scholarly journals Association between socioeconomic status and self-reported, tested and diagnosed COVID-19 status during the first wave in the Northern Netherlands: a general population-based cohort from 49 474 adults

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e048020
Author(s):  
Yinjie Zhu ◽  
Ming-Jie Duan ◽  
Hermien H. Dijk ◽  
Roel D. Freriks ◽  
Louise H. Dekker ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
General Population ◽  
Low Income ◽  
Smoking Status ◽  
Sleep Time ◽  
Population Based ◽  
Lifestyle Factors ◽  
Self Report ◽  
Low Education ◽  
Tv Watching

ObjectivesStudies in clinical settings showed a potential relationship between socioeconomic status (SES) and lifestyle factors with COVID-19, but it is still unknown whether this holds in the general population. In this study, we investigated the associations of SES with self-reported, tested and diagnosed COVID-19 status in the general population.Design, setting, participants and outcome measuresParticipants were 49 474 men and women (46±12 years) residing in the Northern Netherlands from the Lifelines cohort study. SES indicators and lifestyle factors (i.e., smoking status, physical activity, alcohol intake, diet quality, sleep time and TV watching time) were assessed by questionnaire from the Lifelines Biobank. Self-reported, tested and diagnosed COVID-19 status was obtained from the Lifelines COVID-19 questionnaire.ResultsThere were 4711 participants who self-reported having had a COVID-19 infection, 2883 participants tested for COVID-19, and 123 positive cases were diagnosed in this study population. After adjustment for age, sex, lifestyle factors, body mass index and ethnicity, we found that participants with low education or low income were less likely to self-report a COVID-19 infection (OR [95% CI]: low education 0.78 [0.71 to 0.86]; low income 0.86 [0.79 to 0.93]) and be tested for COVID-19 (OR [95% CI]: low education 0.58 [0.52 to 0.66]; low income 0.86 [0.78 to 0.95]) compared with high education or high income groups, respectively.ConclusionOur findings suggest that the low SES group was the most vulnerable population to self-reported and tested COVID-19 status in the general population.

scholarly journals Implementation of Ask-Advise-Connect in a safety net healthcare system: quitline treatment engagement and smoking cessation outcomes

2018 ◽  
Vol 10 (1) ◽  
pp. 163-167 ◽  
Author(s):  
Bárbara Piñeiro ◽  
Damon J Vidrine ◽  
David W Wetter ◽  
Diana S Hoover ◽  
Summer G Frank-Pearce ◽  
...  
Keyword(s):  
Low Income ◽  
Standard Care ◽  
Smoking Status ◽  
Large Population ◽  
Treatment Engagement ◽  
Safety Net ◽  
Population Based ◽  
Self Report ◽  
Tobacco Treatment ◽  
Care Outcomes

Abstract Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.

scholarly journals An Update on Hardening: A Qualitative Review

2019 ◽  
Vol 22 (6) ◽  
pp. 867-871 ◽  
Author(s):  
John R Hughes
Keyword(s):  
General Population ◽  
Low Income ◽  
Population Based ◽  
Medical Problems ◽  
Women Smokers ◽  
Quit Attempt ◽  
Quit Attempts ◽  
Low Education ◽  
Data Points ◽  
Over Time

Abstract Introduction This review examines the evidence for the hardening hypothesis; that is, the prevalence of (1) becoming a former smoker is decreasing over time due to (2) decreased quit attempts, or (3) decreased success on a given quit attempt. Methods PubMed, EMBASE, PsychINFO, trial registries, and other databases were searched for population-based surveys that reported whether one of the aforementioned three outcomes decreased over time. Results None of the 26 studies found that conversion from current to former smoking, number of quit attempts, or success on a given quit attempt decreased over time and several found these increased over time. These results appeared to be similar across survey dates, duration of time examined, number of data points, data source, outcome definitions, and nationality. Conclusions These results convincingly indicate hardening is not occurring in the general population of smokers. On the other hand, the prevalence of smoking is declining less among older and women smokers, and smokers with low education, low income, psychological problems, alcohol or drug abuse, medical problems, and greater nicotine dependence, than among those without these characteristics, presumably due to less quitting. Why this has not lead to decreased success in stopping smoking in the general population is unclear. Implications Some have argued that a greater emphasis on harm reduction and more intensive or dependence-based treatments are needed because remaining smokers are those who are less likely to stop with current methods. This review finds no or little evidence for this assumption. Psychosocial factors, such as low education and psychiatric problems, predict less ability to quit and appear to becoming more prevalent among smokers. Why this is not leading to decreased quitting in the general population is an anomaly that may be worth trying to understand.

