[Epidemiological characteristics of cardio-metabolic risk factors in women aged 15-49 years in 4 provinces of China in 2018]

OBJECTIVE

To analyze the prevalence of cardio-metabolic(CM) risk in women aged 15-49 years in 4 provinces of China and the influence of socioeconomic factors on them.

METHODS

A total of 2851 women aged 15-49 years from Community-based Cohort Study on Nervous System Disease in 2018 were selected. Obesity, central obesity, elevated triglyceride(TG), elevated total cholesterol(TC), decreased high-density lipoprotein cholesterol(HDL-C), elevated low-density lipoprotein cholesterol(LDL-C), elevated blood pressure, elevated blood glucose and risk factor aggregation were analyzed. χ~2 test was used for univariate analysis, multinomial Logit model was used to evaluate the relationship between socioeconomic factors and CM risk factors, and Cochran-Armitage trend test was used for trend analysis.

RESULTS

The detection rate of CM risk factors in this study from high to low were central obesity(26.76%), overweight(22.41%), pre central obesity(17.47%), decreased HDL-C(15.36%), elevated TG(11.78%), borderline elevated TC(11.40%), borderline elevated TG(11.12%), elevated blood pressure(9.71%) and hypertension(9.12%). The prevalence rates of CM risk factors were different among different age groups, income groups and education levels(P<0.05). In addition to decreased HDL-C, the prevalence of other metabolic risk factors increased with age(P_(trend)<0.05). With the improvement of educational level, the prevalence rates of overweight, obesity, central obesity, central obesity, elevated TG, decreased HDL-C, elevated blood pressure, hypertension, elevated blood pressure and diabetes showed a downward trend(P_(trend)<0.05). Multinomial Logit model showed that the rick of metabolic risk factors in the age group of 40 to 49 years old was higher than that in the younger age group aged 15-29 years, and was more significant in hypertension, elevated blood pressure and elevated blood glucose, which were 8.51 times(95% CI 5.45-13.27), 3.14 times(95%CI 2.20-4.48)and 2.66(95% CI 1.52-4.66)times of the younger age group, respectively. Women with high-income level have a higher risk of borderline elevated TC, elevated TC and borderline elevated LDL-C(OR=1.85, 95% CI 1.44-2.38;OR=2.01, 95% CI 1.25-3.22;OR=2.16, 95% CI 1.61-2.90), but the lower risk of overweight and elevated blood pressure(OR=0.79, 95% CI 0.64-0.98;OR=0.69, 95% CI 0.50-0.94). The risk of obesity, hypertension and diabetes of people with college degree or above was about 50% lower than those with junior high school education or below(OR=0.52, 95% CI 0.35-0.78;OR=0.43, 95% CI 0.27-0.67; OR=0.52, 95% CI 0.28-0.96).

CONCLUSION

Central obesity, overweight, pre central obesity and HDL-C decrease were prominent CM risk factors in women aged 15-49 years in four provinces of China in 2018. The detection rate of CM risk factors is higher in women of high age group or low education level.

Social risk factors for pediatric asthma exacerbations: A systematic review

Objective

This systematic review aims to identify social risk factors that influence pediatric asthma exacerbations.

Methods

Cohort studies published between 2010 and 2020 were systematically searched on the OVID Medline, Embase, and PsycInfo databases. Using our established phased inclusion and exclusion criteria, studies that did not address a pediatric population, social risk factors, and asthma exacerbations were excluded. Out of a total of 707 initially retrieved articles, 3 prospective cohort and 6 retrospective cohort studies were included.

Results

Upon analysis of our retrieved studies, two overarching domains of social determinants, as defined by Healthy People 2030, were identified as major risk factors for pediatric asthma exacerbations: Social/Community Context and Neighborhood/Built Environment. Social/Community factors including African American race and inadequate caregiver perceptions were associated with increased risk for asthma exacerbations. Patients in high-risk neighborhoods, defined by lower levels of education, housing, and employment, had higher rates of emergency department readmissions and extended duration of stay. Additionally, a synergistic interaction between the two domains was found such that patients with public or no health insurance and residence in high-risk neighborhoods were associated with excess hospital utilization attributable to pediatric asthma exacerbations.

Conclusion

Social risk factors play a significant role in influencing the frequency and severity of pediatric asthma exacerbations.

Dynamic Evolution of Land Use/Land Cover and Its Socioeconomic Driving Forces in Wuhan, China

Human activities are considered as the main driving forces of land use/land cover (LULC) variation at city scales. Monitoring the dynamic variation of LULC and its socioeconomic driving forces helps to reveal the response of LULC change to human activities and land use policies. However, this issue remains poorly understood. In this study, the spatiotemporal transitions among different LULC types during nearly three decades in Wuhan, China, were modeled in detail using the transfer matrix method. Ten socioeconomic factors indicating the population level, economic condition and social development were selected to quantitatively explain LULC variation. Some typical policies were discussed for the LULC transitions. The results showed that construction land was detected to continuously increase, with the fastest change rate of 560.48% during the 29-year period. Farmland area significantly declined by 1855 km2, decreasing by 31.21%, contributing to 86.14% of the area increase in construction lands. To some extent, the net area increase in construction land was at the expense of farmland area. All 10 indicators considered in this study were positively correlated with the construction land area (R2 of 0.783~0.970) and negatively correlated with farmland area (R2 of 0.861~0.979). In general, social and economic development contributed considerably to urban expansion and cultivated land loss. The largest contributors were non-agricultural population and economic conditions (secondary industry output, primary industry output and local revenues). Governmental guidance and behavior were considered the original impetus for LULC transition, while the impact of land use policies and human activities on LULC transitions varied across the subperiods. These findings provide decision-making support for appropriate urban planning and efficient land use management.

