic status similarities, we observed suboptimal use of antihypertensives in this cohort and racial differences in the prevalence of uncontrolled and unreported hypertension, which merit further investigation.

Health-risk behaviours in deprived urban neighbourhoods: a comparison between Slovak and Dutch cities

OBJECTIVES

International comparisons of the associations of area-level socioeconomic position (SEP) and health-risk behaviours (HRBs) are for the most part lacking. The aims of this study were to compare Slovakia and the Netherlands regarding differences in the prevalence of HRBs by neighbourhood and individual deprivation, and to determine whether area differences could be explained by the SEP of residents.

METHODS

We obtained data on residents aged 19-64 from Slovak and Dutch cities from the FP7 EURO-URHIS2 project and employed multilevel logistic regression.

RESULTS

The association between neighbourhood-level unemployment and HRBs differed between countries. In the Netherlands, the prevalence of almost all HRBs was higher in deprived areas, except for the consumption of fruits and vegetables. These area effects diminished after controlling for individual-level SEP. In Slovakia, no area effects were observed, although Slovak residents showed a higher risk for most HRBs. At the individual level, an inverse SE gradient was found for almost all HRBs in both countries.

CONCLUSIONS

Local analyses of small area health differences and health determinants are critical for efficient implementation of neighbourhood-based interventions.