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To develop composite measures of neighborhood economic factors for use with the national Spinal Cord Injury Model Systems (SCIMSs) database in cross-sectional and longitudinal investigations of the social determinants of health. Secondary data analysis of administrative data from the 2009, 2014, and 2019 American Community Survey (ACS) 5-year estimates and survey data collected for the SCIMS database. Community. The validity of the neighborhood economic measures developed from the ACS data was tested with a sample of SCIMS participants who completed a follow-up interview between 2017 and 2021 (N=8,130). The predictive validity of the neighborhood measures was assessed with a subsample of cases with complete data on the outcome and covariate measures (N=6,457). Not applicable. A binary measure of self-rated health status (1=poor/fair health; 0=good/very good/excellent). A combination of panel review and data reduction techniques yielded 2 distinct measuring neighborhood socioeconomic status (SES) and neighborhood socioeconomic disadvantage that were validated using 3 waves of ACS data and the SCIMS data. The odds of reporting poor health were lower among people living in moderate- and high-SES neighborhoods and highest among people living in moderately and highly disadvantaged neighborhoods. The negative association between neighborhood SES and poor health was fully attenuated by differences in participants' individual demographic and economic characteristics whereas the positive association between neighborhood disadvantage and poor health persisted after adjusting for individual differences. The two composite measures of neighborhood economic factors developed by this study are robust in samples from different periods of time and valid for use with the SCIMS database. Future investigations conducting surveillance of the needs of the SCI population using this resource may consider using these measures to assess the effect of the social determinants of health in outcomes after SCI. [ABSTRACT FROM AUTHOR]

The number of students with special educational needs (SEN) is growing rapidly. This study compared the correlations between the share of students identified with SEN and student diversity (socioeconomic status and ethnicity) at the school level in three countries. We used the principal questionnaire from the 2018 Teaching and Learning International Survey (TALIS) to examine data from principals in three welfare states (the United Kingdom, France, and Sweden) and whether minority students in these three countries also receive special education. We conducted an ordinal regression analysis to examine the data. First, our results suggest that the share of immigrants in schools does not reliably predict the share of students placed in SEN. Second, the schools' share of refugees predicts the share of students placed in SEN, although the results vary by educational stage and country. Third, the schools' share of socioeconomically disadvantaged students predicts the share of students with SEN in all countries. We conclude that our study both agrees and disagrees with overrepresentation theory and equity theory. Finally, we suggest that welfare state theory may explain these differences. [ABSTRACT FROM AUTHOR]

Objectives: Lack of physical activity has a critical effect on the physical and mental health of adolescents. This study examined the influence of family adversities on the longitudinal changes in physical inactivity among adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study used multi-wave data from the Korean Children and Youth Panel Survey, including 2590 Korean adolescents aged 12-14 years. The longitudinal trajectory of physical inactivity among adolescents and the effects of related factors were estimated using a latent growth modeling method. Results: Our results revealed a significant increase in physical inactivity among adolescents over time. At the onset of the pandemic, approximately one-seventh of Korean middle schoolers reported a lack of physical activity. However, 3 years later, during the quarantine, nearly one-fifth of these adolescents reported a significant increase in their physical inactivity. Initially, low level parental education was predictive of adolescents’ physical inactivity, but this effect diminished over time, becoming statistically insignificant by the end of the 3-year period. Moreover, the increase in physical inactivity over the 3 years was significantly influenced by parental rejection. Conclusions: These findings suggest that adolescents who experience parental rejection are more likely to report an increase in sedentary behaviors in contexts such as the COVID-19 pandemic.

Background: Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce. Methods: Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤.05. Results: First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* =.03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* =.02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures. Conclusion: Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine. [ABSTRACT FROM AUTHOR]

Abstract Background Gambling and its harmful effects on human health and well-being represent a significant public health concern in many countries, with electronic gambling machines (EGMs) recognized as one of the most detrimental forms of gambling. Previous research has established an association between EGM accessibility, expenditure, gambling harm, and the socioeconomic status (SES) of neighborhoods. However, there is limited understanding of the direct impact of SES and EGM accessibility on individual player expenditures. Prior estimations of expenditure often rely on self-reported data or venue-level revenue statistics. This study uses high spatial resolution socioeconomic data together with individual-level account-based location and expenditure (point of sales) data (71,669 players, 745 EGM venues) to explore the association between EGM accessibility and neighborhood SES and to examine whether the EGM expenditure of neighborhood residents is associated with EGM accessibility and neighborhood SES. Data and methods Player account data include information on the home location and expenditure of the entire EGM gambling population across every EGM venue located in the Helsinki region, Finland. High-resolution (250 × 250 m) grid-level data on socioeconomic variables were used to obtain the local socioeconomic conditions of the players. EGM accessibility was estimated for every grid cell using a calibrated gravity model derived from the player account data. Statistical analyses included correlation analysis, spatial autocorrelation analysis, and regression models. Results First, significantly higher levels of EGM accessibility were found in areas with lower local SES. Second, regression analysis revealed that both higher EGM accessibility and lower local SES were associated with higher annual losses per adult. These results, in combination with visual and spatial autocorrelation analyses, revealed that accessibility to EGM gambling is highly concentrated, especially in lower socioeconomic neighborhoods with higher levels of EGM expenditure. Conclusions The results lay the groundwork for future spatial research on gambling harm, expenditure, accessibility, and SES utilizing detailed account data on the interaction between players and venues. The results underscore the importance of spatial restrictions when regulating EGM accessibility, particularly in areas with vulnerable populations, as a crucial measure for public health and harm prevention. The results also enable targeted gambling harm prevention actions at the local level.