Disparities in Childhood Obesity Prevalence and Spatial Clustering Related to Socioeconomic Factors in Isaan, Thailand

Globally, rapid economic growth has contributed to an overall increase in the incidence of childhood obesity. Although the prevalence of obesity has been well recognized, the disparities related to a region's socioeconomic environment in terms of the incidence of obesity are still less understood. Therefore, the purpose of this study was to examine the spatial pattern of childhood obesity and identify the potential associations between childhood obesity and socioeconomic environment in the northeastern region of Thailand, Isaan. Using nationally collected obesity data from children aged 0-5 years in 2019, we employed a geographic information system (GIS) to perform obesity cluster analysis at the smaller regional level, investigating a total of 322 districts in study area. Global and local statistical approaches were applied to calculate spatial associations between the socioeconomic status of neighborhoods and childhood obesity. The study revealed that 12.42% of the total area showed significant clusters at the district level, with high values observed in the western and northeastern areas. The results of the spatial statistical model revealed that childhood obesity was significantly positively associated with areas exhibiting high levels of socioeconomic environment factors. Identifying the associated factors and highlighting geographic regions with significant spatial clusters is a powerful approach towards understanding the role of location and expanding the knowledge on the factors contributing to childhood obesity. Our findings, as a first step, offer valuable references that could support policy-makers and local authorities in enhancing policy development with the aim of reducing childhood obesity and improving public health.

Ecological and Socioeconomic Factors in the Occurrence of Rabies: A Forgotten Scenario

In many third world countries, where rabies is endemic in dog populations, humans continue to be at risk of contracting the disease. Vaccination is the most effective form of prophylaxis for people, yet it often fails to adequately protect dogs. The most major implications are the costs of post-exposure prophylaxis (PEP) after an exposure occurs and the loss of human life and productivity due to early mortality from rabies (about 60,000 deaths annually). The largest rabies death tolls can be found in the world's poorest regions, where rabies vaccinations for domestic dogs are uncommon and PEP is scarce. Mass vaccination of dogs, neutering programs, patient PEP, strengthening laboratory and human resources, education and awareness, and animal and human rabies surveillance are all common methods used to prevent, control, and ultimately eradicate dog-mediated human rabies. Current rabies control initiatives, however, pay little attention to the role that ecological and socioeconomic variables play in the disease's occurrence and spread. To help better inform rabies control strategies, we address in this work the ways in which ecological and socioeconomic factors affect the occurrence and spread of rabies.

Predicting death quality from life prior to death among older Chinese in a retrospective cohort study

Background

The pursuit of a good death is crucial in aging societies. This retrospective cohort study investigated the relation between life prior to death and quality of death among older Chinese.

Methods

End-of-life data reported by relatives of participants (aged 54 and over) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) who deceased between January 2011 and June 2019 were utilized. Life prior to death included health condition (morbid or not) and physical functioning (a latent factor with six indicators). Quality of death was assessed by painlessness and consciousness at death. Confirmatory Factor Analysis was employed to examine the factor structure of physical functioning and Structural Equation Modeling to explore associations between life prior to death and death quality based on sex and residence location.

Results

Freedom from chronic diseases was found to contribute to high-quality deaths (i.e., being painless and conscious) both directly and indirectly by enhancing physical functioning. Men and women diverged toward end-of-life: women were moderately less liable to illnesses and thus less painful at death. Yet, men functioned much better, and more often remained conscious when dying. Location's effect was weaker: although rural residents were more prone to painful deaths than urban dwellers, this urban-rural divide was slightly narrowed by rural settlers' relative health, which also indirectly led to their slight advantage in consciousness at death.

Conclusions

The results suggested that different dimensions of life prior to death predicted quality of death. Additionally, morbidity's effect on functioning and death quality stresses health management's role in improving end-of-life experiences.

Prerequisite for COVID-19 Prediction: A Review on Factors Affecting the Infection Rate

Since the year 2020, coronavirus disease 2019 (COVID-19) has emerged as the dominant topic of discussion in the public and research domains. Intensive research has been carried out on several aspects of COVID-19, including vaccines, its transmission mechanism, detection of COVID-19 infection, and its infection rate and factors. The awareness of the public related to the COVID-19 infection factors enables the public to adhere to the standard operating procedures, while a full elucidation on the correlation of different factors to the infection rate facilitates effective measures to minimize the risk of COVID-19 infection by policy makers and enforcers. Hence, this paper aims to provide a comprehensive and analytical review of different factors affecting the COVID-19 infection rate. Furthermore, this review analyses factors which directly and indirectly affect the COVID-19 infection risk, such as physical distance, ventilation, face masks, meteorological factor, socioeconomic factor, vaccination, host factor, SARS-CoV-2 variants, and the availability of COVID-19 testing. Critical analysis was performed for the different factors by providing quantitative and qualitative studies. Lastly, the challenges of correlating each infection risk factor to the predicted risk of COVID-19 infection are discussed, and recommendations for further research works and interventions are outlined.

Factors related to parenting stress among fathers of preschool children in Japan

BACKGROUND

Even though fathers participate in childcare at a higher rate than before, there remains a lack of research on the factors that contribute to parenting stress among fathers. This study explored the socioeconomic and demographic factors associated with parenting stress among fathers of preschool children.