scholarly journals Psychotic symptoms in the general population – an evolutionary perspective

2010 ◽  
Vol 197 (3) ◽  
pp. 167-169 ◽  
Author(s):  
Ian Kelleher ◽  
Jack A. Jenner ◽  
Mary Cannon
Keyword(s):  
General Population ◽  
Clinical Research ◽  
Clinical Phenotype ◽  
Population Based ◽  
Point Of View ◽  
Self Report ◽  
Psychotic Symptoms ◽  
Evolutionary Perspective ◽  
Evolutionary Context ◽  
Research Population

SummaryOur ideas about the intrinsically pathological nature of hallucinations and delusions are being challenged by findings from epidemiology, neuroimaging and clinical research. Population-based studies using both self-report and interview surveys show that the prevalence of psychotic symptoms is far greater than had been previously considered, prompting us to re-evaluate these psychotic symptoms and their meaning in an evolutionary context. This non-clinical phenotype may hold the key to understanding the persistence of psychosis in the population. From a neuroscientific point of view, detailed investigation of the non-clinical psychosis phenotype should provide novel leads for research into the aetiology, nosology and treatment of psychosis.

scholarly journals Posttraumatic stress symptoms and associated comorbidity during the COVID-19 pandemic in Ireland: A population based study

2020 ◽  
Author(s):  
Philip Hyland ◽  
Mark Shevlin ◽  
Jamie Murphy ◽  
Orla McBride ◽  
Menachem Ben-Ezra ◽  
...  
Keyword(s):  
General Population ◽  
Posttraumatic Stress ◽  
Traumatic Stress ◽  
Perceived Risk ◽  
Population Based ◽  
Self Report ◽  
Stress Symptoms ◽  
Younger Age ◽  
Nationally Representative ◽  
The Republic

The prevalence of posttraumatic stress disorder (PTSD) as it relates to people’s experiences of the COVID-19 pandemic has yet to determined. This study was conducted to determine rates of COVID-19 related PTSD in the Irish general population, the level of comorbidity with depression and anxiety, and sociodemographic risk factors associated with COVID-19 related PTSD. A nationally representative sample of adults from the general population of the Republic of Ireland (N = 1,041) completed self-report measures of all study variables. The rate of COVID-19 related PTSD was 17.7% (95% CI = 15.35 - 19.99%: n=184), and comorbidity with generalized anxiety (49.5%) and depression (53.8%) was high. Meeting the diagnostic requirement for COVID-19 related PTSD was associated with younger age, male sex, living in a city, living with children, moderate and high perceived risk of COVID-19 infection, and screening positive for anxiety or depression. Traumatic stress problems related to the COVID-19 pandemic are common in the general population. Our results show that health professionals responsible for responding to the COVID-19 pandemic should expect to routinely encounter traumatic stress problems.

Abstract MP47: The Association of Socioeconomic Status with Subclinical Myocardial Damage

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Anna E Fretz ◽  
Andrea L Schneider ◽  
John McEvoy ◽  
Ron Hoogeveen ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Low Income ◽  
Myocardial Damage ◽  
Low Ses ◽  
12Th Grade ◽  
Low Education ◽  
Prevalence Ratios

Background: The association between socioeconomic status (SES) and clinical cardiovascular events is well established. However, little is known about the relationship between SES and subclinical myocardial damage, as assessed by a novel highly sensitive assay for cardiac troponin T (hs-cTnT). Methods: We conducted a cross-sectional analysis of 11,411 participants from the ARIC Study with no history of cardiovascular disease who had hs-cTnT measured at visit 2 (1990-1992). SES was defined using either annual household income, categorized as: low (<$16,000), mid-level ($16,000 - $34,999), high (≥ $35,000), or lifetime educational attainment, categorized as: low (<12th grade), mid-level (12th grade/some college) and high (college degree or higher). hs-cTnT was categorized as non-elevated (<14 ng/L) and elevated (≥ 14ng/L). Poisson regression was used to generate prevalence ratios for elevated hs-cTnT, separately by level of income and education after adjusting for demographic, clinical, and behavioral factors. Results: Persons with low income or low education were more likely to have subclinical myocardial damage as assessed by elevated hs-cTnT (≥14ng/L). Adjusted prevalence ratios for elevated troponin comparing low to high levels of income and education were 1.74 (95% CI: 1.32, 2.29) and 1.54 (95% CI: 1.21, 1.97), respectively (Table, Model 1). These results were slightly attenuated, but remained statistically significant after adjusting for cardiovascular risk factors and health behaviors (Models 2 and 3). Race-stratified results demonstrate a somewhat stronger and only significant association of low education with subclinical myocardial damage in blacks compared to whites (PR 1.83 vs 1.05, p-interaction =0.08). There was no race interaction with income (p-interaction =0.33). Conclusions: Low SES was associated with elevated hs-cTnT, independent of cardiovascular risk factors, especially in blacks. Further research is needed to explore how low SES contributes to subclinical myocardial damage.

