463,482 research outputs found

    Is the Scottish population living dangerously? Prevalence of multiple risk factors: the Scottish Health Survey 2003

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    <b>Background:</b> Risk factors are often considered individually, we aimed to investigate the prevalence of combinations of multiple behavioural risk factors and their association with socioeconomic determinants.<p></p> <b>Methods:</b> Multinomial logistic regression was used to model the associations between socioeconomic factors and multiple risk factors from data in the Scottish Health Survey 2003. Prevalence of five main behavioural risk factors - smoking alcohol, diet, overweight/obesity, and physical inactivity, and the odds in relation to demographic, individual and area socioeconomic factors.<p></p> <b>Results:</b> Full data were available on 6,574 subjects (80.7% of the survey sample). Nearly the whole adult population (97.5%) reported to have at least one behavioural risk factor; while 55% have three or more risk factors; and nearly 20% have four or all five risk factors. The most important determinants for having four or five multiple risk factors were low educational attainment which conferred around a 3-fold increased odds compared to high education; and residence in the most deprived communities (relative to least deprived) which had greater than 3-fold increased odds.<p></p> <b>Conclusions:</b> The prevalence of multiple behavioural risk factors was high and the prevalence of absence of all risk factors very low. These behavioural patterns were socioeconomically determined. Policy to address factors needs to be joined up and better consider underlying socioeconomic circumstances.<p></p&gt

    Should socioeconomic factors be considered as traditional risk factors for cardiovascular disease, as confounders, or as risk modifiers?

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    A large number of studies show that cardiovascular disease and its traditional risk factors are associated with socioeconomic conditions. However, their etiological role in the development of cardiovascular outcomes is not always well understood. In particular, it is unclear whether socioeconomic factors should be considered as traditional risk factors for CVD, as confounders, or as risk modifiers. In this article, after examining whether socioeconomic conditions meet the criteria for the three definitions, we argue that none of them fully captures the complexity of their contribution in shaping the epidemic of heart disease across and within societies. We argue instead that socioeconomic factors are the “causes of the causes” of heart disease. Implications for research and interventions to reduce heart disease are discussed

    Effect of individual-level and socioeconomic factors on long-term survival after cataract surgery over a 30-year period

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    Purpose: To evaluate survival and the risk for mortality after cataract surgery in relation to individual-level and socioeconomic factors in Scotland over 3 decades. Setting: Linked healthcare data, United Kingdom. Design: Representative population-based study. Methods: A 5% random sample of Scottish decedents linked to hospital records (1981 to 2012) was assessed. Survival time, survival probability, and determinants of mortality were evaluated after the first and second recorded hospital episodes for cataract surgery. Cox proportional-hazards regression models were used to assess the effect of individual-level and socioeconomic factors including age, geographic location, socioeconomic status, and comorbidity on mortality. Results: The study evaluated linked administrative healthcare data from 9228 deceased patients who had cataract surgery. The mean survival time was 2383 days ± 1853 (SD). The survival probability decreased from 98% 90 days after surgery to 22% at 10 years, 2% at 20 years, and 0% after 30 years. The mean age was 77 ± 9 years. Age (hazard ratio [HR] 3.66; 95% confidence interval [CI], 2.97-3.80; P < .001) and severe comorbidity (HR 1.68; 95% CI, 1.47-1.91; P < .001) were associated with an increased risk for mortality; women had a 20% lower risk than men (HR 0.80; 95% CI, 0.76-0.83; P < .001). Socioeconomic status and rural geographic locations were not linked to mortality. Conclusions: Long-term survival after cataract surgery was determined by individual-level characteristics reflecting the mortality patterns of aging populations. The mortality risk was independent of socioeconomic and geographic factors per se

    Socioeconomic differences in stroke among Dutch elderly women: the Rotterdam Study

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    BACKGROUND AND PURPOSE: We sought to assess the association between socioeconomic status and the risk of stroke among elderly women. Methods--The association between socioeconomic status and stroke emerged in cross-sectional and longitudinal data on 4274 female participants of the Rotterdam Study, a prospective, population-based, follow-up study in the Netherlands among older subjects. RESULTS: A history of stroke was more common among women in lower socioeconomic strata. The same trend was observed for the relationship between the lowest socioeconomic groups and the incidence of stroke. Risk factors for stroke were not related to socioeconomic status in a consistent manner. Smoking, history of cardiovascular diseases, and overweight were more common in lower socioeconomic groups. However, socioeconomic differences in hypertension, antihypertensive drug use, prevalence of atrial fibrillation, and prevalence of left ventricular hypertrophy were not observed. The complex of established risk factors could only partly explain the association between socioeconomic status and stroke. CONCLUSIONS: There is a strong association among elderly women between socioeconomic status and stroke. The association could only partly be explained by known risk factors. Our findings indicate that not only the actual risk profile but also risk factors earlier in life may be of importance

    Shaping a Healthier Generation: Successful State Strategies to Prevent Childhood Obesity

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    Provides an overview of the socioeconomic and environmental risk factors and costs of childhood obesity. Presents examples of state policies to prevent the epidemic by promoting healthy behaviors in child care, school, community, and healthcare settings

    Socioeconomic status as a risk factor for dementia death:individual participant meta-analysis of 86 508 men and women from the UK

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    Background Life-course socioeconomic factors may have a role in dementia aetiology but there is a current paucity of studies. Meta-analyses of individual participant data would considerably strengthen this evidence base. Aims To examine the association between socioeconomic status in early life and adulthood with later dementia death. Method Individual participant meta-analysis of 11 prospective cohort studies (1994-2004, n = 86 508). Results Leaving full-time education at an earlier age was associated with an increased risk of dementia death in women (fully adjusted hazard ratio (HR) for age ⩽14 v. age ⩾16: HR = 1.76, 95% CI 1.23-2.53) but not men. Occupational social class was not statistically significantly associated with dementia death in men or women. Conclusions Lower educational attainment in women was associated with an increased risk of dementia-related death independently of common risk behaviours and comorbidities

