scholarly journals Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031251 ◽  
Author(s):  
Robert Luben ◽  
Shabina Hayat ◽  
Anthony Khawaja ◽  
Nicholas Wareham ◽  
Paul P Pharoah ◽  
...  
Keyword(s):  
Social Class ◽  
Smoking Status ◽  
Population Based ◽  
Residential Area ◽  
Education Level ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Highly Educated ◽  
Lower Education Level ◽  
Behavioural Factors

ObjectivesTo investigate whether residential area deprivation index predicts subsequent admissions to hospital and time spent in hospital independently of individual social class and lifestyle factors.DesignProspective population-based study.SettingThe European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) study.Participants11 214 men and 13 763 women in the general population, aged 40–79 years at recruitment (1993–1997), alive in 1999.Main outcome measureTotal admissions to hospital and time spent in hospital during a 19-year time period (1999–2018).ResultsCompared to those with residential Townsend Area Deprivation Index lower than the average for England and Wales, those with a higher than average deprivation index had a higher likelihood of spending >20 days in hospital multivariable adjusted OR 1.18 (95% CI 1.07 to 1.29) and having 7 or more admissions OR 1.11 (95% CI 1.02 to 1.22) after adjustment for age, sex, smoking status, education, social class and body mass index. Occupational social class and educational attainment modified the association between area deprivation and hospitalisation; those with manual social class and lower education level were at greater risk of hospitalisation when living in an area with higher deprivation index (p-interaction=0.025 and 0.020, respectively), while the risk for non-manual and more highly educated participants did not vary greatly by area of residence.ConclusionResidential area deprivation predicts future hospitalisations, time spent in hospital and number of admissions, independently of individual social class and education level and other behavioural factors. There are significant interactions such that residential area deprivation has greater impact in those with low education level or manual social class. Conversely, higher education level and social class mitigated the association of area deprivation with hospital usage.

scholarly journals Medicine package inserts from the users’ perspective: are they read and understood?

2019 ◽  
Vol 22 ◽  
Author(s):  
Tatiane da Silva Dal Pizzol ◽  
Cassia Garcia Moraes ◽  
Paulo Sérgio Dourado Arrais ◽  
Andréa Dâmaso Bertoldi ◽  
Luiz Roberto Ramos ◽  
...  
Keyword(s):  
Population Based ◽  
Education Level ◽  
Descriptive Statistics ◽  
Cross Sectional ◽  
Population Based Study ◽  
Package Inserts ◽  
Factors Associated ◽  
Written Information ◽  
Lower Education Level ◽  
Lower Education

ABSTRACT: Introduction: The written information on medicines has been acknowledged as an important tool for health education. Objective: To analyze the use and understanding of medicine package inserts by users and assess sociodemographic and medical factors associated with their comprehension. Method: Data in this analysis are part of the PNAUM National Survey - a cross-sectional population-based study conducted in Brazil. Descriptive statistics and the Pearson χ2 tests were performed to compare proportions between sociodemographic and medical characteristics, as well as use and understanding of medicine package inserts. Results: A total of 28.427 individuals responded to questions related to medicine package inserts. From these, 59.6% (95%CI 57.7 - 61.5) said they usually read the inserts, and 98.4% (95%CI 98.0 - 98.8) considered them necessary. Among people who read the medicine package inserts, more than half indicated difficulties with legibility (57.4%; 95%CI 55,2 - 59,6) and readability (54.1%; 95%CI 52.1 - 56.1). People from a lower education level reported greater difficulty in understanding them. Conclusion: The larger portion of the population usually read medicine package inserts. Nevertheless, people have difficulty in reading and understanding them.

scholarly journals Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Kathleen M Fairfield ◽  
Adam W Black ◽  
Erika C Ziller ◽  
Kimberly Murray ◽  
F Lee Lucas ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Rate Ratio ◽  
Geographic Area ◽  
Population Based ◽  
Socioeconomic Deprivation ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Behavioral Risk ◽  
Cross Sectional ◽  
Cancer Prevalence

Abstract Background We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality. Methods We conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System. Results Among 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79). Conclusion Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.

