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PubMed2004

Maternal socio-economic factors and the risk of low birth weight in Lithuania.

AIM: To evaluate the importance of maternal socio-economic factors on the risk of low birth weight in Lithuania. MATERIAL AND METHODS: The case-control study involved 851 newborns with low birth weight (<2500 g) (cases) and 851 newborns with normal weight (controls). Study was accomplished from 1st February, 2001 until 31st October, 2002 in six main maternity hospitals in Lithuania. Mothers of infants were interviewed on the first day after delivery using the structured questionnaire. The database was processed by the application of statistical package "SPSS for Windows v.10.0". RESULTS: Young (<20 years) and older (35 years and older) maternal age, primary or basic education, being single, divorced or widowed, low income, living in rural area and unemployment before pregnancy and during pregnancy increased the risk to deliver low birth weight baby in univariate analysis. In logistic multivariable regression analysis, low education, low income and unemployment during pregnancy significantly increased risk of low birth weight--OR - 2.0, 1.7 and 1.6 respectively. Interaction between several unfavorable risk factors increased risk of low birth weight by 3.4-7.8 times, being the highest among mothers with low education, unstable marital status and low income. CONCLUSION: Maternal unfavorable socio-economic factors increased the risk to deliver low birth weight baby.

Adult↗
PubMed2005

Economic factors and the percentage of residency positions filled by United States medical graduates.

OBJECTIVE: To study the association between economic factors and the percentage of specialty residency positions filled by U.S. medical graduates. METHODS: Data from the 2004 National Resident Matching Program were used to estimate the percentage of residency positions filled by U.S. medical graduates in 15 major specialties. Data from the Medical Group Management Association, American Medical Association, and a major Massachusetts liability insurer were used to estimate the mean and median physician income, work hours, and the relative cost of professional liability insurance. RESULTS: The percentage of residency positions filled by United States medical graduates varied by specialty. In 2004, U.S. graduates filled more than 90% of the residency positions in orthopedics, plastic surgery, and neurosurgery. In contrast, U.S. graduates filled fewer than 60% of the residency positions in internal medicine and family medicine. A positive correlation between mean annual income and the percentage of residency positions filled by U.S. medical graduates (r = 0.78, P < .001) was observed across the 15 specialties studied. In a multivariate analysis, professional liability costs were not associated with the percentage of residency positions filled by U.S. graduates after controlling for annual income (P = .46). CONCLUSION: Economic factors are associated with the percentage of specialty positions filled by U.S. medical graduates. Procedure-based and hospital-based specialties with an above-average annual income are most likely to have their residency positions filled by U.S. medical graduates. LEVEL OF EVIDENCE: III.

Career Choice↗
PubMed2004

Socio-economic factors and tuberculosis: a district-based ecological analysis in Hong Kong.

BACKGROUND: Relatively little is known about the impact of socio-economic factors on tuberculosis in a metropolitan city with high disease incidence. METHOD: District-specific tuberculosis notification rates for 1995--1997 and 2000--2002 were indirectly sex- and age-adjusted and compared with the socio-economic characteristics in the 1996 by-census and 2001 census. RESULTS: The differences between the 18 districts persisted after 3-year averaging and indirect standardisation. Only the percentage of population born locally, the percentage of the population widowed or divorced and the percentage of households residing in rooms or bedsits were consistently associated with the standardised notification ratios (SNR) for both periods, the first being negatively so (all P < 0.05). In a combined analysis with a general linear model for both periods, birth in China, residence <7 years, speaking other Asian languages, being married and in a single household were also significantly associated with the SNR (all P < 0.05). Using a backward conditional approach, only local birth, being married, and residing in rooms or bedsits were independent predictors of SNR (all P < 0.05). There was no significant association between SNR and socio-economic indices on education, occupation, unemployment and income. CONCLUSION: Socio-economic factors other than simple poverty are affecting the district-specific tuberculosis rates in Hong Kong.

Female↗
PubMed2004

The impact of socio-economic factors on functional status decline among community-dwelling older adults in China.

