Socioeconomic inequalities in physical and cognitive functioning: cross-sectional evidence from 37 cohorts across 28 countries in the ATHLOS project

BackgroundPhysical and cognitive functioning in older age follows a socioeconomic gradient but it is unclear whether the strength of the association differs between populations. Using harmonised data from an international collaboration of cohort studies, we assessed socioeconomic inequalities in physical and cognitive functioning and explored if the extent of inequalities varied across countries based on their economic strength or wealth distribution.MethodsHarmonised data from 37 population-based cohorts in 28 countries were used, with an overall sample size of 126 765. Socioeconomic position of participants was indicated by education and household income. Physical functioning was assessed by self-reported mobility and activities of daily living; and cognitive functioning by memory and verbal fluency tests. Relative (RII) and slope (SII) index of inequality were calculated in each cohort, and their association with the source country’s Gross Domestic Product (GDP) and Gini-index was assessed with correlation and cross-level interaction in multilevel models.ResultsRII and SII values indicated consistently higher risk of low physical and cognitive functioning in participants with lower education or income across cohorts. Regarding RII, there were weak but statistically significant correlations and interactions with GDP and Gini-index, suggesting larger inequalities in countries with lower Gini-index and higher GDP. For SII, no such correlations were observed.ConclusionThis study confirms that socioeconomic inequalities in physical and cognitive functioning exist across different social contexts but the magnitude of these inequalities varies. Relative inequalities appear to be larger in higher-income countries but it remains to be seen whether such observation can be replicated.

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Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008–2016: a repeated cross-sectional study

Environmental Health and Preventive Medicine ◽

10.1186/s12199-021-00948-y ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Minoru Takakura ◽

Masaya Miyagi ◽

Akira Kyan

Keyword(s):

Time Trends ◽

Parental Education ◽

Cross Sectional Study ◽

Socioeconomic Inequalities ◽

School Type ◽

Sectional Study ◽

Cross Sectional ◽

Japanese Adolescents ◽

Index Of Inequality ◽

Over Time

Abstract Background Smoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016. Methods We conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated. Results Smoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time. Conclusions Smoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

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Trends in socioeconomic inequalities in the prevalence of functional dentition among older people in Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00202017 ◽

2018 ◽

Vol 34 (10) ◽

Cited By ~ 3

Author(s):

Fabiola Bof de Andrade ◽

Jose Leopoldo Ferreira Antunes

Keyword(s):

Older Adults ◽

Cross Sectional Study ◽

Socioeconomic Inequalities ◽

Community Dwelling ◽

Cross Sectional ◽

Relative Index ◽

Functional Dentition ◽

Natural Teeth ◽

Index Of Inequality ◽

Position Measure

The objective of this research was to evaluate trends in socioeconomic inequalities in the prevalence of functional dentition among community-dwelling older adults in Brazil. This was a cross-sectional study with data from the last two SBBrasil Project surveys conducted in 2003 and 2010. Functional dentition was defined as the presence of 20 or more natural teeth and was assessed during the clinical examination of dentition status. Schooling was used as the socioeconomic position measure. Socioeconomic inequality was measured using two complex measures; the slope index of inequality (SII) and the relative index of inequality (RII). The prevalence of functional dentition was 10.8% (95%CI: 8.1-14.2) in 2003 and 13.6% (95%CI: 11.1-16.5) in 2010. The prevalence of functional dentition increased significantly over the educational rank in both years. Absolute inequalities were significant for both years and remained unaltered between 2003 and 2010. Significant relative inequality in the prevalence of functional dentition was found in both years of the survey. Socioeconomic inequalities in the prevalence of functional dentition among older adults in Brazil persisted significantly between both national oral health surveys.

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Oral health status of the ethnic group Xukuru from Ororubá: multilevel analysis

Revista Brasileira de Epidemiologia ◽

10.1590/1809-4503201400030017 ◽

2014 ◽

Vol 17 (3) ◽

pp. 787-800 ◽

Cited By ~ 2

Author(s):

Herika de Arruda Mauricio ◽

Rafael da Silveira Moreira

Keyword(s):

Health Status ◽

Oral Health ◽

Indigenous People ◽

Multilevel Models ◽

Dental Treatment ◽

Descriptive Analysis ◽

Population Based ◽

Oral Health Status ◽

Cross Sectional ◽

Oral Examinations

Objective: To analyse the oral health status of the indigenous people Xukuru from Ororubá aged 10 to 14 years old, in Pernambuco, Brazil. Method: A cross-sectional population-based study developed within the limits of the Indigenous Land Xukuru, from January to March 2010. Oral examinations were performed on a sample of 233 indigenous people. The software SPSS 13.0® was used for descriptive analysis. Later, in order to measure the effect of factors associated with the absence of caries, Poisson log-linear multilevel models were tested with the statistical software MLwiN 2.02®. Results: Oral examinations identified a DMFT Index average of 2.38 (± 2.62). Among all individuals examined, 26.61% were caries free. Multiple regression analysis revealed a negative association between the absence of caries and the variables: higher average of people per household in the villages, higher number of residents per household, older age, male sex, not knowing how to read and write, and very dissatisfied/dissatisfied with teeth/mouth. The variables higher income per capita, not sleeping due to dental problems, had never been to the dentist, no occurrence of toothache, and no need for dental treatment were positively associated with the absence of caries. Conclusion: The absence of caries is associated with contextual and individual factors of the indigenous people Xukuru from Ororubá, aged 10 to 14 years old.