Poor person and areal socioeconomic status is associated with increased diabetic retinopathy and visual impairment incidence and progression

2020 ◽  
pp. bjophthalmol-2020-316430
Author(s):  
Jin Rong Low ◽  
Alfred Tau Liang Gan ◽  
Eva K Fenwick ◽  
Preeti Gupta ◽  
Tien Y Wong ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Diabetic Retinopathy ◽  
Visual Impairment ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Vision Loss ◽  
Population Based ◽  
Housing Type ◽  
Incidence Risk

BackgroundTo investigate the longitudinal associations between person-level and area-level socioeconomic status (PLSES and ALSES, respectively) with diabetic retinopathy (DR) and visual impairment (VI) in Asians with diabetes mellitus (DM).MethodsIn this population-based cohort study, we included 468 (39.4%) Malays and 721 (60.6%) Indians with DM, with a mean age (SD) of 58.9 (9.1) years; 50.6% were female and the mean follow-up duration was 6.2 (0.9) years. Individual PLSES parameters (education, monthly income and housing type) were quantified using questionnaires. ALSES was assessed using the Socioeconomic Disadvantage Index derived from Singapore’s 2010 areal census (higher scores indicate greater disadvantage). Incident DR and VI were defined as absent at baseline but present at follow-up, while DR and VI progression were defined as a ≥1 step increase in severity category at follow-up. Modified Poisson regression analysis was used to determine the associations of PLSES and ALSES with incidence and progression of DR and VI, adjusting for relevant confounders.ResultsIn multivariable models, per SD increase in ALSES score was associated with greater DR incidence (risk ratio (95% CI) 1.27 (1.13 to 1.44)), DR progression (1.10 (1.00 to 1.20)) and VI incidence (1.10 (1.04 to 1.16)), while lower PLSES variables were associated with increased DR (low income: 1.68 (1.21 to 2.34)) and VI (low income: 1.44 (1.13 to 1.83); ≤4 room housing: 2.00 (1.57 to 2.54)) incidence.ConclusionsWe found that both PLSES and ALSES variables were independently associated with DR incidence, progression and associated vision loss in Asians. Novel intervention strategies targeted at low socioeconomic status communities to decrease rates of DR and VI are warranted.

scholarly journals Does religious involvement affect mortality in low-income Americans? A prospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028200 ◽  
Author(s):  
Wanqing Wen ◽  
David Schlundt ◽  
Shaneda Warren Andersen ◽  
William J Blot ◽  
Wei Zheng
Keyword(s):  
Social Support ◽  
Socioeconomic Status ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Low Income ◽  
Prospective Cohort ◽  
Underserved Populations ◽  
Religious Involvement ◽  
Lifestyle Factors ◽  
Southeastern Usa

ObjectiveThis study aimed to evaluate the impacts of various forms of religious involvement, beyond individual socioeconomic status, lifestyle factors, emotional well-being and social support, on all-cause and cause-specific mortality in socioeconomic disadvantaged neighbourhoods.DesignThis is a prospective cohort study conducted from 2002 through 2015.SettingsThis study included underserved populations in the Southeastern USA.ParticipantsA total of nearly 85 000 participants, primarily low-income American adults, were enrolled. Eligible participants were aged 40–79 years at enrolment, spoke English and were not under treatment for cancer within the prior year.ResultsWe found that those who attended religious service attendance >1/week had 8% reduction in all-cause death and 15% reduction in cancer death relative to those who never attended. This association was substantially attenuated by depression score, social support, and socioeconomic and lifestyle covariates, and further attenuated by other forms of religious involvement. This association with all-cause mortality was found being stronger among those with higher socioeconomic status or healthier lifestyle behaviours.ConclusionOur results indicate that the association between religious services attendance >1/week and lower mortality was moderate but robust, and could be attenuated and modified by socioeconomic or lifestyle factors in this large prospective cohort study of underserved populations in the Southeastern USA.

