A Multilevel Study of Socio-economic Inequalities in Self-reported Oral and General Health in South-east Norway

This study assesses the association between socioeconomic determinants and self-reported health using data from a regional Norwegian health survey. A total of 9,068 participants 25+ were included. Survey data were linked to registry data on education and personal income. Self-reported oral health and general health were separately assessed and categorized into ‘good’ and ‘poor’. The exposures were educational level, personal income, and economic security. Prevalence ratios (PRs) were computed to assess the associations between socioeconomic determinants and self-reported health using multilevel Poisson regression. Participants with low education or income had poorer oral and general health than those with more education or higher income. Comparing the highest education level versus the lowest, adjusted PRs for poor oral and general health were 1.44 (95%CI 1.26-1.65) and 1.53 (95%CI 1.35-1.74). Correspondingly, with the highest income quintile versus the lowest, estimates were 1.64 (95%CI 1.39-1.94) and 2.34 (95%CI 1.97-2.79) for oral and general health. Lack of economic security was also significantly associated with poor self-reported oral and general health. Positive linear trends between levels of education and income were documented for both outcomes (P-linear trends <0.001), including a pattern of socioeconomic gradients, both for oral and general health.

Association of Household Income Level with Vitamin and Mineral Intake

Appropriate nutrient intake is essential for maintaining health and resisting disease. The current study investigated the association between household income quintile and nutrient intake using data from KNHANES 2019. A total of 5088 South Korean adults were analyzed. The estimated average requirement cut-point method, extended to handle participants with intakes higher than the tolerable upper level, was utilized to determine the need for dietary modification. The suitability of overall vitamin, overall mineral, and individual nutrient intake was evaluated by logistic regression analysis. Subgroup analysis was performed on overall mineral intake suitability. None of the individual nutrients had an intake ratio of over 70%, with the ratio being under 30% for some nutrients. The intake of iron, phosphorus, vitamin B9, and vitamin C had a significant upward trend as household income rose. A subgroup analysis revealed sex differences in the trends of overall mineral intake. The results revealed that some nutrients are not consumed appropriately in the Korean population. Furthermore, they suggest that household income is significantly associated with the intake of overall minerals and several individual nutrients. These results suggest that nutritional assistance is required for certain vulnerable groups, and provide supplementary data for appropriate interventions or further research.

Income inequalities, social support and depressive symptoms among older adults in Europe: a multilevel cross-sectional study

This study analysed the association between income inequality and depression from a multilevel perspective among older adults in Europe, including an examination of the role of social support. The data came from Eurostat’s European Health Interview Survey (EHIS). Selected participants were aged 65 years or above (n = 68,417) and located in 24 European countries. The outcome variable (depression) was measured using the eight-item Patient Health Questionnaire (PHQ-8). The resulting dataset included individual-level (level-1) and aggregate-level (level 2) exposure variables. Level-1 included income quintiles and social support as exposure variables and sex, age, living alone, limitation in activities of daily living and general activity limitation as control variables. Level 2 included the Gini coefficient, healthcare expenditure and dependency ratio. A multilevel linear regression analysis was performed with maximum likelihood (ML) estimation. All the income quintiles from 1 to 4 showed higher average scores for depression than quintile 5 (the highest). Higher social support scores were associated with lower scores for depression. An interaction was found between income quintile and social support, with higher levels of social support associated with lower scores for depression in quintiles 1 and 2. Higher Gini coefficient scores were associated with higher scores for depression. A significative random slope for social support was also found, meaning that the relationship between social support and depression differed across countries. No significant interaction was found between the Gini coefficient and social support. The study findings suggest that more unequal societies provide a less favourable context for the mental health of older adults. There are also significant country-dependent differences in terms of the relationship between support and mental health among older adults.

Housing Expenditure and Income Inequality

The trend of rising income inequality in Germany since the mid-1990s is strongly amplified when considering income after housing expenditure. The income share of housing expenditure rose disproportionally for the bottom income quintile and fell for the top quintile. Factors contributing to these trends include declining relative costs of homeownership versus renting, changes in household structure, declining real incomes for low-income households, and residential mobility towards larger cities. Younger cohorts spend more on housing and save less than older cohorts did at the same age, which will affect future wealth accumulation, particularly at the bottom of the income distribution.

