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Association with prevalent disease and cardiovascular risk factors. Odds ratios are shown per ten-unit increase in PPI (a) and per one-unit increase in GISD (b)
Source publication
Background
Low individual socioeconomic status (SES) is a known risk factor for morbidity and mortality. A related measure is the area-based SES (abSES), which describes the average SES of a region. The association of measures of abSES with morbidity and mortality is less well studied.
Methods
The Ludwigshafen Risk and Cardiovascular Health study...
Citations
... A stark illustration of the importance of social gradient is provided by an evident 48-year spread of life expectancy among countries ranging from 34 years in Sierra Leone to 81.9 years in Japan [17,18]. Similarly, in the United States, the death rate amongst the socially disadvantaged is triple compared to that of their higher socioeconomic strata peers [19,20]. The magnitude of the impact of social factors on physical functioning is similar to those of traditional risk factors (hypertension, diabetes, and smoking) [21], where increased deprivation of social privilege is associated with increased cardiovascular mortality [22]. ...
... The magnitude of the impact of social factors on physical functioning is similar to those of traditional risk factors (hypertension, diabetes, and smoking) [21], where increased deprivation of social privilege is associated with increased cardiovascular mortality [22]. An association between living in a socially advantaged area as opposed to a disadvantaged area has been previously described [20], showing a decrease in purchasing power to be associated with an increase in coronary artery disease and its risk factors. Additionally, socioeconomic status was found to favorably modulate the increased acute cardiovascular mortality conferred by exposure to particulate matter in the Phoenix area [23]. ...
... For instance, Marmot [17], in their article, illustrates a gradient of mortality from the poorest 20% to the richest. Moissl et al. [20] used purchasing power as a measure, while Wilson et al. [23] used education and income. ...
Cardiovascular disease remains a leading cause of morbidity and mortality in the United States (US). Although high-quality data are accessible in the US for cardiovascular research, digital literacy (DL) has not been explored as a potential factor influencing cardiovascular mortality, although the Social Vulnerability Index (SVI) has been used previously as a variable in predictive modeling. Utilizing a large language model, ChatGPT4, we investigated the variability in CVD-specific mortality that could be explained by DL and SVI using regression modeling. We fitted two models to calculate the crude and adjusted CVD mortality rates. Mortality data using ICD-10 codes were retrieved from CDC WONDER, and the geographic level data was retrieved from the US Department of Agriculture. Both datasets were merged using the Federal Information Processing Standards code. The initial exploration involved data from 1999 through 2020 (n = 65,791; 99.98% complete for all US Counties) for crude cardiovascular mortality (CCM). Age-adjusted cardiovascular mortality (ACM) had data for 2020 (n = 3118 rows; 99% complete for all US Counties), with the inclusion of SVI and DL in the model (a composite of literacy and internet access). By leveraging on the advanced capabilities of ChatGPT4 and linear regression, we successfully highlighted the importance of incorporating the SVI and DL in predicting adjusted cardiovascular mortality. Our findings imply that just incorporating internet availability in the regression model may not be sufficient without incorporating significant variables, such as DL and SVI, to predict ACM. Further, our approach could enable future researchers to consider DL and SVI as key variables to study other health outcomes of public-health importance, which could inform future clinical practices and policies.
... In the international literature, evidence of negative impacts on mental health, well-being, quality of life, behaviour and delinquency and physical health and lifestyle in children and young people by regional poverty/deprivation is reported (23,29,49,50,51). For Germany, several studies already used GISD and were able to demonstrate associations between regional deprivation and different health outcomes (3,10,52,53,54,55). ...
Background: Early childhood is essential for a child’s overall development. Twenty to 30%of children are impaired by a lack of needed social and emotional skills when starting school. Children living in socioeconomic deprivation are particularly affected. Early childhood development is determined by family socioeconomic status (SES) and regional socioeconomic aspects. In a preventive early childhood development support program for preschool children in social hotspots,an annual standardized developmental screening (Dortmunder Entwicklungsscreening für den Kindergarten - DESK 3–6 R) was carried out. This study aimed to investigate the association between the prevalence ofpreschool children at risk of social-emotional problems and socioeconomic deprivation in northeast Germany.
