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PubMed2005

[Analysis on direct economic burden of stroke in the rural population of Hanzhong, Shaanxi Province].

OBJECTIVE: To analyze the direct economic burden of stroke in rural areas of Hanzhong. METHODS: Plan on primary interview was made after the purpose of the study had been informed to the managers of the 'surveillance field base', heads and members of the monitor assistants and detailed information was collected in the fields. Every single patient of stroke was then interviewed by the above said interviewers,using a self-designed questionnaire. 164 patients with stroke were interviewed in 53 villages with 75,000 persons lived there. The main items involved in the questionnaire would include: costs for inpatient or outpatient, reaching-out fees, fee for accommodation during treatment as outpatient, costs for treatment at home, long term medicine, caregivers and funerals as well as average income. RESULTS: The median of annual direct economic burden was 3100 Yuan for each patient in Hanzhong rural area. There were no significant differences seen between males and females or among age groups (P > 0.05). The proportion of patients with medians of annual direct economic burden of: 1000 Yuan and below, 1001-5000 Yuan, 5001-10,000 Yuan, 10,001-20,000 Yuan and over 20,001 Yuan, were 29.2%, 36.0%, 18.3%, 9.8% and 6.0% respectively. The median of annual direct economic burden of first episode stroke was 5500 Yuan for each patient, and that of stroke was 1700 Yuan for each chronic patient. The direct economic burden of first episode was significantly higher than that of stroke (P < 0.01). The costs of hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old age patients (P < 0.05). CONCLUSION: In this study, the direct economic burden of stroke was 2.9 times of the annual personal average income, which was contrary to the reports from other countries. However, the State Health Bureau bore 87.1% of the direct economic burden for urban patients, but patients in the rural areas had to pay from their own pockets. The direct economic burden of stroke was heavy in Hanzhong rural region, which called for measures to be made to decrease the direct economic burden of stroke in the region.

Age Distribution↗
PubMed2005

[Immunization coverage survey: empirical assessment of the cluster sampling method proposed by the World Health Organization].

OBJECTIVE: To assess sample representativeness and the precision of estimates of immunization coverage obtained with the 30 by 7 cluster sampling method proposed by the World Health Organization, by applying the method to determine immunization coverage in two municipalities (Diadema and São Caetano do Sul) in the state of São Paulo, Brazil, in 2000. METHOD: The representativeness of the samples was determined by comparing the census sectors picked by lot for the surveyed sectors and for the nonsurveyed sectors in both municipalities, in terms of socioeconomic and demographic characteristics (age distribution of the population, schooling, proportion of households headed by a women, monthly income of household head, and sanitary conditions of the home (piped-in water, connected to the sewer system)). The precision of the coverage estimates for the vaccines in the basic immunization schedule-BCG; diphtheria, pertussis, and tetanus (DPT); poliomyelitis; hepatitis B; measles; and measles, mumps, and rubella (MMR)-was determined by calculating the design effect and the width of the confidence intervals. Precision was considered to be satisfactory if the design effect was below 2.0 and the confidence interval width was below 10%. RESULTS: In both municipalities the comparison between the surveyed and nonsurveyed sectors showed a similar distribution in terms of socioeconomic and demographic variables. Concerning the precision of the estimates, the design effect was below 2.0 for all the vaccines, both in São Caetano do Sul and Diadema. In Diadema, the confidence interval width was below 10% for all the vaccines, except for MMR (10.1%). In São Caetano do Sul, only 89% of the expected sample were included, so the width of the confidence interval was slightly above 10% for the poliomyelitis vaccine (10.3%), the hepatitis B vaccine (11.8%), the mumps vaccine (10.4%), the MMR (12.9%), and the complete schedule (11.2%). CONCLUSION: The cluster sampling method proposed by the World Health Organization produces representative data as long as the methodological procedures for selecting the sample are rigorously followed in the field.

Adolescent↗
PubMed2005

Childhood leukemia and socioeconomic status in Canada.