Background: Gambling and its harmful effects on human health and well-being represent a significant public health concern in many countries, with electronic gambling machines (EGMs) recognized as one of the most detrimental forms of gambling. Previous research has established an association between EGM accessibility, expenditure, gambling harm, and the socioeconomic status (SES) of neighborhoods. However, there is limited understanding of the direct impact of SES and EGM accessibility on individual player expenditures. Prior estimations of expenditure often rely on self-reported data or venue-level revenue statistics. This study uses high spatial resolution socioeconomic data together with individual-level account-based location and expenditure (point of sales) data (71,669 players, 745 EGM venues) to explore the association between EGM accessibility and neighborhood SES and to examine whether the EGM expenditure of neighborhood residents is associated with EGM accessibility and neighborhood SES. Data and methods: Player account data include information on the home location and expenditure of the entire EGM gambling population across every EGM venue located in the Helsinki region, Finland. High-resolution (250 × 250 m) grid-level data on socioeconomic variables were used to obtain the local socioeconomic conditions of the players. EGM accessibility was estimated for every grid cell using a calibrated gravity model derived from the player account data. Statistical analyses included correlation analysis, spatial autocorrelation analysis, and regression models. Results: First, significantly higher levels of EGM accessibility were found in areas with lower local SES. Second, regression analysis revealed that both higher EGM accessibility and lower local SES were associated with higher annual losses per adult. These results, in combination with visual and spatial autocorrelation analyses, revealed that accessibility to EGM gambling is highly concentrated, especially in lower socioeconomic neighborhoods with higher levels of EGM expenditure. Conclusions: The results lay the groundwork for future spatial research on gambling harm, expenditure, accessibility, and SES utilizing detailed account data on the interaction between players and venues. The results underscore the importance of spatial restrictions when regulating EGM accessibility, particularly in areas with vulnerable populations, as a crucial measure for public health and harm prevention. The results also enable targeted gambling harm prevention actions at the local level. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) poses a significant health burden, particularly among pediatric populations, leading to long-term cognitive, physical, and psychosocial impairments. Timely transfer to specialized trauma centers is crucial for optimal management, yet the influence of socioeconomic factors, such as the Area Deprivation Index (ADI), on transfer patterns remains understudied. A retrospective study was conducted on pediatric TBI patients presenting to a Level I Pediatric Trauma Center between January 2012 and July 2023. Transfer status, distance, mode of transport, and clinical outcomes were analyzed in relation to ADI. Statistical analyses were performed using Student t -test and analysis of variance. Of 359 patients, 53.5% were transferred from outside hospitals, with higher ADI scores observed in transfer patients (P < 0.01). Air transport was associated with greater distances traveled and higher ADI compared to ground ambulance (P < 0.01). Despite similarities in injury severity, intensive care unit admission rates differed between transfer modes, with no significant impact on mortality. High ADI patients were more likely to be transferred, suggesting disparities in access to specialized care. Differences in transfer modes highlight the influence of socioeconomic factors on logistical aspects. While transfer did not independently impact outcomes, disparities in intensive care unit admission rates were observed, possibly influenced by injury severity. Integrating socioeconomic data into clinical decision-making processes can inform targeted interventions to optimize care delivery and improve outcomes for all pediatric TBI patients. Prospective, multicenter studies are warranted to further elucidate these relationships. [ABSTRACT FROM AUTHOR]

We use a sample of 78,160 cases involving adults who pleaded guilty to drunk driving in a New South Wales (NSW) court between 2014 and 2019 to assess the contribution of neighbourhood disadvantage to charge dismissal. Data are analysed using a multilevel random effects model with controls for magistrate identity and legal factors that must be considered by the magistrate when deciding whether to dismiss a PCA charge against an offender. Findings indicate that magistrates with a higher dismissal rate are more lenient towards individuals from advantaged or highly advantaged socio-economic neighbourhoods. Magistrates with a lower dismissal rate, are less lenient toward those from advantaged or highly advantaged socio-economic neighbourhoods. Neighbourhood disadvantage has a statistically significant effect on judicial willingness to dismiss a charge of drink driving and record no conviction. The effect is small but affects many people. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions To examine low birth weight (LBW) in First Nations babies born in a large metropolitan health service in Queensland, Australia.A retrospective population‐based study using routinely collected data from administrative data sources. All singleton births in metropolitan health services, Queensland, Australia of ≥20 weeks gestation or at least 400 g birthweight and had information on First Nations status and born between 2019 and 2021 were included. The study measured birthweight and birthweight z‐score, and also identified the predictors of LBW. Multivariate regression models were adjusted by demographic, socioeconomic and perinatal factors.First Nations babies had higher rates of LBW (11.4% vs 6.9%, P < 0.001), with higher rates of preterm birth (13.9% vs 8.8%, P < 0.001). In all babies, the most important factors contributing to LBW were: maternal smoking after 20 weeks of gestation; maternal pre‐pregnancy underweight (body mass index <18.5 kg/m2); nulliparity; socioeconomic disadvantage; geographical remoteness; less frequent antenatal care; history of cannabis use; pre‐existing cardiovascular disease; pre‐eclampsia; antepartum haemorrhage; and birth outcomes including prematurity and female baby. After adjusting for all contributing factors, no difference in odds of LBW was observed between First Nations and non‐First Nation babies.First Nations status was not an independent factor influencing LBW in this cohort, after adjustment for identifiable factors. The disparity in LBW relates to modifiable risk factors, socioeconomic disadvantage, and prematurity. Upscaling culturally safe maternity care, focusing on modifiable risk factors is required to address LBW in Australian women. [ABSTRACT FROM AUTHOR]

Introduction: Reduced sleep health has been consistently linked with increased negative emotion in children. While sleep characteristics have been associated with neural function in adults and adolescents, much less is known about these associations in children while considering socioeconomic context. In this study,we examined the associations among socioeconomic factors, sleep duration and timing, and resting-state functional connectivity (rsFC) of the amygdala in children. Methods: Participants were typically-developing 5- to 9-year-olds from socioeconomically diverse families (61% female; N = 94). Parents reported on children's weekday and weekend bedtimes and wake-up times, which were used to compute sleep duration and midpoint. Analyses focused on amygdalaanterior cingulate cortex (ACC) connectivity followed by amygdala-whole brain connectivity. Results: Lower family income-to-needs ratio and parental education were significantly associated with later weekday and weekend sleep timing and shorter weekday sleep duration. Shorter weekday sleep duration was associated with decreased amygdala-ACC and amygdala-insula connectivity. Later weekend sleepmidpoint was associated with decreased amygdala-paracingulate cortex and amygdala-postcentral gyrus connectivity. Socioeconomic factors were indirectly associated with connectivity in these circuits via sleep duration and timing. Discussion: These results suggest that socioeconomic disadvantage may interfere with both sleep duration and timing, in turn possibly altering amygdala connectivity in emotion processing and regulation circuits in children. Effective strategies supporting family economic conditions may have benefits for sleep health and brain development in children. [ABSTRACT FROM AUTHOR]

