Socioeconomic status,food security,and chewing discomfort of Korean elders: results from the Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVESThe purpose of this study was to investigate the association between socioeconomic status and chewing discomfort and identify the role of food insecurity in the association''s causal pathway in a representative sample of Korean elders.MATERIALS/METHODSWe conducted cross-sectional analyses of the Korea National Health and Nutrition Examination Survey (2013–2015) data for elders aged ≥ 65 years. Socioeconomic status indicators used included household income and education level. Chewing discomfort was assessed according to the self-reported presence of chewing problems. Food security was surveyed using a questionnaire based on the US Household Food Security Survey Module.RESULTSThe odds ratios of chewing discomfort in the 1st and 2nd income quartiles were 1.55 (95% confidence interval [CI], 1.15–2.10) and 1.40 (95% CI, 1.03–1.90), respectively, compared to participants in the highest income quartile. Participants with the lowest education level were 1.89 (95% CI, 1.30–2.75) times more likely to have chewing discomfort than those without chewing discomfort. After including food security in the final model, the logistic coefficients were attenuated in the income and education quartiles.CONCLUSIONSLow socioeconomic status was associated with chewing discomfort. In addition, the results confirm that food insecurity can mediate the association between socioeconomic inequalities and chewing discomfort among the elderly.     

Inpatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education,occupational class,income, and employment

The object of the study was to describe socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Information from the 1996 Finnish Hospital Discharge Register was linked with the 1995 Population Census. Poisson regression analyses were made with the total and the gainfully employed workforce aged 20-64 y as reference. All 48 public and seven private acute care general hospitals treating LIDD patients in Finland. In the workforce, 4643 patients aged 20-64 y (3692 among the gainfully employed) were admitted to the hospital due to LIDD (ICD-10: M51.1-M51.9) in 1996. About one-half were treated surgically. The duration of unemployment in 1995 was inversely associated with hospitalisation for LIDD in 1996, allowing for age, sex, education and personal income (unemployed for 12 months vs 0 months: rate ratio 0.66; 95% CI 0.57-0.77). Among those employed for 12 months in 1995, the level of education was inversely associated with the hospital admission rate. The rate was also higher in manual occupations as compared with the upper white-collar employees. The associations were clearer among the medically than the surgically treated patients. Hospitalisation for back disorder was, however, less common in the lowest income group as compared with the highest (0.65; 0.57-0.77) allowing for education, occupational class, age and sex. Women were less often admitted to the hospital than men, allowing for the socioeconomic factors (0.83; 0.77-0.90). When indicated by education or occupation, low socioeconomic status was associated with a relatively high rate of inpatient hospital care for LIDD. When indicated by personal income, the situation was the reverse. Unemployment and female gender predicted a relatively low rate of hospitalisation.     

Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic,geographic, maternal,and child characteristics

BackgroundEthiopia is a priority country of Gavi, the Vaccine Alliance to improve vaccination coverage and equitable uptake. The Ethiopian National Expanded Programme on Immunisation (EPI) and the Global Vaccine Action Plan set coverage goals of 90% at national level and 80% at district level by 2020. This study analyses full vaccination coverage among children in Ethiopia and estimates the equity impact by socioeconomic, geographic, maternal and child characteristics based on the 2016 Ethiopia Demographic and Health Survey dataset.MethodsFull vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose pneumococcal (PCV3), and 2-dose rotavirus vaccines) of 2,004 children aged 12–23 months was analysed. Mean coverage was disaggregated by socioeconomic (household wealth, religion, ethnicity), geographic (area of residence, region), maternal (maternal age at birth, maternal education, maternal marital status, sex of household head), and child (sex of child, birth order) characteristics. Concentration indices estimated wealth and education-related inequities, and multiple logistic regression assessed associations between full vaccination coverage and socioeconomic, geographic, maternal, and child characteristics.ResultsFull vaccination coverage was 33.3% [29.4–37.2] in 2016. Single vaccination coverage ranged from 49.1% [45.1–53.1] for PCV3 to 69.2% [65.5–72.8] for BCG. Wealth and maternal education related inequities were pronounced with concentration indices of 0.30 and 0.23 respectively. Children in Addis Ababa and Dire Dawa were seven times more likely to have full vaccination compared to children living in the Afar region. Children in female-headed households were 49% less likely to have full vaccination.ConclusionVaccination coverage in Ethiopia has a pro-advantaged regressive distribution with respect to both household wealth and maternal education. Children from poorer households, rural regions of Afar and Somali, no maternal education, and female-headed households had lower full vaccination coverage. Targeted programmes to reach under-immunised children in these subpopulations will improve vaccination coverage and equity outcomes in Ethiopia.     