BACKGROUND: Leukemia is one of the most common potentially fatal illnesses in children, and its causes are not well understood. Although socioeconomic status (SES) has been related to leukemia in some studies, this apparent association may be attributable to ascertainment or participation bias. This study was undertaken to determine whether there is a difference in incidence of childhood leukemia for different levels of SES, as measured by neighborhood income, in an unselected population case group. METHODS: All cases of childhood leukemia diagnosed in the years 1985-2001 were identified from population-based cancer registries in Canada. Postal codes for the place of residence at diagnosis were used to ascertain the census neighborhoods for cases. We constructed neighborhood-based income quintiles from census population data, and stratified the population at risk by sex and 5-year age groupings. Age-standardized incidence rates and 95% confidence intervals (CIs) were calculated. We used Poisson regression to compare incidence rate ratios (RRs) across income quintiles. RESULTS: A slightly lower relative risk of childhood leukemia was observed in the poorest quintile compared with the richest (RR = 0.87; 95% CI = 0.80-0.95). The lower risk in the poorest quintile was restricted to acute lymphoid leukemia (0.86; 0.78-0.95) and was strengthened slightly by restriction to urban areas (0.83; 0.74-0.93). CONCLUSIONS: This analysis suggests that high SES is a true risk factor for childhood leukemia and that inconsistent results from other studies may be related to differences in case ascertainment or study participation.

Adolescent↗
PubMed2006

Income-related health inequality in Belgium: a longitudinal perspective.

This paper provides new evidence on the degree of income-related inequality in self-assessed health in Belgium. First of all, we combine the time dimension, which has been shown to be very important in the analysis of inequality, and the use of the recently developed interval regression approach to transform a categorical health variable in a continuous one. Second, we measure how the long-run inequality differs from the short-run inequality. Finally, we decompose this health-related income mobility index as well as the long-run concentration index (CI) itself into its contributors. Using data from the panel survey of Belgian households (1994-2002), we find that health is pro-rich distributed and that its inequality is underestimated by 9.45% when neglecting the dynamics of individuals over time. Income, education, job status and age are the most important contributors in the CI and the difference between the short-run and long-run inequality.

Adult↗
PubMed2005

Percentile distribution of the waist circumference among Mexican pre-adolescents of a primary school in Mexico City.

AIM: The aim of this study is to describe the percentile distribution of the waist circumference in Mexican pre-pubertal children living in an urban, middle-income area. METHODS: Children, aged 6-10, from a primary school, located in a middle-income area in Mexico City were included (n=833). Anthropometric measurements were made in the case of all children by using standardized procedures. RESULTS: The prevalence of obesity and overweight was greater among boys (p<0.001). Of them, 30 were obese (7.2%) and 47 were overweight (11.4%). Girls had a prevalence of obesity of 2.8% and of overweight of 8.8%. Boys had greater waist circumference than girls (p<0.001). This observation was independent from differences in age or body mass index (BMI). The distribution of the waist circumference was shifted towards higher values among boys. The values corresponding to the 85th percentile ranged, in boys aged 6-10, between 62.9 and 85.9 cm. By contrast, for girls, those values were 66.8 and 72.08 cm, respectively. A receiver-operator curve was constructed in order to identify the waist circumference most likely to be associated with a BMI of > 85th percentile. We found that age- and sex-specific cut-off points are required for the detection of central adiposity in children aged 6-10. CONCLUSIONS: The percentile distribution of the waist circumference in Mexican pre-pubertal children living in urban, middle-income areas is described in this study. Moreover, included are the cut-off points most likely to be associated with increased adiposity. This information can be used for defining abdominal obesity in paediatric populations.

Anthropometry↗
PubMed2006

Arsenic, cadmium, lead, and mercury in surface soils, Pueblo, Colorado: implications for population health risk.

