Coverage of BCG Vaccination for children aged until 7 years old and its determinants in French Guiana

INTRODUCTION

The overall incidence of tuberculosis (TB) in France is low; thus, BCG vaccination is no longer mandatory. In French Guiana - a French overseas territory - BCG vaccination is strongly recommended because the incidence of TB is high in the context of mass immigration from endemic countries with low BCG vaccination rates. Thus, it is important to assess Bacillus Calmette-Guérin (BCG) vaccination coverage and its predictors.

METHODS

We used data from the 2014 French Guiana Yellow Fever survey, which was conducted by the Observatoire Régional de la Santé de Guyane. Demographic and immunization data from eligible children and their families were collected using a questionnaire. Children who had an immunization card and who were no older than 7 years of age at the time of the survey were eligible. The Coverage for BCG and other mandatory vaccines were estimated; the delay in BCG vaccination was also computed. Univariate and multivariate analyses identified predictors associated with BCG immunization and BCG delayed immunization (after 2 months of age).

RESULTS AND CONCLUSION

Overall, 469 children were eligible for this study. The total BCG coverage was 79.5 %, and the proportion of children vaccinated with delay was 50.7 %. The multivariate analysis indicated that BCVA was significantly greater among children younger than 3 years of age, whose household head was employed and whose education level was greater. None of the predictors were associated with the delay of BCG vaccination.

Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis

BACKGROUND

Socioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis.

METHODS

Retrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories.

RESULTS

Two-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, -4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, -1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, -21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score.

CONCLUSIONS

Socioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.

Non-alcoholic fatty liver disease and socioeconomic determinants in an Iranian cohort study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is widespread worldwide. On the other hand, social inequality and socioeconomic status (SES) can affect all aspects of health. Therefore, this study aimed to investigate the relationship between SES indicators and NAFLD.

METHODS

This was a cross-sectional study using data from the registration phase of the Hoveyzeh Cohort Study, which included 10,009 individuals aged 35-70 years from May 2016 to August 2018. Fatty liver disease was determined based on Fatty Liver Index (FLI). The crude and adjusted odds ratios were calculated by logistic regression analysis to estimate associations between the fatty liver index and SES after controlling the potential confounders.

RESULTS

According to the FLI index, there were 2,006 people with fatty liver (28%) and 5,246 people without fatty liver (72%). Several 4496 people (62%) were women. The chi-square test showed significant relationships between the educational level and skill level (P < 0.001), the wealth index (P < 0.001), and Townsend Index (P < 0.001) with fatty liver index. In multivariable analysis, after adjustment for age, sex, physical activity, smoking, type of residence, calorie intake, dyslipidemia, skill level, and diabetes, the wealth index (p < 0.001) was positively associated with the fatty liver index. Besides, a reverse and significant association was seen between the Townsend index and the fatty liver index(p < 0.001). In contrast, no significant associations were seen between gender and educational level with the fatty liver index.

CONCLUSIONS

A more vulnerable SES is associated with NAFLD. Fatty liver index and socioeconomic indicators can be powerful monitoring tools to monitor health differences in diagnosing NAFLD.

Analyzing the socioeconomic determinants of PM2.5 air pollution at the global level

Since PM2.5 pollution has jeopardized public health, the research on how ambient fine particulate matter (PM2.5) concentrations are influenced has been increasingly important for the implementation of regional PM2.5 concentration reduction. This study analyzed the socioeconomic determinants of PM2.5 air pollution of 132 countries/economies. It was found that the main inhibitor for the PM2.5 air pollution is the emission intensity (EmI), which is measured by the PM2.5 emission when a united of energy is consumed, in every income level of countries, while the energy intensity (EnI) is the second inhibitor. Meanwhile, economic output (EO) was the largest driving factor on the PM2.5 concentrations, while population (P) growth was the second. Overall, the national employment rate (Emp) showed very little impact on the countries. This study also analyzed the income-based variation in the effects of the five factors on PM2.5 concentration changes: overall, the effects of the determinants all decreased with the rise of income levels, i.e., both the inhibiting effects of PM2.5 EmI and EnI and driving effects of EO and P performed stronger in lower-income countries than higher-income ones. Regarding the income-based variation of the determinants, this study also discussed the policy implications, such as adopting technologies on reducing PM2.5 intensity and EnI, transferring the EO from the manufacturing industry to the service industry, and international organizations on public health and environmental protection should provide targeted strategies, guidelines, and other assistances to lower-income countries as both driving and inhibiting factors performed more influential on their PM2.5 concentration changes.