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Prevalence of Loneliness and Associated Factors among Older Adults in South Africa

Global Journal of Health Science ◽

10.5539/gjhs.v9n12p1 ◽

2017 ◽

Vol 9 (12) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Nancy Phaswana-Mafuya ◽

Karl Peltzer

Keyword(s):

South Africa ◽

Older Adults ◽

Cognitive Functioning ◽

Subjective Health ◽

Population Based ◽

Poor Health ◽

Outcome Variable ◽

Cross Sectional ◽

Nationally Representative ◽

Preventative Interventions

OBJECTIVE: Loneliness can be detrimental to health. The aim of this study is to estimate the prevalence of loneliness as well as its risk factors in older adults in South Africa.MATERIALS & METHODS: This cross-sectional population based study investigated factors associated with loneliness in a nationally representative sample (n=3624) of older South Africans who took part in the “Study of Global Ageing and Adults Health (SAGE)” wave 1 in 2008. The outcome variable was self-reported prevalence of loneliness and the exposure variables were socio-demographic characteristics and health variables.RESULTS: The overall prevalence of self-reported loneliness was 9.9%. Prevalence of loneliness was 10.2% for females and 9.5% for males, lowest among those married (7.5%), and highest among the 70+ years olds (12.5%). Individuals with highest level of education had the lowest prevalence of loneliness (5.9%). Indians or Asians were significantly more likely to experience loneliness than other population groups (Adjusted Odds Ratio=AOR: 3.20; 95% Confidence Interval=CI: 1.31, 7.80). Married or cohabiting individuals were significantly less likely to experience loneliness than unmarried or non-cohabiting ones, respectively (AOR: 0.55; 95% CI: 0.37, 0.81). In multivariable logistic regression, individuals with good subjective health were less likely to experience loneliness than those with poor health (AOR: 0.40, 95% CI: 0.22, 0.73). Similarly, individuals with good cognitive functioning were significantly less likely to experience loneliness than those with poor cognitive functioning (AOR: 0.55, 95% CI: 0.32, 0.97).CONCLUSION: The study found that the prevalence of loneliness among older adults in South Africa is significant. Preventative interventions that address the identified factors, including poor health status and low cognitive functioning, associated with loneliness need to be developed.

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Trends in socioeconomic inequalities in underweight and obesity in 5-year-old children, 2011–2018: a population-based, repeated cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-042023 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042023

Author(s):

Ryan Stewart ◽

John J Reilly ◽

Adrienne Hughes ◽

Louise A Kelly ◽

David I Conway ◽

...

Keyword(s):

Risk Ratio ◽

Primary Schools ◽

Population Based ◽

Cross Sectional Study ◽

Socioeconomic Inequalities ◽

Sectional Study ◽

Cross Sectional ◽

School Year ◽

The Uk ◽

Deprived Areas

ObjectiveTo explore trends in prevalence and socioeconomic inequalities in underweight and obesity in 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.DesignA population-based, repeated cross-sectional study.SettingLocal authority primary schools in Scotland.Participants373 189 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.MethodologyTrends in prevalence and inequalities in underweight and obesity were examined across seven school years (2011/2012–2017/2018) for 373 189 5-year-old schoolchildren in Scotland. Body mass index SD scores were calculated, and epidemiological cut-offs relative to the UK 1990 references categorised underweight and obesity. Slope/relative indices of inequality (SII/RII) were calculated for underweight and obesity by school year using the area-based Scottish Index of Multiple Deprivation.ResultsThe prevalence of obesity rose slightly overall during the study period (9.8% in 2011/2012; 10.1% in 2017/2018). However, this masked a widening of inequalities, with children from the most deprived areas experiencing a greater risk of obesity in 2017/2018 than in 2011/2012 (risk ratio=1.14, 95% CI 1.04 to 1.25) compared with an unchanged risk in children from the least deprived areas (risk ratio=0.95, 95% CI 0.82 to 1.11). SII and RII indicate widening inequalities for obesity, with RII rising from 1.95 (95% CI 1.71 to 2.22) in 2011/2012 to 2.22 (95% CI 1.93 to 2.56) in 2017/2018. The prevalence of underweight was consistently low (compared with the UK 1990 references) and remained unchanged over the study period (1.2% in 2011/2012; 1.1% in 2017/2018), with no consistent evidence of social patterning over time.ConclusionsInequalities in obesity in schoolchildren in Scotland are large and have widened from 2011, despite only a slight rise in overall prevalence. In contrast there has been little change in underweight prevalence or inequalities during the study period. Extra resources for policy implementation and measures which do not widen inequalities and focus on reaching the most deprived children are required to tackle the high prevalence and growing inequalities in childhood obesity in Scotland.