Decades of intensive industrial and agricultural practices as well as rapid urbanization have left communities like Pueblo, Colorado facing potential health threats from pollution of its soils, air, water and food supply. To address such concerns about environmental contamination, we conducted an urban geochemical study of the city of Pueblo to offer insights into the potential chemical hazards in soil and inform priorities for future health studies and population interventions aimed at reducing exposures to inorganic substances. The current study characterizes the environmental landscape of Pueblo in terms of heavy metals, and relates this to population distributions. Soil was sampled within the city along transects and analyzed for arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb). We also profiled Pueblo's communities in terms of their socioeconomic status and demographics. ArcGIS 9.0 was used to perform exploratory spatial data analysis and generate community profiles and prediction maps. The topsoil in Pueblo contains more As, Cd, Hg and Pb than national soil averages, although average Hg content in Pueblo was within reported baseline ranges. The highest levels of As concentrations ranged between 56.6 and 66.5 ppm. Lead concentrations exceeded 300 ppm in several of Pueblo's residential communities. Elevated levels of lead are concentrated in low-income Hispanic and African-American communities. Areas of excessively high Cd concentration exist around Pueblo, including low income and minority communities, raising additional health and environmental justice concerns. Although the distribution patterns vary by element and may reflect both industrial and non-industrial sources, the study confirms that there is environmental contamination around Pueblo and underscores the need for a comprehensive public health approach to address environmental threats in urban communities.

Arsenic↗
PubMed2006

Association of socio-economic status with diabetes prevalence and utilization of diabetes care services.

BACKGROUND: Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, however, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system. METHODS: Data on referral for diabetes care, diabetes prevalence and median household income were obtained from a regional Diabetes Education Centre (DEC) database, the Canadian National Diabetes Surveillance System (NDSS) and the 2001 Canadian Census respectively. Diabetes rate per capita, referral rate per capita and proportion with diabetes referred was determined for census dissemination areas. We used Chi square analyses to determine if diabetes prevalence or population rates of referral differed across income quintiles, and Poisson regression to model diabetes rate and referral rate in relation to income while controlling for education and age. RESULTS: There was a significant gradient in both diabetes prevalence (chi2 = 743.72, p < 0.0005) and population rates of referral (chi2 = 168.435, p < 0.0005) across income quintiles, with the lowest income quintiles having the highest rates of diabetes and referral to the DEC. Referral rate among those with diabetes, however, was uniform across income quintiles. Controlling for age and education, Poisson regression models confirmed a significant socio-economic gradient in diabetes prevalence and population rates of referral. CONCLUSION: Low income is associated with a higher prevalence of diabetes and a higher population rate of referral to this regional DEC. After accounting for diabetes prevalence, however, the equal proportions referred to the DEC across income groups suggest that there is no access bias based on income.

Alberta↗
PubMed1993

The prevalence of root surface caries amongst Irish adults.

In a national survey of adult dental health conducted in the Republic of Ireland in 1989/90 a total of 1,527 subjects aged 25 and older were examined for root surface caries. It was found that the prevalence of root surface caries was highest in older age groups and also amongst males, residents of non-fluoridated communities and those earning low incomes. Tooth loss masked the potential prevalence of root surface caries. With more persons retaining their natural teeth into middle and old age the prevalence of root surface caries is likely to increase in the future.

Adolescent↗
PubMed2001

Relationship between breast-feeding duration and acute respiratory infections in infants.

OBJECTIVE: To study the relationship of breast-feeding duration on the frequency of respiratory tract infections in infants during the first 2 years of life. METHODS: A retrospective study where the files of infants randomly selected from Shamasan Primary Health Care Center were analyzed for different related factors and frequencies of respiratory infections. RESULTS: The mean duration of lactation was shorter than in previous national reports (5.1 +/- 3.4 months). The frequencies of respiratory infections were high in the first 2 years reaching an average of 9.2 +/- 4.1 attacks per infant. The lower respiratory tract suffered more frequent attacks than the upper averaging a rate of 5.6 +/- 2.6 attacks per infant compared to 3.7 +/- 2.2 attacks per infant. The multiple regression models pointed out to highly significant predictors for respiratory infection rates: Lactation duration (p < 0.001) for the 2 years rates, child rank (p < 0.001) for the first year rates and family income (p < 0.001) for the 2nd year rates. CONCLUSION: The lactation duration has an important relation to the frequency of respiratory infections in infancy. Every effort should be made to encourage and support longer duration of breast-feeding.

Acute Disease↗
PubMed1980

Association of breast cancer and cervical cancer incidence with income and education among whites and blacks.