Mental health in refugee children

Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.

Towards low-carbon domestic circulation: Insights from the spatiotemporal variations and socioeconomic determinants of emissions embedded within cross-province trade in China

For a country like China with unbalanced development pattern among provinces, domestic circulation (i.e., cross-province trade) is important for the long-term stability and prosperous development of economic market. However, with the rapid advance of integration of domestic regional economy, while expanding the internal market scale and deepening the provincial division of labor network for promoting the economic growth, the carbon emissions embedded within the cross-province traded products and services cannot be underestimated. Under the background of climate-trade dilemma, it is necessary to exploring the spatiotemporal variations and socioeconomic determinants of provincial "invisible" carbon emissions for a better understanding of trade-induced eco-environmental effects. To that end, this study developed an environmental-economic system model through integrating the environmentally extended multiregional input-output method and weighted average structural decomposition analysis technique to explore the trade-related emissions at the provincial level and generate the mitigation-management strategies for decisionmakers. Overall, more than half the emissions were embedded within cross-province goods and services trade over the whole study period. Furthermore, the distribution of traded emissions showed obvious spatial heterogeneity and great unbalance was existed between provincial imports and exports. Among all provinces, carbon surplus provinces were always more than deficit ones and the trading patterns of approximately 65% regions remained unchanged during 2007-2017. Remarkably, the emissions trading pattern undergone transition from carbon deficit to carbon surplus in provinces like Henan, Hubei, Guizhou, and so on. Conversely, provinces like Jilin, Shanghai, and Xinjiang showed opposite change. With the prevalence of online payment and electronic commerce in the future, the central and sub-national government could consider launching a pilot project for the design and creation of personal carbon consumption account in the carbon surplus provinces such as Guangdong, Henan, and Jiangsu. Meanwhile, for the provinces with larger carbon exports, it is necessary to establish the horizontal high technical transfer channels and vertical compensation mechanisms such as financial subsidies for improving the low-carbon production level. Our findings provided a holistic depict of national traded emissions at the provincial level, highlighting the importance of cross-province emission effect in exploring ways to promote the low-carbon transition of domestic circulation and fulfill the high-quality development of 'dual circulation' new pattern and successful achievement of 'double carbon' solemn commitment.

Socio-economic and socio-demographic determinants of diet diversity among rural pregnant women from Pune, India

Background

Diet diversity signifies the nutrient adequacy of an individual and thus has gained widespread significance in recent times. In developing countries achieving maximum diet diversity, especially among pregnant women from rural areas is challenging although of great importance. However, to do so understanding the primary factors associated with diet diversity is important. This paper, therefore, assessed the socio-demographic and socio-economic determinants of diet diversity among rural pregnant women in India.

Methods

The study consisted of a community-based prospective cohort of n = 204 pregnant women attending primary healthcare centers (PHC) across 14 villages in Mulshi Taluka, Pune, Maharashtra, India. The data was collected using a structured questionnaire through a one-to-one interview method.

Results

The prevalence of low, medium and high diet diversity was 56.4%, 33.3%, and 10.3% respectively. Minimum diversity in the diet was achieved among 73.5% of pregnant women. The mean diet diversity score (DDS) was 3.6 ± 1.3 with starchy staples being (100%) of commonly consumed foods. Young (< 20 years) women (OR = 5.2; CI:1.9- 13.8), housewives (OR = 3; CI:1.4–6.7), husbands working as skilled laborers (OR = 2.5; CI:1.2–5.5) were at significant risk of having low diet diversity scores. Whereas, those living in a joint family (OR = 0.3; CI:0.1–0.6), not owning a house (OR = 0.5; CI:0.2–0.9), and having a poor income (OR = 1.9; CI: 0.9- 3.7) were less likely to have low diet diversity.

Conclusion

Socio-economic and demographic factors (maternal age, mother's occupation, and husband's occupation) influenced the diet diversity among pregnant women. Monotonous diets are commonly seen in developing countries, especially in rural areas which can be a risk factor for poor nutrient adequacy and health of pregnant women. Policies and programs about these determinants of diet diversity should be enacted to replace the poor quality diets to ensure improved diet diversity and nutrient adequacy.

The bad, the ugly and the monster behind the mirror - Food insecurity, mental health and socio-economic determinants

INTRODUCTION

Food insecurity is associated with poor mental health outcomes, including depression and anxiety and COVID-19 could increase these relations. In this sense, we aimed to explore the relationship between food insecurity and mental health features and behaviors in adults from Portugal.