This article explores the concept of conviviality: the practice and negotiation of sharing space in suburbs with diverse populations. Australia has a growing Muslim population and reports of Islamophobia remain widespread. While there is some evidence, however, that forming intercultural connections can foster more positive attitudes toward religious minority groups, we know little about how Muslim and non‐Muslim communities share space in Australia. This paper presents the findings of a qualitative investigation into how conviviality is perceived in Australian suburbs with high concentrations of Muslim residents. Following qualitative, thematic analysis of 15 interviews with multicultural service providers who work with Muslims in Melbourne, Victoria, we conclude that conviviality is fostered by a sense of community between people who share similar backgrounds as well as increased opportunities to form intercultural social connections. We discuss the scholarly and policy implications of these findings, with consideration of existing arguments about the practices of sharing space in Australian cities. [ABSTRACT FROM AUTHOR]

Background Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships. Methods We performed a cross-sectional analysis of data from the Childhood Cancer Survivor Study between 1970 and 1999 and self-reported financial information from 2017 to 2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material and financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status. Results Analysis was restricted to 3475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 years (interquartile range [IQR] = 33-46 years and 47 years (IQR = 39-59 years), respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings; P <.001). One quintile increases in deprivation were associated with small increases in behavioral (second quintile, P =.017) and psychological financial hardship (second quintile, P =.009; third quintile, P =.014). Lower psychological financial hardship was associated with individual factors including greater household income (≥$60 000 income, P <.001) and being single (P =.048). Conclusions Childhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Neighborhood-level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships. [ABSTRACT FROM AUTHOR]

Abstract Background Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic. Methods The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017–2022 were explored, using linear regression models. Results The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020–2022). Conclusions Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies.

Abstract Background It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020. Methods This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction. Results In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI. Conclusions Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems.

Abstract Background Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce. Methods Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05. Results First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures. Conclusion Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

Dementia is a global public health priority. Physical activity has myriad health benefits, including for reducing dementia risk. To increase physical activity, detailed understanding of influencing factors is needed. Socioeconomic deprivation affects many aspects of health and wellbeing. Qualitative research with older people experiencing socioeconomic deprivation is needed to explore barriers and enablers to engaging in physical activity, with the view to co-designing interventions for implementation trials. A whole of society approach is pivotal to improving effectiveness of physical activity interventions for older adults with cognitive impairment, and target support for people experiencing socioeconomic deprivation, to improve their health outcomes. [ABSTRACT FROM AUTHOR]

Background: Youth experiencing socioeconomic deprivation may be exposed to disadvantage in multiple contexts (e.g., neighborhood, family, and school). To date, however, we know little about the underlying structure of socioeconomic disadvantage, including whether the 'active ingredients' driving its robust effects are specific to one context (e.g., neighborhood) or whether the various contexts increment one another as predictors of youth outcomes. Methods: The present study addressed this gap by examining the underlying structure of socioeconomic disadvantage across neighborhoods, families, and schools, as well as whether the various forms of disadvantage jointly predicted youth psychopathology and cognitive performance. Participants were 1,030 school-aged twin pairs from a subsample of the Michigan State University Twin Registry enriched for neighborhood disadvantage. Results: Two correlated factors underlay the indicators of disadvantage. Proximal disadvantage comprised familial indicators, whereas contextual disadvantage represented deprivation in the broader school and neighborhood contexts. Results from exhaustive modeling analyses indicated that proximal and contextual disadvantage incremented one another as predictors of childhood externalizing problems, disordered eating, and reading difficulties, but not internalizing symptoms. Conclusions: Disadvantage within the family and disadvantage in the broader context, respectively, appear to represent distinct constructs with additive influence, carrying unique implications for multiple behavioral outcomes during middle childhood. [ABSTRACT FROM AUTHOR]

Background: Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic. Methods: The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017–2022 were explored, using linear regression models. Results: The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020–2022). Conclusions: Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies. [ABSTRACT FROM AUTHOR]

Background: Roma living in marginalized communities often face poor living conditions and material deprivation, which may negatively impact parenting. Our aim is to compare the parenting behavior (support, harsh discipline, and stimulation) of mothers from marginalized Roma communities and the majority population in Slovakia. We also examine the role of socioeconomic disadvantage and related worries in the differences in parenting behavior between these groups. Methods: We obtained cross-sectional data from mothers of children aged 14-18 months using the first wave of the longitudinal RomaREACH study dataset. Two groups were included in the sample: 93 mothers from MRCs and 102 mothers from the majority. We performed multiple regression and mediation analyses to assess whether the educational level of mothers, the degree of poverty, and poverty-related feelings of stress and worries explain parenting behavior differences between the groups of mothers. Results: We found significant differences in parenting, especially in harsh disciplining and stimulation. These two domains were significantly associated with maternal education, degree of poverty, and poverty-related stress and worries. The degree of poverty partially mediated stimulation differences between the two groups of mothers. Conclusion: Parenting in MRCs seems harsher and less stimulative than parenting in the Slovak majority. These differences are associated with the socioeconomic disadvantage of mothers. The degree of poverty partially explains why parenting in MRCs is less stimulative. These results may inform intervention efforts aimed at disadvantaged families. [ABSTRACT FROM AUTHOR]

Background: It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020. Methods: This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction. Results: In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI. Conclusions: Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems. [ABSTRACT FROM AUTHOR]

