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Social competence and behavior problems in premature children at school age.

Social competence and behavior problems of 87 children born weighing less than 1501 g were measured using the Child Behavior Checklist when the children were 7 to 8 years old. Both premature boys and girls had significantly lower Social Competence scores than the normative samples of their respective sexes. Only premature boys had significantly higher Behavior Problems scores, with significantly higher scores on behaviors associated with conduct disorders. Premature children in each of three social class groups had significantly lower Social Competence scores and higher Behavior Problems scores than normative children. Furthermore, there was an interaction between prematurity and social class on Behavior Problems scores, with the greatest discrepancy in scores between premature and normative children in the lower-class group. Relative to other predictors, IQ score best explained Social Competence scores and family stability best explained Behavior Problems scores in the premature sample.

Child↗

The use of the ophthalmological services during the preschool age, ocular findings and family background.

The series consists of 12,059 children followed-up since their mothers' pregnancy. Of these children, 5.2 percent had visited an ophthalmological department during their first five years. Visits were significantly more frequent among the children of social classes I to III than among those of class IV and the farmers', and thus the frequencies of the diseases based on diagnoses given in the ophthalmological departments were also higher in social classes I to III. These children clearly had the best opportunities to have their diseases diagnosed at an early age. Squint was the most common diagnosis with the prevalence being 18.4 per thousand for the children in social classes I to III and 15.9 for the total series. The second largest group consisted of children without any positive ocular finding. These were mainly risk children having some other disease. The third most common diagnosis was dacryostenosis--its incidence in social classes I to III being 9.4 per thousand and that in the total series 7.9 per thousand. Squint correlated negatively with birth weight and was more common among children with some other disease, especially some nervous or mental disease. Dacryostenosis correlated positively with gestational age. If the mother smoked during the pregnancy she was more likely to give birth to a child with squint and less likely to bear a child with dacryostenosis.

Agriculture↗

Perthes' disease of the hip in Liverpool.

A survey of Perthes' disease of the hip in three regions of England showed a higher incidence in the Mersey region compared with Trent or Wessex. To explore this further a case register was set up in Liverpool. Analysis of all new cases that occurred in Liverpool and adjacent parts of Knowsley and Sefton during 1976-81 showed a steep gradient with social class, ranging from 7.7/100 000 children in the higher classes to 26.3/100 000 in social class V. The inner city of Liverpool, which has been shown to be underprivileged, had the highest yearly incidence of the disease ever reported--21.1 cases/100 000 children aged 14 years and under. The associations with poverty support the hypothesis that undernutrition is a causative factor in the disease.

Child↗

Onset of addiction: a first attempt at prediction.

This study attempts to identify predictors of early heroin addiction. Natives of low social class origins are, as predicted by "social structure and anomie theory," more likely to be addicted when young. However, social class has little impact on age of addiction among migrants. Blue-collar migrants are strikingly less likely than blue-collar natives to be addicted when young; a nonsignificant trend in the same direction is found for white-collar respondents. Findings are interpreted in terms of commitment to traditional values. Contrary to expectations based on Moynihan, family intactness is unrelated to age of addiction.

Adolescent↗

Socioeconomic gradients in the prevalence of cardiovascular disease in Scotland: the roles of composition and context.

OBJECTIVE: To investigate whether occupational social class and area deprivation are independently associated with the prevalence of cardiovascular disease (CVD) conditions after adjustment for smoking status. DESIGN: Stratified multistage random sample analysed using multilevel logistic regression. PARTICIPANTS: 8804 adults aged 18-74 at time of interview in 1998-1999, clustered in 312 small areas. The outcome considered was a self report of doctor diagnosis of one of a number of CVD conditions. The survey also provided information concerning the respondent's occupational social class and current smoking status. The Carstairs score (based on the 1991 census) was used to describe small area deprivation. MAIN RESULTS: The gradient in CVD prevalence across individual social class was attenuated and became insignificant when area deprivation was considered. The aggregation of individual social class and smoking to the area level increased the correlation with disease prevalence at the individual level. CONCLUSIONS: Although there is a relation between socioeconomic status and CVD prevalence in Scotland, the relation is dominated by area deprivation. When externally validated deprivation measures are not available, aggregated individual characteristics may show a contextual (as compared with compositional) relation.

