Negative impact of socioeconomic deprivation on clinical outcomes after cryoablation for atrial fibrillation: 18-month study

Background Lower socioeconomic status has also been shown to associate with higher incidence of atrial fibrillation (AF), increased mortality and morbidity. However, the impact of socioeconomic deprivation on clinical outcomes post AF cryoablation has yet to be investigated. Aim To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with AF post cryoablation. Methods A retrospective study of paroxysmal or persistent AF patients after cryoablation. Parameters included basic demographics, weight, past medical history (hypertension, heart failure, diabetes, stroke, myocardial infarction, sleep apnoea) and alcohol misuse. Medical treatment post ablation (Beta blocker, calcium channel blocker, flecainide, amiodarone, dronaderone, sotolol, anticoagulant use) were also recorded. Socioeconomic deprivation index, as per SIMD was recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1–2,3–4,5–6,7–8, 9–10). Follow-up for 18 months. Clinical outcome assessed was rate of readmission for symptomatic AF, rate of heart failure admission, stroke, bleeding diathesis and all-cause mortality. Results 383 patients were identified: 78 from the lowest quintile (SIMD 1–2), 68 (SIMD 3–4), 64 (SIMD 5–6), 62 (SIMD 7–8), and 111 from the highest quintile (SIMD 9–10). No statistical difference exists between age, gender or weight. Lowest socioeconomic quintile has higher incidence of heart failure (p=0.006) and hypertension (p=0.005) but other past medical history was no different. No difference in incidence of alcohol misuse. Medicine prescription was not different. Echo features: left ventricular function, atrial size and valvular dysfunction were not different between all groups. 18 months follow-up demonstrated that both readmission for symptomatic documented AF and recurrence of symptoms at 18 months were higher among patients of lowest socioeconomic quintile (Keplan Meier plot, p=0.014 and p=0.006 respectively). Stepwise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcome (p=0.02). Risk of symptom recurrence at 18 months in patients from the least deprived background is less than one third as compared to the ones from the most deprived background (Odd-ratio 0.32 (0.17 - 0.59)) Risk of readmission for AF in patients from the wealthiest socioeconomic group is also less than a third as compared to those of most deprived social group (Odd-ratio 0.31 (95% CI 0.15–0.61)). Other clinical outcomes including risk of admissions for heart failure, stroke, bleeding diathesis and all-cause mortality was not statistically different across all groups. Summary After cryoablation, patients from the lowest socioeconomic group are more likely to experience symptoms recurrence and readmission for symptomatic AF FUNDunding Acknowledgement Type of funding sources: None.

Consumer choice of health facility among the lowest socioeconomic group in newly established demand-side health-financing scheme in Khyber Pakhtunkhwa, Pakistan

Background: The Social Health Protection Initiative was introduced initially in Pakistan in Khyber Pakhtunkhwa Province. The initiative aimed to provide the lowest socioeconomic group of the population with in-patient healthcare services, which otherwise would be financially hard to obtain. It is one of the flagship projects of the Provincial Government to contribute towards the United Nations Sustainable Development Goals and universal health coverage. Aims: To assess consumer choice of health facility and its determinants for public versus private sector health facilities by people enrolled in Social Health Protection Initiative. Methods: We used secondary data of availed health services from February 2016 to September 2017 under the Social Health Protection Initiative. A proxy outcome variable, visit to health facility, was used to determine consumer choice between public and private sector health facilities. The treatment group (health services received by beneficiaries) was used as an independent variable controlled for age groups, cost groups, and geographic location of health facilities. All statistical analyses were performed by SPSS version 20. Results: Most beneficiaries chose private over public health facilities (90.25%). However, adjusted odds of visiting a public sector health facility for surgical and gynaecological services were 0.12 [95% confidence interval (CI): 0.10–0.16] and 0.11 (95% CI: 0.09–0.14) respectively, when compared to medical services. Conclusion: Social Health Protection Initiative beneficiaries have lesser odds of visiting a public hospital over a private one. The choice may be affected by factors such as age of the beneficiary, cost of health services, and geographic location of health facilities.