The Targets for Stunting Prevention Policies in Papua,Indonesia: What Mothers’ Characteristics Matter?

The study aimed to analyze the most appropriate maternal characteristics for stunting prevention policies. The study employed secondary data from the 2017 Indonesia Nutritional Status Monitoring Survey. The study obtained weighted samples of 11,887 Papuan children under five years of age. On the other hand, the study used the nutritional status as an outcome variable and maternal characteristics as an exposure variable. The research employed the following four control variables: residence, region, under-five age, and gender. The study occupied the binary logistic regression. The results show that mothers who graduated from primary school and under were 1.263 times more likely than mothers with a college education to have stunted children. Mothers who graduated from junior high school are 1.222 times more likely than mothers with a college education to have stunted children. Mothers who graduated from senior high school were 1.122 times more likely than mothers with a college education to have stunted children. Mothers with a never-married status have a 1.138 times greater probability than divorced/widowed mothers to have stunted children. Meanwhile, married mothers are 0.936 times more likely than divorced/widowed mothers to have stunted children. The study concluded that the target group for stunting prevention policies are mothers with poor education and who are single.     

Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999.

OBJECTIVES: To examine the associations of socioeconomic status and acculturation with obesity and lifestyle characteristics that may be risk factors for diabetes and cardiovascular disease among low-income Puerto Rican women. METHODS: This cross-sectional study was conducted between 1998 and 1999 by interviewing a convenience sample of 200 low-income Puerto Rican female caretakers of young children in Hartford, Connecticut, United States of America. Various recruitment methods were used to ensure adequate representation of the target community. The associations of obesity (body mass index > or = 30.0) and lifestyle factors (physical activity, cigarette smoking, alcohol consumption, food intake) with socioeconomic status (education, employment, car ownership), acculturation, age, and marital status were examined with Spearman rho, chi-squared, and Mann-Whitney U tests and logistic regression analyses. RESULTS: Mean age was 29 years. Obesity (40%), physical inactivity (47%), and cigarette smoking (32%) were common. Less acculturated participants were 57% less likely to smoke and 54% less likely to be obese than their more acculturated counterparts. Lower socioeconomic status (not finishing high school or not owning a car) was associated with a higher likelihood of obesity, but unemployed (vs. employed) women were less likely to be obese (P < 0.05). Women who did not own a car consumed meat, eggs and fish less often than those who owned a car. Smokers were more likely to have an unhealthy food intake pattern than nonsmokers. CONCLUSIONS: The associations of acculturation and socioeconomic status with some lifestyle characteristics suggest the need for culturally appropriate programs to promote healthy lifestyle behaviors in this low-income community.     

Prosthetic treatment in the adult French population: Prevalence and relation with demographic,socioeconomic and medical characteristics

BackgroundThe aim of this study was to estimate the prevalence of dental prosthetic treatment and to investigate the demographic, social, economic and medical factors associated with the use of fixed and removable dentures in a representative sample of adults living in France.MethodsThe data were obtained from the 2002–2003 Decennial Health Survey, a cross-sectional study of a representative sample of the population living in France, which included 29,679 adults. Information was collected by interview. The variables collected were fixed denture, removable denture, age, gender, number of children, area of residence, nationality, educational attainment, family social status, employment status, annual household income per capita, supplementary insurance, chronic disease, eyesight problems/glasses, hearing problems/hearing aids. Multinomial logistic regression models were used to study the relationship between prosthetic treatment and demographic, socioeconomic and medical characteristics unadjusted, adjusted for age and adjusted for all the characteristics.ResultsThe prevalence of prosthetic treatment was 34.6% (95% confidence interval (CI): [34.1; 35.2]) for fixed prosthetic dentures and 13.8% (95% CI: [13.4; 14.2]) for removable prosthetic dentures. We showed a gradient between educational attainment and removable dentures; the odds ratio adjusted for all the variables (aOR) associated with no or primary education compared to post-secondary education was 2.56; 95% CI: [2.09; 3.13]. When annual household income per capita was low, subjects were less likely to report fixed dentures (aOR = 0.68; 95% CI: [0.62; 0.75]) than those with high annual household income per capita. Individuals without insurance less often reported fixed dentures than those with private insurance. Those reporting chronic disease were less likely to report fixed dentures (aOR = 0.87; 95% CI: [0.79; 0.95]) but more likely to report removable dentures (aOR = 1.29; 95% CI: [1.17; 1.43]) than those without chronic disease.ConclusionThis study reveals social, economic and medical inequalities in fixed and removable prosthetic treatment among adults in France.     