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Obesity and impaired cognitive functioning in the elderly: a population-based cross-sectional study (NEDICES)

European Journal of Neurology ◽

10.1111/ene.12083 ◽

2013 ◽

Vol 20 (6) ◽

pp. 899-e77 ◽

Cited By ~ 64

Author(s):

J. Benito-León ◽

A. J. Mitchell ◽

J. Hernández-Gallego ◽

F. Bermejo-Pareja

Keyword(s):

Cognitive Functioning ◽

The Elderly ◽

Population Based ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg

PLoS ONE ◽

10.1371/journal.pone.0153966 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0153966 ◽

Cited By ~ 6

Author(s):

Anastase Tchicaya ◽

Nathalie Lorentz ◽

Stefaan Demarest

Keyword(s):

Smoking Cessation ◽

General Population ◽

Population Based ◽

Cross Sectional Study ◽

Socioeconomic Inequalities ◽

Smoking Ban ◽

Sectional Study ◽

Cross Sectional

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Individual-level and area-level socioeconomic inequalities in hearing impairment among Chinese adults: a population-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-213437 ◽

2020 ◽

pp. jech-2019-213437 ◽

Cited By ~ 1

Author(s):

Yanan Luo ◽

Jiamin Gao ◽

Xiaoying Zheng

Keyword(s):

Hearing Impairment ◽

Large Population ◽

Pure Tone Audiometry ◽

Population Based ◽

Socioeconomic Inequalities ◽

Sample Survey ◽

Cross Sectional ◽

Individual Level ◽

Income Per Capita ◽

Per Capita

BackgroundIt is unclear whether individual-level and area-level socioeconomic status (SES) is associated with hearing impairment (HI). This study determines an association of individual SES, area SES and their interaction with HI among working-aged adults.MethodsData were obtained from the large, population-based sample of the Second China National Sample Survey on Disability, a cross-sectional study conducted in China. A total of 1 333 528 participants aged 25–59 years were included. HI was measured by pure-tone audiometry (PTA) and audiologists further ascertained for a final diagnosis. Individual SES was defined as a summed of z-scored of education level and household income per capita, and area SES was calculated as a summed of z-scored of county-level income per capita, high school rate, poverty rate and rate of upper-class occupation. Multilevel logistic regression was used.ResultsIndividual and area SES were associated with HI among Chinese working-aged adults. A 1-SD increase in individual SES was associated with decreased risk of HI (OR=0.3, 95% CI: 0.3 to 0.3). Area SES was positively related to HI (OR=1.2, 95%CI: 1.2 to 1.3). The cross-level interaction on individual and area SES was significantly associated with HI, indicating that among those who lived in higher SES areas, participants with lower SES had a greater likelihood to develop HI.ConclusionsSignificant individual and area socioeconomic inequalities were observed in HI among Chinese working-aged adults. Lower SES adults who resided in prosperous areas may face more deprivation on hearing health than those with higher SES.

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Cognitive functioning and associated factors in older adults in South Africa

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v18i4.368 ◽

2012 ◽

Vol 18 (4) ◽

pp. 7 ◽

Cited By ~ 2

Author(s):

K Peltzer ◽

N Phaswana-Mafuya

Keyword(s):

South Africa ◽

Cognitive Functioning ◽

Associated Factors ◽

Digit Span ◽

Subjective Health ◽

Population Based ◽

Adult Health ◽

Subjective Health Status ◽

Cross Sectional ◽

Healthcare Needs

Objective. To investigate cognitive functioning and associated factors in a national probability sample of older South Africans who participated in the Study of Global AGEing and Adult Health (SAGE) in 2008.Methods. In 2008 we conducted a national population-based cross-sectional study with a sample of 3 840 adults aged ≥50 years in South Africa. We administered a questionnaire surveying socio-demographic characteristics, health variables, and anthropometric and blood pressure measurements. Multivariate regression analyses were used to assess the association of socio-demographic factors and health variables with cognitive functioning. Results. Mean variables in the sample were: 5.9 recalled words, a verbal fluency of 9.9 words in a specified category (animals), a forward and backward digit span of 5.2 and 3.2, respectively, and an overall mean cognition score of 48.5. Higher overall cognitive functioning (a combination of memory and executive functioning) was positively associated with: younger age; white, Indian/Asian or coloured ethnicity; being married; a higher level of education; greater wealth; a higher level of physical activity; a greater quality of life; and a better subjective health status.Conclusions. Our findings can be used to refine future projections of cognitive function and healthcare needs in ageing middle-income societies such as those in South Africa.

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