Obesity Transition and Inequalities by Sociodemographic Factors in Korean Adults, 1998–2018

Objectives To investigate the obesity transition and inequalities by socio-demographic factors in Korea, we examined the nationwide overall and abdominal obesity trends and its association with socio-demographic factors in Korean adults (aged 19–79 years) in 1998–2018. Methods In the Korea National Health and Nutrition Examination Survey 1998–2018 (n = 85,262), we estimated the age-standardized prevalence of overall (body mass index [BMI)≥25kg/m2) and abdominal obesity (waist circumference [WC]≥90 cm) in men and ≥85cm in women) in each sociodemographic subgroup. Weight, height, and WC were measured by medical staff. Logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between obesity prevalence and sociodemographic factors after mutual adjustment for all sociodemographic factors under study. All analyses accounted for a complex survey design. Results During the study period, the prevalence of overall and abdominal obesity increased in men (24.8% to 42.4%; 20.1% to 32.1%; respectively) but only a small change was observed in women (26.5% to 26.0%; 22.7% to 20.9%; respectively). When stratified by sociodemographic groups, obesity prevalence similarly increased in all groups of men but, in women, the trends varied across groups. In women, income (2016–2018: OR = 0.66, 95% CI = 0.56–0.78 overall obesity; OR = 0.60, 95% CI = 0.51–0.71 abdominal obesity) and education (OR = 0.62, 95% CI = 0.54–0.72 overall obesity; OR = 0.58, 95% CI = 0.50–0.68 abdominal obesity) were inversely associated with obesity prevalence, and the gaps between the groups became wider and solidified since 2007. Conclusions This is the largest and the most recent study including the entire survey phases of the KNHANES data (I-VII). Our data suggest that the inequalities in obesity prevalence by sex (men higher than women) and by socioeconomic status (women in lower-socioeconomic group higher than women in higher-socioeconomic group) have increased over time. These findings indicate that targeted, customized preventive strategies are needed to prevent further increase in obesity and related disease burdens in Korea. Funding Sources This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (2019R1G1A1004227 and 2019S1A3A2099973).

Alcohol Use and Its Affordability in Adolescents in Slovakia between 2010 and 2018: Girls Are Less Adherent to Policy Measures

Background: The article analyzes selected indicators of alcohol use (weekly use, drunkenness within last month) and the ability of adolescents to buy alcohol in Slovakia between 2010 and 2018. Methods: Health Behavior in School-Aged Children (HBSC) is a cross-sectional questionnaire study. A standardized uniform questionnaire was used to create a representative sample of 15-year-old adolescents. Two surveys carried out in Slovakia in 2010 (n = 1568) and 2018 (n = 1298) were analyzed. Results: Weekly alcohol use and drunkenness declined only in boys, not in girls. Affordability of alcohol (not being prevented from buying it) declined among weekly drinking boys (from 60.4 to 34.1%) but remained almost unchanged in girls from a higher socioeconomic group compared to those from a lower one (57.9% vs. 30.6% in 2018). Conclusions: Affordability of alcohol in boys decreased with a decline in alcohol use, corresponding with implemented legislative measures. However, it remained unchanged in girls from a higher socioeconomic group.

Covid-19, Gender and Intersectionality

This document lists and summarises published resources on Covid-19, gender and intersectionality. It includes evidence, news, tools and guidance about how various factors – including race, ethnicity, age, disability, sexuality, socioeconomic group and immigration status – interact with gender to create different experiences and inequalities around Covid-19.

Socioeconomic deprivation and 1 year clinical outcomes after cryablation for atrial fibrillation

Funding Acknowledgements Type of funding sources: None. BACKGROUND Socioeconomic deprivation has previously been demonstrated to result in worse heart failure and myocardial infarction outcomes. Published studies shown lower socioeconomic group to associate with higher prevalence of atrial fibrillation (AF), increased mortality and morbidity. However, the impact of socioeconomic deprivation on clinical outcomes post AF cryoablation has yet to be investigated. AIM To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with AF treated by cryoablation. METHODS A retrospective study of paroxysmal or persistent AF patients after cryoablation. The parameters included basic demographics, weight, past medical history (inclusive of hypertension, heart failure, diabetes, stroke or transient ischaemic attacks, prior myocardial infarction, obstructive sleep apnoea) and alcohol misuse. Medical treatment post AF ablation (Beta blocker, non-dihydropyridine calcium channel blocker, flecainide, amiodarone, dronaderone, sotolol, anticoagulant use) were also recorded. Individual’s socioeconomic deprivation index, as described SIMD was also recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1-2,3-4,5-6,7-8, 9-10). Follow-up for 12 months. Clinical outcome assessed was rate of readmission for symptomatic documented AF, rate of heart failure admission, stroke, bleeding diathesis and all-cause mortality. RESULTS 312 patients were identified: 65 from the lowest quintile (SIMD 1-2), 57 from SIMD 3-4, 54 from SIMD 5-6, 52 from SIMD 7-8, and 84 from the highest quintile (SIMD 9-10). No statistical difference exists between age, gender or weight. Lowest socioeconomic quintile has higher incidence of heart failure (p =0.018) but other past medical history was no different. No difference in incidence of alcohol misuse. Prescription rate/rhythm control agents and anticoagulant use post ablation was not statistically different between all groups. 12 months follow-up demonstrated readmission for symptomatic documented AF was statistically higher among patients of lowest socioeconomic quintile (Keplan Meier plot, p = 0.001). Stepwise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcome (p = 0.02). Risk of readmission for AF in patients from the wealthiest socioeconomic group is almost a quarter as compared to those of most deprived social group (Odd-ratio 0.273 (95% CI 0.122 – 0.607)). Other clinical outcomes including risk of admissions for heart failure, stroke, bleeding diathesis and all-cause mortality was not statistically different across all groups. Summary After cryoablation for AF, patients from the lower socioeconomic group are still more likely to experience readmission for symptomatic AF at 12-month, despite similar post-procedure pharmaceutical agents utilised.