Adolescent↗

Impact of upward social mobility on population mortality: analysis with routine data.

OBJECTIVE: To examine the contribution of changes in the distribution of social class to the mortality of the whole population between 1970-2 and 1991-3. DESIGN: Examination of routine data at two time points: 1970-2 and 1991-3. DATA SOURCE: Data provided by the Office for National Statistics. MAIN OUTCOME MEASURES: Difference for the total population in the number of deaths between 1971 and 1991. Proportion of difference accounted for by change in population size, change in risk of death within each social class, or change in distribution of population across social classes. RESULTS: Reductions in mortality between 1970-2 and 1991-3 among men in England and Wales were partially (16% of all deaths) attributable to increases in the proportion of men in higher social classes, representing 3943 fewer deaths per year or one less death for every 3056 men in 1991-3 compared with 1970-2. CONCLUSION: Some of the observed reduction in mortality seen between 1970-2 and 1991-3 can be accounted for by improved overall socioeconomic status of the population.

Adult↗

The epidemiology of blood pressure in young Mexican adults.

The distribution of blood pressure and associated factors (height, weight, body mass index, age, social class) was assessed in young Mexican adults, with a cross-sectional study of 657 male and female students enrolled at the University of Mexico, aged from 19 to 25 years. Significantly higher blood pressure levels were observed in males than in females. Borderline hypertension was found in 20.7% of the study subjects. Of all anthropometric factors, age and social class, weight was determined by stepwise regression analysis as the best predictor for blood pressure when using a linear model. However, when a quadratic model was used, a 'U' relationship and a significant variation between blood pressure and social class was detected. This relationship was magnified when blood pressure was categorized into borderline hypertension and normotensives. These findings suggest the hypothesis that hypertension has a non-linear association with social class in environments that are undergoing an intermediate step of modernization and economic transition such as is occurring in Latin American countries today.

Adult↗

Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility.

BACKGROUND: Short-term increases in particulate air pollution are linked with increased daily mortality and morbidity. Socioeconomic status (SES) is a determinant of overall health. We investigated whether social class is an effect modifier of the PM(10) (particulate matter with diameter <10 micron)-daily mortality association, and possible mechanisms for this effect modification. METHODS: Area-based traffic emissions, income, and SES were available for each resident in Rome. All natural deaths (83,253 subjects) occurring in Rome among city residents (aged 35+ years) during the period 1998-2001 were identified. For each deceased individual, all the previous hospitalizations within 2 years before death were available via a record linkage procedure. PM(10) daily data were available from two urban monitoring sites. A case-crossover analysis was utilized in which control days were selected according to the time stratified approach (same day of the week during the same month). Conditional logistic regression was used. RESULTS: Due to the social class distribution in the city, exposure to traffic emissions was higher among those with higher area-based income and SES. Meanwhile, people of lower social class had suffered to a larger extent from chronic diseases before death than more affluent residents, especially diabetes mellitus, hypertension, heart failure, and chronic obstructive pulmonary diseases. Overall, PM(10) (lag 0-1) was strongly associated with mortality (1.1% increase, 95%CI = 0.7-1.6%, per 10 microg/m(3)). The effect was more pronounced among persons with lower income and SES (1.9% and 1.4% per 10 microg/m(3), respectively) compared to those in the upper income and SES levels (0.0% and 0.1%, respectively). CONCLUSIONS: The results confirm previous suggestions of a stronger effect of particulate air pollution among people in low social class. Given the uneven geographical distributions of social deprivation and traffic emissions in Rome, the most likely explanation is a differential burden of chronic health conditions conferring a greater susceptibility to less advantaged people.

Adult↗

Sociodemographic risk factors for autism in a US metropolitan area.

The present study examined the association between autism and sociodemographic factors, overall and in subgroups of children with autism with and without mental retardation (Autism/MR and Autism/No MR, respectively); the association was further examined in subanalyses by child's source of ascertainment to assess the presence of ascertainment bias. In the main analyses, one marker of higher social class (higher median family income) was significantly associated with autism overall. Both markers of higher social class (higher maternal education and higher median family income) were significantly associated with autism/no MR, but not associated with autism/MR. In the subanalyses, associations with social class varied by ascertainment source. Future studies should consider phenotypic subgroups of children with autism and must consider potential ascertainment bias.