Healthcare cost attributable to bronchiolitis: A population-based cohort study

Objective To determine 1-year attributable healthcare costs of bronchiolitis. Methods Using a population-based matched cohort and incidence-based cost analysis approach, we identified infants <12 months old diagnosed in an emergency department (ED) or hospitalized with bronchiolitis between April 1, 2003 and March 31, 2014. We propensity-score matched infants with and without bronchiolitis on sex, age, income quintile, rurality, co-morbidities, gestational weeks, small-for-gestational-age status and pre-index healthcare cost deciles. We calculated mean attributable 1-year costs using a generalized estimating equation model and stratified costs by age, sex, income quintile, rurality, co-morbidities and prematurity. Results We identified 58,375 infants with bronchiolitis (mean age 154±95 days, 61.3% males, 4.2% with comorbidities). Total 1-year mean bronchiolitis-attributable costs were $4,313 per patient (95%CI: $4,148–4,477), with $2,847 (95%CI: $2,712–2,982) spent on hospitalizations, $610 (95%CI: $594–627) on physician services, $562 (95%CI: $556–567)] on ED visits, $259 (95%CI: $222–297) on other healthcare costs and $35 ($27–42) on drugs. Attributable bronchiolitis costs were $2,765 (95%CI: $2735–2,794) vs $111 (95%CI: $102–121) in the initial 10 days post index date, $4,695 (95%CI: $4,589–4,800) vs $910 (95%CI: $847–973) in the initial 180 days and $1,158 (95%CI: $1,104–1213) vs $639 (95%CI: $599–679) during days 181–360. Mean 1-year bronchiolitis costs were higher in infants <3 months old [$5,536 (95%CI: $5,216–5,856)], those with co-morbidities [$17,530 (95%CI: $14,683–20,377)] and with low birthweight [$5,509 (95%CI: $4,927–6,091)]. Conclusions Compared to no bronchiolitis, bronchiolitis incurs five-time and two-time higher healthcare costs within the initial and subsequent six-months, respectively. Most expenses occur in the initial 10 days and relate to hospitalization.

Value of willingness to pay for a QALY gained in Iran; a modified chained-approach

Background Due to the lack of a constant Willingness to Pay per one additional Quality Adjusted Life Years gained based on the preferences of Iran’s general public, the cost-effectiveness of health system interventions is unclear and making it challenging to apply economic evaluation to health resources priority setting. Methods We have measured this cost-effectiveness threshold with the participation of 2854 individuals from five provinces, each representing an income quintile, using a modified Time Trade-Off-based Chained-Approach. In this online-based empirical survey, to extract the health utility value, participants were randomly assigned to one of two green (21121) and yellow (22222) health scenarios designed based on the earlier validated EQ-5D-3L questionnaire. Results Across the two health state versions, mean values for one QALY gain (rounded) ranged from $6740-$7400 and $6480-$7120, respectively, for aggregate and trimmed models, which are equivalent to 1.35-1.18 times of the GDP per capita. Log-linear Multivariate OLS regression analysis confirmed that respondents were more likely to pay if their income, disutility, and education level were higher than their counterparts. Conclusions In the health system of Iran, any intervention that is with the incremental cost-effectiveness ratio, equal to and less than 7402.12 USD, will be considered cost-effective.

Inequalities in Income and Education are Associated with Survival Differences after Out-of-hospital Cardiac Arrest: A Nationwide Observational Study

Background: Despite the acknowledged importance of socioeconomic factors as regards cardiovascular-disease onset, and survival, the relationship between individual-level socioeconomic factors and survival after out-of-hospital cardiac arrest (OHCA) is not fully established. Our aim was to investigate whether socioeconomic variables are associated with 30-day survival after OHCA. Methods: We linked data from the Swedish Registry for Cardiopulmonary Resuscitation with individual-level data on socioeconomic factors (i.e. educational level and disposable income) from Statistics Sweden. Confounding and mediating variables included demographic factors, comorbidity and Utstein resuscitation variables. Outcome was 30-day survival. Multiple modified Poisson regression was used for the main analyses. Results: A total of 31,373 OHCAs occurring in 2010-2017 were included. Crude 30-day survival rates by income quintiles were: Q1 (low) 414/6277 (6.6%), Q2=339/6276 (5.4%), Q3=423/6275 (6.7%), Q4=652/6273 (10.4%) and Q5 (high) 928/6272 (14.8%). In adjusted analysis, the chance of survival by income level followed a gradient-like increase, with a risk ratio (RR) of 1.86 (95% CI 1.65-2.09) in the highest-income quintile vs. the lowest. This association remained after adjusting for comorbidity, resuscitation factors and initial rhythm. A higher educational level was associated with improved 30-day survival, the RR associated with post-secondary education ≥ 4 years being 1.51 (95% CI 1.30-1.74). Survival disparities by income and educational level were observed in both men and women. Conclusions: In this nationwide observational study using individual-level socioeconomic data, higher income and higher educational level were associated with better 30-day survival following OHCA, in both sexes.