METHODS

Our study included 17 645 fathers who participated in the 2016 Comprehensive Survey of Living Conditions in Japan. Parenting stress was assessed using a single question. Socioeconomic and demographic factors were predictors. Logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence interval (CI) for parenting stress.

RESULTS

Overall, 6.6% fathers experienced parenting stress. Fathers with a youngest child aged 0-2 years were more likely to experience parenting stress than those with a youngest child aged 3-6 (OR: 1.45, 95% CI: 1.25-1.68). Compared with fathers who lived in two-parent households without grandparents, those who lived in single-father households (both with and without grandparents) were more likely to experience parenting stress (OR: 12.13, 95% CI: 5.60-26.29 and OR: 4.19, 95% CI: 2.04-8.60, respectively). Furthermore, there was a significant negative association between education and parenting stress.

CONCLUSIONS

Having a child aged 0-2 years, single fatherhood, and higher education were associated with parenting stress among fathers of preschool children. Healthcare professionals need to be aware of these factors when supporting fathers in raising their children.

Socioeconomic Inequalities in Oral Health-related Behaviors in 18-Year-Old Adolescents: A Cross-sectional Study

AIMS

This study aimed to assess the socioeconomic inequalities in oral health-related behaviors, such as frequency of toothbrushing, flossing, and dental appointments, in 18-year-old Portuguese adolescents.

MATERIALS AND METHODS

Data were obtained from the third National Prevalence Study of Oral Health Diseases (III ENPDO), which was carried out in Portugal between 2012 and 2013. This study included 1075 adolescents aged 18 years. The information on socioeconomic status and oral health behaviors was collected using a semi-structured questionnaire. Binary logistic regression models were used to assess the association between social determinants and oral health-related behaviors. Unadjusted and adjusted odds ratios and confidence intervals were estimated.

RESULTS

The results found that father's educational level and both father's and mother's employment status were associated with adolescents not visiting a dental professional before the last 12 months. Male sex, living in a rural area, and lower adolescent's educational level were associated with toothbrushing less than twice a day. Furthermore, father's educational level and mother's employment status were also associated with a lower frequency of toothbrushing, whereas only mother's employment status was associated with a lower frequency of flossing.

CONCLUSION

These findings demonstrated that socioeconomic inequalities in oral health-related behaviors of 18-year-old adolescents were associated with parental employment status and educational level, adolescent's educational level, sex, and residential zone.

Unrecorded alcohol consumption in Thailand: Prevalence, geographical variation, relationship with socioeconomic factors and related consequences

INTRODUCTION

Information on unrecorded alcohol consumption in Southeast Asia and Thailand is lacking. The primary objective of this study was to estimate the prevalence of unrecorded alcohol (including illegally produced alcohol and untaxed cross-border alcohol) consumption among past-year drinkers in Thailand. The secondary objectives were to examine the geographical variation of unrecorded alcohol consumption, effects of socioeconomic factors on unrecorded alcohol consumption and the association between unrecorded alcohol consumption and alcohol-related consequences.

METHODS

This study analysed data from the 2017 Smoking and Drinking Behavior Survey. The prevalence of unrecorded alcohol consumption was estimated. Associations of interest were tested using multivariate logistic regression.

RESULTS

Overall, 12.3% of past-year drinkers consumed any unrecorded alcohol. The prevalence was highest in the north (24.8%) and lowest in the central region (7.4%). In multivariate analysis, living in the north was associated with consumption of any unrecorded alcohol and illegally produced alcohol, whereas living in the south was associated with untaxed cross-border alcohol consumption. The lowest education and income group had the highest likelihood of consumption of any unrecorded alcohol and illegally produced alcohol, but the lowest likelihood of untaxed cross-border alcohol consumption. Consumption of unrecorded alcohol was associated with a higher chance of alcohol-related consequences.

DISCUSSION AND CONCLUSIONS

This study estimated the prevalence of unrecorded alcohol consumption among Thai drinkers and demonstrated the geographical variation in the prevalence and types of unrecorded alcohol consumed. We also found heterogenous associations between socioeconomic factors and each type of unrecorded alcohol.

The role of parental education on the relationship between gestational age and school outcomes

BACKGROUND

Individuals born preterm may experience difficulties beyond the neonatal period, such as poorer school outcomes. However, whether these outcomes are modified by family factors is less well-known.

OBJECTIVES

To investigate whether parental educational level modify the relationship of gestational age with completion of final examinations and grade point average in compulsory education.

METHODS

This nationwide register-based cohort study included singletons born in Denmark during 1995-2001. We investigated the differences in the associations between gestational age (24-44 weeks) and two school outcomes at 16 years according to parental educational level (lower (≤10 years), intermediate (11-13 years), and higher (>13 years)). Mixed-effect logistic regression and mixed-effect linear regression were used to model completion of final examination and grade point average, respectively.

RESULTS

Of the 425 101 singletons, 4.7% were born before 37 weeks. The risk of not completing final examination increased with shorter gestational age and lower parental educational level. For instance, among adolescents whose parents had a lower educational level, the risk increased from 23.9% (95% CI, 23.1, 24.6) for those born in week 40 to 36.6% (95% CI, 31.5, 42.1) for those born in week 28. For adolescents whose parents had a higher educational level, the corresponding risk increase was 5.9% (95% CI, 5.7, 6.1) to 10.5% (95% CI, 8.6, 12.8), respectively. Grade point average decreased with shorter gestational age in adolescents born before 30 weeks and with lower parental educational level. The associations between gestational age and grade point average were similar across parental educational levels. For completions of final examination, the associations with gestational age were weaker with higher parental educational level.