Age Factors↗

Consultation rates among middle aged men in general practice over three years.

OBJECTIVE: To provide data on consultation rates in general practice for middle aged men over three years according to their age and social class. DESIGN: Prospective study of men over eight years. Data on consultation rates during years 6-8 were collected retrospectively from practice records. SETTING: Over 1000 general practices in Great Britain by year 8. Initially (in 1978-80) the men had been selected at random from one practice in each of 24 towns. SUBJECTS: 7013 Men aged 46-65 in the sixth year of follow up. MAIN OUTCOME MEASURE: Number of consultations a year over three years. RESULTS: The mean annual consultation rate over the three years rose steadily with age (7.0 at age 46-50 to 9.7 at age 61-65) and with social class (6.4 in class I to 10.0 in class V) but was potentially misleading as the distribution was skew: 10.5% of men (736) did not consult over the three years and 17.2% (1209) consulted only once or twice, whereas 11.4% (798) of men were seen more than 18 times. The percentage of men who did not consult over three years fell only slightly with age and was unrelated to social class, with roughly a tenth of all age and social class groups not consulting. Two thirds of non-consulters in year 6 (1598/2334) consulted in year 7 or 8. CONCLUSIONS: The mean is not an appropriate summary measure of consultation rates and may conceal important differences among practices or other groups. The new general practitioner contract stipulates that all patients aged 16-74 must be provided with information to promote health and prevent illness at least once every three years. Most practices will have to approach a tenth of their men aged 46-65 specially to provide this service even if one consultation in three years is regarded as sufficient to allow a service to be provided.

Age Factors↗

Prostate cancer: how aware is the public?

OBJECTIVE: To assess the public awareness of prostate cancer and willingness to seek medical attention for urinary symptoms, and to determine associated factors. SUBJECTS AND METHODS: A community survey was conducted using a questionnaire administered by the interviewer to 280 randomly selected Irish men aged 40-69 years. RESULTS: A quarter of the men had not heard of prostate cancer; factors associated with having heard were nonmanual social class, living with a female partner and a history of treatment for urinary disease. Eighty per cent said they would be willing to attend a GP if they had urinary symptoms; associated factors were living with a female partner, having heard of prostate cancer and having seen a GP more than once in the preceding year. Just over half deemed attendance to be urgent/important; associated factors were having heard of prostate cancer, living with a female partner and having a relative with cancer. Having a General Medical Services card (a means-tested medical card entitling the holder to free medical services) was negatively associated. Lower social class was negatively associated with routine questioning by a GP about urinary symptoms. CONCLUSIONS: There is a marked social-class gradient in knowledge and willingness to seek medical advice. In the absence of population screening, earlier clinical presentation with prostate cancer is essential if prognosis is to be improved; there is an evident need to improve prostate cancer awareness, particularly in the lower social classes, if this goal is to be achieved.

Adult↗

Social indicators of health needs for general practice: a simpler approach.

The ability of different measures of socioeconomic position to predict distress in a sample of general practice attenders has been examined. Perceived distress was measured using the Nottingham health profile. The measures of socioeconomic position included: social class, Jarman scores of patients' areas of residence, whether or not patients owned their own home, whether or not patients owned a car, whether or not they had been unemployed during the previous year and whether or not they had had further education. Social class data were only available for 84% of the 1075 respondents completing the Nottingham health profile. Those respondents for whom social class data were not available were significantly more likely to score positively on the social isolation, sleep and physical mobility dimensions of the Nottingham health profile. Not owning one's own home emerged as the measure of socioeconomic status that best predicted distress. The other measures of socioeconomic status that were significantly predictive of distress were not having had further education and having been unemployed during the last year. Different measures of socioeconomic position significantly predicted positive scores on different dimension of the Nottingham health profile. Although the Jarman score significantly predicted a positive score on the sleep dimension, it did not predict distress well when compared with the direct measures of disadvantage. There are simple, more direct measures of socioeconomic position than social class that could be collected routinely by practices which would form a better basis for the evaluation of services required to target those needs created by persisting social inequalities in health.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Health status in patients awaiting hip replacement for osteoarthritis.