Despite much empirical evidence highlighting the harmful effect of socioeconomic disadvantage on educational outcomes, there is a relative lack of understanding of how different risk factors impact upon attainment. Importantly, it has yet to be established what effect, if any, austerity cuts have had on the most disadvantaged students. Using rich data from two British cohort studies (Next Steps and MCS), this cross-cohort study explores how educational inequalities impact on attainment in distinct cohorts of students at identical age-points, whilst also examining the role of wider political and socioeconomic circumstances. The analysis reconfirms the detrimental effect of exposure to socioeconomic risk factors on attainment, highlighting the relative importance of some (e.g. social housing) over others, and emphasising the disproportionate association of exposure to multiple risks with poorer outcomes. For both cohorts, the attainment gap is already clear at age 11, and widens at every level of risk across secondary education. Despite the implementation of austerity, no evidence is found for worsening inequalities at an individual level. However, the persistent link between disadvantage and attainment means that, on a cohort level, increasing levels of disadvantage during austerity will inevitably lead to greater proportions of young people facing an attainment 'penalty'. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between socioeconomic disadvantage using national area deprivation index (ADI) and CT-based body composition measures derived from fully automated artificial intelligence (AI) tools to identify body composition measures associated with increased risk for all-cause mortality and adverse cardiovascular events. Methods: Fully automated AI body composition tools quantifying abdominal aortic calcium, abdominal fat (visceral [VAT], visceral-to-subcutaneous ratio [VSR]), and muscle attenuation (muscle HU) were applied to non-contrast CT examinations in adults undergoing screening CT colonography (CTC). Patients were partitioned into 5 socioeconomic groups based on the national ADI rank at the census block group level. Pearson correlation analysis was performed to determine the association between national ADI and body composition measures. One-way analysis of variance was used to compare means across groups. Odds ratios (ORs) were generated using high-risk, high specificity (90% specificity) body composition thresholds with the most disadvantaged groups being compared to the least disadvantaged group (ADI < 20). Results: 7785 asymptomatic adults (mean age, 57 years; 4361:3424 F:M) underwent screening CTC from April 2004-December 2016. ADI rank data were available in 7644 patients. Median ADI was 31 (IQR 22–43). Aortic calcium, VAT, and VSR had positive correlation with ADI and muscle attenuation had a negative correlation with ADI (all p <.001). Compared with the least disadvantaged group, mean differences for the most disadvantaged group (ADI > 80) were: Aortic calcium (Agatston) = 567, VAT = 27 cm2, VSR = 0.1, and muscle HU = -6 HU (all p <.05). Compared with the least disadvantaged group, the most disadvantaged group had significantly higher odds of having high-risk body composition measures: Aortic calcium OR = 3.8, VAT OR = 2.5, VSR OR = 2.0, and muscle HU OR = 3.1(all p <.001). Conclusion: Fully automated CT body composition tools show that socioeconomic disadvantage is associated with high-risk body composition measures and can be used to identify individuals at increased risk for all-cause mortality and adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak posed impact on healthcare. This study evaluated the effect of SARS-CoV-2 outbreak on the outpatient visits of patients with type 2 diabetes and determined the most affected groups. We analyzed Taiwan's National Health Insurance data, including 1,922,702 patients diagnosed with type 2 diabetes from 2018 to 2021. Group-based trajectory modelling identified four distinct outpatient visit patterns, namely, consistently high (Group 1, 74.2%), low-to-high (Group 2, 8.1%), high-to-low (Group 3, 6.0%) and consistently low (Group 4, 11.7%) utilization. Logistic regression was used to analyze correlations between trajectory types and patients' demographics and health statuses. Group 3 members had higher odds of being male [adjusted odds ratio (aOR) = 1.04, 95% confidence interval (CI) 1.03-1.05] and earning below 20,000 New Taiwan Dollar monthly (aOR = 1.29, 95% CI 1.26-1.31) than those in Group 1. However, they were less likely to be under 80 years old (aOR = 0.70-0.97), from lower median family income regions (aOR = 0.81-0.89) or possess a Charlson Comorbidity Index score > 2 (aOR = 0.67, 95% CI 0.66-0.68). Patients with lower income in affluent areas displayed the highest likelihood of falling into Group 3. Patients with type 2 diabetes and low income from wealthy areas were vulnerable during the pandemic. This result emphasizes the need to target resources and support for this subgroup during such crises. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods: We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan–Meier survival curves and calculated the predicted marginal probability for each SHI category. Results: We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88–1.10), 1.01 (0.93–1.11), 1.02 (0.93–1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75–1.38), 1.08 (0.84–1.38), 1.18 (0.91–1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions: We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.

The substantive equality doctrine is an important aspect of legal scholarship and judicial practice built around the principles of equal treatment and non-discrimination. The doctrine departs from the critique of the "formal approach to equality" and places great expectations on the legislator and the courts vis-à-vis its equality aspirations, which encompass objectives related to both redistribution and recognition. The paper examines the relationship between its basic postulates, its equality goals, and the law as its main method. The author charts the developmental trajectory of the doctrine, provides an overview of its premises, and an analysis of its objectives. The author concludes that the proponents of the substantive equality doctrine rightly point to deeper societal structures as the source of patterned inequalities, yet they are mistaken in their belief that the subtle and complex forms of discrimination can be effectively addressed through anti-discrimination law.

Abstract Background An increased risk of cardiovascular diseases (CVD) has been associated with women’s parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. Methods The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. Results CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02–1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10–1.83; and HR = 1.39, 95% CI: 1.03–1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. Conclusions Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.

Socioeconomic disadvantage during childhood predicts an increased risk for mental health problems across the life span. Socioeconomic disadvantage shapes multiple aspects of children’s proximal environments and increases exposure to chronic stressors. Drawing from multiple literatures, we propose that childhood socioeconomic disadvantage may lead to adaptive changes in the regulation of stress response systems including the hypothalamic-pituitary-adrenal (HPA) axis. These changes, in turn, affect the development of prefrontal cortical (PFC) circuitry responsible for top-down control over cognitive and emotional processes. Translational findings indicate that chronic stress reduces dendritic complexity and spine density in the medial PFC and anterior cingulate cortex, in part through altered HPA axis regulation. Socioeconomic disadvantage has frequently been associated with reduced gray matter in the dorsolateral and ventrolateral PFC and anterior cingulate cortex and lower fractional anisotropy in the superior longitudinal fasciculus, cingulum bundle, and uncinate fasciculus during middle childhood and adolescence. Evidence of socioeconomic disparities in hair cortisol concentrations in children has accumulated, although null findings have been reported. Coupled with links between cortisol levels and reduced gray matter in the PFC and anterior cingulate cortex, these results support mechanistic roles for the HPA axis and these PFC circuits. Future longitudinal studies should simultaneously consider multiple dimensions of proximal factors, including cognitive stimulation, while focusing on epigenetic processes and genetic moderators to elucidate how socioeconomic context may influence the HPA axis and PFC circuitry involved in cognitive and emotional control. These findings, which point to modifiable factors, can be harnessed to inform policy and more effective prevention strategies.