CONCLUSIONS

Shorter gestational age and lower parental educational level were associated with poorer school outcomes. Our findings suggest that parental educational level mitigates the adverse effects of shorter gestational age on some school outcomes.

Physical Activity Is Associated With Sleep Quality: Results of the ESSE-RF Epidemiological Study

Background and hypothesis

Physical activity (PA) is an important behavioral factor associated with the quality of life and healthy longevity. We hypothesize that extremely low and extremely high levels of daily PA (including occupational PA) may have a negative impact on sleep quality and psychological well-being.

Objective

The aim of the study is to investigate the association between the level and type of PA and sleep problems in adult population.

Materials and methods

The sample of the study consisted of the participants from the population-based cohort of The Epidemiology of Cardiovascular Risk Factors and Diseases in Regions of the Russian Federation Study (ESSE-RF). The data of three regions (Saint Petersburg, Samara, Orenburg), varying in geographic, climatic, socioeconomic characteristics, was included into analysis. The total sample consisted of 4,800 participants (1,600 from each region; 1,926 males, 2,874 females), aged 25–64. The level of PA was evaluated using three parameters: the type of PA at work, the frequency of an intensive/high PA including sport (times a week), the mean duration of leisure-time walking (minutes a day). The measures of sleep quality were sleep duration and the frequency of difficulty falling asleep, difficulty maintaining sleep, daytime sleepiness, and sleep medication use. PA and sleep characteristics were assessed by interview carried by the trained medical staff.

Results

When controlling for gender, age and socioeconomic status (SES) extremely high occupational PA was a significant risk factor for difficulty falling asleep three or more times a week [OR(CI95%) = 1.9(1.2–3.0), p = 0.003] while working in a sitting position or having moderate physical load at work were not associated with sleep characteristics. Having a high physical load six or more times a week was a risk factor for difficulty falling asleep controlling for gender, age and SES [OR(CI95%) = 1.9(1.4–3.4), p = 0.001]. The association between leisure-time walking and sleep characteristics was insignificant. Walking less than an hour a day was associated with increased depression scores (46.5 vs. 41.9%, p = 0.006).

Conclusion

High physical load at work and excessively frequent intensive PA are associated with difficulties initiating sleep and may represent a risk factor for insomnia.

Self-determined Occupational Performance Model for Children From Economically Disadvantaged Backgrounds : Modèle de performance occupationnelle autodéterminée pour les enfants issus de milieux économiquement défavorisés

Background. Children from low-income backgrounds have a higher incidence of handwriting challenges due to the unique social and environmental stressors associated with poverty. Additionally, children from economically disadvantaged households are at risk for motor, cognitive, and social deficits, which further impact their handwriting performance. Purpose. The purpose of this paper is to propose a theoretical model that provides a holistic perspective for addressing the handwriting needs of children from low-socioeconomic backgrounds. Key Issues. The presented conceptual model is derived from the person-environment-occupation model for occupational performance and self-determination theory. These theories reciprocally complement and enhance each other, providing a foundation from which clinicians can guide evaluation and intervention. Implications. Through the use of the proposed model, evaluation and intervention focus on intrinsic motivation while considering the physical, social, and cultural impacts on a child's occupational performance. The provider connects with the child's basic psychological needs, thus improving handwriting outcomes and facilitating improved academic performance.

Socioeconomic Factors Contributing to Antibiotic Resistance in China: A Panel Data Analysis

The relationship between socioeconomic factors and antibiotic resistance (ABR) prevalence remains a knowledge gap in China. In this study, our aim was to examine the association between ABR prevalence and socioeconomic factors across 30 provinces in mainland China. We used two measures of level of ABR: the proportion of methicillin-resistant Staphylococcus aureus (MRSA), third-generation cephalosporin-resistant Escherichia coli (3GCREC), and third-generation cephalosporin-resistant Klebsiella pneumoniae (3GCRKP), and the aggregate resistance. The data of ABR prevalence, education, gross domestic product (GDP) per capita, out-of-pocket (OOP) health expenditure, physician density, hospital bed density, and public toilet density during 2014 and 2018 in 30 provinces in mainland China were included. We examined the association between ABR prevalence and potential contributing socioeconomic factors using panel data modeling. In addition, we explored this relationship in the eastern, central, and western economic zones. Our results indicated that GDP per capita was significantly positively correlated with ABR in mainland China and the eastern economic zone; however, significantly positive associations did not exist in the central and western economic zones. Surprisingly, both higher GDP per capita and higher OOP health expenditure were associated with a higher level of MRSA, but a lower level of 3GCREC; higher physician density was associated with a lower level of MRSA, but a higher level of 3GCREC. In addition, ABR prevalence presented a decline trend during 2014 and 2018. Our study showed the potential associ-ations between resistance and GDP per capita, OOP health expenditure, physician density. It high-lights that the social and economic determinants can be of importance in tacking the development and spread of ABR in mainland China.

