Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors : a prospective cohort study with 17-years of follow up

Background The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. Methods The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). Results A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. Conclusions Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.

Multilevel determinants of breast cancer survival : association with geographic remoteness and area-level socioeconomic disadvantage

A major priority for cancer control agencies is to reduce geographical inequalities in cancer outcomes. While the poorer breast cancer survival among socioeconomically disadvantaged women is well established, few studies have looked at the independent contribution that area- and individual-level factors make to breast cancer survival. Here we examine relationships between geographic remoteness, area-level socioeconomic disadvantage and breast cancer survival after adjustment for patients’ socio- demographic characteristics and stage at diagnosis. Multilevel logistic regression and Markov chain Monte Carlo simulation were used to analyze 18 568 breast cancer cases extracted from the Queensland Cancer Registry for women aged 30 to 70 years diagnosed between 1997 and 2006 from 478 Statistical Local Areas in Queensland, Australia. Independent of individual-level factors, area-level disadvantage was associated with breast-cancer survival (p=0.032). Compared to women in the least disadvantaged quintile (Quintile 5), women diagnosed while resident in one of the remaining four quintiles had significantly worse survival (OR 1.23, 1.27, 1.30, 1.37 for Quintiles 4, 3, 2 and 1 respectively).) Geographic remoteness was not related to lower survival after multivariable adjustment. There was no evidence that the impact of area-level disadvantage varied by geographic remoteness. At the individual level, Indigenous status, blue collar occupations and advanced disease were important predictors of poorer survival. A woman’s survival after a diagnosis of breast cancer depends on the socio-economic characteristics of the area where she lives, independently of her individual-level characteristics. It is crucial that the underlying reasons for these inequalities be identified to appropriately target policies, resources and effective intervention strategies.

Reported consumption of takeaway food and its contribution to socioeconomic inequalities in body mass index

The aim of this study was to examine whether takeaway food consumption mediated (explained) the association between socioeconomic position and body mass index (BMI). A postal-survey was conducted among 1500 randomly selected adults aged between 25 and 64 years in Brisbane, Australia during 2009 (response rate 63.7%, N=903). BMI was calculated using self-reported weight and height. Participants reported usual takeaway food consumption, and these takeaway items were categorised into "healthy" and "less healthy" choices. Socioeconomic position was ascertained by education, household income, and occupation. The mean BMI was 27.1kg/m(2) for men and 25.7kg/m(2) for women. Among men, none of the socioeconomic measures were associated with BMI. In contrast, women with diploma/vocational education (β=2.12) and high school only (β=2.60), and those who were white-collar (β=1.55) and blue-collar employees (β=2.83) had significantly greater BMI compared with their more advantaged counterparts. However, household income was not associated with BMI. Among women, the consumption of "less healthy" takeaway food mediated BMI differences between the least and most educated, and between those employed in blue collar occupations and their higher status counterparts. Decreasing the consumption of "less healthy" takeaway options may reduce socioeconomic inequalities in overweight and obesity among women but not men.

Change in walking for transport : a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults

Background Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples’ engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 – 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned? Methods The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression. Results The odds of being defined as a ‘never walker’ were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households. Conclusions Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.

Household food insecurity, diet, and weight status in a disadvantaged district of Ho Chi Minh City, Vietnam: A cross-sectional study

Background Food security exists when all people, at all times, have physical, economic and socially acceptable access to safe, sufficient, and adequately nutritious food in order to meet their dietary needs for an active and healthy life. For high income countries and those experiencing the nutrition transition, food security is not only about the quantity of available food but also the nutritional quality as related to over- and under-nutrition. Vietnam is currently undergoing this nutrition transition, and as a result the relationship between food insecurity, socio-demographic factors and weight status is complex. The primary objective of this study was to therefore measure the prevalence of household food insecurity in a disadvantaged urban district in Ho Chi Minh City (HCMC) in Vietnam using a more comprehensive tool. This study also aims to examine the relationships between food insecurity and socio-demographic factors, weight status, and food intakes. Methods A cross-sectional study was conducted using multi-stage sampling. Adults who were mainly responsible for cooking were interviewed in 250 households. Data was collected on socioeconomic and demographic factors using previously validated tools. Food security was assessed using the Latin American and Caribbean Household Food Security Scale (ELCSA) tool and households were categorized as food secure or mildly, moderately or severely food insecure. Questions regarding food intake were based on routinely used and validated questions in HCMC, weight status was self-reported. Results Cronbach’s alpha coefficient was 0.87, showing the ELCSA had a good internal reliability. Approximately 34.4% of households were food insecure. Food insecurity was inversely related to total household income (OR = 0.09, 95% CI = 0.04 - 0.22) and fruit intakes (OR = 2.2, 95% CI 1.31 - 4.22). There was no association between weight and food security status. Conclusions Despite rapid industrialization and modernization, food insecurity remains an important public health issue in large urban areas of HCMC, suggesting that strategies to address food insecurity should be implemented in urban settings, and not just rural locations. Fruit consumption among food insecure households may be compromised because of financial difficulties, which may lead to poorer health outcomes particularly related to non-communicable disease prevention and management.

SAP-Related Education - Status-Quo and Experience

Integrating Enterprise Systems solutions in the curriculum of not only universities but all types of institutes of higher learning has been a major challenge for nearly ten years. Enterprise Systems education is surprisingly well documented in a number of papers on Information Systems education. However, most publications in this area report on the individual experiences of an institution or an academic. This paper focuses on the most popular Enterprise System - SAP - and summarizes the outcomes of a global survey on the status quo of SAP-related education. Based on feedback of 305 lecturers and more than 700 students, it reports on the main factors of Enterprise Systems education including, critical success factors, alternative hosting models, and students’ perceptions. The results show among others an overall increasing interest in advanced SAP solutions and international collaboration, and a high satisfaction with the concept of using Application Hosting Centers.

Employability and job status as moderators of the effects of job insecurity on work outcomes

Despite greater use of temporary employment contracts, little is known about how employees react to job length uncertainty. Individual careers within the safety of one or two primary organisations are no longer the norm. This study investigates the effects of job insecurity and employment status (temporary/permanent) on work outcomes. Three hundred and ninety-one employees (122 temporary and 269 permanent) in low to medium level non-academic positions from two Australian universities completed a survey. The results show that a belief that comparable employment is easily available did not alleviate the negative effects of job insecurity. Work attitudes for temporaries and permanents though were differentially influenced by employee perceptions of their own employability.