METHODOLOGY

We conducted a cross-sectional online snowball study from November 2020 until February 2021. A total of 882 Portuguese residents 18 years of age or older with food security data were included. Data on socio-demographics, food security status, and anxiety and depression symptoms were collected. Crude and adjusted logistic regression models were performed. Odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

RESULTS

Most participants were women (71.3%), with a mean (SD) age of 36.8 (10.9) years, three-thirds had a university degree (76.7%), and 65.3% lived in the country's northern region. Regarding the characteristics associated with food insecurity, we observed that less-educated participants (OR = 7.84; 95% CI: 3.67-16.73), with depression symptoms (OR = 5.91; 95% CI: 3.12-11.19) and with anxiety symptoms (OR = 6.41; 95% CI: 3.02-13.59), had a higher odds of belonging to a food-insecure household. After adjustments less educated individuals (OR = 8.37; 95% CI: 3.81-18.35), those who faced a reduction in income (OR = 0.27; 95% CI: 0.13-0.53) and, presenting anxiety symptoms (OR = 7.32; 95% CI: 3.53-15.17) had a higher odds of belonging to a food-insecure household.

CONCLUSIONS

Approaching food insecurity without addressing mental health, and the opposite is making partial and reductive interventions. It is important to have an integrative approach.

Health-related biological and non-biological consequences of forgoing healthcare for economic reasons

Forgoing healthcare for economic reasons has been previously associated with adverse health outcomes, including a higher risk of hospitalization, a lower quality of life, and worse self-reported health. However, the exact cause-to-effect relation between forgoing healthcare and health-related outcomes has been insufficiently described. Here, we investigate the prospective health consequences of forgoing healthcare for economic reasons using data from “ReBus” (N = 400), a prospective study examining the health consequences of forgoing healthcare (Baseline: 2008–2013, Follow-up: 2014–2016). Using regression models, we explored the baseline determinants of forgoing healthcare, including socioeconomic, demographic, and pre-existing health-risk factors, and examined the associations between forgoing healthcare at baseline and health deterioration at follow-up, using highly pertinent biomarkers (glucose, glycated hemoglobin, lipids, blood pressure) and SF-36 questionnaire data.

Low income, low occupation, low education, and smoking were associated with higher odds of forgoing healthcare at baseline. Forgoing healthcare for economic reasons at baseline was subsequently related to detrimental changes in glucose, high-density lipoprotein cholesterol (HDL), and blood pressure (BP) at follow-up, independently of baseline socioeconomic factors (Glucose-β = 0.19, 95%CI[0.03;0.34], HDL-β = -0.07, 95%CI[-0.14;0.01], BP-β = 3.30, 95%CI[-0.01;6.60]). Moreover, we found strong associations between forgoing healthcare and adverse SF-36 health scores at follow-up, with individuals forgoing healthcare systematically displaying worse health scores (6%–11% lower scores).

For the first time, we show that forgoing healthcare for economic reasons predicts adverse health-related consequences 2–8 years later. Our findings shall further encourage the implementation of public health measures aimed at identifying individuals who forgo healthcare and preventing the adverse health consequences of unmet medical needs.

Determinants of maternal health four weeks after delivery: cross-sectional findings from the KUNO-kids health study

BACKGROUND

The aim of this study was to examine the interaction of a multitude of socio-economic, lifestyle, environmental, psychosocial and birth related determinants and their effect on maternal health four weeks after delivery.

METHODS

We used data from a German birth cohort study, the KUNO-Kids health study. Social determinants, as well as the self-rated maternal health and the physical and mental health status of mothers (indicated by means of the SF-12-questionnaire) were assessed through standardized questionnaires and personal interviews right after delivery and four weeks later. Linear regression models were calculated to determine the relationship between influencing factors and health outcomes.

RESULTS

1428 women were included in the analysis. Maternal self-rated health showed significant positive associations with breastfeeding (B (regression coefficient) 2.67; 0.86-4.48 (95% Confidence interval)) and estimating one's child as rather healthy (B 0.27; 0.19-0.34) and negative associations with social and emotional strains (B -3.50; -5.11- -1.88), obesity (B -2.56; -4.69- -0.42), having experienced a C-section (B -1.73; -3.23- -0.23), a positive history of somatic diseases (B -2.14; -3.53- -0.74), parental stress (B -0.39; -0.66- -0.11) and education of more than ten years (B -2.42; -3.95- -0.90). Maternal physical health status showed significant negative associations with age (B -0.13; -0.25- -0.01), employment before maternity leave (B -1.90; -3.59- -0.21), social and emotional strains (B -1.50; -2.67- -0.34), parental stress (B -0.28; -0.45- -0.12), C-section (B -4.06; -5.12- -2.99), having the first child (B -2.03; -3.09- -0.97) and a history of somatic diseases (B -2.00; -2.99- -1.01). Maternal mental health status showed significant positive associations with education of more than 10 years (B 2.27; 0.98-3.56) and a high level of social support (B 1.20; 0.06-2.34), while social and emotional strains (B -4.16; -5.48- -2.84) and parental stress (B -0.70; -0.92- -0.47) were negatively associated.