Socioeconomic factors and the onset of peripheral artery disease in older adults

Background: As evidence concerning the impact of socioeconomic factors on the risk of peripheral artery disease (PAD) is sparse, we assessed the association of education and area-level factors (population density, type of municipality and local unemployment rate) on the onset of PAD in older adults. Patients and methods: The analysis used data of the getABI study, a prospective cohort study with seven years of follow-up. Onset of PAD was determined by ankle brachial index (<0.9) or PAD symptoms. Cox regression analysis was employed. Results: Out of 5,444 primary care attendees without PAD at baseline, there were 1,381 participants with PAD onset (cumulative observation time 31,739 years), yielding an event rate of 43.5 (0.95 confidence interval [0.95 CI] 41.2-45.8) per 1,000 person-years. Multivariable Cox regression analysis showed an association of PAD onset with low education (hazard ratio 1.29; 0.95 CI 1.14-1.46; P<0.001), high population density (0.93; 0.89-0.98; P=0.002), small cities (compared to large cities) (0.71; 0.53-0.96; P=0.027) and high local unemployment rate (1.04; 1.00-1.07; P=0.032). The impact of low education on PAD onset was higher for men (2.11; 1.64-2.72) than for women (1.22; 1.07-1.40) (interaction term P=0.013). Conclusions: Socioeconomic factors, education as well as area-level socioeconomic indicators, make independent contributions to PAD onset in older adults.

Factors Associated With Family Member's Spanking of 3.5-year-old Children in Japan

Background

Spanking can cause adverse psychological development and biological functional changes in children. However, spanking is widely used by parents in Japan. This study explored the risk factors for family member’s spanking of 3.5-year-old children using nationwide population data in Japan.

Methods

Surveys were administered to family members in Japan who had a child in 2001 (first cohort) or in 2010 (second cohort), and the data when their child was 0.5, 1.5, and 3.5 years old were used. We used multivariate binary and ordinal logistic regression analyses to examine the associations between risk factors and spanking children at 3.5 years of age, which was subcategorized into frequencies of never, sometimes, and always spanking, presented with odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Among 70,450 families, 62.8% and 7.9% sometimes and always spanked their children, respectively. Children in the second cohort were spanked less frequently compared with those in the first cohort, and fathers who responded to the questionnaire spanked children less frequently than mothers who responded. Identified associated factors for spanking were male child, presence of siblings of the child, not living in a two-parent household, not living in a three-generation household, younger parents, parents with lower education, no outside work or unstable work, and lower family income.

Conclusions

We found a high prevalence of spanking and its associated factors. Approaching those with lower socioeconomic factors and promoting fathers’ involvement in parenting may be important public health strategies for reducing and preventing spanking.

Disease Control and Gender Predict the Socioeconomic Effects of Acromegaly: A Nationwide Cohort Study

CONTEXT

Acromegaly is an insidious disease associated with severe somatic morbidity but data on socioeconomic status are scarce.

OBJECTIVE

To study the socioeconomic status in acromegaly in a population-based follow-up study.

METHODS

All incident cases of acromegaly (n = 576) during the period 1977-2010 were included. For every patient, 100 persons were sampled from the general population matched for date of birth and gender (comparison cohort). Cox regression and hazard ratios (HR), conditional logistic regression and linear regression with 95% confidence intervals (CI) were used.

OUTCOME MEASURES

Retirement, social security benefit, annual income, cohabitation, separation, parenthood and educational level.

RESULTS

The proportion of retired individuals was significantly higher in patients with acromegaly after the time of diagnosis (HR, 1.43; 95% CI, 1.26-1.62) and also during the 5-year pre-diagnostic period (HR, 1.15; 95% CI, 1.03-1.28). More individuals with acromegaly received social security benefit compared with the comparison cohort during the initial period after the time of diagnosis. Among patients who maintained a job, the annual income was similar to the comparison cohort. Compared with the background population, cohabitation was lower (HR, 0.69; 95% CI, 0.50-0.95) as was parenthood (HR, 0.56; 95% CI, 0.39-0.80), whereas neither educational level (HR, 0.61; 95% CI, 0.35-1.06) nor separation (HR, 1.13; 95% CI, 0.86-1.47) were different. Female gender and insufficient disease control were associated with a significantly worse socioeconomic status.

CONCLUSIONS

1) Socioeconomic status is impaired in patients with acromegaly even before a diagnosis of acromegaly. 2) Females and patients without disease remission have worse outcomes. 3) Early diagnosis and effective treatment of acromegaly could be important factors in mitigating the negative impact on socioeconomic factors.

Minorities' Diminished Returns of Parental Educational Attainment on Adolescents' Social, Emotional, and Behavioral Problems

Aim: To compare racial groups for the effect of parental educational attainment on adolescents' social, emotional, and behavioral problems. Methods: In this cross-sectional study, 10,762 youth from the Adolescent Brain Cognitive Development (ABCD) study were included. The independent variable was parental educational attainment. The main outcomes were 1) anxious and depressed mood, 2) withdrawn and depressed affect, 3) somatic complaints, 4) social and interpersonal problems, 5) thought problems, 6) rule-breaking behaviors, 7) attention problems, and 8) violent and aggressive behaviors. These scores were generated based on parent-reported behavioral problems measured using the Child Behavior Checklist (CBCL). Race and ethnicity were the moderators. Linear regression was used to analyze the ABCD data. Results: Overall, high parental educational attainment was associated with lower scores across all domains. Race and ethnicity showed statistically significant interactions with parental educational attainment on adolescents' fewer social, emotional, and behavioral problems (all domains), net of all confounders, indicating smaller tangible gains from their parental educational attainment for Black and Hispanic compared to non-Hispanic White adolescents. Conclusion: The protective effects of parental education against social, emotional, and behavioral problems are systematically diminished for Hispanic and Black than non-Hispanic White adolescents.

