Education eclipses ethnicity in predicting the development of the metabolic syndrome in different ethnic groups in midlife: the Study of Women's Health Across the Nation (SWAN)

Objective To determine the respective roles of socio‐economic status (SES) and ethnicity in the risk of incident metabolic syndrome in middle‐aged women. Design and participants A total of 3302 pre‐ and peri‐menopausal women, not receiving hormone therapy at baseline, took part in the Study of Women's Health Across the Nation, a multi‐site, community‐based, longitudinal study of the menopausal transition. The main outcome measures were to ascertain the prevalence of the metabolic syndrome and the incidence of the metabolic syndrome over 5 years of follow‐up. Results At baseline, the prevalence of the metabolic syndrome was 21% (n = 673). Among 2512 women without metabolic syndrome at baseline, 12.8% (n = 321) developed the metabolic syndrome during 5 years of follow‐up. Both ethnicity and SES were significant univariate predictors of incident metabolic syndrome. In multivariate logistic regression models that included age at baseline, menopausal status and site, baseline smoking and alcohol consumption at follow‐up visit 1, as well as baseline values of each of the components of the metabolic syndrome, only education was an independent predictor of incident metabolic syndrome. Conclusion Approximately 13% of peri‐menopausal women developed the metabolic syndrome during the 5‐year follow‐up period. Education, but not ethnicity, was an independent predictor of incident metabolic syndrome risk.     

Short-term prognosis of occupational asthma in a Finnish population

Background: Causative agents of occupational asthma (OA) are well described in literature but far less is known about factors affecting the outcome of OA. Short duration of exposure, early diagnosis when symptoms appear and further avoidance of exposure have been suggested as good prognostic factors. This study was designed to investigate a short‐term outcome of OA. Methods: The medical records of 47 Caucasian patients from a Finnish population diagnosed with OA in year 2003 were reviewed retrospectively. Employment status at 6‐month follow‐up of all patients was determined. We assessed the following potential predictors of unemployment at follow‐up: the causative agents of OA, asthma medication, spirometry results, smoking status, gender, age, occupation, atopy status, bronchial hyperresponsiveness and time to diagnosis. We calculated odd ratios (ORs) to predict employment status at follow‐up. Results: At the follow‐up examination, 23 persons (49%) were not working. At the time of follow‐up there were no significant differences in pulmonary function between those employed and those who discontinued to work. Atopy at baseline predicted diminished lung function at the 6‐month follow‐up. In addition, atopy was the only prognostic factor and was inversely related to the work discontinuation at the follow‐up [OR 0.18, 95% confidence interval (CI) 0.04–0.79]. Work continuation as an OA outcome at 6 months could not be predicted by gender, age, occupational status, exposure antigen, smoking habits or duration of symptoms before diagnosis. Conclusions: The socio‐economic short‐term prognosis of OA was relatively poor since half of the patients were not at work at the 6 months follow‐up. Please cite this paper as: Kauppi P, Hannu T, Helaskoski E, Toivio P and Sauni R. Short‐term prognosis of occupational asthma in a Finnish population. Clin Respir J 2011; 5: 143–149.     

Patterns of early transmission of pandemic influenza in London - link with deprivation

Please cite this paper as: Balasegaram et al. (2012) Patterns of early transmission of pandemic influenza in London – link with deprivation. Influenza and Other Respiratory Viruses 6(3), e35–e41. Background  During the early containment phase in England from April to June 2009, the national strategy for H1N1 pandemic influenza involved case investigation and treatment, and tracing and prophylaxis of contacts. Objective  To describe the relationship between early transmission of H1N1 pandemic influenza in London and age and socio‐economic status. Methods  Epidemiological data on cases of pandemic flu in London reported to the London Flu Response Centre were analysed to determine patterns of transmission. Results  There were 3487 reported cases (2202 confirmed, 1272 presumed and 14 probable) from 20 April to 28 June 2009, during the ‘containment’ period. The highest report rate of 206 per 100 000 (95% CI 195–218) was seen in primary school–age children (5−11 years) followed by 129 (95% CI 119–139) in secondary school–age children (12–18 years). Reports of cases were initially concentrated in affluent areas but overall showed a clear trend with deprivation and risk ratio of 2·32 (95% CI 1·94–2·78) between the most deprived and the least deprived. Conclusion  Early transmissions were highest amongst school‐aged children but linked with socio‐economic deprivation across all age groups.     