我国就业流动人口睡眠状况及影响因素分析

目的 了解我国18～59岁就业流动人口睡眠状况及其影响因素,为改善流动人口睡眠状况的相关政策提供依据。方法 利用2012年中国慢性病及其危险因素监测流动人口专题调查数据,该调查采用按行业分层多阶段整群抽样的方法在全国范围开展,以面对面访谈的方式,询问调查对象的人口学基本信息、行为危险因素、睡眠时间以及社会压力状况。对数据进行复杂加权后,采用多因素logistic回归模型,探讨就业流动人口睡眠状况及其影响因素。结果 共纳入43 521名研究对象,就业流动人口平均每天睡眠时间为7.77 h,女性（7.87 h）高于男性（7.69 h）。就业流动人口睡眠不足率为12.3%（95% CI：11.8%～12.7%）,45～59岁人群（21.2%）高于18～岁人群（11.2%）。多因素logistic回归分析发现,性别、年龄、婚姻状况、文化程度、职业、流入地区、行为危险因素、BMI、社会压力、自评健康状况和自报患有慢性病是影响流动人口睡眠不足率的主要因素。男性流动人口睡眠不足率是女性的1.18倍（95% CI：1.07～1.31）;吸烟人群是不吸烟人群的1.22倍（95% CI：1.11～1.33）;过量饮酒人群是正常人群的1.31倍（95% CI：1.16～1.49）;工作和生活压力较大的流动人口睡眠不足率是没有工作和生活压力人群的1.46倍（95% CI：1.29～1.65）和1.33倍（95% CI：1.18～1.50）。结论 我国就业流动人口睡眠不足率受多种因素的影响,政府有关部门应加强对流动人口睡眠状况的重视,不断提高流动人口的睡眠质量。     

The Association Between Women's Self-Rated Health and Satisfaction with Environmental Services in an Underserved Community in Lebanon

This research evaluated the association between women's self-rated health and a number of socioeconomic and environmental health indicators relating to drinking water services in an underserved Lebanese community. A population-based, cross-sectional survey using interviews was adopted to obtain information from female homemakers of 2,223 households in the town of Bebnine, Lebanon. The questionnaire included indicators on self-rated health, satisfaction with water quality, source of drinking water, occurrence of diarrhea, and socioeconomic variables, such as education, occupation, and perceived economic status. Self-rated health was categorized as poor, fair, and good. Odds ratios for poor and fair compared to good self-rated health values were calculated using multinomial logistic regression. A total of 712 women (32%) reported poor self-rated health. Women who perceived their household income to be worse than others in town were four times as likely to report poor health. Compared to women who were satisfied with drinking water quality, dissatisfied women were 42% more likely to report poor health. Women living in households reporting recent episodes of diarrheal illness had poorer health ratings than those without. The findings suggest a positive relationship between individual perceptions of water quality and self-rated health. Community concerns over their surrounding environment serve as a primary guide for infrastructural development and government policy.     

HIV感染者及艾滋病患者就医告知情况及影响因素分析

目的 了解HIV感染者及艾滋病患者(HIV/AIDS)在就医过程中,向医生告知其感染HIV情况及其影响因素。方法 依托HIV/AIDS随访方式,在7个省份的疾病预防控制中心、社会组织活动场所以及抗病毒定点治疗医院对目标人群进行调查,采用SAS 9.2软件进行统计学分析,率的比较采用χ²检验,应用非条件logistic回归进行单因素和多因素分析。结果 共调查HIV/AIDS 2 432例,就医时未主动告知率为49.7%(716/1 442),其中男性、18~30岁年龄组、小学以上文化程度、民营/三资/个体职业、居住地为小型城市的调查对象不主动告知率分别为51.9%(559/1 077)、62.9%(212/337)、58.1%(555/955)、65.7%(241/367)和62.5%(197/315),传播途径中性传播未主动告知率最高,达66.3%(275/415)。多因素logistic回归分析表明,既往非法采供血传播途径的调查对象在就医时更愿意主动告知(OR=0.083,95%CI:0.049~0.141);民营/三资/个体职业患者在就医时更不愿意主动告知(OR=1.531,95%CI:1.017~2.304)。结论 HIV/AIDS就医时未主动告知率高,应对HIV/AIDS、医务工作者和社会公众进行针对性宣传教育,以提高HIV/AIDS就医时主动告知率。     