Income-Related Inequality in Traffic Accident Health Outcomes (Injury, Disability and Mortality): Evidence from the Nationwide Survey in Iran

Background:

Despite many efforts, Iran continues to have a high rate of traffic accidents and poor health outcomes. This study aimed to measure income-related inequality for traffic accident health outcomes in Iran, a country with one of the highest rates of traffic accidents and related health problems.

Methods:

The source of data was a national representative survey named the Iranian Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010). Monthly household income is obtained through self-report in different quarters. Disparity rate ratio (DRR), slop index of inequality (SII) and the population attributable risk percentage measure (PAR%) were calculated. The concentration index (CI) of RTIs was used as our measure of socioeconomic inequality and decomposed into its determining factors.

Results:

Using the DRR index, in the lowest income group, the risk of death from an accident was 2.3 times, greater and the risk of accidental disability was 11.7 times greater than for the third income quartet. The slope index also shows that the rate of road traffic deaths, disability and injury per 100,000 individuals decreased by 28, 82, and 392 moving from lower to higher incomes. This decrease in injury was about 581 for motorcyclists. CI was −0.04078643 (SE=.01424828, P-value 0.004). Male sex (68.9%), 15–29 yr old age (9.4%), employed activity status (20.8%) has a positive contribution in the RTIs concentration index.

Conclusion:

In addition to intervention related to the road safety and vehicles and reducing human errors, prevention of the road traffic ill health outcomes requires attention to reduction of inequality in society.

Spatiotemporal Pattern of Fine Particulate Matter and Impact of Urban Socioeconomic Factors in China

Frequent hazy weather has been one of the most obvious air problems accompanying China's rapid urbanization. As one of the main components of haze pollution, fine particulate matter (PM2.5), which severely affects environmental quality and people's health, has attracted wide attention. This study investigated the PM2.5 distribution, changing trends and impact of urban factors based on remote-sensing PM2.5 concentration data from 2000 to 2015, combining land-use data and socioeconomic data, and using the least-squares method and structural equation model (SEM). The results showed that the high concentration of PM2.5 in China was mainly concentrated in the eastern part of China and Sichuan Province. The trends of the PM2.5 concentration in eastern part and Northeast China, Sichuan, and Guangxi Provinces were positive. Meanwhile, the ratios of increasing trends were strongest in built-up land and agricultural land, and the decreasing trends were strongest in forest and grassland, but the overall trends were still growing. The SEM results indicated that economic factors contributed most to PM2.5 pollution, followed by demographic factors and spatial factors. Among all observed variables, the secondary industrial GDP had the highest impact on PM2.5 pollution. Based on the above results, PM2.5 pollution remains an important environmental issue in China at present and even in the future. It is necessary for decision-makers to make actions and policies from macroscopic and microscopic, long-term and short-term aspects to reduce pollution.

Relationship between community-level variables and number of general dentists

BACKGROUND

In this study, the authors used observational data from 2014 to evaluate the association between the number of general dentists and several community characteristics.

METHODS

The authors collected community-level characteristics from secondary sources for all 947 Iowa incorporated communities to study their relationships with the mean number of general dentists per 1,000 population per square mile (population density), the dependent variable. The authors used zero-inflated negative binomial models to examine the association between the dependent and predictor variables.

RESULTS

Only 22.8% of communities had a dentist. Urban, young, well-educated, fluoridated communities with at least 1 elementary school had the highest estimated mean concentration of dentists. Isolated communities with older, less educated adults and lacking fluoridation and an elementary school had the fewest dentists.

CONCLUSIONS

Although population is an important determinant for where a dentist practices, other variables such as urbanization, demographic characteristics, fluoridation status, and presence of at least 1 elementary school are also predictors of the number of dentists in a community.

PRACTICAL IMPLICATIONS

These findings provide dental students and young practitioners useful information by highlighting community characteristics that are associated with office locations.

Socioeconomic Drivers of PM2.5 in the Accumulation Phase of Air Pollution Episodes in the Yangtze River Delta of China

Recent studies in PM_2.5 sources show that anthropogenic emissions are the main contributors to haze pollution. Due to their essential roles in establishing policies for improving air quality, socioeconomic drivers of PM_2.5 levels have attracted increasing attention. Unlike previous studies focusing on the annual PM_2.5 concentration (C_year), this paper focuses on the accumulation phase of PM_2.5 during the pollution episode (PMAE) in the Yangtze River Delta in China. This paper mainly explores the spatial variations of PMAE and its links to the socioeconomic factors using a geographical detector and simple linear regression. The results indicated that PM_2.5 was more likely to accumulate in more developed cities, such as Nanjing and Shanghai. Compared with C_year, PMAE was more sensitive to socioeconomic impacts. Among the twelve indicators chosen for this study, population density was an especially critical factor that could affect the accumulation of PM_2.5 dramatically and accounted for the regional difference. A 1% increase in population density could cause a 0.167% rise in the maximal increment and a 0.214% rise in the daily increase rate of PM_2.5. Additionally, industry, energy consumption, and vehicles were also significantly associated with PM_2.5 accumulation. These conclusions could serve to remediate the severe PM_2.5 pollution in China.