Data from the 1969-71 Third National Cancer Survey were used to study the association of cancer incidence with income and education as indicated by census tract of residence. Also considered was the effect of adjustment for differences in socioeconomic distribution on the observed excess risk of cervial cancer and lower risk of breast cancer among black women compared to white women. Strong positive associations with both income and education were found, with the rates based on 19,344 breast cancer cases among white women. These observations were noted in most geographic areas studied. The relative risk showed little apparent relationship to age. The rates based on 1,570 cases among black women indicated a strong positive association with education but not with income. Socioeconomic adjustment reduced by almost one-half the black-white difference in breast cancer rates, and education had a stronger effect than did income. White women continued to have a significantly higher rate after such adjustment. Conversely, the incidence of cancer of the cervix showed strong negative associations with each of the two variables among both the 3,802 cases in white women and 954 cases in black women. The negative gradient decreased with age and was apparent in almost all the areas. The excess risk among black women was reduced by two-thirds with socioeconomic adjustment, though the rates remained significantly different. Income had a stronger association than did education with cervical cancer incidence.

Adult↗
PubMed2006

Sitting time and socio-economic differences in overweight and obesity.

OBJECTIVES: To examine (1) the inter-relationships between socio-economic status (SES), physical activity, three different domains of sitting time (weekday, weekend day and leisure-time sitting), and being overweight or obese (body mass index>/=25 kg/m(2)); and (2) the potential mediation effects of sitting time in the relationship between socio-economic factors and being overweight or obese in working Australian adults. DESIGN: Observational epidemiological study. SUBJECTS: One thousand forty eight working adults. Using a multistage sampling design on neighbourhood SES, participants were from high and low SES neighbourhoods of an Australian capital city. MEASUREMENTS: Neighbourhood SES was assessed using census data; individual SES was based on self-reported educational attainment and household income. There were three sitting time variables: sitting time on weekdays, weekend days and in leisure time. Overweight and obesity were determined using self-reported body weight and height. RESULTS: Gender, age, neighbourhood SES, education, working hours and physical activity were independently associated with weekday, weekend day and leisure-related sitting time. With the exception of education and working hours, these variables were also independently associated with being overweight or obese. Leisure-time sitting was found to be a mediator in the relationships between gender, education and being overweight or obese. CONCLUSION: Strategies to promote less sitting in leisure time are required to combat overweight and obesity in Australian adults, especially among those from low SES neighbourhoods, and among those with high levels of education and income who work long hours.

Adult↗
PubMed1985

The distribution and impact of health resource availability in China.

Since 1949, China's progress in mortality reduction has far exceeded that experienced by other developing countries with comparable levels of national income. This achievement has taken place in the context of a development strategy oriented, in part, to the elimination of the worst aspects of poverty. Using recent cross-section data, this paper provides a statistical assessment of the extent to which health resources are evenly distributed in contemporary China, and the degree to which improvements in health resource availability may account for the observed variation in mortality levels. Contrary to expectation, the analysis finds that substantial inequalities do remain in the distribution of health resources, and that these differentials are principally associated with levels of urban income and urbanization. However, these differences in health resource availability do not appear to explain the significant variation which also persists in mortality levels, a finding consistent with the results of similar analyses for developed countries.

China↗
PubMed2002

Self-reported health in Bulgaria: levels and determinants.

AIMS: Self-reported health has been widely used in studies of health inequalities in many industrialized countries, but there is still little information on their distribution within populations in countries in Central and Eastern Europe (CEE). There is growing evidence that, since the political transition at the end of the 1980s, income and health inequalities have widened considerably throughout CEE. This paper examined self-perceived health in Bulgaria in relation to financial status (measured by income and self-assessed financial status) after adjustment for other potential explanatory variables. METHODS: Data were derived from a national representative survey of the population of Bulgaria aged over 18, in 1997. Respondents were asked "How would you describe your own health status over the past 12 months on the whole?" with answers "good", "rather good", "rather poor", and "poor". Responses were assessed in relation to a variety of measures including income, education, marital status, and self-perceived financial hardship. RESULTS: As expected, the prevalence of poor/rather poor health increases steeply with age. Those with only primary education are more likely to be in poor/rather poor health than those with secondary or higher education. Self-assessed financial status is a much better predictor of health than is income, with the relationship especially strong among women. There was no association with marital status or urban vs. rural dwelling. CONCLUSIONS: The survey found marked inequalities in self-reported health in Bulgaria. Some of its determinants, such as age and education, are comparable to those seen in the West. Self-reported health is particularly associated with self-perceived financial hardship, a proxy for material deprivation that is sensitive to informal economic exchanges. An accelerated pace of economic and social reforms at the end of the 1990s means that the health divisions in Bulgaria are likely to increase in the short term.