CONCLUSIONS

We identified important protective factors for maternal health four weeks after delivery, such as a high level of social support. However, parental stress and social and emotional strains in particular seem to have a negative influence on maternal health. These findings have public health relevance.

Assisted reproduction in Spain, outcome and socioeconomic determinants of access

Research question

We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth.

Design

We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services.

Results

The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general.

Conclusions

Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.

The varying driving forces of PM2.5 concentrations in Chinese cities: Insights from a geographically and temporally weighted regression model

BACKGROUND

Particulate pollution is currently regarded as a severe environmental problem, which is intimately linked to reductions in air quality and human health, as well as global climate change.

OBJECTIVE

Accurately identifying the key factors that drive air pollution is of great significance. The temporal and spatial heterogeneity of such factors is seldom taken into account in the existing literature.

METHOD

In this study, we adopted a geographically and temporally weighted regression model (GTWR) to explore the direction and strength of the influences of natural conditions and socioeconomic issues on the occurrence of PM_2.5 pollutions in 287 Chinese cities covering the period 1998 to 2015.

RESULT

Cities with serious PM_2.5 pollution were discovered to mainly be situated in northern China, whilst cities with less pollution were shown to be located in southern China. Higher temperature and wind speed were found to be able to alleviate air pollution in the country's southeast, where enhanced precipitation was also shown to reduce PM_2.5 concentrations; whilst in southern and central and western regions, precipitation and PM_2.5 concentrations were positively correlated. Increased relative humidity was found to reinforce PM_2.5 concentration in southwest and northeast China. Furthermore, per capita GDP and population density were shown to intensify PM_2.5 concentrations in northwest China, inversely, they imposed a substantial adverse effect on PM_2.5 concentration levels in other areas. The amount of urban built-up area was more positively associated with PM_2.5 concentration levels in southeastern cities than in other cities in China.

CONCLUSION

PM_2.5 concentrations conformed to a series of stages and demonstrated distinct spatial differences in China. The associations between PM_2.5 concentration levels and their determinants exhibit obvious spatial heterogeneity. The findings of this paper provide detailed support for regions to formulate targeted emission mitigation policies.

Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform been successful?

BACKGROUND

Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women's health care access.

METHODS

The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time.

RESULTS

Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use.

CONCLUSIONS

While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.

Investigating spatial variation and change (2006-2017) in childhood immunisation coverage in New Zealand

BACKGROUND

Immunisation is a safe and effective way of protecting children and adults against harmful diseases. However, immunisation coverage of children is declining in some parts of New Zealand.

AIM

Use a nationwide sample to first, examine the socioeconomic and demographic determinants of immunisation coverage and spatial variation in these determinants. Second, it investigates change in immunisation coverage in New Zealand over time.

METHODS

Individual immunisation records were obtained from the National Immunisation Register (NIR) (2005-2017; 4,482,499 events). We calculated the average immunisation coverage by year and milestone age for census area units (CAU) and then examined the immunisation coverage by selected socioeconomic and demographic determinants. Finally, local variations in the association between immunisation coverage and selected determinants were investigated using geographically weighted regression.

RESULTS

Findings showed a decrease of immunisation rates in recent years in CAUs with high immunisation coverage in the least deprived areas and increasing immunisation rates in more deprived areas. Nearly all explanatory variables exhibited a spatial variation in their association with immunisation coverage. For instance, the strongest negative effect of area-level deprivation is observed in the northern part of the South Island, the central-southern part of the North Island, around Auckland, and in Northland.

CONCLUSION

Our findings show that childhood immunisation coverage varies by socioeconomic and demographic factors across CAUs. We also identify important spatial variation and changes over time in recent years. This evidence can be used to improve immunisation related policy in New Zealand.

Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

Background

The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults.

Methods

A secondary analysis used the data of 13,464 adults from the 4th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants.

Results

The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was − 0.1391 and for the decayed tooth (DT), it was − 0.2252. For out-of-pocket payment, the Kakwani index was − 0.3154 and for health insurance payment it was − 0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure.