If policy preferences follow material interests, the experience of socioeconomic disadvantage ought to increase support for redistributive policies. However, experiencing disadvantage might also reduce faith in government's ability to make things better, indirectly reducing support for redistributive action, and leading to a spiral of widening disadvantage and increasing political disengagement. Indeed, disadvantaged communities sometimes favour right-wing platforms over those offering redistribution, as in the taking of 'red wall' constituencies in the North and Midlands of England by the UK Conservative party in 2019. This article uses quantitative data from a survey of 'red wall' voters (n = 805) to examine the bases of people's perceptions of redistributive policies. We find that even a radical redistributive policy, Universal Basic Income (UBI), receives consistently high levels of support (69.45 SD 27.24). Lower socioeconomic status, greater financial distress and greater risk of destitution all increase support. These effects are partly mediated by mental distress, which is markedly higher among the less well off. However, the same socioeconomic factors also reduce faith in government, which in turn is associated with lower support. Thus, those who stand to benefit most from redistribution are aware of their material interests, but are also the least confident in the ability of government to improve their lives. As such, there is a clear political challenge for progressive politicians: those whose support they depend upon require a significant redistributive offer, but also need to be persuaded of the viability of reform to support progressive change. [ABSTRACT FROM AUTHOR]

Background: An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. Methods: The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. Results: CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02–1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10–1.83; and HR = 1.39, 95% CI: 1.03–1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. Conclusions: Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded. [ABSTRACT FROM AUTHOR]

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IntroductionReduced sleep health has been consistently linked with increased negative emotion in children. While sleep characteristics have been associated with neural function in adults and adolescents, much less is known about these associations in children while considering socioeconomic context. In this study, we examined the associations among socioeconomic factors, sleep duration and timing, and resting-state functional connectivity (rsFC) of the amygdala in children.MethodsParticipants were typically-developing 5- to 9-year-olds from socioeconomically diverse families (61% female; N = 94). Parents reported on children’s weekday and weekend bedtimes and wake-up times, which were used to compute sleep duration and midpoint. Analyses focused on amygdala-anterior cingulate cortex (ACC) connectivity followed by amygdala-whole brain connectivity.ResultsLower family income-to-needs ratio and parental education were significantly associated with later weekday and weekend sleep timing and shorter weekday sleep duration. Shorter weekday sleep duration was associated with decreased amygdala-ACC and amygdala-insula connectivity. Later weekend sleep midpoint was associated with decreased amygdala-paracingulate cortex and amygdala-postcentral gyrus connectivity. Socioeconomic factors were indirectly associated with connectivity in these circuits via sleep duration and timing.DiscussionThese results suggest that socioeconomic disadvantage may interfere with both sleep duration and timing, in turn possibly altering amygdala connectivity in emotion processing and regulation circuits in children. Effective strategies supporting family economic conditions may have benefits for sleep health and brain development in children.

BackgroundRoma living in marginalized communities often face poor living conditions and material deprivation, which may negatively impact parenting. Our aim is to compare the parenting behavior (support, harsh discipline, and stimulation) of mothers from marginalized Roma communities and the majority population in Slovakia. We also examine the role of socioeconomic disadvantage and related worries in the differences in parenting behavior between these groups.MethodsWe obtained cross-sectional data from mothers of children aged 14–18 months using the first wave of the longitudinal RomaREACH study dataset. Two groups were included in the sample: 93 mothers from MRCs and 102 mothers from the majority. We performed multiple regression and mediation analyses to assess whether the educational level of mothers, the degree of poverty, and poverty-related feelings of stress and worries explain parenting behavior differences between the groups of mothers.ResultsWe found significant differences in parenting, especially in harsh disciplining and stimulation. These two domains were significantly associated with maternal education, degree of poverty, and poverty-related stress and worries. The degree of poverty partially mediated stimulation differences between the two groups of mothers.ConclusionParenting in MRCs seems harsher and less stimulative than parenting in the Slovak majority. These differences are associated with the socioeconomic disadvantage of mothers. The degree of poverty partially explains why parenting in MRCs is less stimulative. These results may inform intervention efforts aimed at disadvantaged families.

The misconception that eating disorders are conditions of affluence has shaped research and public understanding for decades. Here, we highlight links between socioeconomic disadvantage and eating disorder risk. With prevailing stereotypes discredited, we argue that considering disadvantage as a key eating disorder risk factor will advance science and reduce disparities The misconception that eating disorders are conditions of affluence has shaped research and public understanding for decades. Here, we highlight links between socioeconomic disadvantage and eating disorder risk. With prevailing stereotypes discredited, we argue that considering disadvantage as a key eating disorder risk factor will advance science and reduce disparities. [ABSTRACT FROM AUTHOR]

Abstract In the digital age, the internet has become an essential source of information gathering and maintains a network of social contact. In this paper, we use microdata from the China Family Panel Studies to examine the effects of guardian's internet use on teenager's cognitive skills. Using mobile internet users and base station density as instruments, we found that guardian's internet use had a significant impact on teenager's cognitive abilities as measured by math and verbal tests. Heterogeneity analysis shows that the impact is more substantial for guardians in rural areas and less‐educated guardians. Further exploration of the mechanism shows that internet usage affects cognitive skills through monetary investment, time investment, and parental environment. The result suggests that promoting internet usage for less educated families in rural areas can potentially improve children's academic performance and decrease inequality across regions and generations.