Socioeconomical Factors Associated With Pediculosis (Phthiraptera: Pediculidae) in Athens, Greece

Pediculosis in humans and especially in children is a very common dermatological disorder caused by the ectoparasite Pediculus humanus capitis De Geer. We investigated the socioeconomic factors affecting the prevalence of pediculosis in the Greek urban area of Athens during 2004-2006. The target population consisted of children from kindergartens. In total, 434 children from single- or two-parent families were investigated with respect to socioeconomic factors such as education, income and family composition, and the prevalence of pediculosis. The overall pediculosis rate was 5.30%. Head louse infestations were significantly higher in female children and in two-parent families. Lice infestations peaked in low- and medium-income families. Head louse infestation rates were influenced by income, parents' education, and nationality.

Social Activities, Socioeconomic Factors, and Overweight Status Among Middle-Aged and Older Korean Adults: A Cross-Sectional Study

This study aims to investigate the relationship between social activities and overweight among middle-aged and older adults. This study used data from the 2008 Korean Longitudinal Study of Aging which included a total of 8157 adults. We divided body mass index into 2 groups: normal weight and overweight. Multivariable logistic regression analysis was used to identify the association between social activities and overweight. For males, frequency of meetings with neighbors (1-3 times a week) was associated with being less overweight. Middle-aged adults who met with neighbors 1 to 3 times a week were less likely being overweight than those with once a year meeting frequency. On the contrary, social activity participation is related with high risk of overweight especially in the female and older adults. Our results suggest that social activity participation and social support needs to be taken into consideration when dealing with being overweight.

Socioeconomic Conditions in Childhood, Adolescence, and Adulthood and the Risk of Ischemic Stroke

BACKGROUND AND PURPOSE

The association between socioeconomic status in adulthood and the risk of stroke is well established; however, the independent effects of socioeconomic conditions in different life phases are less understood.

METHODS

Within a population-based stroke registry, we performed a case-control study with 470 ischemic stroke patients (cases) aged 18 to 80 years and 809 age- and sex-matched stroke-free controls, randomly selected from the population (study period October 2007 to April 2012). We assessed socioeconomic conditions in childhood, adolescence, and adulthood, and developed a socioeconomic risk score for each life period.

RESULTS

Socioeconomic conditions were less favorable in cases regarding paternal profession, living conditions and estimated family income in childhood, school degree, and vocational training in adolescence, last profession, marital status and periods of unemployment in adulthood. Using tertiles of score values, low socioeconomic conditions during childhood (odds ratio 1.77; 95% confidence interval 1.20-2.60) and adulthood (odds ratio 1.74; 95% confidence interval 1.16-2.60) but not significantly during adolescence (odds ratio 1.64; 95% confidence interval 0.97-2.78) were associated with stroke risk after adjustment for risk factors and other life stages. Medical risk factors attenuated the effect of childhood conditions, and lifestyle factors reduced the effect of socioeconomic conditions in adolescence and adulthood. Unfavorable childhood socioeconomic conditions were particularly associated with large artery atherosclerotic stroke in adulthood (odds ratio 2.13; 95% confidence interval 1.24-3.67).

CONCLUSIONS

This study supports the hypothesis that unfavorable childhood socioeconomic conditions are related to ischemic stroke risk, independent of established risk factors and socioeconomic status in adulthood, and fosters the idea that stroke prevention needs to begin early in life.

Childbirth expense support and small-for-gestational-age infants in Japan

BACKGROUND

Poor nutritional status during the fetal period could cause perinatal and lifelong health disadvantages in neonates. The aim of this study was to investigate the background of pregnant women receiving childbirth expense support (CES), pregnancy outcome, and neonatal anthropometric data.

METHODS

A retrospective cohort study was conducted using 823 antenatal and delivery records in a perinatal center located in one of the poorest areas in Japan. Neonates who were small for gestational age (SGA) were compared between the CES and the non-CES groups.

RESULTS

The incidences of low birthweight (LBW) and SGA were significantly higher in the group receiving CES (14.6% and 14.6%, respectively). The adjusted OR of CES was 2.78 (95%CI: 1.32-5.87) and the adjusted OR of maternal smoking was 5.03 (95%CI: 2.74-9.21), indicating that CES and maternal smoking were directly associated with SGA.

CONCLUSIONS

CES recipients had a higher prevalence of SGA infants. CES was independently associated with SGA. Previous studies have shown that smoking is a major risk factor for SGA. Further studies are needed to identify risk factors of SGA specific to CES recipients.

Impact of socioeconomic status on ionizing radiation exposure from medical imaging in children

PURPOSE

To characterize cumulative radiation exposure from diagnostic imaging (CEDI) in pediatric patients and to investigate its relationship to patients' socioeconomic status and comorbid medical conditions.

METHODS

A retrospective cohort study of >19,000 pediatric patients seen within the outpatient clinic system of an academic tertiary care urban medical center during the month of January 2006 was conducted to estimate CEDI from all procedures performed within 3 years of the index visit (until January 2009). Socioeconomic status was estimated from census tract geocoding. Comorbid medical conditions were identified from the electronic medical record.

RESULTS

A total of 19,063 patients underwent imaging tests within the index month. The mean age was 8.9 ± 6.3 years. Most had private insurance (56%), with 36% receiving Medicaid and 8% private payers. Our population lived in census tracts in which 27 ± 16% of the population were below the federal poverty level with 62% living in areas in which 20% of residents were living below the poverty level. There were differences in CEDI (P < .0001) by age, insurance type, and percentage poverty in the census tract of residence but not among racial groups (P = .6508). The association between poverty and CEDI was generally explained by the 26 Elixhauser diagnoses, with the exception of rheumatoid arthritis.