Sugar-sweetened beverage consumption from 1998–2017: Findings from the health behaviour in school-aged children/school health research network in Wales

To date no study has examined time trends in adolescent consumption of sugar-sweetened beverages and energy drinks, or modelled change in inequalities over time. The present study aimed to fill this gap by identifying historical trends among secondary school students in Wales, United Kingdom. The present study includes 11–16 year olds who completed the Health Behaviour in School-aged Children (HBSC) survey and the Welsh School Health Research Network (SHRN) survey between 1998 to 2017. Multinomial regression models were employed alongside tests for interaction effects. A total of 176,094 student responses were assessed. From 1998 to 2017, the prevalence of daily sugar-sweetened beverage consumption decreased (57% to 18%) while weekly consumption has remained constant since 2006 (49% to 52%). From 2013 to 2017, daily consumption of energy drinks remained stable (6%) while weekly consumption reports steadily decreased (23% to 15%). Boys, older children and those from a low socioeconomic group reported higher consumption rates of sugar-sweetened beverages and energy drinks. Consumption according to socioeconomic group was the only characteristic to show a statistically significant change over time, revealing a widening disparity between sugar-sweetened beverage consumption rates of those from low and high socioeconomic groups. Findings indicate a positive shift in overall consumption rates of both sugar-sweetened beverages and energy drinks. Adolescents from a low socioeconomic group however were consistently shown to report unfavourable sugar-sweetened beverages consumption when compared to peers from high socioeconomic group. Given the established longer term impacts of sugar-sweetened beverage and energy drink consumption on adolescent health outcomes, urgent policy action is required to reduce overall consumption rates, with close attention to equity of impact throughout policy design and evaluation plans.

Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data

ObjectivesTo explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI).DesignCross-sectional survey.SettingUK.Participants1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England.Outcome measuresSelf-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics.ResultsOverall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18–34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity.ConclusionsExposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.

Study of depot medroxyprogesterone acetate as an extended postpartum contraceptive at SCB medical college and hospital, Cuttack

Background: Increase in contraceptive use during the postpartum period substantially reduces the rate of maternal and infant mortality by preventing unplanned and unwanted pregnancies. Injectable Medroxy Progesterone acetate (DMPA) is one long acting reversible safe and effective method for postpartm contraception. Aims and Objectives to study the acceptance, efficacy, side effects and compliance of DMPA as an extended postpartum contraceptive at SCB Medical College, Cuttack.Methods: The study includes 76 women between 6weeks to 1year postpartum who had chosen DMPA as contraceptive after counseling regarding the basket of choices. DMPA injection was given within 7 days of menstruation if it has returned or at any time after being confirmed that woman is not pregnant with a back up for first 7days. Subsequent injections were given at three monthly intervals and followed up for one year after the first injection for pregnancy rate, side-effects, discontinuation and patient satisfaction.Results: Maximum females were from the combined age groups 25-29 (39.47%) and 20-24 years (35.52%). 46.1% women belong to lower middle socioeconomic group. The most common menstrual problem was amenorrhea in 47.36% followed by scanty bleeding in 22.36%. 25% discontinued after 1st dose of injection, which is the maximum. The commonest reason for discontinuation observed was menstrual problems (37.93%) followed by use of other methods of contraception (17.24%). Out of 76, 23 women were not satisfied (30.26%), main reason of dissatisfaction being menstrual problems. Failure rate was nil.Conclusions: The study concludes that DMPA is a very effective, safe, and long acting contraceptive with no effect on lactation. Proper counseling can improve the acceptance and compliance.