Internet usage is a salient developmental factor in adolescents' lives. Although relevant correlates of Internet use have been documented earlier, there is a lack of information on lower socioeconomic status groups. This is important, as these adolescents have increased risk of negative online experiences. The current survey aimed to explore Internet use and parental involvement amongst adolescents from areas of socio-economic disadvantage in 30 urban schools across five European countries. A total of 2594 students participated, of whom 90% were 14–16 years. Virtually all adolescents of socioeconomic disadvantage had Internet access, with 88.5% reporting spending more than two hours per day online, often on apps such as Instagram, Snapchat, and YouTube. Almost one-third of adolescents did not talk with their parents about their Internet use and almost two-thirds indicated that their parents were only a little or not interested in their Internet use. A consistent finding across countries was that girls more often talked with their parents about their Internet use and more often reported that their parents were interested in their Internet use than boys. The results suggest that parents have an important task in explicitly showing interest in their adolescents' Internet use, with special attention needed for boys. [ABSTRACT FROM AUTHOR]

Although socioeconomic conditions are crucial predictors of adult attachment, the relationships between attachment patterns and distinct dimensions of socioeconomic disadvantage, reflecting its structure as a multi-faceted social construct, remain largely unexplored. Moreover, the overwhelming majority of the previous studies utilized samples from Western, educated, industrialized, rich, and democratic (WEIRD) societies, so little is known about how these relationships unfold in underrepresented cultural contexts. To fill these gaps, we explored the relationships between attachment dimensions and multiple indicators of socioeconomic disadvantage in a large community sample of married couples (N = 2622) in Turkey. We expected that indicators of socioeconomic disadvantage would be positively related to both attachment anxiety and avoidance, particularly among women. In line with our expectations, we found that several indicators of socioeconomic disadvantage are related to both dimensions of insecure attachment. Furthermore, lower income levels emerged as a predictor for women's attachment avoidance. Results are discussed in light of gender, evolutionary, and cultural perspectives. [ABSTRACT FROM AUTHOR]

Background: A combination of walking, other moderate physical activity, and vigorous physical activity is recommended for achieving good health. Vigorous activity has unique health benefits but may be less accessible to disadvantaged people. To reduce health inequity, we need to understand the differences in physical activity participation among socioeconomic subgroups and whether this is changing over time. Methods: Data from the 2002 to 2015 Adult New South Wales Population Health Surveys (164,652 responses) were analyzed to investigate trends in walking, moderate and vigorous physical activity participation by socioeconomic status as measured by educational attainment. Analysis used age- and sex-adjusted multivariable linear models that accounted for complex survey design. Results: In 2002, the highest socioeconomic group spent 18.5 (95% confidence interval, 8.2–28.8) minutes per week more than the lowest socioeconomic group being vigorously active. By 2015, this gap had steadily increased to 41.4 (95% confidence interval, 27.6–55.1) minutes per week. Inequity between groups was also found for duration of moderate activity but not for time spent walking. Conclusions: Low participation in vigorous activity in the lowest socioeconomic group is likely driving increasing inequities in physical activity and widening participation gaps over time. Barriers preventing the most disadvantaged people in New South Wales from engaging in vigorous activity should be addressed urgently. [ABSTRACT FROM AUTHOR]

Evidence from around the world shows low university participation among young people from low socioeconomic status backgrounds. A common concern is that disadvantaged young people may be unable to afford higher education costs. Using data on government benefits intended to support students from low income households in high school, we identify students at risk of being unable to pay higher education costs. Large differences in university participation rates are observed which are no longer evident after controlling for high school achievement. Results suggest improving high school achievement is an important channel through which disadvantaged student participation may be improved. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the presence or absence of accredited breast imaging facilities in ZIP codes with high or low neighborhood socioeconomic deprivation. A retrospective ecological study design was used. Neighborhood socioeconomic disadvantage rankings at the ZIP code level were defined by the University of Wisconsin Neighborhood Atlas Area Deprivation Index. Outcomes included the presence or absence of FDA- or ACR-accredited mammographic facilities, accredited stereotactic biopsy or breast ultrasound facilities, and ACR Breast Imaging Centers of Excellence. US Department of Agriculture rural-urban commuting area codes were used to define urban and rural status. Access to breast imaging facilities in high-disadvantage (≥97th percentile) and low-disadvantage (≤3rd percentile) ZIP codes was compared using χ2 tests, stratified by urban or rural status. Among 41,683 ZIP codes, 2,796 were classified as high disadvantage (1,160 rural, 1,636 urban) and 1,028 as low disadvantage (39 rural, 989 urban). High-disadvantage ZIP codes were more likely rural (P <.001) and less likely to have FDA-certified mammographic facilities (28% versus 35%, P <.001), ACR-accredited stereotactic biopsy (7% versus 15%, P <.001), breast ultrasound (9% versus 23%, P <.001), or Breast Imaging Centers of Excellence (7% versus 16%, P <.001). Among urban areas, high-disadvantage ZIP codes were less likely to have FDA-certified mammographic facilities (30% versus 36%, P =.002), ACR-accredited stereotactic biopsy (10% versus 16%, P <.001), breast ultrasound (13% versus 23%, P <.001), and Breast Imaging Centers of Excellence (10% versus 16%, P <.001). People living in ZIP codes with high socioeconomic disadvantage are less likely to have accredited breast imaging facilities within their ZIP codes, which may contribute to disparities in access to breast cancer care experienced by underserved groups living in these areas. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic deprivation drives poor functional outcomes after intracerebral hemorrhage (ICH). Stroke severity and background cerebral small vessel disease (CSVD) burden have each been linked to socioeconomic status and independently contribute to worse outcomes after ICH, providing distinct, plausible pathways for the effects of deprivation. We investigate whether admission stroke severity or cerebral small vessel disease (CSVD) mediates the effect of socioeconomic deprivation on 90-day functional outcomes. Methods: Electronic medical record data, including demographics, treatments, comorbidities, and physiological data, were analyzed. CSVD burden was graded from 0 to 4, with severe CSVD categorized as ≥3. High deprivation was assessed for patients in the top 30% of state-level area deprivation index scores. Severe disability or death was defined as a 90-day modified Rankin Scale score of 4-6. Stroke severity (NIH stroke scale (NIHSS)) was classified as: none (0), minor (1-4), moderate (5-15), moderate-severe (16-20), and severe (21+). Univariate and multivariate associations with severe disability or death were determined, with mediation evaluated through structural equation modelling. Results: A total of 677 patients were included (46.8% female; 43.9% White, 27.0% Black, 20.7% Hispanic, 6.1% Asian, 2.4% Other). In univariable modelling, high deprivation (odds ratio: 1.54; 95% confidence interval: [1.06-2.23]; p = 0.024), severe CSVD (2.14 [1.42-3.21]; p < 0.001), moderate (8.03 [2.76-17.15]; p < 0.001), moderate-severe (32.79 [11.52-93.29]; p < 0.001), and severe stroke (104.19 [37.66-288.12]; p < 0.001) were associated with severe disability or death. In multivariable modelling, severe CSVD (3.42 [1.75-6.69]; p < 0.001) and moderate (5.84 [2.27-15.01], p < 0.001), moderate-severe (27.59 [7.34-103.69], p < 0.001), and severe stroke (36.41 [9.90-133.85]; p < 0.001) independently increased odds of severe disability or death; high deprivation did not. Stroke severity mediated 94.1% of deprivation's effect on severe disability or death (p = 0.005), while CSVD accounted for 4.9% (p = 0.524). Conclusion: CSVD contributed to poor functional outcome independent of socioeconomic deprivation, while stroke severity mediated the effects of deprivation. Improving awareness and trust among disadvantaged communities may reduce admission stroke severity and improve outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Living in socially disadvantaged circumstances has a widespread impact on one’s physical and mental health. That is why individuals living in this situation are often considered vulnerable. When pregnant, not only the woman’s health is affected, but also that of her (unborn) child. It is well accepted that vulnerable populations experience worse (perinatal) health, however, little is known about the lived adversities and health of these vulnerable individuals. Objectives With this article, insights into this group of highly vulnerable pregnant women are provided by describing the adversities these women face and their experienced well-being. Methods Highly vulnerable women were recruited when referred to tailored social care during pregnancy. Being highly vulnerable was defined as facing at least three different adversities divided over two or more life-domains. The heat map method was used to assess the interplay between adversities from the different life domains. Demographics and results from the baseline questionnaires on self-sufficiency and perceived health and well-being were presented. Results Nine hundred nineteen pregnant women were referred to social care (2016–2020). Overall, women had a median of six adversities, distributed over four life-domains. The heat map revealed a large variety in lived adversities, which originated from two parental clusters, one dominated by financial adversities and the other by a the combination of a broad range of adversities. The perceived health was moderate, and 25–34% experienced moderate to severe levels of depression, anxiety or stress. This did not differ between the two parental clusters. Conclusions This study shows that highly vulnerable pregnant women deal with multiple adversities affecting not only their social and economic position but also their health and well-being.