SARS-CoV-2 testing and COVID-19 related primary care use among people with citizenship, permanent residency, and temporary immigration status in British Columbia: Cross-sectional analysis of population-based administrative data

Background: Having temporary immigration status affords limited rights, workplace protections, and access to services. There is not yet research data on impacts of the COVID-19 pandemic for people with temporary immigration status in Canada. Methods: We use linked administrative data to describe SARS-CoV-2 testing, positive tests, and COVID-19 primary care service use in British Columbia from January 1, 2020, to July 31, 2021, stratified by immigration status (Citizen, Permanent Resident, Temporary Resident). We plot the rate of people tested and the rate of people confirmed positive for COVID-19 by week from April 19, 2020, to July 31, 2021, across immigration groups. Results: 4.9% of people with temporary immigration status had a positive test for SARS-CoV-2 over this period, compared to 4.0% among people with permanent residency and 2.1% among people who hold Canadian citizenship. This pattern is persistent by sex/gender, age group, neighborhood income quintile, health authority, and in both metropolitan and small urban settings. At the same time we observe lower access to testing and COVID-19 related primary care among people with temporary status. Interpretation: People with temporary immigration status in BC experience higher SARS-CoV-2 test positivity; alarmingly, this was coupled with lower access to testing and primary care. Interwoven immigration, health and occupational policies place people with temporary status in circumstances of precarity and higher health risk. Extending permanent residency status to all immigrants residing in Canada and decoupling access to health care from immigration status could reduce precarity due to temporary immigration status.

Socioeconomic Status and Medical Assistance in Dying: A Regional Descriptive Study

Purpose Concerns that medical assistance in dying (MAiD) may harm vulnerable groups unable to access medical treatments and social supports have arisen since the legalization of MAiD on June 17, 2016; however, there is little research on the topic. The purpose of this study is to investigate the socioeconomic status (SES) of patients who request MAiD at the London Health Sciences Centre (LHSC). Methods A retrospective analysis of patients from the LHSC MAiD database between June 6, 2016 and December 20, 2019 was conducted. Patients were linked to income data from the 2016 Canadian Census, and their corresponding income quintile was a proxy for SES. Geographic information system (GIS) mapping software was used to visualize the distribution of income and MAiD requests. Results 39.4% of the LHSC catchment area was classified as low SES. Two hundred thirty-seven (58.1%) MAiD requests came from low SES patients and 171 (41.9%) requests came from high SES patients. Two hundred fifty-nine (63.5%) patients who requested a MAiD assessment did not receive MAiD following their request. Of the 237 lower SES patients, 150 (63.3% [95% CI 57.2-69.3]) did not receive MAiD. Of the 171 higher SES patients, 109 (63.7% [95% CI 56.5-70.9]) did not receive MAiD. Conclusion A disproportionate number of requests for a MAiD assessment at LHSC came from lower SES patients; however, similar proportions of patients who requested MAiD from each SES group received aid in dying. Future research should explore why a disproportionately high number of low SES patients request MAiD at LHSC.

Identification of Foods To Monitor The Sodium Content of Processed Foods for Developing a Sodium Reduction Program in The Philippines

Background In response to the global target for reduction in salt intake, several countries have implemented population sodium reduction strategies. These strategies include identification of major sources of sodium in the diet and reformulation of a set number of products available on the market. This study aimed to identify processed foods that can be targeted for reformulation and whose sodium content can be monitored over time in order to reduce sodium intake in the Philippines. The objectives were to: 1) Estimate per capita sodium intake from minimally processed and processed food groups by income quintile and urban/rural location; 2) Identify foods that contribute to the variance in per capita sodium intake that can be used as indicators for monitoring the sodium content of Philippine processed foods. One-day household food weighing data covering 4880 households from the 2008 National Nutrition Survey was used. Per capita sodium consumption from processed and minimally processed food categories and percentiles of sodium intake from these categories by income quintile and urban/rural location were obtained. The percentage contribution of different food categories to mean per capita sodium intake was calculated. Specific foods that contributed to the variance in sodium intake among Filipinos were identified. Results Foods which significantly accounted for 99.4% of the variance in sodium intake were 13 types of processed foods and 2 types of minimally processed foods. The category Processed Soup, Sauces, and Flavor Enhancers contributed the greatest proportion to per capita sodium intake. Specific processed foods that contributed to the variance in per capita sodium intake were instant noodles, traditional fermented condiments and sauces, dried and processed meat, fish, and poultry products, salted eggs, white bread and pan de sal (a traditional Filipino bread), wheat and egg noodles, crispy cereal chips and extruded snacks, butter and margarine, cheese, and chocolate-based beverages. Conclusion Identifying processed foods that significantly contribute to sodium intake, followed by reformulating and monitoring the sodium content of these foods over time should be considered as one strategy to reduce sodium intake in the Philippines.