Adult↗
PubMed2003

[Social inequality and noise pollution by traffic in the living environment--an analysis by the German Federal Health Survey (Bundesgesundheitssurvey)].

AIM OF THE STUDY: The study deals with the relationship between socioeconomic status and the uneven distribution of noise pollution in residential areas. Based on the social indicators education, occupation, income and an index of socioeconomic status, the study investigates whether people of lower socioeconomic status are more likely to live in busier streets and to be more affected by traffic and noise pollution than others. MATERIAL: The German Federal Health Survey (Bundesgesundheitssurvey, BGS) is a representative survey of the health status of the adult population in Germany. The representative sample in question reflects the opinions of 6,644 individuals aged between 18 and 79 years who were asked to fill in a standardised questionnaire between autumn 1997 and spring 1999. RESULTS: People of lower socioeconomic status are more likely to live in busy to extremely busy main roads and through roads. They feel significantly more often affected by traffic noise pollution. People of higher socioeconomic status are more likely to live in quiet environments. Essentially, all four social indicators reflect the social gradient of noise pollution, but their impact is differently weighted. CONCLUSION: Noise pollution in environments is unevenly distributed, with people of lower socioeconomic status suffering more than others. In view of the increased social burden and assumed vulnerability experienced by lower socioeconomic groups, environmental objectives for protection from noise pollution should be developed which ensure a socially just distribution of environmental noise pollution in addition to avoiding danger to health.

Adult↗
PubMed1977

Mexican American and European Americal psychopathology and hospital course.

Demographic information, reason for admission, mental status on admission, hospital course variables, and discharge diagnosis were collected for 99 patients admitted consecutively to the psychiatric inpatient unit of a community mental health center serving a low-income population with a large proportion of Mexican-Americans; Patient ethnic distribution reflected that of the catchment area. Although ethnicity, sex, and social class each showed distinct characteristics, when any two of the factors were held constant, only three variables maintained significance, none of which indicated severe, flamboyant psychopathology. This study does not support earlier reports that hospitalized Mexican Americans are more severely disturbed than other ethnic groups.

Attitude to Health↗
PubMed2000

Division of labour and seasonality in the ant Leptothorax albipennis: worker corpulence and its influence on behaviour.

We address the organization of workers in social insect societies. We distinguish between changes in behavioural role over the nurse to forager role sequence, which may depend on changes in physiology, and potentially more rapid changes of task within role. We investigated the association between role and nutrient status in the ant Leptothorax albipennis. Worker lipid stores were quantified using a new body size-controlled method, and were related to worker behaviour. Worker lipid stores were evenly distributed amongst colony members at the end of winter, splitting rapidly into two distinct modes (replete nurses and lean foragers) in spring. The proportion of lean foragers increased throughout spring and summer, until most colonies contained only workers of this type. Callow workers then eclosed with intermediate lipid stores. We developed a computer vision system that tracks all nest ants to extract detailed behaviour of individuals of known lipid stores. Lipid storage was negatively correlated with a worker's foraging propensity, and with measures of spatial occupation in the nest and of activity. Different colonies showed a similar quantitative correlation between lipid stores and behavioural role, suggesting that lipid stores were not only correlated with the relative organization of individuals within each nest, but may also have influenced their absolute role. We reviewed the literature and found evidence that nutrient status influences role predisposition in social insect workers. We conclude that the distribution of worker roles may be linked to the balance between foraging income and energetic consumption within the colony directly via worker nutrient status. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