Prevalence of malnutrition in free living elderly people in Iran: a cross-sectional study

INTRODUCTION: The elderly are a particularly vulnerable group. Malnutrition is common and increases an old person's vulnerability to disease. We determine the prevalence of malnutrition in free living elderly people and its relationship with nutritional status and some socioeconomic conditions. METHODS: Nutritional status and its relationship with socioeconomic conditions were evaluated using Mini Nutritional Assessment in free-living elderly people (n=1962 using cluster sampling, 917 male/1045 female, aged>60). RESULTS: Among the population, 42.7% were well nourished, 12.0% malnourished and 45.3% at risk of malnutrition. There was more malnutrition in females compared to males (13% vs. 10.8%; p<0.001), rural than urban (14.8% vs. 9.9%; p<0.001), non educated than educated (13.3% vs 6.9%; p<0.001), lonely than living with family (17.5% vs. 10.3%; p<0.001), unemployed than employed (13.3% vs. 6.3%; p<0.05), elderly on income support (Behsisty charity) compared with elderly on retirement salary, (41.7% vs. 3.3%; p<0.05). Total Mini Nutritional Assessment scores correlated significantly with length of education, age, waist circumference, and body mass index (r =0.426, -0.142, 0.355 and 0.269 respectively). CONCLUSION: This study revealed a 12% malnutrition prevalence in this elderly group, with higher percentages in special socioeconomic conditions. Health care providers need to be aware of this problem and its scope. These results reinforce the need to screen, monitor and support elderly people.     

Working with cancer: health and disability disparities among employed cancer survivors in the U.S

IntroductionApproximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer.MethodsCross-sectional data pooled from the 1997–2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n = 22,952) and those without (n = 358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors.ResultsRelative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor–fair health (0.25; 0.24–0.26) and (2.06; 1.96–2.17) respectively, and ≥ 2 functional limitations (0.37; 0.35–0.38) and (1.72; 1.64–1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers.ConclusionBlue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers.     

Role of employment or scholar status and gender: Drug use among 18 to 25 year-olds in France in 2005

BackgroundIn France, drug use levels of college students remain quite unknown, mainly because of the lack of representative samples of this specific part of the population. There is also a lack of studies concerning gender and drug use.MethodsThe Health barometer 2005 is a wide national telephone survey which is representative of the 12–75-year-olds (n = 30,514). Among the 18–25-year-olds, 1290 students were surveyed, besides 1480 employed and 538 unemployed people. Various licit and illicit drug use levels of these three groups were compared using logistic regression models for men and women, controlling for age, level of diploma, category of area of residence, living in couple, religion and type of phone equipment. These results were compared with those obtained in the Health Barometer 2000, with exactly the same variables and definitions.ResultsAnalysis showed that among women, alcohol and cannabis use as well as drunkenness were more frequent among unemployed and college students than among workers. For men, drug use, and especially illicit drug use, appeared more frequent among unemployed. As a consequence, gender differences for alcohol and cannabis use were lower among students than among workers or unemployed. For both sexes, logistic models controlling for age showed that alcohol consumption as well as daily tobacco smoking were less frequent among students than among employed people, contrarily to drunkenness and cannabis use. For almost all drug uses, differences between genders are smaller among students. Except for alcohol and tobacco use, these differences disappeared when controlling for other sociodemographic variables. Compared with data from year 2000, differences among the three groups appeared smaller, especially for drunkenness and cannabis smoking among college students.ConclusionAlchol and tobacco uses are less frequent among students than active people, employed or not, but there is no significant difference for drunkenness and cannabis use. For both genders, unemployment is associated with increased levels of drug use, but pursuing higher education is associated with an increased level of alcohol and cannabis use among women, which is not the case among men.     