CONCLUSION

Patients living in areas of greater poverty were exposed over time to more radiation from diagnostic testing than those living in areas with lower percentages of residents living in poverty. This association was explained almost entirely by the presence of disease burden. No direct association was found between socioeconomic status and CEDI.

Bone graft substitutes for the treatment of traumatic fractures of the extremities

HEALTH POLITICAL AND SCIENTIFIC BACKGROUND: Bone graft substitutes are increasingly being used as supplements to standard care or as alternative to bone grafts in the treatment of traumatic fractures.

RESEARCH QUESTIONS

The efficacy and cost-effectiveness of bone graft substitutes for the treatment of traumatic fractures as well as the ethical, social and legal implications of their use are the main research questions addressed.

METHODS

A systematic literature search was conducted in electronic medical databases (MEDLINE, EMBASE etc.) in December 2009. Randomised controlled trials (RCT), where applicable also containing relevant health economic evaluations and publications addressing the ethical, social and legal aspects of using bone graft substitutes for fracture treatment were included in the analysis. After assessment of study quality the information synthesis of the medical data was performed using metaanalysis, the synthesis of the health economic data was performed descriptively.

RESULTS

14 RCT were included in the medical analysis, and two in the heath economic evaluation. No relevant publications on the ethical, social and legal implications of the bone graft substitute use were found. In the RCT on fracture treatment with bone morphogenetic protein-2 (BMP-2) versus standard care without bone grafting (RCT with an elevated high risk of bias) there was a significant difference in favour of BMP-2 for several outcome measures. The RCT of calcium phosphate (CaP) cement and bone marrow-based composite materials versus autogenous bone grafts (RCT with a high risk of bias) revealed significant differences in favour of bone graft substitutes for some outcome measures. Regarding the other bone graft substitutes, almost all comparisons demonstrated no significant difference. The use of BMP-2 in addition to standard care without bone grafting led in the study to increased treatment costs considering all patients with traumatic open fractures. However, cost savings through the additional use of BMP-2 were calculated in a patient subgroup with high-grade open fractures (Gustilo-Anderson grade IIIB). Cost-effectiveness for BMP-2 versus standard care with autologous bone grafts as well as for other bone graft substitutes in fracture treatment has not been determined yet.

DISCUSSION

Although there were some significant differences in favour of BMP-2, due to the overall poor quality of the studies the evidence can only be interpreted as suggestive for efficacy. In the case of CaP cements and bone marrow-based bone substitute materials, the evidence is only weakly suggestive for efficacy. From an overall economic perspective, the transferability of the results of the health economic evaluations to the current situation in Germany is limited.

CONCLUSIONS

The current evidence is insufficient to evaluate entirely the use of different bone graft substitutes for fracture treatment. From a medical point of view, BMP-2 is a viable alternative for treatment of open fractures of the tibia, especially in cases where bone grafting is not possible. Autologous bone grafting is preferable comparing to the use of OP-1. Possible advantages of CaP cements and composites containing bone marrow over autogenous bone grafting should be taken into account in clinical decision making. The use of the hydroxyapatite material and allograft bone chips compared to autologous bone grafts cannot be recommended. From a health economic perspective, the use of BMP-2 in addition to standard care without bone grafting is recommended as cost-saving in patients with high-grade open fractures (Gustilo-Anderson grade IIIB). Based on the current evidence no further recommendations can be made regarding the use of bone graft substitutes for the treatment of fractures. To avoid legal implications, use of bone graft substitutes outside their approved indications should be avoided.

Risk factors associated with head louse infestation in Korea

Head louse infestation (HLI) is one of the most frequently occurring parasitic diseases in children. This study was conducted to investigate the socioeconomic and personal factors influencing HLI in the Republic of Korea. A total of 2,210 questionnaires about various factors related to HLI were obtained from children in 17 primary schools throughout the country. The rate of HLI was significantly lower in children who lived together with mother or in a family where both parents worked. In addition, HLI was lower in children whose fathers or mothers were public officers or teachers. However, HLI was higher in children who had small families and washed their hair less often. Education levels of parents and the number of children in family were not significant. Improvement of socioeconomic factors and personal hygiene will be helpful for reducing HLI.

Socioeconomic status and cancer screening in Japanese males: Large inequlaity in middle-aged and urban residents

OBJECTIVES

Cancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males.

METHODS

Using the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ≥65 years).

RESULTS

The cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas.

CONCLUSIONS

There are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.

Effects of socioeconomic factors on suicide from 1980 through 1999 in Osaka Prefecture, Japan

Suicide rate in Japan surged in 1998. Although the standardized mortality ratios (SMRs) of suicide in Osaka Prefecture, Japan had been mostly lower than the national SMRs of suicide between 1980 and 1997, they surpassed the increased national SMR of suicide in 1998 and 1999. We investigated whether the suicide rates for 1980-97 and the recent increased suicide rates in Osaka Prefecture were associated with socioeconomic factors. Time-series regression analyses of the suicide rate and socioeconomic factors were performed on respective data for five sub-areas in Osaka Prefecture. The suicide rates of young people and middle-aged men were more strongly associated with the job application and divorce rates for 1980-99 than for 1980-97. Some relations between the suicide rate and public assistance rate were found. The suicide rate was negatively associated with the marriage rate in some areas. The suicide rate of elderly women was strongly associated with the number of persons per household. The notable relation was found between the suicide rate of middle-aged men and the job application rate for 1980-99. The inverse relation between the suicide rate of elderly women and the number of persons per household was noteworthy.