Attitudes of haemophilic patients towards their health and socio‐economic problems in Iran

Summary. Although new technologies and treatments have improved the quality of life of people with haemophilia, they still face many health and socio‐economic problems. We designed this study to identify some of these problems according to patients’ attitudes towards efforts to solve them. This cross‐sectional study was conducted in Shiraz, southern Iran, during January and May 2010. The participants were 100 patients with haemophilia who were referred to Shiraz Hemophilia Center, a major referral centre in southern Iran. A questionnaire was used to obtain data on the attitudes of haemophilic patients about some of their health and socio‐economic problems. Mean age of the patients was 28.2 ± 9.0 (range of 16–67 years). In univariate analysis, disease severity, joint involvement, HCV status, income level and educational level of the patients were found to have possible effect on patients’ attitude towards their health and socio‐economic problems. However, in multivariate model we found that only income level, educational level and HCV status as independent factors influencing the patients’ attitude towards childbearing, employment problems, occupational problems, social and friend relationship and continuing education. Haemophilic patients had many social and health problems, which could be alleviated with interdisciplinary interventions to improve their quality of life. Financial support of these patients should be taken into account to reduce their economic problems. Also, encouraging them and providing facilities to achieve a higher educational level could help them to have a better attitude towards their health and overcome the disease‐related problems.     

Diabetes risk in British adults in mid life: a national prevalence study of glycated haemoglobin.

AIMS: Information on the population at risk of developing Type 2 diabetes in the UK is scarce. We used data from the 1958 British birth cohort to estimate geographical and socio-economic variations in HbA(1c) in mid life. METHODS: Participants (n = 7799) born in England, Scotland and Wales and currently living in the UK. Individuals were classified according to the presence of Type 2 diabetes and by thresholds of HbA(1c). HbA(1c)> or = 5.5 was used as an indicator for possible subclinical alterations in glucose metabolism. RESULTS: The majority of the population had HbA(1c) < 5.5% (79.3%); 16.7% had HbA(1c) 5.5-5.9%, 2.0% 6.0-6.9% and 0.6% had HbA(1c)> or = 7.0%. Individuals from manual socio-economic groups and those living in the East of England and Scotland had a higher prevalence of HbA(1c) at or above the upper normal range (5.5%). CONCLUSIONS: Estimates from this nationwide sample suggest that a proportion of Britons are likely to have subclinical alterations in glucose metabolism by their mid 40s, and this proportion is greater in some socio-economic groups and geographical regions than in others.     

Scottish smoke‐free legislation and trends in smoking cessation

Aim To investigate trends in smoking cessation before and after the introduction of Scottish smoke‐free legislation and to assess the perceived influence of the legislation on giving up smoking and perceptions of the legislation in smokers. Design, setting and participants Longitudinal data on smoking cessation were obtained from 1998 to 2007 on a cohort of 3350 Scottish adults aged between 50 and 75 years at baseline. All members of the cohort were participating in a clinical trial of aspirin in people at moderately increased risk of cardiovascular events. A subgroup of 474 participants who had smoked in the year prior to the introduction of legislation in March 2006 also completed a questionnaire on the influence and perceptions of the smoke‐free legislation following its introduction. Measurements Smoking status was recorded yearly, including dates of quitting and restarting. Participants who gave up smoking for at least 3 months were recorded as having quit smoking. The questionnaire included scales on whether the smoke‐free legislation had helped/influenced cessation, made the individual think about/prompt them to quit and perceptions of the legislation. Findings The odds of smokers quitting annually increased throughout the 7‐year period prior to introduction of the smoke‐free legislation to 2 years afterwards (odds ratio 1.09, 95% confidence interval 1.05–1.12, P < 0.001). During 2006, the pattern of quarterly quitting rates changed, with an increase in quit rates (to 5.1%) in the 3‐month period prior to introduction of the legislation (January–March 2006). Socio‐economic status was not related to smoking cessation. In the subgroup completing the questionnaire (n = 474), 57 quit smoking between June 2005 and May 2007 and 43.9% of these said that the smoke‐free legislation had helped them to quit. Most (>70%) smokers were positive about the legislation, especially those from more affluent compared with more deprived communities (P = 0.01). Conclusions The Scottish smoke‐free legislation was associated with an increase in the rate of smoking cessation in the 3‐month period immediately prior to its introduction. Overall quit rates in the year the legislation was introduced and the subsequent year were consistent with a gradual increase in quit rates prior to introduction of the legislation. Socio‐economic status was not related to smoking cessation, but individuals from more affluent communities were more positive about the legislation.     

Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review

Recent obesity trends in children and adolescents suggest a plateau. However, it is unclear whether such trends have been experienced across socioeconomic groups. We analysed whether recent trends in child and adolescent overweight and obesity differ by socioeconomic position (SEP) across economically advanced countries. Eligible studies reported overweight and obesity prevalence in children and/or adolescents (2–18 years), for at least two time points since 1990, stratified by SEP. Socioeconomic differences in trends in child and adolescent overweight and obesity over time were analysed. Differences in trends between SEP groups were observed across a majority of studies. Over half the studies indicated increasing prevalence among low SEP children and adolescents compared to a third of studies among children and adolescents with a high SEP. Around half the studies indicated widening socioeconomic inequalities in overweight and obesity. Since 2000 a majority of studies demonstrated no change or a decrease in prevalence among both high and low SEP groups. However around 40% of studies indicated widening of socioeconomic inequalities post‐2000. While our study provides grounds for optimism, socioeconomic inequalities in overweight and obesity continue to widen. These findings highlight the need for greater consideration of different population groups when implementing obesity interventions. © 2015 World Obesity     

Prevalence of overweight in the Seychelles: 15 year trends and association with socio‐economic status

We assessed the 15‐year trends in the distribution of body mass index (BMI) and the prevalence of overweight in the Seychelles (Indian Ocean, African Region) and the relationship with socio‐economic status (SES). Three population‐based examination surveys were conducted in 1989, 1994 and 2004. Occupation was categorized as ‘labourer’, ‘intermediate’ or ‘professional’. Education was also assessed in 1994 and 2004. Between 1989 and 2004, mean BMI increased markedly in all sex and age categories (overall: 0.16 kg m^?2 per calendar year, which corresponds to 0.46 kg per calendar year). The prevalence of overweight (including obesity, BMI ≥ 25 kg m^?2) increased from 29% to 52% in men and from 50% to 67% in women. The prevalence of obesity (BMI ≥ 30 kg m^?2) increased from 4% to 15% in men and from 23% to 34% in women. Overweight was associated inversely with occupation in women and directly in men in all surveys. In multivariate analysis, overweight was associated similarly (direction and magnitude) to occupation and education. In conclusion, the increasing prevalence of overweight and obesity over time in all age, sex and SES categories suggests large‐scale changes in societal obesogenic factors. The sex‐specific association of SES with overweight suggests that prevention measures should be tailored accordingly.     

Variation in the physical activity environment according to area‐level socio‐economic position—A systematic review

Physical inactivity is a major contributing factor to obesity, and both follow a socio‐economic gradient. This systematic review aims to identify whether the physical activity environment varies by socio‐economic position (SEP), which may contribute to socio‐economic patterning of physical activity behaviours, and in turn, obesity levels. Six databases were searched. Studies were included if they compared an objectively measured aspect of the physical activity environment between areas of differing SEP in a high‐income country. Two independent reviewers screened all papers. Results were classified according to the physical activity environment analysed: walkability/bikeability, green space, and recreational facilities. Fifty‐nine studies met the inclusion criteria. A greater number of positive compared with negative associations were found between SEP and green space, whereas there were marginally more negative than positive associations between SEP and walkability/bikeability and recreational facilities. A high number of mixed and null results were found across all categories. With a high number of mixed and null results, clear socio‐economic patterning in the presence of physical activity environments in high‐income countries was not evident in this systematic review. Heterogeneity across studies in the measures used for both SEP and physical activity environments may have contributed to this result.     

Prevalence and risk factors of overweight and obesity among children and adolescents with intellectual disabilities

Recent literature reviews showed that overweight and obesity represent a major health threat in adults with intellectual disability (ID). However, the current evidence around the prevalence and risk factors associated with overweight and obesity in children and adolescents with ID remains unclear. The objective of this article was thus to review the available English‐ and French‐language studies examining the prevalence and risk factors associated with overweight and obesity in youths with ID. Ten studies providing original data on this topic were identified and included in this review. Results demonstrated that (i) overweight and obesity represent a significant secondary health problem in youths with ID; and (ii) obesity risk significantly increases with age. Considering all of the limitations of the reviewed studies (i.e. heterogeneity in sample size and in overweight and obesity classification criteria; lack of comparison group; restrictive number of risk factors examined, etc.), these findings remain preliminary and highlight the need for future research in this area.     

Socio-economic status in childhood and later alcohol use: a systematic review

AIM: To conduct a systematic review of longitudinal studies that examined the association between childhood socio-economic status (SES) and alcohol use in later life. METHODS: A systematic search to identify all longitudinal population-based studies that examined the association between childhood SES and later alcohol use. RESULTS: Nineteen relevant articles were identified (eight birth cohorts and 11 papers on school-aged cohorts). There was little consistent evidence to support an association between lower childhood SES and later (mis)use of alcohol. Only a minority of studies included assessment of problem alcohol use, and in only one study was the relationship between SES and alcohol use the main research question. CONCLUSION: We found little robust evidence to support the assumption that childhood disadvantage is associated with later alcohol use/abuse. Given the importance of this issue in terms of policy, the lack of evidence is surprising and emphasizes the need for further research in order to inform future policies and public health messages.     

Education is the strongest socio‐economic predictor of smoking in pregnancy

Aims

To investigate socio‐economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions.

Design

Cross‐sectional analysis with linked survey and register data.

Setting

South‐western Finland.

Participants

A total of 2667 pregnant women [70% of the original sample (n = 3808)] from FinnBrain, a prospective pregnancy cohort study.