社会经济状况对北京市急性心肌梗死患者心血管疾病危险因素分布和临床治疗的影响

目的 评估社会经济状况对北京市急性心肌梗死患者心血管疾病危险因素分布和临床治疗的影响.方法 数据来源于前瞻性、多中心、注册研究.包括2005年11月至2006年12月连续入选自北京市19家医院因患急性ST段抬高型心肌梗死并于24 h2:内到达上述医院且住院接受治疗的800名患者.主要社会经济指标包括:自述个人经济收入、受教育程度以及医疗保险情况.按照受教育程度,将患者分为社会经济状况较差和较好两组.分别比较两组患者的心血管疾病危险因素分布和住院期间临床治疗情况.结果 社会经济状况较好的患者中糖尿病和高血脂症患者的比例明显高于社会经济状况较差的患者(P＜0.05,P＜0.01).社会经济状况较差的患者中吸烟患者的比例较高(P＜0.05).社会经济状况较差的患者接受冠脉造影和经皮腔内冠状动脉成形术(PTCA)的比例明显低于社会经济状况较好的患者.医疗保险与经济收入是决定进行PTCA的最重要的两个社会经济因素.结论 与社会经济状况较差的冠心病患者相比,社会经济状况较好的患者其危险因素中,高脂血症和糖尿病的比例较高,而吸烟率较低;社会经济状况较差的患者接受介入性检查和治疗手段的比例较低.     

Association Between Parental Marital Status and Types of Suicidal Behavior Among Korean Adolescents: A Cross-sectional Study

ObjectivesAdolescent suicide is a global problem. This study aimed to identify associations between parental marital status and suicidal behavior.MethodsThis study analyzed 118 715 middle and high school students from the 13th and 14th Korea Youth Risk Behavior Web-based Survey. The odds ratios (ORs) of suicidal ideation, planning, and attempts were calculated based on parental marital status, living situation, and socioeconomic factors. The data were analyzed using multiple logistic regression.ResultsWhen compared to those living with 2 married biological parents, the ORs of suicidal ideation among adolescents living with either remarried or no parents were 1.34 (95% confidence interval [CI], 1.17 to 1.53) and 1.36 (95% CI, 1.11 to 1.66), respectively. For suicidal planning, the OR of those living with 1 remarried biological parent was 1.24 (95% CI, 1.01 to 1.52), and that of those living without parents was 1.28 (95% CI, 0.95 to 1.73), when compared to adolescents living with 2 married biological parents. For suicide attempts, when compared to adolescents with 2 married biological parents, the OR of those living with 1 remarried biological parent was 1.48 (95% CI, 1.17 to 1.87) and that of those living without parents was 2.02 (95% CI, 1.44 to 2.83). For adolescents living with 1 remarried biological parent, suicidal behavior was strongly associated with having no siblings and were weakly associated with not living with grandparents.ConclusionsSuicidal behavior among adolescents was associated with the remarriage and loss of parents. Therefore, special attention and interventions are needed for adolescents in those situations.     

中美欧中老年人健康预期寿命及其社会经济因素比较研究

目的 计算和比较中国、美国、欧盟发展中国家和发达国家中老年人健康预期寿命（HLE）,分析社会经济因素对不同国家或地区中老年人生命长度及质量的影响。方法 使用2010-2019年调查,数据分别来自中国老年健康与退休追踪调查、美国老年人健康和退休调查以及欧洲健康、老龄化和退休调查,其中欧盟发达国家和欧盟发展中国家被分为两组分别计算。选择文化程度、家庭经济水平以及工作退休状态作为社会经济指标,日常生活自理能力作为健康状态指标。使用多状态生命周期表法计算在某一时段内不同健康状态间的转换概率,测算HLE。结果 研究共纳入69 544例中老年人,年龄上,欧盟发达国家和美国中老年人在各年龄段中均有更高HLE;性别上,仅中国女性的HLE低于中国男性。社会经济因素上,文化程度较高、家庭经济水平高的中老年人有更高HLE;在中国,工作的中老年人有更高的HLE,而在美国女性和欧盟发达国家,退休/无业的中老年人有更高的HLE。结论 人口和社会经济因素对不同国家或地区中老年人的HLE影响有所不同,作为发展中国家,中国应当更加关注女性、文化程度较低、家庭经济水平低的退休中老年人健康。     

Sociodemographic and socioeconomic differences in sleep duration and insomnia-related symptoms in Finnish adults