Conclusion

Dental expenditure for Chinese adults was at a lower level due to underutilization. The ratio of payments of dental expenditure and utilization was disproportional, whether it was out-of-pocket or insurance payment. Individuals who were more in need of oral care showed less demand for service or not required service in time. For future policy making on oral health, it is worth the effort to further promote the awareness of the importance of oral health and utilization of dental service.

Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

BACKGROUND

Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other.

METHODS

In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section.

RESULTS

Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups.

CONCLUSIONS

Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

Examining the spatially varying effects of factors on PM2.5 concentrations in Chinese cities using geographically weighted regression modeling

Whilst numerous studies have explored the spatial patterns and underlying causes of PM_2.5, little attention has been paid to the spatial heterogeneity of the factors affecting PM_2.5. In this study, a geographically weighted regression (GWR) model was used to explore the strength and direction of nexus between various factors and PM_2.5 in Chinese cities. A comprehensive interpretive framework was established, composed of 18 determinants spanning the three categories of natural conditions, socioeconomic factors, and city features. Our results indicate that PM_2.5 concentration levels were spatially heterogeneous and markedly higher in cities in eastern China than in cities in the west of the country. Based on the results of GWR, significant spatial heterogeneity was identified in both the direction and strength of the determinants at the local scale. Among all of the natural variables, elevation was found to be statistically significant with its effects on PM_2.5 in 95.60% of the cities and it correlated negatively with PM_2.5 in 99.63% cities, with its effect gradually weakening from the eastern to the western parts of China. The variable of built-up areas emerged as the strongest variable amongst the socioeconomic variables studied; it maintained a positive significant relationship in cities located in the Pearl River Delta and surrounding areas, while in other cities it exhibited a negative relationship to PM_2.5. The highest coefficients were located in cities in northeast China. As the strongest variable amongst the six landscape factors, patch density maintained a positive relationship in part of cities. While in cities in the northeast regions, patch density exhibited a negative relationship with PM_2.5, revealing that increasing urban fragmentation was conducive to PM_2.5 reductions in those regions. These empirical results provide a basis for the formulation of targeted and differentiated air quality improvement measures in the task of regional PM_2.5 governances.

Examining the effects of socioeconomic development on China's carbon productivity: A panel data analysis

China, which is the largest carbon emitter and the largest developing country in the world, faces the challenge of achieving energy conservation and emission reduction without sacrificing economic development. Improving carbon productivity consists a possible way to seek a coordination between economic development and carbon emission reduction. Therefore, it is of great significance to examine the effects of socioeconomic development on China's carbon productivity and accordingly provide policy suggestions for China's low-carbon economic development. However, this topic has not been adequately addressed in previous studies. In order to fill this gap, this study detailed an empirical investigation into the impacts of socioeconomic development on China's carbon productivity. First, aided by spatial analysis methods, a detailed analysis of the spatiotemporal patterns and dynamics of China's province-level carbon productivity was conducted. Moreover, using an extended STIRPAT model and panel data modeling technique, the effects of a range of socioeconomic factors on China's carbon productivity were quantitatively examined. The results indicated that China's carbon productivity increased gradually between 1997 and 2016, and carbon productivity in East China was much higher than that of their counterparts in Central China and West China. Provincial administrative units with highly developed economies witnessed spectacular increases in carbon productivity. Panel data analysis demonstrated that GDP per capita, technology level, trade openness, and foreign direct investment exerted positive effects, while energy consumption structure, industrial proportion, and urbanization level exerted negative effects, on China's carbon productivity. Based on the findings of this study, a series of policy suggestions with respect to improving China's carbon productivity were proposed.

[Association between socioeconomic determinants and environmental tobacco smoke exposure in children]

OBJECTIVE

To assess the association between exposure to environmental tobacco smoke (ETS) and different socioeconomic determinants among Spanish children.

METHOD

We analyzed the data of 5495 children included in the 2011-2012 Spanish National Health Survey. We estimated the prevalence of exposure to ETS and adjusted logistic regression models to identify variables related to exposure to ETS: total exposure and exposure in the home in addition to ETS exposure in enclosed public places/transport.

RESULTS

Total exposure to ETS among children aged 15 and younger was 11.8%, 11.5% of whom were exposed at home and 0.8% in enclosed public places/transport. The prevalence odds ratio (POR) of exposure at home increased with age (6-9 years: 2.19; 10-14 years: 2.28), in children with parents of low or medium education levels (1.97 and 1.29), of social class IV-VI (1.42), among those living in a household with a composition other than a "couple with children" (1.43), and in smaller-sized homes (1.39). Total exposure results were similar to home exposure results.