scholarly journals Education Level and Cigarette Smoking: Diminished Returns of Lesbian, Gay and Bisexual Individuals

2019 ◽  
Vol 9 (10) ◽  
pp. 103 ◽  
Author(s):  
Shervin Assari ◽  
Mohsen Bazargan
Keyword(s):  
High Risk ◽  
Cigarette Smoking ◽  
Tobacco Use ◽  
Minority Groups ◽  
Smoking Status ◽  
The United States ◽  
Education Level ◽  
Protective Effects ◽  
Highly Educated ◽  
And Bisexual

Background: Education level is one of the strongest protective factors against high-risk behaviors such as cigarette smoking. Minorities’ Diminished Returns (MDRs), however, suggest that the protective effects of education level tend to be weaker for racial and ethnic minority groups relative to non-Hispanic White people. Only two previous studies have shown that MDRs may also apply to lesbian, gay, and bisexual (LGB) individuals; however, these studies have focused on outcomes other than tobacco use. Aims: To compare LGB and non-LGB American adults for the effects of education level on cigarette-smoking status. Methods: Population Assessment of Tobacco and Health (PATH; 2013) entered 31,480 American adults who were either non-LGB (n = 29,303, 93.1%) or LGB (n = 2,177; 6.9%). The independent variable was education level. The dependent variable was current established cigarette smoking. Race, ethnicity, age, gender, poverty status, employment, and region were the covariates. LGB status was the moderator. Results: Overall, individuals with higher education level (odds ratio (OR) = 0.69) had lower odds of current established smoking. We found a significant interaction between LGB status and education level suggesting that the protective effect of education level on smoking status is systemically smaller for LGB people than non-LGB individuals (OR for interaction = 1.19). Conclusions: Similar to the patterns that are shown for racial and ethnic minorities, MDRs can be observed for the effects of education level among sexual minorities. In the United States, highly educated LGB adults remain at high risk of smoking cigarettes, a risk which is disproportionate to their education level. In other terms, high education level better helps non-LGB than LGB individuals to avoid cigarette smoking. The result is a relatively high burden of tobacco use in highly educated LGB individuals.

Factors associated with attendance and attendance patterns in a population-based mammographic screening program

2020 ◽  
pp. 096914132093294
Author(s):  
Marthe Larsen ◽  
Nataliia Moshina ◽  
Silje Sagstad ◽  
Solveig Hofvind
Keyword(s):  
Negative Binomial ◽  
Screening Program ◽  
Smoking Status ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Education Level ◽  
Attendance Rate ◽  
Late Afternoon ◽  
Factors Associated ◽  
Attendance Pattern

Objective To explore the factors associated with attendance and attendance pattern in BreastScreen Norway. Methods We evaluated the number of invitations (n = 1,253,995) and attendances, 2015–2019, stratified by age, invitation method, screening unit and time of appointment. Attendance pattern was analysed for women invited 10 times (n = 47,979), 1996–2019. The association of education level, body mass index, physical activity and smoking status with attendance was analysed for a sub-sample of women (n = 37,930). Descriptive statistics were used to analyse attendance, and negative binomial regression was used to analyse the association between the total number of attendances and education level and lifestyle factors. Results The attendance rate was 76.0%, 2015–2019. The rate was 78.0% for women aged >64 and 73.9% for those <55 . We found a rate of 82.0% for women who received a digital invitation, while it was 73.7% for those invited by post. The rate was 78.1% for invitations in the late afternoon, 3–6 p.m., while later appointments reached a rate of 73.7%. Half of the women invited 10 times attended all times. The predicted total number of attendances was 9 out of 10 for the factors investigated. Conclusion The highest attendance rates were shown for women aged >64, those who received digital invitations and those having appointments in late afternoon. The differences in predicted number of attendances between the investigated factors were minor. Overall, BreastScreen Norway has a high attendance rate. However, efforts aimed at increasing the attendance in specific groups should be considered.

scholarly journals Socioeconomic status and lifestyle behaviours in cancer survivors: smoking and physical activity