Methods: Screening data from DESK 3–6 R were linked with the German Index of Socioeconomic Deprivation (GISD) for 2019. For the social-emotional domains ‘social behaviour’, ‘social competence’ and ‘social interaction’ as dependent variables and the GISD score as explanatory variable Generalized Linear Regressions (GLR) and to model spatially varying relationships Local Bivariate Relationships (LBR) were performed within ArcGIS pro 3.1.
Results: A total of 147preschools participated, with atotal of 7,836 three- to six-year-old children in 2019. The prevalence of developmental risks for ‘social behavior’ was 14 % (standard deviation (SD) = 13 %), for ‘social competence’ 13 % (SD=12 %) and for ‘social interaction’ 10 % (SD=10 %). For ‘social behavior’ and ‘social interaction’, GLR showed statistically significant coefficients of approximately0.5 but low data fit (explaining only 6.3% of thevariance at max). LBR revealed no relevant association.
Conclusions: Contrary to our expectation, we did not observe consistent significant associations between social-emotional developmental risks (measured with DESK) and regional deprivation (operationalized with GISD) of 3- to 6-year-olds attending preschools in social hotspots in Mecklenburg Western-Pomerania. Although the GISD was available on the level of five-digit postal zip codes, due to the relatively low population density, the relatively large administrative units, and the modifiable area unit problem (MAUP), differences in the degree of deprivation are evened out. To reflect the effect of regional differences on individual children, small-scale data with high geographical resolution are needed.
... The findings suggest that people living in communities with low socioeconomic status are at greater risk for cardiovascular disease, in coherence with the conclusion of Stewart et al. (2009), who argued that socioeconomic deprivation was a detrimental factor to cardiovascular health. This is because unhealthy behavioral practices, such as smoking and an unhealthy diet, are more prevalent in low socioeconomic populations (Moissl et al., 2020). In addition, related studies have shown that those living in low socioeconomic status communities had unequal access to health care, thereby increasing the development and morbidity of cardiovascular disease (Lang et al., 2016;Lee and Carrington, 2007). ...
To examine what built environment characteristics improve the health outcomes of human beings is always a hot issue. While a growing literature has analyzed the link between the built environment and health, few studies have investigated this relationship across different spatial scales. In this study, eighteen variables were selected from multi-source data and reduced to eight built environment attributes using principal component analysis. These attributes included socioeconomic deprivation, urban density, street walkability, land-use diversity, blue-green space, transportation convenience, ageing, and street insecurity. Multiscale geographically weighted regression was then employed to clarify how these attributes relate to cardiovascular disease at different scales. The results indicated that: (1) multiscale geographically weighted regression showed a better fit of the association between the built environment and cardiovascular diseases than other models (e.g., ordinary least squares and geographically weighted regression), and is thus an effective approach for multiscale analysis of the built environment and health associations; (2) built environment variables related to cardiovascular diseases can be divided into global variables with large scales (e.g., socioeconomic deprivation, street walkability, land-use diversity, blue-green space, transportation convenience, and ageing) and local variables with small scales (e.g., urban density and street insecurity); and (3) at specific spatial scales, global variables had trivial spatial variation across the area, while local variables showed significant gradients. These findings provide greater insight into the association between the built environment and lifestyle-related diseases in densely populated cities, emphasizing the significance of hierarchical and place-specific policy formation in health interventions.
... Furthermore, it may lead to poorer health as a result of harmful health behaviors, such as tobacco smoking, an unhealthy diet, and lower physical activity [9,10]. In addition to individual factors, CSD-related mortality could be linked with socioeconomic deprivation (SED) at the area level [11][12][13][14][15]. Deprivation is a state of observable and demonstrable disadvantages, which can be of social or material nature, compared to the local community or the wider society to which an individual, family, or group belongs [16]. ...
Background
Socioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland.
Methods
The 2010–2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations.
Results
Among men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010–2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index).
Conclusions
Significant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.
... It was found that subjective financial position and quality of life were positively correlated, which supports earlier research conclusions (Denvir et al., 2006). Socioeconomically disadvantaged patients with CD have been linked to more mortality rates, increased recurrence rates, and worse postoperative quality of life (Moissl et al., 2020). Lower economic levels and individuals with CD who are experiencing severe emergencies need to be given special attention from the public system in order to ensure that they receive the care required to maintain their quality of life (QoL). ...