Prenatal socioeconomic disadvantage (SD) has been linked to DNA methylation (DNAm) in adulthood, but whether such epigenetic alterations are present at birth remains unclear. We carried out an epigenome-wide analysis of the association between several measures of individual- and area-level prenatal SD and DNAm assessed in neonatal cord blood via the Infinium EpicBeadChip among offspring born to mothers of White British (N = 455) and Pakistani (N = 493) origin in the Born in Bradford Study. Models were adjusted for mother’s age, ethnicity, and education level as well as cell-type fractions and then for maternal health behaviours and neonate characteristics, and last, stratified by mother’s ethnicity. P-values were corrected for multiple testing and a permutation-based approach was used to account for small cell sizes. Among all children, housing tenure (owning versus renting) as well as father’s occupation (manual versus non-manual) were each associated with DNAm of one CpG site and index of multiple deprivation (IMD) was associated with DNAm of 11 CpG sites. Among children born to White British mothers, father’s occupation (student or unemployed versus non-manual) was associated with DNAm of 1 CpG site and IMD with DNAm of 3 CpG sites. Among children born to Pakistani mothers, IMD was associated with DNAm of 1 CpG site. Associations were largely unchanged after further adjustment for maternal health behaviours or neonate characteristics and remained statistically significant. Our findings suggest that individual- and area-level prenatal SD may shape alterations to the neonatal epigenome, but associations vary across ethnic groups.

Abstract Background There is consensus that low socioeconomic status (SES) is associated with an increased risk of acute myocardial infarction (AMI), but the extent to which traditional coronary risk factors and other characteristics of low SES mediate this effect remains uncertain. This study examined AMI patients residing in neighbouring city districts with the same local hospital despite having among the most considerable differences in mean SES in Norway. Our purpose was to assess low SES as a coronary risk factor and examine whether traditional coronary risk factors or ancestry mediate this effect. Methods Six hundred six patients (215 and 391 with a low and high neighbourhood-level SES, respectively) admitted to Diakonhjemmet Hospital with non-ST-elevation myocardial infarction (NSTEMI) between 2014 and 2017, entered analysis. Data from the Norwegian Myocardial Infarction Register were used to identify patient characteristics, and the STATA/SE 15.1 software was used to perform the statistical analyses. Results Patients from socioeconomically disadvantaged city-districts had a 4.9 years earlier onset of AMI (68.99 vs. 73.89 years; p

Abstract Background Relative age effect is defined as a phenomenon where children born early generally perform better than children born later in the same cohort. Physical activity is an important factor that might be influenced by the relative age effect. Socioeconomic factors (e.g., parent’s income, education level) are also associated with the adolescent’s physical activity. However, no existing study has examined whether socioeconomic factors moderate the relative age effect on the adolescent’s physical activity. This study aims to clarify whether and how birth month and socioeconomic factors relate to organized sports and physical activity among adolescents in Japan. Methods We conducted a questionnaire survey targeting 21,491 adolescents who live in a widespread neighborhood. We included 8102 adolescents (4087 males and 4015 females: mean age 13.1 ± 1.4) in the analysis. Based on the participants’ birth months, we divided them into four groups (April to June, July to September, October to December, January to March). We asked participants to report their organized sports participation. Using the International Physical Activity Questionnaire for Japanese Early Adolescents, we identified their moderate to vigorous physical activity (MVPA). Neighborhood-level socioeconomic factors (areal deprivation, average annual income, education level) were analyzed based on national surveys, such as the population census. We performed multilevel logistic and linear regression analysis for organized sports participation and MVPA, respectively. Moreover, a simple slope analysis was implemented if the interaction between birth month and socioeconomic factor was significant in the multilevel linear regression analysis. Results Among males, relatively younger adolescents (adolescents who were born later in the same grade) were less likely to participate in organized sports activites (OR=0.90, 95% CI 0.82–0.97, p