Measurements

The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire‐based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio‐economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated.

Findings

Mother's education was the strongest socio‐economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI) = 1.2–3.9; P = 0.011] for tertiary vocational education, 4.4 (95% CI = 2.1–9.0; P < 0.001) for combined general and vocational secondary education, 2.9 (95% CI = 1.4–6.1; P = 0.006) for general secondary education, 9.5 (95% CI 5.0–18.2; P < 0.001) for vocational secondary education and 14.4 (95% CI = 6.3–33.0; P < 0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR = 1.8; 95% CI = 1.1–3.1; P = 0.022). Antenatal stress predicted SIP (aOR = 2.0; 95% CI = 1.4–2.8; P < 0.001), but did not attenuate its socio‐economic disparities.

Conclusions

In Finland, socio‐economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general).     

The association between hepatitis B self‐awareness and depression: Exploring the modifying effects of socio‐economic factors

China has a high prevalence of HBV. Despite previous studies, uncertainty remains about the association of HBV with depression. This study explores the strength of the association and the modifying effects of participants' self‐awareness of the disease and their socio‐economic status. Data from the baseline of a Chinese cohort study of approximately 500 000 adults were analysed. Depression was assessed using the Composite International Diagnostic Inventory. Blood spot tests were conducted to detect hepatitis B surface antigen. Logistic regression was used to assess the association between depression and HBV adjusting for demographic, socio‐economic and lifestyle factors of major depression. To understand the effect modifications of disease self‐awareness and socio‐economic factors, a series of stratified analyses were undertaken. The overall prevalence of HBV is 3.2%, with 2.8% screen‐detected and 0.3% self‐reported cases. There was an 84% increased odds of depression among self‐reported HBV patients (OR=1.84, 95% CI: 1.16‐2.90), but no association was found in the screen‐detected group (OR=0.98, 95% CI: 0.79‐1.23). Male (OR=2.28, 95% CI: 1.30‐3.98), younger age (OR=3.57, 95% CI: 1.82‐7.00), rural resident (OR=2.31, 95% CI: 1.36‐3.94), lower household income (OR=2.38, 95% CI: 1.34‐4.25) and agricultural worker (OR=2.92, 95% CI: 1.63‐5.77) were found having greater odds of depression in the HBV self‐aware group, compared to those without HBV. A strong association between hepatitis B self‐awareness and depression was found. Lower socio‐economic status could modify the association between hepatitis B status and depression. Further studies are needed to understand the underlying psychosocial mechanisms of the association.     

Affluence is not related to delay in diagnosis of Type 2 diabetes as judged by the development of diabetic retinopathy.

AIM: To determine the relationship between affluence and the presence of diabetic retinopathy at time of diagnosis of Type 2 diabetes. METHODS: Records of patients held by Southampton Retinal Screening Programme were examined. Patients (n = 1844) newly diagnosed with Type 2 diabetes and subsequently receiving photographic retinal screening within 24 months were selected. Townsend scores for social deprivation were calculated and the patients with and without retinopathy at first screening were then compared. RESULTS: No significant difference was found in the median Townsend score of those people with (-0.2, interquartile range (IQR) -3.7 to 3.8) and those without (-0.5, IQR -3.3 to 3.6) diabetic retinopathy at first screening after diagnosis of Type 2 diabetes (P = 0.6). CONCLUSION: The relative affluence of the area in which a person lives, as judged by postcode, does not appear to predict likelihood of diabetic retinopathy at diagnosis of Type 2 diabetes.     

Family average income and diagnosed Type 2 diabetes in urban and rural residents in regional mainland China.

AIMS: To explore the relationship between family average income (FAI; an index of socio-economic status) and Type 2 diabetes in a region of mainland China. METHODS: Population-based cross-sectional study, conducted between October 2000 and March 2001 in administrative villages (n = 45) randomly selected from three urban districts and two rural counties of NanJing municipality, mainland China, with a regional population of 5.6 million. Participants were all local residents aged > or = 35 years old (n = 29 340); 67.7% from urban areas, 32.3% from rural areas, 49.8% male and 50.2% female. RESULTS: The response rate of eligible participants was 90.1%. The overall prevalence of self-reported Type 2 diabetes was 1.9%. After adjustment for possible confounding variables (age, gender, area of residence, body mass index, educational level, smoking status, occupational and leisure-time physical activity), participants in the higher and middle FAI categories were more than twice as likely to have Type 2 diabetes as those in the lower FAI category. CONCLUSIONS: The prevalence of Type 2 diabetes is positively related to socio-economic status (indexed by FAI) in Chinese at the population level. After controlling for potential confounding factors, people in higher socio-economic status groups are more likely to have Type 2 diabetes. These associations are consistent with other effects of epidemiological transition and identify a need for preventive initiatives.