Background: The most popular form of treatment for coronary disease is percutaneous coronary intervention (PCI). Along with recurrence rates and mortality, quality of life (QoL) is a crucial PCI outcome indicator. Purpose: The purpose of this research was to look at the variables affecting individuals with coronary disease who had undergone PCI's quality of life. The cardiac center of the hospital provided a convenient sampling for this descriptive, cross-sectional research. On a population of 630 patients who had coronary disease, this research was carried out utilizing a standardized questionnaire and individual medical data. Information on general, medical, and psychological traits was gathered using the questionnaire. Descriptive statistics, the independent t-test, one-way variance analysis and Scheffé test were all used to analyze the data. The significant variables in univariate analysis were combined with the key parameters found in a multiple linear regression to identify the factors that strongly affected QoL. Results: We discovered that age, subjective economic status, being the primary caregiver, time since the first PCI, anxiety, and depression all significantly influenced QoL. The Age, primary caregivers and marital status were the strongly significant variables that were proven to have an impact on QoL in patients who had gone through PCI. The period since the initial PCI was among the main clinical factors that were proven to have an impact on QoL. Depression and anxiety were among the important psychosocial traits that were found to have an impact on quality of life. The study's PCI patients' primary caregivers were shown to have the biggest influence on their quality of life. Conclusions: Patients' post-PCI psychological and physical symptoms must be frequently evaluated in order to improve QoL in those who had underwent PCI. In addition, patients with significant functional impairments and those getting family care need intervention measures that aim at enhancing quality of life. Abbreviations Left ventricular ejection fraction-LVEF Myocardial infarction-MI Quality of Life-QoL Coronary Disease-CD Diseased Vessels-DV/DVs Coronary Artery Bypass Graft-CABG
... Socioeconomic status was defined using a proxy measure based on the regional purchasing index, collected at study entry as previously described. (26) All patients were screened for T2DM at baseline, diagnosis being based on the 2014 criteria of the American Diabetes Association, (27) history of T2DM, and/or use of oral antidiabetics or insulin. Cardiac-related death was subsequently ascertained. ...
Romososumab is a newly available treatment for osteoporosis acting by sclerostin inhibition. Its cardiovascular safety has been questioned after finding excess cardiovascular disease (CVD)‐related events in a pivotal phase III trial. Previous studies of relationships between circulating sclerostin levels and CVD and associated risk factors have yielded conflicting findings, likely reflecting small numbers and selected patient groups. We aimed to characterise relationships between sclerostin and CVD and related risk factors in more detail, by examining these in two large cohorts, LURIC (34% female, mean 63.0 years) and ALSPAC mothers (mean 48.1 years). Together these provided 5069 participants with complete data. Relationships between sclerostin and CVD risk factors were meta‐analysed, adjusted for age, sex (LURIC), BMI, smoking, social deprivation and ethnicity (ALSPAC). Higher sclerostin levels were associated with higher risk of diabetes mellitus (DM) [1.25 (1.12, 1.37)], risk of elevated fasting glucose [1.15 (1.04, 1.26)], and triglyceride levels [0.03 (0.00, 0.06)]. Conversely, higher sclerostin was associated with lower eGFR [‐0.20 (‐0.38, ‐0.02)], HDL cholesterol [‐0.05 (‐0.10, ‐0.01)], and Apolopoprotein A‐I [‐0.05 (‐0.08, ‐0.02)] (odds ratio/ difference in mean SD per SD increase in sclerostin, with 95% CI). In LURIC, higher sclerostin was associated with an increased risk of death from cardiac disease during follow up [HR 1.13 (1.03, 1.23)], and with severity of coronary artery disease on angiogram as reflected by Friesinger score [0.05 (0.01, 0.09)]. Associations with cardiac mortality and coronary artery severity were partially attenuated after adjustment for risk factors potentially related to sclerostin, namely LDL and HDL cholesterol, log triglycerides, DM, hypertension, eGFR and Apolipoprotein A‐I. Contrary to trial evidence suggesting sclerostin inhibition leads to an increased risk of CVD, sclerostin levels appear to be positively associated with CAD severity and mortality, partly explained by a relationship between higher sclerostin levels and major CVD risk factors. This article is protected by copyright. All rights reserved.