The purpose of this paper is to examine the impact of baseline socio-economic factors on functional status decline over a period of 3 years among a sample of Chinese older men and women, using the China Health and Nutrition Surveys of 1997 and 2000. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic, health-related and nutritional risk factors. The eligible study population was defined as women and men aged 55 years and over who at baseline were free from any form of disablement in activities of daily living (ADLs) or instrumental activities of daily living (IADL) tasks. Among subjects with complete data at followed-up (N = 976), the overall incidence proportions of any functional status decline, IADL only and ADL declines were 25.8%, 18.9% and 6.9%, respectively. Our study found that education is strongly and inversely associated with incidence of combined functional status decline and IADL only but not with the onset of ADL disability. Similarly, household income per capita was inversely associated with functional status decline and IADL disability incidence, with a clear dose-response relationship, even after adjustment for age and gender. However, multivariate analysis demonstrated that the latter association was highly confounded by other demographic factors, especially urban-rural area of residence. Using a combined measure of socio-economic status that includes years of education and household income per capita, the age and gender-adjusted odds ratio for functional status decline and belonging to lower SES class as compared to middle, upper middle and upper classes was 3.82 (95% CI: 2.15, 6.77) and 2.77 (95% CI: 1.52, 5.03) after further adjustment for urban-rural area of residence and living arrangements. Hence, there are wide socio-economic disparities in the functional health of older adults in China, although such disparities are more seen for IADL decline and are almost exclusively attributed to differentials in educational attainment. Finally, nutritional and health-related risk factors do not seem to act as intermediate factors in this association and hence further research should try to uncover other mechanisms by which SES affects changes in functional health among older adults in China.

Activities of Daily Living↗
PubMed1999

Socio-economic factors that predict psychiatric admissions at a local level.

BACKGROUND: The aim of the study was to confirm the predictive relationship between socio-economic factors and psychiatric admissions at a fine grain geographical level. The strength of association was compared with those of other studies that have looked at separate diagnostic groups. METHOD: Psychiatric admissions were from electoral wards of the County of South Glamorgan, which encompasses the capital city of Wales, Cardiff. Standardized psychiatric admission ratios (SAR) for different diagnostic groups were calculated for a 5-year period. The ecological association with deprivation indices and with single variables at the level of electoral ward was examined. Of a total of 15266 psychiatric admissions, 11296 were analysed. RESULTS: Psychiatric morbidity, reflected in SAR was inversely related to socio-economic deprivation for both sexes. This applied to all diagnostic groups except organic disorders. The relationship was most marked for schizophrenia, delusional disorders and substance abuse, closely followed by personality disorders, and less for affective and neurotic disorders. Little difference existed between three composite indices of deprivation (Carstairs, Jarman, Townsend), but the marginally best predictor was that designed by Jarman. However, low rates of car ownership and high unemployment were as good at predicting SAR as any of the compound indices. CONCLUSION: Socio-economic factors account for almost 50 % of the variance in psychiatric admission rates between electoral wards. The degree of association between psychiatric morbidity and deprivation varies between diagnostic groups, arguing against a common factor linking deprivation and psychiatric admissions generally. Frequently updated unemployment figures provide nearly as useful and more immediate information than 10-yearly Census data used to calculate the deprivation indices. These figures may be used for needs assessment and targeting resources at a local level.

Adolescent↗
PubMed2006

Clinical and economic factors associated with ambulance use to the emergency department.

BACKGROUND: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. OBJECTIVES: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. METHODS: This was a retrospective, cross-sectional study of all patients seen during 2001 (N = 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. RESULTS: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0-10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight-8 am (OR, 2.0; 95% CI = 1.8 to 2.1), and age > or =65 years (OR, 1.3; 95% CI = 1.2 to 1.5). CONCLUSIONS: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means.

Adult↗
PubMed2005

Socio-economic factors and health care system characteristics related to cancer survival in the elderly. A population-based analysis in 16 European countries (ELDCARE project).