CONCLUSION

The prevalence of ETS is higher among children younger than 15 years with a more difficult economic situation. These inequalities must be considered in the establishment and development of public health policies.

Identifying the socioeconomic determinants of population exposure to particulate matter (PM2.5) in China using geographically weighted regression modeling

Air pollution contributes significantly to premature death in China. However, only a limited number of studies have identified the potential determinants of population exposure to PM_2.5 from a socioeconomic perspective. This paper analyses the socioeconomic determinants of population exposure at the city level in China. We first estimated population exposure to PM_2.5 by integrating high resolution spatial distribution maps of PM_2.5 concentrations and population density, using data for 2013. Then, geographically weighted regression (GWR) modeling was undertaken to explore the strength and direction of relationships between the selected socioeconomic factors and population exposure. The results indicate that approximately 75% of the population of China lived in an area where PM_2.5 concentrations were over 35 μg/m³ in 2013. From the GWR models, we found that the percentages for cities that showed a statistically significant relationship (p < 0.05) between population exposure and each of the six factors were: urbanization, 91.92%; industry share, 91.58%; construction level, 88.55%; urban expansion, 73.40%; income disparity, 64.98%; and private vehicles, 27.27%. The R-squared value for the six factors in the multivariable GWR model was 0.88, and all cities demonstrated a statistically significant relationship. More importantly, the association between the six factors and population exposure was found to be spatially heterogeneous at the local geographic level. Consideration of these six drivers of population exposure can help policy makers and epidemiologists to evaluate and reduce population exposure risks.

Risk of Major Depressive Episodes After Separation: The Gender-Specific Contribution of the Income and Support Lost Through Union Dissolution

Marital status and union dissolution are strongly associated with health. Separated men and women have a mental health disadvantage compared to partnered individuals. The lower financial and social resources of separated individuals partly explained their poorer health. However, it is unclear whether this association is due to the loss in income and support precisely experienced through the separation. Due to the frequent asymmetry in partners' individual resources within couples, these losses are gender-specific, giving rise to a debate currently in France. As part of this debate, we explored to what extent gender-specific losses contribute to the separation/mental health association. We used the two-wave survey "Health and Occupational Trajectories," looking at 7321 individuals aged 25-74 in couple in 2006. We analyzed their depressive symptoms self-reported at second wave (2010) and their association with separation between the two waves; we took into account the concomitant social and income changes, as well as the socioeconomic and health situation in 2006. Separation between 2006 and 2010 is significantly associated with depressive symptoms in 2010, independently of the situation in 2006; it is associated with a loss of income, mainly in women, and a loss of support, slightly more pronounced in men. Nested logistic models indicate that the loss of support explained 5.5% of the separation/mental health association in men; the loss of income explained 19.2% of it in women. In France, an economic penalty of separation still primarily affects women and substantially contributes to the mental health vulnerability of newly separated women.

Neighborhood price of healthier food relative to unhealthy food and its association with type 2 diabetes and insulin resistance: The multi-ethnic study of atherosclerosis

This study examined the association between the price of healthier food relative to unhealthy food and type 2 diabetes prevalence, incidence and insulin resistance (IR). Data came from the Multi-Ethnic Study of Atherosclerosis exam 5 administered 2010-2012 (exam 4, five years prior, was used only for diabetes incidence) and supermarket food/beverage prices derived from Information Resources Inc. For each individual, average price of a selection of healthier foods, unhealthy foods and their ratio was computed for supermarkets within 3miles of the person's residential address. Diabetes status was confirmed at each exam and IR was assessed via the homeostasis model assessment index. Multivariable-adjusted logistic, modified Poisson and linear regression models were used to model diabetes prevalence, incidence and IR, respectively as a function of price and covariates; 2353 to 3408 participants were included in analyses (depending on the outcome). A higher ratio of healthy-to-unhealthy neighborhood food price was associated with greater IR (4.8% higher HOMA-IR score for each standard deviation higher price ratio [95% CI -0.2% to 10.1%]) after adjusting for region, age, gender, race/ethnicity, family history of diabetes, income/wealth index, education, smoking status, physical activity, and neighborhood socioeconomic status. No association with diabetes incidence (relative risk=1.11, 95% CI 0.85 to 1.44) or prevalence (odds ratio=0.95, 95% CI 0.81 to 1.11) was observed. Higher neighborhood prices of healthier food relative to unhealthy food were positively associated with IR, but not with either diabetes outcome. This study provides new insight into the relationship between food prices with IR and diabetes.