... This finding is even more important, as metabolic disorders are connected to socioeconomic status. Obesity, the Metabolic Syndrome and type 2 diabetes are more common among low-income households [35]. Especially these households require professional dietary consultation to assure health and food literacy, but also sufficient financial support in order to effectively change their unhealthy dietary pattern. ...
Affordability of different isocaloric healthy diets in Germany-an assessment of food prices for seven distinct food patterns Background: For decades, low-fat diets were recommended as the ideal food pattern to prevent obesity, type 2 diabetes and their long-term complications. Nowadays, several alternatives considering sources and quantity of protein, fat and carbohydrates have arisen and clinical evidence supports all of them for at least some metabolic outcomes. Given this variety in diets and the lack of a single ideal diet, one must evaluate if patients at risk, many of which having a lower income, can actually afford these diets.
Aim:
We modelled four-week food plans for a typical family of two adults and two school children based on seven different dietary patterns: highly processed standard omnivore diet (HPSD), freshly cooked standard omnivore diet (FCSD), both with German average dietary composition, low-protein vegan diet (VeganD), low-fat vegetarian diet (VegetD), low-fat omnivore diet (LFD), Mediterranean diet (MedD) and high-fat moderate-carb diet (MCD). The isocaloric diets were designed with typical menu variation for all meal times. We then assessed the lowest possible prices for all necessary grocery items in 12 different supermarket chains, avoiding organic foods, special offers, advertised exotic super foods and luxury articles. Prices for dietary patterns were compared in total, stratified by meal time and by food groups.
Results:
Among all seven dietary patterns, price dispersion by supermarket chains was 12-16%. Lowest average costs were calculated for the VegetD and the FCSD, followed by HPSD, LFD, VeganD, MedD and-on top-MCD. VeganD, MedD and MCD were about 16%, 23% and 67% more expensive compared to the FCSD. Major food groups determining prices for all diets are vegetables, salads and animal-derived products. Calculations for social welfare severely underestimate expenses for any kind of diet.
Conclusions:
Food prices are a relevant factor for healthy food choices. Food purchasing is financially challenging for persons with very low income in Germany. Fresh-cooked plant-based diets are less pricy than the unhealthy HPSD. Diets with reduced carbohydrate content are considerably more expensive, limiting their use for people with low income. Minimum wage and financial support for long-term unemployed people in Germany are insufficient to assure a healthy lifestyle.
... The associations between area deprivation and individual socioeconomic status with cardiovascular disease or cardiometabolic risk factors have also been investigated in a number of studies [6,10,[20][21][22][23]. In a systematic review by Toms et al. [6], 24 studies investigating geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution reported associations of higher prevalence of hyperglycaemia, dyslipidaemia, BMI, blood pressure and reduced glomerular filtration rate with greater area-level socioeconomic disadvantage, which is in contrast to our results. ...
Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany.
Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND ( n = 3,731) and KORA-F4 ( n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke).
Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models.
Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.
... Rauchen, Übergewicht sowie mit der erhöhten Häufigkeit von assoziierten Risikoerkrankungen, z.B. Diabetes mellitus Typ 2, Bluthochdruck oder erhöhte Cholesterinwerte [4,5]. ...
... Als Indikator für den Bedarf der Inanspruchnahme von Hausärzt*innen wurde der subjektive Gesundheitszustandes herangezogen, der anhand der Frage ,,Wie ist Ihr Gesundheitszustand im Allgemeinen?'' auf einer 5-stufigen Skala zwischen sehr gut und sehr schlecht bewertet werden konnte und in die multivariable Analyse dichotomisiert als ,,gut'' (≤2) respektive ,,schlecht'' (3)(4)(5) ...
Zusammenfassung
Hintergrund
Soziale Ungleichheiten in der ambulanten Nachsorge der koronaren Herzkrankheit (KHK) sind in Deutschland kaum erforscht.
Methode
Die Analysen basieren auf Angaben der Teilnehmer*innen der bundesweiten Querschnittsstudie „Gesundheit in Deutschland aktuell“ (GEDA) 2014/2015, die das Vorliegen einer koronaren Herzkrankheit in den letzten 12 Monaten selbstberichteten (N = 920). Die ambulante Versorgung der KHK wurde anhand der selbstberichteten Einnahme von blutdruck- und cholesterinsenkenden Medikamenten sowie der Häufigkeit von Besuchen bei Hausärzt*innen analysiert.