The ELDCARE study aims to investigate, at the ecological level, the relationships between socio-economic variables and cancer survival in patients aged 65 years and over. Survival data for patients diagnosed during the period 1985-1989 and followed up to 1994 were provided by 43 European Cancer Registries in 16 countries participating in the EUROCARE 2 project. Relative survival was computed by Hakulinen's methods. Data on socio-economic factors were collected by national statistics offices for the years around 1991. Pearson's correlation was used to study the relationships between cancer survival and socio-economic factors. We selected four groups of variables. The first group included macro-economic variables (such as Gross Domestic Product, GDP; Total Health Expenditure, THE); the second, the main characteristics of national health care systems; the third, demographic factors; and the fourth, variables on labour market organisation. The countries with the largest proportions of elderly populations, in Northern and Western Europe, spent more on health than the less affluent countries of Eastern Europe. GDP was strongly related to THE but a very high variability in Computed Tomography Scanners (CTS) among countries with similar THE was observed. Indeed, those countries with THE around US 1500 dollars per capita had survival rates for breast cancer ranging from 67 to 82%. Cancer survival in elderly patients in Europe was most strongly related to GDP and THE, especially for good prognosis cancers. Survival was strongly correlated with health care technologies, particularly CTS, but not with health employment. Survival was positively correlated with proportion of married elderly people (and negatively with widowed elderly), suggesting a role played by social support in influencing the prognosis of elderly patients. These results highlight how health outcomes in the elderly are a complex phenomenon, not determined only by GDP and THE, but affected by social organisation and life habits as well as economic development conditions.

Age Factors↗
PubMed2006

Associations between socio-economic factors and the use of prescription medication during pregnancy: a population-based study among 19,874 Danish women.

OBJECTIVE: To examine the association between socio-economic factors and use of prescription medication during pregnancy in a population of Danish women. METHODS: This was a population-based cohort study. Using record linkage from public administrative registries, we described the use of prescription medication during pregnancy and the financial and educational resources for each pregnant woman in the cohort. RESULTS: The analyses included all 19,874 primiparous women delivering singletons in North Jutland county, Denmark, in 1991-1998. We identified 24,243 prescriptions filled by the women during their pregnancies. The highest overall prescription medication use was among women with basic schooling (OR 1.3; 95% CI 1.2-1.4), and lowest among women with the highest education (OR: 0.8; 95% CI 0.7-0.9) compared with women who had vocational education. Stratified analysis of therapeutic subgroups revealed that socio-economic factors were associated with the use of anti-infective and anti-asthmatic medications during pregnancy. CONCLUSION: Maternal educational level, and to a lesser degree household income, paternal educational level and cohabitation status, was associated with the use of prescription medication during pregnancy. However, the analyses did not take into account important clinical variables such as maternal illness, and the results could be affected by differential misclassification of exposure information, by confounding or chance.

Adult↗
PubMed1989

Socio-economic factors and rheumatic fever occurrence. Differences between patients with and without frequent sore throat.

One hundred and fourty-eight rheumatic fever patients and 444 controls matched by age, sex and place of residence, were interviewed about socio-economic and some other variables. Socio-economic factors recognized as risk factors for rheumatic fever (flat dampness, more than 2 persons per room, sleeping in bed with other person, low education of mother and undernourishment) were of lesser importance for persons with frequent sore throat in comparison to persons without frequent sore throat. According to the results obtained it seems that there is positive connection between host's propensity to clinical manifestation of throat infection and manifestation of rheumatic fever. The lesser susceptibility the more additional factors are needed for Rheumatic Fever to occur. The relative importance of socio-economic factors in rheumatic fever occurrence depends on host's susceptibility to infection.

Case-Control Studies↗
PubMed1979

Physician awareness of economic factors in clinical decision-making.