Lauren Swan,1,2 N Frances Horgan,3 Chie Wei Fan,4 Austin Warters,5 Maria O’Sullivan1 1Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland; 2North Dublin Homecare Ltd, Dublin, Ireland; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; 5Older Person Services CHO9, Health Service Executive (HSE), Dublin, IrelandCorrespondence: Lauren Swan, Email swanla@tcd.ieIntroduction: Socioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults.Methods: We conducted a cross-sectional analysis of data from 1591 community-dwelling adults aged 65 years and older of mean age 83.9 ± 7.1 years and in receipt of state home support in Ireland. The HP Pobal Deprivation Index was used to categorize residential areas by socioeconomic deprivation. Health variables analysed included physical dependency (Barthel Index), polypharmacy (≥ 5 medications), previous acute hospital admission, cognitive impairment, and mental health diagnoses. Associations between residential area deprivation and prespecified health outcomes were explored in multivariable logistic regression analysis.Results: In socioeconomically disadvantaged areas, high physical dependency was twice that observed in affluent areas (16.2% vs 6.9%, p = 0.009). Similarly, acute hospitalization, as the trigger for increased dependency, was more common in deprived settings (41.6% v 29.1%, p < 0.001). Polypharmacy was common in this population (67.6%), but significantly higher in deprived vs affluent settings (74.7% v 64.5%, p = 0.030). The findings persisted in multivariable analyses when adjusted for age and gender. While all participants were accessing home support, those in deprived areas were on average 6.5 years younger than in affluent areas. Associations between residential deprivation and mental health conditions or cognitive impairment, however, were not observed in this study.Conclusion: Community-dwelling older adults living in socioeconomically disadvantaged areas experienced greater polypharmacy, high physical dependency, hospitalization-associated dependency, and a 6.5-year earlier need for state home support than in affluent settings. The findings suggest that health inequality persists in populations of more advanced age and dependency and highlight a need for further research as well as community-based health and social care initiatives.Keywords: ageing in place, older adults, deprivation index, socioeconomic disadvantage, health inequalities

Socioeconomic disadvantage predicts the level of cognitive performance in old age, but findings have been mixed for trajectories of performance. This study examined associations between life-course socioeconomic conditions, including social mobility, and cognitive performance assessed in terms of level and change, across multiple cognitive domains in two independent cohorts of older adults. Data were from two Swiss population-based cohorts: CoLaus|PsyCoLaus (N = 1210, mean age 72 years) and Vivre/Leben/Vivere (N = 993, mean age 75 years). Verbal fluency, processing speed, cognitive flexibility, memory, and global cognitive performance were assessed at two time points, each spaced 6 years apart. Associations between socioeconomic conditions (father's occupation, parental education, own education, own occupation, household income, and social mobility) and cognitive performance were examined within each cohort, and using pooled data. Covariates included health behaviors, comorbidities, and depressive symptoms. Across cohorts, socioeconomic disadvantage predicted a lower level of performance across different cognitive domains, including processing speed, verbal fluency, and memory. Moreover, individuals who experienced life-course socioeconomic disadvantage performed worse than those who experienced upward social mobility. Associations between socioeconomic disadvantage and cognitive decline were less consistent. Life-course socioeconomic conditions predict performance level across different cognitive domains, and, to a lesser extent, performance trajectories. [ABSTRACT FROM AUTHOR]

Disruptions caused by COVID‐19 have the potential to create long‐term negative impacts on children's well‐being and development, especially among socioeconomically disadvantaged children. However, we know little about how socioeconomically disadvantaged families are coping with the pandemic, nor the types of support needed. This study presents qualitative analysis of responses to an open‐ended question asking parents how children are coping with the restrictions associated with COVID‐19, to identify areas in which these cohorts can be supported. Four main themes were identified: health concerns, schooling difficulties, social isolation and adjustment to restrictions. Health concerns included exacerbation of pre‐existing health conditions, fear about the virus, difficulty getting children to understand the pandemic and increased sedentary behaviour. Schooling difficulties referred to the challenges of home schooling, which were behavioural (e.g. difficulty concentrating) and logistical (e.g. technology). Social isolation, expressed as missing friends, family and/or institutions was common. Finally, parents expressed that children experienced both positive adjustments to restrictions, such as spending more time with family, and negative adjustments such as increased screen time. Many responses from parents touched on topics across multiple themes, indicating a need for comprehensive, holistic assessment of children's and families' needs in the provision of support services. The content of the themes supports calls for resources to support children and families including increased financial and practical accessibility of social services, physical health and exercise support, mental health support and COVID‐19 communication guides. [ABSTRACT FROM AUTHOR]

BackgroundSocioeconomic deprivation drives poor functional outcomes after intracerebral hemorrhage (ICH). Stroke severity and background cerebral small vessel disease (CSVD) burden have each been linked to socioeconomic status and independently contribute to worse outcomes after ICH, providing distinct, plausible pathways for the effects of deprivation. We investigate whether admission stroke severity or cerebral small vessel disease (CSVD) mediates the effect of socioeconomic deprivation on 90-day functional outcomes.MethodsElectronic medical record data, including demographics, treatments, comorbidities, and physiological data, were analyzed. CSVD burden was graded from 0 to 4, with severe CSVD categorized as ≥3. High deprivation was assessed for patients in the top 30% of state-level area deprivation index scores. Severe disability or death was defined as a 90-day modified Rankin Scale score of 4–6. Stroke severity (NIH stroke scale (NIHSS)) was classified as: none (0), minor (1–4), moderate (5–15), moderate–severe (16–20), and severe (21+). Univariate and multivariate associations with severe disability or death were determined, with mediation evaluated through structural equation modelling.ResultsA total of 677 patients were included (46.8% female; 43.9% White, 27.0% Black, 20.7% Hispanic, 6.1% Asian, 2.4% Other). In univariable modelling, high deprivation (odds ratio: 1.54; 95% confidence interval: [1.06–2.23]; p = 0.024), severe CSVD (2.14 [1.42–3.21]; p

The aim of this study was to explore key informants' views on and experiences with Covid-19 vaccine hesitancy in a Dublin community with a high concentration of economic and social disadvantage and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake. Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes. Drivers of vaccine hesitancy identified by key informants largely fell under the WHO '3Cs' model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth 'C' whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine's effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific solutions involve the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions. The proposed Confidence, Complacency, Convenience, Covid-19 Communications ('4Cs') model provides a tool for considering vaccine hesitancy in disadvantaged urban communities reacting to the rapid development and distribution of a novel vaccine. The model and in-depth key informants' perspectives can be used to compliment equitable vaccination efforts currently underway by public health agencies and non-governmental organizations. [ABSTRACT FROM AUTHOR]