Ergebnisse
Die Befragten suchten durchschnittlich 7,5-mal im Jahr eine*n Hausarzt*Hausärztin auf. Bei 46% wurde die KHK nicht gemäß der Empfehlung sowohl mit Blutdruck- als auch mit Cholesterinsenkern behandelt. Personen mit niedrigem im Vergleich zu einem hohen Sozialstatus berichteten etwa zwei Termine mehr im letzten Jahr bei ihrem Hausarzt/ ihrer Hausärztin (AME: 1,94; 95%-KI 0,56–3,31). Für die Versorgung mit blutdruck- und cholesterinsenkenden Medikamenten konnten weder für den Sozialstatus noch für das Geschlecht signifikante Unterschiede gefunden werden, jedoch haben Befragte mit erhöhten Blutfetten oder Cholesterinwerten eine um 54 Prozentpunkte (AME: -0,54; KI95% -0,61– -0,48) reduzierte Wahrscheinlichkeit, eine lediglich partielle Medikation einzunehmen bei der mindestens eines der zur Behandlung der KHK empfohlenen Medikamente nicht eingenommen wird.
Diskussion
Soziale Ungleichheiten in der ambulanten Nachsorge der KHK bestehen nicht in der Versorgung mit blutdruck- und cholesterinsenkenden Medikamenten, jedoch in der Inanspruchnahme eines*r Hausarztes*in, die* den Menschen mit niedrigem Sozialstatus häufiger aufsuchen.
Schlussfolgerung
KHK-Patient*innen suchen mit im Mittel 7,5 Konsultationen pro Jahr überdurchschnittlich oft ihren Hausarzt/ ihre Hausärztin auf, jedoch ist etwa die Hälfte der Patient*innen nicht optimal mit Medikamenten versorgt. Dieses mögliche Versorgungsdefizit in der medikamentösen Behandlung der KHK lässt sich jedoch nicht durch soziale Ungleichheiten erklären. Ein möglicher Anhaltspunkt für eine Verbesserung der Versorgung, vor allem von Patient*innen ohne weitere Risikofaktoren, ist eine stärkere Fokussierung auf die leitliniengerechte Versorgung der KHK bei der Verschreibung von Medikamenten.
... Most of the evidence on the relationship between socioeconomic inequalities and CSD mortality is based on the studies conducted in Western Europe and the United States [12][13][14][15], whereas much less is available from the Central and Eastern European countries [16]. The recent study in Poland, Russia and Czechia, con rmed the strong relationship between a risk of death from CSD and psycho-socioeconomic factors [17,18]. ...
... Our study indicate that variation of CSD mortality in sub-regions of Poland can be explained partially at least by the differences in SES. Our results comply with the research in which synthetic SES indexes were used to assess the relationship between deprivation and mortality due to CSD and IHD [12][13][14]. Some studies suggest that deprivation has a stronger impact on CSD mortality in men than in women [12,31]. ...
Background. Socioeconomic status (SES) influences cardiovascular health, but studies on the relation between deprivation and circulatory system diseases (CSD) in Eastern Europe are scarce. This study aimed to assess the relationship between SES and mortality from CSD at the population level in 66 sub-regions of Poland.
Methods. Area-based index based on education, structure in employment, salary, unemployment and poverty was constructed to assess SES. Data on mortality and the components of SES were obtained from the Central Statistical Office. Associations were tested using multivariate Poisson regression models.
Results. In men, compared to 2010, percent of Deaths Prevented or Postponed (DPP) in 2014 was 31.1% for CSD, 23.4% for ischemic heart disease (IHD) and 21.4% for cerebrovascular diseases (CD). In women proportion, of DPP was 12.8%, 25.6% and 21.6 respectively. CSD mortality was negatively related to SES with the exception to CD mortality in women. However, low-SES regions experienced a greater decrease in CSD mortality than high-SES regions.
Conclusions. Decrease of CSD mortality was more pronounced in women than in men, particularly in more deprived sub-regions compared with affluent regions. After adjustment for covariates SES was related with CSD and IHD mortality in men, and with CD mortality women.