Physicians' awareness of economic factors in clinical decision-making at one large urban university medical center was studied by a 50-item questionnaire. Their dollar estimates were considered correct if within +/- 20 per cent of the true October 1976 figure. Eighty-one per cent of the house staff and all of the attendings correctly estimated the daily semi-private room rate, but only 15 per cent of each group correctly estimated the charge for a serum potassium. Roughly half of the questions concerning various third-party benefit plans were answered correctly. These results are consistent with those of the few previous studies. If the findings are generally applicable, they may suggest that a directed teaching program in simple economic facts and principles may be useful at all levels of physician training.

Attitude of Health Personnel↗
PubMed1998

Intra-urban variation of antibiotic utilization in children: influence of socio-economic factors.

OBJECTIVE: The aim of this study was to investigate the intra-urban variation of antibiotic utilization in children in Malmö and to evaluate the influence of socio-economic factors on this variation. METHODS: In an ecological analysis, the variations in antibiotic utilization in children, expressed as defined daily dose (DDD) or as the number of prescriptions per 1000 inhabitants per day, were compared with variations in socio-economic and demographic factors in the 17 administrative districts of the Swedish city of Malmö (235000 inhabitants). RESULTS: There were large between-area differences in antibiotic utilization, especially in children aged 0-6 years. Socio-economic factors reflecting a privileged situation correlated positively with antibiotic utilization. Thus, in districts with a high median family income and a high employment rate, the utilization of antibiotics was higher than in other districts. Conversely, in districts with a high proportion of blue-collar workers, people with foreign backgrounds and recipients of social benefit, antibiotic utilization was comparatively low. In contrast, the utilization of penicillin V relative to other antibiotics showed an opposite pattern, including positive correlations with the proportion of social benefit, immigrants and blue-collar workers and a negative correlation with employment rate. Conversely, the utilization of macrolides in relation to other antibiotics in children aged 0-6 years was highest in districts inhabited by those who were socio-economically privileged. INTERPRETATION: The findings suggest that utilization of antibiotics in children may vary considerably within a city, that it may increase with the degree of parental affluence, and that such affluence may reduce the utilization of penicillin V relative to other antibiotics.

Adolescent↗
PubMed2002

Role of socio-economic factors and cytology in cervical erosion in reproductive age group women.

A cross-sectional study involving 357 females in the reproductive age group (15-44) was conducted in an urban community of Nagpur with the objective of studying the role of socio-economic factors & cytology in cervical erosion. Cervical erosion was detected in 82 (22.96%) females. Out of these mild dysplasia was seen in 9.75% females & moderate dysplasia in 2.43% females. High percentages of inflammatory smears i.e. (75.68%) were obtained in women with cervical erosion. Cervical erosion was more common in illiterate & women with low literacy status as compared to women with higher education. Majority of cases of cervical erosion (75.6%) were detected in women with high parity. A statistically significant association was found between lower socio-economic status, early age at marriage & ocurrence of cervical erosion (p<0.001 & p<0.01 respectively). The study concludes that socio-economic factors such as illiteracy and low literacy status, lower socio-economic status, early age at marriage and high parity are contributory for the occurrence of cervical erosion and regular cytological screening by Pap smear will help in early detection of carcinoma cervix and thereby reduce the morbidity and mortality caused by the same.

Adult↗
PubMedDate not supplied

The influence of socio-economic factors on Helicobacter pylori infection rates of students in rural Zambia.

OBJECTIVES: Although prevalence of disease in sub-Saharan Africa is often quite high and attracts much research, relatively little is known about less critical maladies. We examined Helicobacter pylori infected students in rural Zambia. We attempted to determine if any socio-economic or co-occurring diseases were correlated to H. pylori infection. Understanding the context in which H. pylori infections occur may increase our understanding of this organism. DESIGN: We conducted a screening survey with diagnostic tests of primary and secondary school students to determine rates of H. pylori infection. We then correlated these rates to socio-economic factors such as income and tobacco use. We also explored the correlation of H. pylori to HIV and malaria. SETTING: Zimba, Zambia. SUBJECTS: Eighty seven primary and secondary school students. MAIN OUTCOME MEASURE: Correlation of H. pylori to socio-economic factors. RESULTS: H. pylori infection was common (60.9%) and was consistent with rates found in other African countries. We found no significant correlation between H. Pylori and disease and socio-economic variables. CONCLUSION: In the studied population H. pylori infection does not appear to be correlated with the measured socio-economic or disease variables.