    Why is leptospirosis hard to avoid for the impoverished? Deconstructing leptospirosis transmission risk and the drivers of knowledge, attitudes, and practices in a disadvantaged community in Salvador, Brazil

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    Several studies have identified socioeconomic and environmental risk factors for infectious disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and more importantly their web of effects on individual infection risk, have not previously been evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and epidemiological data on leptospirosis transmission. Residents’ knowledge influenced their attitudes which influenced their practices. However, different KAP variables were driven by different socioeconomic and environmental factors; and while improved KAP variables reduced risk, there were additional effects of socioeconomic and environmental factors on risk. For example, males and those of lower socioeconomic status were at greater risk, but once we controlled for KAP, male gender and lower socioeconomic status themselves were not direct drivers of seropositivity. Employment was linked to better knowledge and a less contaminated environment, and hence lower risk, but being employed was independently associated with a higher, not lower risk of leptospirosis transmission, suggesting travel to work as a high risk activity. Our results show how such complex webs of influence can be disentangled. They indicate that public health messaging and interventions should take into account this complexity and prioritize factors that limit exposure and support appropriate prevention practices

    Socioeconomic status and the 25 x 25 risk factors as determinants of premature mortality : a multicohort study and meta-analysis of 1.7 million men and women

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    Background In 2011, WHO member states signed up to the 25 x 25 initiative, a plan to cut mortality due to noncommunicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 x 25 conventional risk factors. Methods We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 x 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 x 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. Findings During 26.6 million person-years at risk (mean follow-up 13.3 years [SD 6.4 years]), 310 277 participants died. HR for the 25 x 25 risk factors and mortality varied between 1.04 (95% CI 0.98-1.11) for obesity in men and 2.17 (2.06-2.29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1.42, 95% CI 1.38-1.45 for men; 1.34, 1.28-1.39 for women); this association remained significant in mutually adjusted models that included the 25 x 25 factors (HR 1.26, 1.21-1.32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2.1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0.5 years for high alcohol intake, 0.7 years for obesity, 3.9 years for diabetes, 1.6 years for hypertension, 2.4 years for physical inactivity, and 4.8 years for current smoking. Interpretation Socioeconomic circumstances, in addition to the 25 x 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality.Peer reviewe

    Socioeconomic position and coronary heart disease in older age: associations and possible pathways

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    Low socioeconomic position is known to be associated with greater coronary heart disease (CHD) risk in most developed countries. However, studies have largely focused on the association between socioeconomic position and CHD in middle-aged populations and little is known about the extent to which socioeconomic position affects CHD risk in later life. This thesis uses the British Regional Heart Study, a populationbased cohort of British men to investigate the extent of socioeconomic inequalities in CHD in older age and the possible pathways to these inequalities. Issues addressed in detail include trends in socioeconomic inequalities in CHD with increasing age and over time, the extent of socioeconomic inequalities in CHD in older age (60-79 years), the contribution of established and novel coronary risk factors to these inequalities, and the influence of early life socioeconomic position on CHD risk in later life. Although CHD mortality declined over the last two decades in Britain, relative social class differences in CHD did not narrow between 1980 and 2005. With increasing age (from 40-59 years to 65-84 years), relative social class inequalities in CHD narrowed, although absolute differences widened with age. Marked socioeconomic differences in CHD were present in older age; CHD risk increased from the highest to the lowest social class group. Socioeconomic differences in behavioural coronary risk factors (particularly cigarette smoking) could explain at least a third of these inequalities; inflammatory markers made some additional contribution. Lower socioeconomic position in childhood was associated with increased CHD risk in older age; part of this association was due to the relationship of childhood socioeconomic position with adult behavioural factors. Appreciable socioeconomic inequalities were also present in disability among older men with CHD. The results suggest that important socioeconomic inequalities in CHD persist in older age; the implications for public health and further epidemiological research are discussed

    Stillbirth in a Tertiary Care Referral Hospital in North Bengal - A Review of Causes, Risk Factors and Prevention Strategies

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    Background and Aims: Stillbirth is one of the most common adverse outcomes of pregnancy, accounting for half of all perinatal mortality. Each year approximately 4 million stillbirths are reported, with 97% occurring in developing countries. The objective of the present study was to evaluate the stillbirth rate, exploring the risk factors and causes of stillbirth and suggest policies to reduce it. Settings and Design: A retrospective study of stillbirth among all deliveries over 5 years at North Bengal Medical College, a referral tertiary care teaching hospital in a rural background. The stillbirth rate and its trend were defined and the probable causes and risk factors were identified. Results: Stillbirth rate is 59.76/1000 live births, and Perinatal Mortality 98.65/1000 births. Of the still births, 59.72% were fresh and 40.27% were macerated. Among the causes of stillbirths, poor antenatal attendance and low socioeconomic status were important; other risk factors included prematurity, PIH, birth asphyxia, poor intrapartum care including prolonged and obstructed labour. In 23% cases, the cause remained unexplained. Conclusion: In addition to poor antenatal care, low socioeconomic condition, poor referral service, suboptimal intrapartum care in health facilities including tertiary centre were mainly responsible for majority of still births which could have been prevented. We speculate that upgrading the existing health system performance, particularly high quality intrapartum care by skilled health personnel, will reduce stillbirths substantially in our institut
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