scholarly journals Incremental direct medical costs of systemic lupus erythematosus patients in the years preceding diagnosis: A general population-based study

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1247-1258 ◽  
Author(s):  
N McCormick ◽  
C A Marra ◽  
M Sadatsafavi ◽  
J A Aviña-Zubieta
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Socioeconomic Status ◽  
General Population ◽  
Lupus Erythematosus ◽  
Medical Costs ◽  
Population Based ◽  
Newly Diagnosed ◽  
Systemic Lupus ◽  
Direct Medical Costs ◽  
The Impact

Objective We estimated the incremental (extra) direct medical costs of a population-based cohort of newly diagnosed systemic lupus erythematosus (SLE) for five years before and after diagnosis, and the impact of sex and socioeconomic status (SES) on pre-index costs for SLE. Methods We identified all adults newly diagnosed with SLE over 2001–2010 in British Columbia, Canada, and obtained a sample of non-SLE individuals from the general population, matched on sex, age, and calendar-year of study entry. We captured costs for all outpatient encounters, hospitalisations, and dispensed medications each year. Using generalised linear models, we estimated incremental costs of SLE each year before/after diagnosis (difference in costs between SLE and non-SLE, controlling for covariates). Similar models were used to examine the impact of sex and SES on costs within SLE. Results We included 3632 newly diagnosed SLE (86% female, mean age 49.6 ± 15.9) and 18,060 non-SLE individuals. Over the five years leading up to diagnosis, per-person healthcare costs for SLE patients increased year-over-year by 35%, on average, with the biggest increases in the final two years by 39% and 97%, respectively. Per-person all-cause medical costs for SLE the year after diagnosis (Year + 1) averaged C$12,019 (2013 Canadian) with 58% from hospitalisations, 24% outpatient, and 18% from prescription medications; Year + 1 costs for non-SLE averaged C$2412. Following adjustment for age, sex, urban/rural residence, socioeconomic status, and prior year's comorbidity score, SLE was associated with significantly greater hospitalisation, outpatient, and medication costs than non-SLE in each year of study. Altogether, adjusted incremental costs of SLE rose from C$1131 per person in Year –5 (fifth year before diagnosis) to C$2015 (Year –2), C$3473 (Year –1) and C$6474 (Year + 1). In Years –2, –1 and +1, SLE patients in the lowest SES group had significantly greater costs than the highest SES. Unlike the non-SLE cohort, male patients with SLE had higher costs than females. Annual incremental costs of SLE males (vs. SLE females) rose from C$540 per person in Year –2, to C$1385 in Year –1, and C$2288 in Year + 1. Conclusion Even years before diagnosis, SLE patients incur significantly elevated direct medical costs compared with the age- and sex-matched general population, for hospitalisations, outpatient care, and medications.

scholarly journals Low Socioeconomic Status Is Associated with Cardiovascular Risk Factors and Outcomes in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (4) ◽  
pp. 777-783 ◽  
Author(s):  
JANET W. MAYNARD ◽  
HONG FANG ◽  
MICHELLE PETRI
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Socioeconomic Status ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Cardiovascular Risk Factors ◽  
Low Income ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Low Education

Objective.Accelerated atherosclerosis is a major cause of death in systemic lupus erythematosus (SLE), yet little is known about the effect of socioeconomic status. We investigated whether education or income levels are associated with cardiovascular risk factors and outcomes in SLE.Methods.Our study involved a longitudinal cohort of all patients with SLE enrolled in the Hopkins Lupus Cohort from 1987 through September 2011. Socioeconomic status was measured by education level (≥ 12 years or < 12) and income tertiles (> $60,000, $25,000–$60,000, or < $25,000).Results.A total of 1752 patients with SLE were followed prospectively every 3 months. There were 1052 whites and 700 African Americans. Current smoking, obesity, hypertension, and diabetes mellitus were more common in African Americans (p < 0.01 for all), but there was no statistical difference in the frequency of myocardial infarction or stroke. In multivariate analyses stratified by ethnicity, low income was strongly associated with most traditional cardiovascular risk factors in whites, but only with smoking and diabetes in African Americans. In whites, low income increased the risk of both myocardial infarction (OR 3.24, 95% CI 1.41–7.45, p = 0.006) and stroke (OR 2.85, 95% CI 1.56–5.21, p = 0.001); in African Americans, these relationships were not seen. Low education, in contrast, was associated with smoking in both ethnic groups.Conclusion.Low income, not low education, is the socioeconomic status variable associated with cardiovascular risk factors and events. This association is most clearly demonstrable in whites.

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