Adolescent↗
PubMed1993

Political and economic factors influencing contraceptive uptake.

International, national and local level politics influence the uptake of contraception through consensuses, laws, financial and moral support or the creation of an enabling atmosphere. Opposition to contraception generally comes from some churches and groups opposed to particular technologies. Socio-economic factors, particularly education, the health care system and the perceived or actual cost of fertility regulation as compared to benefits expected from children also powerfully influence contraceptive use. For many poor women in developing countries their powerlessness in relation to their male partners is an important obstacle.

Contraception↗
PubMedDate not supplied

Trends and variations in perinatal mortality and low birthweight: the contribution of socio-economic factors.

OBJECTIVE: To examine trends and regional variations in perinatal mortality and low birthweight (LBW) and regional variations in socio-economic risk factors. METHODS: Population-based study of Central West Region of Ontario with approximately 28,000 births annually during the period 1988-1995 using vital statistics records and Census data. RESULTS AND CONCLUSIONS: There was no significant change in the perinatal mortality rate averaging 9.4 per 1,000 births per year. The LBW rate increased from 49.7 to 54.8 per 1,000, while the prematurity rate increased from 56.1 to 75.8 per 1,000. Significant variation occurred in outcomes among different regions, which was partially explained by socio-economic factors. The increases in LBW and prematurity rate emphasize the need for effective targeted services and programs. In their planning and implementation, regional variations in socio-economic factors, and other factors such as: the availability and utilization of services and barriers to access in services, require further evaluation and consideration.

Cause of Death↗
PubMed2006

Bovine respiratory disease in feedlot cattle: environmental, genetic, and economic factors.

The objective of this study was to characterize genetic, environmental, and economic factors related to the incidence of bovine respiratory disease (BRD) in feedlot calves. Records from 18,112 calves representing 9 breeds (Angus, Braunvieh, Charolais, Gelbvieh, Hereford, Limousin, Pinzgauer, Red Poll, and Simmental) and 3 composite types (MARC I, MARC II, and MARC III) over a 15-yr period (1987 to 2001) were evaluated. Disease incidence was observed and recorded by station veterinary and technical staff. The incidence of BRD varied across years, with the annual observed incidence ranging from 5 to 44%. From 1987 to 1992, the annual average incidence generally exceeded 20%. However, in later years the annual incidence did not exceed 14%. The epidemiological pattern indicated that BRD infection increased dramatically after 5 d on feed and remained high until approximately 80 d on feed. Previous BRD infection during the preweaning period did not influence subsequent BRD infection in the feedlot. Steers were more likely to become sick with BRD than heifers; castration before entry in the feedlot may be a predisposing cause. Few significant differences among breeds were detected for BRD incidence. Adjusted solutions from mixed model analyses indicated that Herefords were generally more susceptible to BRD infection (P < 0.05) than MARC I and III composite types. Composite breed types had similar susceptibility compared with other purebred breeds. Mortality associated with BRD was greatest in Red Poll calves (9%) compared with the average over all breeds (4%). Estimates of heritability for resistance to BRD ranged from 0.04 to 0.08 +/- 0.01. When the observed heritability was transformed to an underlying continuous scale, the estimate increased to 0.18. Selection for resistance to BRD could be effective if phenotypes for BRD resistance were known. Thus, development of an inexpensive and humane method of challenging animals with BRD to determine resistance would be an important step in reducing the incidence of BRD. This study also demonstrated that producer-collected field data could be used for selection against this disease. The economic loss associated with lower gains and treatment costs for BRD infection in a 1,000-cattle feedlot was estimated as dollar 13.90 per animal, not including labor and associated handling costs.

Animal Husbandry↗