BACKGROUND: Hip osteoarthritis is a major cause of pain and disability, especially in the elderly. As part of a study investigating factors that could be associated with advanced osteoarthritis of the hip, we compared the health status of patients awaiting arthroplasty for hip osteoarthritis with controls. We further investigated the interaction of hip osteoarthritis with other variables (age, gender, social class and concurrent pain) in relation to health status. METHODS: A case-control study was performed in two English health districts (Portsmouth and North Staffordshire) during 1993-1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period formed the case group and were compared with an equal number of controls selected from the general population and individually matched for age, gender and general practice. Cases and controls completed a structured interviewer-administered questionnaire, which included queries about their medical condition, occupation (from which a measure of social class was derived), and general health status using the SF36. RESULTS: Physical function (t=32.1, P<0.001), social function (t=16.8, P<0.001) and perceived general health (t=4.1, P<0.001) were worse in the case group, but energy/vitality and mental health showed little difference between cases and controls. Cases were more likely to report knee pain than controls, but case-control status was not associated with pain in the fingers or shoulders, or with social class. However, differences in physical and social function between cases and controls did vary with socio-demographic factors and concurrent knee pain status. CONCLUSION: Patients awaiting hip-replacement because of osteoarthritis were more likely to be restricted in their physical and social life than adults in the general population, but mental state and vitality appear unimpaired in this group. This contrasts with findings from other chronic pain disorders. Manual social class is not linked to being on a waiting list for osteoarthritic hip replacement but does add to the burden on health status, particularly social functioning in those with osteoarthritis of the hip.

Aged↗

Discrimination and Chinese fertility in Canada.

The study examines Chinese fertility in Canada in the context of minority-status and fertility. Chinese-Canadians are compared with British-Canadians, who are considered in this analysis as the majority group. The study is unique in three ways. First, we argue that discrimination brings a minority group not only psychological insecurity but also social-economic insecurity, which can be measured by Chinese husbands' economic status relative to the British. Second, we analyze the relationship between discrimination against the Chinese at the social class level and Chinese fertility behavior at the individual level, which has been ignored by most previous studies. Third, we describe "insecurities" effects to explain the fertility behavior of the Chinese across social classes, including the lower classes to which many researchers believe the minority status hypothesis is not applicable. We conclude that discrimination variations over social classes combined with normative influence are a major factor in causing class fertility differentials between the Chinese and the British in Canada.

Adolescent↗

Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study.

OBJECTIVE: To investigate the association between social circumstances in childhood and mortality from various causes of death in adulthood. DESIGN: Prospective observational study. SETTING: 27 workplaces in the west of Scotland. SUBJECTS: 5645 men aged 35-64 years at the time of examination. MAIN OUTCOME MEASURES: Death from various causes. RESULTS: Men whose fathers had manual occupations when they were children were more likely as adults to have manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all P<0.05), generally increasing from men whose fathers had professional and managerial occupations (social class I and II) to those whose fathers had semiskilled and unskilled manual occupations (social class IV and V). Relative rates of mortality adjusted for age for men with fathers in manual versus non-manual occupations were 1.52 (95% confidence interval 1.24 to 1.87) for coronary heart disease, 1.83 (1.13 to 2. 94) for stroke, 1.65 (1.12 to 2.43) for lung cancer, 2.06 (0.93 to 4. 57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratory disease. Mortality from other cancers and accidental and violent death showed no association with fathers' social class. Adjustment for adult socioeconomic circumstances and risk factors did not alter results for mortality from stroke and stomach cancer, attenuated the increased risk of coronary heart disease and respiratory disease, and essentially eliminated the association with lung cancer. CONCLUSIONS: Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood.

Accidents↗

Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system.