ABSTRACT: BACKGROUND: Poor sleep tends to be patterned by sociodemographic and socioeconomic factors. The aim of this study was to examine the associations of sociodemographic and socioeconomic factors with sleep duration and insomnia-related symptoms across life course. METHODS: We used cross-sectional Health 2000 Survey (2000-2001) among a total of 5,578 adult Finns, aged 30-79 years, representative of adult Finnish population. Data about sociodemographic and socioeconomic circumstances, insomnia-related symptoms over the previous month as well as average sleep duration were collected by questionnaires. Multinomial logistic regression models were adjusted first for gender and age, second for sociodemographic factors, and third for all covariates simultaneously. RESULTS: On average 70% of Finnish adults slept 7-8 hours a day. Frequent insomnia-related symptoms were more prevalent among women (14%) than men (10%). Not being married, not having children, having low education, low income, being unemployed, and being a disability retiree were associated with frequent insomnia-related symptoms. Similar factors were associated with short and long sleep duration. However, childhood socioeconomic position was mostly unrelated to sleep in adulthood except parental education had some associations with short sleep duration. CONCLUSIONS: Disadvantaged socioeconomic position in adulthood, in particular income and employment status, is associated with poorer sleep. When promoting optimal sleep duration and better sleep quality, families with low incomes, unemployed people, and disability retirees should be targeted. Key words: marital status; parental status; education; employment status; household income; residential area; insomnia-related symptoms; sleep duration; life course; self-perceived health.     

Changes in activities of daily living (ADL) among elderly Chinese by marital status, living arrangement, and availability of healthcare over a 3-year period

Objectives  The purpose of this study was to assess how changes from different baselines of activities of daily living (ADL) can be explained by marital status, living arrangement and healthcare. Methods  Using data from the Chinese Longitudinal Health Longevity Study conducted in 2002 and 2005, 8,099 surviving and 3,822 deceased elderly aged 65 years and over were evaluated using multinomial logistic regression. Results  After adjusting for demographic, socioeconomic and health factors, elderly who were either married or living alone were less likely to encounter ADL decline compared to their counterparts. This was true only for those with fully independent ADL at baseline. Notably, once the functional status of the elderly declined from baseline and they became dependent on others, the status of living alone was no longer a significant predictor of the rate of future decline. On the other hand, elderly who had a spouse, children or other relatives as caregivers were more likely to experience a faster recovery and lower likelihood of death, compared to those who were cared by unrelated live-in caregivers. In addition, Chinese elderly with health insurance had a lower likelihood of death than their counterparts lacking health insurance, among those with ADL at the dependent baseline. Conclusions  Although there has been a change in family structure and living arrangements, the majority of Chinese elderly still rely on traditional forms of family support, especially after acquiring dependency status. As the elderly have different functional levels, healthcare policies in China should consider the need for both community and family support systems.     

Social inequality in perceived environmental exposures in relation to housing conditions in Germany

In Germany the impact of socioeconomic factors on environmental exposures and adverse housing conditions has been rarely studied up to now. The aim of our study was to assess whether and, if yes, how perceived exposure to noise and air pollution is influenced by socioeconomic status in Germany. We used data from a large-scale population-based survey. In this survey, data on perceived exposure to noise and air pollution and on socioeconomic status and housing conditions were collected on an individual basis. The study population consisted of 7,275 adults aged 17-98 years (40% women), each representing the head of one household. For the association between perceived environmental exposure and social factors confounder-adjusted odds ratios (OR) with 95% confidence intervals were calculated by binary or ordinal logistic regression. In bivariate analyses subjects with non-German nationality, East Germans, respondents with low income, those with lower educational and occupational status, and subjects living in adverse housing conditions were more likely to report being highly exposed. In multivariate analyses high perceived exposure to noise was associated with low household income (OR 1.52 [95% CI 1.13-2.05] lowest versus highest income group). Perceived air pollution exposure was also related to household income (1.67 [1.14-2.44] lower middle versus highest income group). Further associated variables were need for renovation of the house, type of house, and type of neighborhood. This study shows that in Germany, as in other industrial countries, environmental exposures are distributed unequally and that especially economic differences play important roles.     

Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran

ObjectivesThe incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran.MethodsThis cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality.ResultsThe overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, −0.077: 95% confidence interval, −0.103 to −0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model.ConclusionsThe most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.