2016 ◽  
Vol 23 (6) ◽  
pp. 546 ◽  
Author(s):  
H. Naik ◽  
X. Qiu ◽  
M. C. Brown ◽  
L. Eng ◽  
D. Pringle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Socioeconomic Status ◽  
Cancer Survivors ◽  
Smoking Status ◽  
Education Level ◽  
Socioeconomic Indicators ◽  
Cross Sectional ◽  
Lifestyle Behaviours ◽  
Lower Education Level ◽  
Lower Education

Purpose Smoking cessation and increased physical activity (pa) have been linked to better outcomes in cancer survivors. We assessed whether socioeconomic factors influence changes in those behaviours after a cancer diagnosis.Methods As part of a cross-sectional study, a diverse group of cancer survivors at the Princess Margaret Cancer Centre (Toronto, ON), completed a questionnaire about past and current lifestyle behaviours and perceptions about the importance of those behaviours with respect to their health. The influence of socioeconomic indicators on smoking status and physical inactivity at 1 year before and after diagnosis were assessed using multivariable logistic regression with adjustment for clinico-demographic factors.Results Of 1222 participants, 1192 completed the smoking component. Of those respondents, 15% smoked before diagnosis, and 43% of those smokers continued to smoke after. The proportion of survivors who continued to smoke increased with lower education level (p = 0.03). Of the 1106 participants answering pa questions, 39% reported being physically inactive before diagnosis, of whom 82% remained inactive afterward. Survivors with a lower education level were most likely to remain inactive after diagnosis (p = 0.003). Lower education level, household income, and occupation were associated with the perception that pa had no effect or could worsen fatigue and quality of life (p ≤ 0.0001).Conclusions In cancer survivors, education level was a major modifier of smoking and pa behaviours. Lower socioeconomic status was associated with incorrect perceptions about pa. Targeting at-risk survivors by education level should be evaluated as a strategy in cancer survivorship programs.

scholarly journals Socioeconomic Position and the Incidence, Severity, and Clinical Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

2020 ◽  
Vol 135 (3) ◽  
pp. 364-371 ◽  
Author(s):  
Timothy L. Wiemken ◽  
Ruth M. Carrico ◽  
Stephen P. Furmanek ◽  
Brian E. Guinn ◽  
William A. Mattingly ◽  
...  
Keyword(s):  
Socioeconomic Position ◽  
Population Based ◽  
Community Acquired Pneumonia ◽  
Community Level ◽  
Deprivation Index ◽  
Area Deprivation ◽  
High Deprivation ◽  
The Relationship ◽  
Long Term Mortality

Objectives The influence of socioeconomic disparities on adults with pneumonia is not well understood. The objective of our study was to evaluate the relationship between community-level socioeconomic position, as measured by an area deprivation index, and the incidence, severity, and outcomes among adults with community-acquired pneumonia (CAP). Methods This was an ancillary study of a population-based, prospective cohort study of patients hospitalized with CAP in Louisville, Kentucky, from June 1, 2013, through May 31, 2015. We used a race-specific, block group–level area deprivation index as a proxy for community-level socioeconomic position and evaluated it as a predictor of CAP incidence, CAP severity, early clinical improvement, 30-day mortality, and 1-year mortality. Results The cohort comprised 6349 unique adults hospitalized with CAP. CAP incidence per 100 000 population increased significantly with increasing levels of area deprivation, from 303 in tertile 1 (low deprivation), to 467 in tertile 2 (medium deprivation), and 553 in tertile 3 (high deprivation) ( P < .001). Adults in medium- and high-deprivation areas had significantly higher odds of severe CAP (tertile 2 odds ratio [OR] = 1.2 [95% confidence interval (CI), 1.06-1.39]; tertile 3 OR = 1.4 [95% CI, 1.18-1.64] and 1-year mortality (tertile 2 OR = 1.3 [95% CI, 1.11-1.54], tertile 3 OR = 1.3 [95% CI, 1.10-1.64]) than adults in low-deprivation areas. Conclusions Compared with adults residing in low-deprivation areas, adults residing in high-deprivation areas had an increased incidence of CAP, and they were more likely to have severe CAP. Beyond 30 days of care, we identified an increased long-term mortality for persons in high-deprivation areas. Community-level socioeconomic position should be considered an important factor for research in CAP and policy decisions.

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