Socioeconomic Determinants of Cipro-floxacin-Resistant Shigella Infections in Bangladeshi Children

Background:

Shigella species (spp.) are a leading cause of moderate to severe diarrhea in children worldwide. The recent emergence of quinolone-resistant Shigella spp. gives cause for concern, and South Asia has been identified as a reservoir for global spread. The influence of socioeconomic status on antimicrobial resistance in developing countries, such as those in South Asia, remains unknown.

Methods:

We used data collected from 2009 to 2014 from a hospital specializing in the treatment of diarrhea in Dhaka, Bangladesh, to determine the relationship between ciprofloxacin-resistant Shigella spp. isolates and measures of socioeconomic status in Bangladeshi children less than 5 years of age.

Results:

We found 2.7% (230/8,672) of children who presented with diarrhea had Shigella spp. isolated from their stool, and 50% (115/230) had resistance to ciprofloxacin. Using multivariable logistic regression analysis, we found that children from families where the father's income was in the highest quintile had significantly higher odds of having ciprofloxacin-resistant Shigella spp. compared to children in the lowest quintile (OR = 6.1, CI 1.9-19). Factors protective against the development of resistance included access to improved sanitation (OR = 0.27, CI 0.11-0.7), and improved water sources (OR = 0.48, CI 0.25-0.92). We did not find a relationship between ciprofloxacin resistance and other proxies for socioeconomic status, including the presence of animals in the home, nutritional status, paternal education level, and the number of family members in the home.

Conclusions:

Although the associations between wealth and antimicrobial resistance are not fully understood, possible explanations include increased access and use of antibiotics, greater access to healthcare facilities and thus resistant pathogens, or greater consumption of commercially produced foods prepared with antibiotics.

A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol

Upstream interventions - e.g. housing programs and community health worker interventions- address socioeconomic and behavioral factors that influence health outcomes across diseases. Studying these types of interventions in clinical trials raises a methodological challenge: how should researchers measure the effect of an upstream intervention in a sample of patients with different diseases? This paper addresses this question using an illustrative protocol of a randomized controlled trial of collaborative-goal setting versus goal-setting plus community health worker support among patients multiple chronic diseases: diabetes, obesity, hypertension and tobacco dependence. At study enrollment, patients met with their primary care providers to select one of their chronic diseases to focus on during the study, and to collaboratively set a goal for that disease. Patients randomly assigned to a community health worker also received six months of support to address socioeconomic and behavioral barriers to chronic disease control. The primary hypothesis was that there would be differences in patients' selected chronic disease control as measured by HbA1c, body mass index, systolic blood pressure and cigarettes per day, between the goal-setting alone and community health worker support arms. To test this hypothesis, we will conduct a stratum specific multivariate analysis of variance which allows all patients (regardless of their selected chronic disease) to be included in a single model for the primary outcome. Population health researchers can use this approach to measure clinical outcomes across diseases.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT01900470.

[Vaccination coverage and socioeconomic determinants of BCG vaccination in children before 3 months: Results of the Elfe cohort study, 2011]

BACKGROUND

In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination.

METHODS

The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR).

RESULTS

CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80).

CONCLUSION

In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better vaccinated.

Social Disorder in Adults with Type 2 Diabetes: Building on Race, Place, and Poverty

The recent resurgence of social and civic disquiet in the USA has contributed to increasing recognition that social conditions are meaningfully connected to disease and death. As a "lifestyle disease," control of diabetes requires modifications to daily activities, including healthy dietary practices, regular physical activity, and adherence to treatment regimens. One's ability to develop the healthy practices necessary to prevent or control type 2 diabetes may be influenced by a context of social disorder, the disruptive social and economic conditions that influence daily activity and, consequently, health status. In this paper, we report on our narrative review of the literature that explores the associations between social disorder and diabetes-related health outcomes within vulnerable communities. We also propose a multilevel ecosocial model for conceptualizing social disorder, specifically focusing on its role in racial disparities and its pathways to mediating diabetes outcomes.

A survey on socioeconomic determinants of diabetes mellitus management in a lower middle income setting

BACKGROUND

Information on socioeconomic determinants in the management of diabetes mellitus is scarce in lower middle income countries. The aim of this study is to describe the socioeconomic determinants of management and complications of diabetes mellitus in a lower middle income setting.