OBJECTIVE: The purpose of this study was to analyse whether differences exist in social class or education level in coronary heart disease (CHD) secondary prevention and in cardiovascular risk factor control in a universal coverage health care system. DESIGN: Cross-sectional multi-centre study. PARTICIPANTS AND SETTING: 1022 CHD patients recruited from residents in the catchment areas covered by 23 primary health care facilities in Catalonia, Spain. MAIN OUTCOME MEASURES: Demographic data, cardiovascular co-morbidity, smoking, blood pressure, fasting blood glucose, triglycerides, total cholesterol, HDL and LDL cholesterol, body mass index (BMI), drug therapy used for secondary prevention, educational level, and social class based on occupation. RESULTS: Patients at the lowest educational level were more frequently women, older, and diabetic. Patients in the middle educational level were more frequently smokers than those in the highest or the lowest level (24.7, 8.7, and 12.0%, respectively; P = 0.008) and had better systolic blood pressure levels (125 mmHg (15), 135 mmHg (16), and 134 mmHg (17), respectively; P = 0.001). All educational levels and social classes had similar adjusted rates of risk factor control. Therapeutic management was also similar among all educational levels and social classes, after adjusting for confounders. CONCLUSIONS: CHD patients in the lower SES received similar treatment for secondary prevention and achieved similar control of risk factors. No social inequalities were found in secondary prevention in CHD patients using the National Health System in Spain.

Adult↗

Education and mortality from cancer in São Paulo, Brazil.

This study investigated social class differentials in cancer mortality in São Paulo county, Brazil, for the period 1978 to 1982. A measure of socioeconomic status based on education was used, and cancer risk by level of education was estimated by a case-control approach in which other cancers were considered as controls. For most cancers, the socioeconomic differences in risk were similar to those found in western Europe and North America. For lung cancer, however, the highest risk was observed in men and women with the most education. Other cancers related to tobacco--cancer of the larynx, pharynx, and esophagus--showed a negative association with education. The differences between social classes in consumption habits of alcohol and maté and the use of black tobacco are probably responsible for these contrasting patterns. For breast and cervix uteri cancer the social class patterns were similar to those found in developed countries--a positive relationship for breast and a negative one for cervix uteri cancer. The magnitude of the differences observed between social classes for these cancers was frequently greater in South America than in the United States or western Europe.

Adult↗

Epidemiology of Helicobacter pylori infection among 4742 randomly selected subjects from Northern Ireland.

BACKGROUND: Despite the widespread prevalence and serious clinical sequelae of infection with Helicobacter pylori, there have been few large population-based studies, using randomly selected subjects, examining the epidemiology of this infection. AIM: To examine the distribution and determinants of H. pylori infection in a developed country. SUBJECTS AND SETTING: Overall 4742 subjects, aged 12-64, from Northern Ireland were randomly selected. METHODS: Helicobacter pylori specific IgG antibodies were measured by enzyme linked immunosorbent assay, using an acid-glycine extract antigen, in stored serum from subjects who had participated in three linked population-based surveys of cardiovascular risk factors performed in 1986 and 1987. RESULTS: The overall prevalence of H. pylori infection was 50.5%. Prevalence increased with age from 23.4% in 12-14 year olds to 72.7% in 60-64 year olds: chi 2 for trend 518, P < 10(-4). In subjects aged > or = 25, infection was more common in males (60.9%) than females (55.2%): chi 2 = 9.53, P < 0.01. This relation remained significant after adjusting for age, and measures of socioeconomic class: odds ratio (OR) for infection, male versus female was 1.19 (95% confidence interval [CI]: 1.02-1.40). Infection was associated with social class: the adjusted OR of infection in subjects from manual social classes relative to those from non-manual classes was 1.7 (95% CI: 1.47-1.98). Infection was significantly more common in current smokers and ex-smokers than in subjects who had never smoked: adjusted OR for infection, ex-smokers versus never smoked was 1.22 (95% CI: 1.01-1.49); for smokers of > or = 20/day versus never smoked OR = 1.33 (95% CI: 1.05-1.67). Infection was not associated with height in adult males but mean height in infected women was lower than in uninfected women after adjusting for age and socioeconomic status: difference in mean height (SE), -0.85 cm (0.32), P < 0.01. There was no demonstrable relationship between H. pylori infection and current alcohol intake. CONCLUSIONS: This study demonstrated a high prevalence of infection in a population from a developed country. Previously reported associations between H. pylori infection, age, sex, social class, and reduced height in females were confirmed and smoking was identified as a possible risk factor for H. pylori infection.

Adolescent↗