METHODS

Cross sectional descriptive study on a stratified random sample of 1300 individuals was conducted by an interviewer administered questionnaire, clinical examinations and blood investigations. A single fasting venous blood sugar of ≥126 mg/dl was considered diagnostic of new diabetics and poor control of diabetes mellitus as HbA1C > 6.5 %.

RESULTS

There were 202 (14.7 %) with diabetes mellitus. Poor control was seen in 130 (90.7 %) while 71 (49.6 %) were not on regular treatment. Highest proportions of poor control and not on regular medication were observed in estate sector, poorest social status category and poorest geographical area. The annual HbA1C, microalbuminuria, retinal and neuropathy examination were performed in less than 6.0 %. Social gradient not observed in the management lapses. Most (76.6 %) had accessed private sector while those in estate (58.1 %) accessed the state system. The microvascular complications of retinopathy, neuropathy and microalbuminuria observed in 11.1 %, 79.3 % and 54.5 % respectively. Among the macrovascular diseases, angina, ischaemic heart disease and peripheral arterial disease seen in 15.5 %, 15.7 % and 5.5 % respectively. These complications do not show a social gradient.

CONCLUSIONS

Diabetes mellitus patients, irrespective of their socioeconomic status, are poorly managed and have high rates of complications. Most depend on the private healthcare system with overall poor access to care in the estate sector.

The influence of demographics and working conditions on self-reported injuries among Latino day laborers

BACKGROUND

The majority of day laborers in the USA are Latinos. They are engaged in high-risk occupations and suffer high occupational injury rates.

OBJECTIVES

To describe on-the-job injuries reported by Latino day laborers, explore the extent that demographic and occupational factors predict injuries, and whether summative measures for total job types, job conditions, and personal protective equipment (PPE) predict injuries.

METHODS

A community survey was conducted with 327 participants at 15 corners in Houston, Texas. Hierarchical and multiple logistic regressions explored predictors of occupational injury odds in the last year.

RESULTS

Thirty-four percent of respondents reported an occupational injury in the previous year. Education, exposure to loud noises, cold temperatures, vibrating machinery, use of hard hats, total number of job conditions, and total PPE significantly predicted injury odds.

CONCLUSION

Risk for injury among day laborers is not only the product of a specific hazard, but also the result of their exposure to multiple occupational hazards.

Assessing the short term health impact of the Great Recession in the European Union: a cross-country panel analysis

BACKGROUND

There are great concerns and some initial country-specific, descriptive evidence about potential adverse health consequences of the recent Great Recession.

METHODS

Using data for 23 European Union countries we examine the short-term impact of macroeconomic decline during the Great Recession on a range of health and health behaviour indicators. We also examine whether the effect differed between countries according to the level of social protection provided.

RESULTS

Overall, during the recent recession, an increase of one percentage point in the standardised unemployment rate has been associated with a statistically significant decrease in the following mortality rates: all-cause-mortality (3.4%), cardiovascular diseases (3.7%), cirrhosis- and chronic liver disease-related mortality (9.2%), motor vehicle accident-related mortality (11.5%), parasitic infection-related mortality (4.1%), but an increase in the suicide rate (34.1%). In general, the effects were more marked in countries with lower levels of social protection, compared to those with higher levels.

CONCLUSIONS

An increase in the unemployment rate during the Great Recession has had a beneficial health effect on average across EU countries, except for suicide mortality. Social protection expenditures appear to help countries "smooth" the health response to a recession, limiting health damage but also forgoing potential health gains that could otherwise result.

Family history of immigration from a tuberculosis endemic country and low family income are associated with a higher BCG vaccination coverage in Ile-de-France region, France

After withdrawal of multipuncture BCG device from the French market in January 2006, vaccination coverage (VC) with the intradermal device has dropped and since remained sub-optimal in Ile-de-France, the only region of mainland France where BCG is recommended to all children. We conducted a cross-sectional study to identify socio-economic factors associated with BCG VC in children of Paris metropolitan area born after January 2006. Two-stage random sampling was used to include 425 children up to 5 years old from Paris and its suburbs. Information was collected through face-to-face interviews and vaccination status confirmed by a vaccination document. Poisson regression analyzed the association between VC and potential determinants. VC of children from families with the lowest incomes (first quartile of family income/consumption unit (CU) (<883 €) was close to 100% regardless of family origin. In families with higher incomes (≥ 883 €/CU), VC was significantly higher among children born to families from a tuberculosis highly endemic country (98.2%) compared with other children (76.2%) (p=0.004). Children of low socio-economic background as well as those with a family history of immigration, regardless of family income, are correctly identified as being at high risk of tuberculosis and properly vaccinated with BCG in this area.