Neighborhood socioeconomic status and BMI differences by immigrant and legal status: Evidence from Utah

We build on recent work examining the BMI patterns of immigrants in the US by distinguishing between legal and undocumented immigrants. We find that undocumented women have relative odds of obesity that are about 10 percentage points higher than for legal immigrant women, and their relative odds of being overweight are about 40 percentage points higher. We also find that the odds of obesity and overweight status vary less across neighborhoods for undocumented women than for legal immigrant women. These patterns are not found among immigrant men: undocumented men have lower rates of obesity (by about 6 percentage points in terms of relative odds) and overweight (by about 12 percentage points) than do legal immigrant men, and there is little variation in the impact of neighborhood context across groups of men. We interpret these findings in terms of processes of acculturation among immigrant men and women.     

The combined effect of individual and neighborhood socioeconomic status on cancer survival rates

Background

This population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for major cancers in Taiwan.

Methods

A population-based follow-up study was conducted with 20,488 cancer patients diagnosed in 2002. Each patient was traced to death or for 5 years. The individual income-related insurance payment amount was used as a proxy measure of individual SES for patients. Neighborhood SES was defined by income, and neighborhoods were grouped as living in advantaged or disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding and risk factors.

Results

After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation and adjuvant therapy), and hospital characteristics (ownership and teaching level), colorectal cancer, and head and neck cancer patients under 65 years old with low individual SES in disadvantaged neighborhoods conferred a 1.5 to 2-fold higher risk of mortality, compared with patients with high individual SES in advantaged neighborhoods. A cross-level interaction effect was found in lung cancer and breast cancer. Lung cancer and breast cancer patients less than 65 years old with low SES in advantaged neighborhoods carried the highest risk of mortality. Prostate cancer patients aged 65 and above with low SES in disadvantaged neighborhoods incurred the highest risk of mortality. There was no association between SES and mortality for cervical cancer and pancreatic cancer.

Conclusions

Our findings indicate that cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.     

Postmenopausal hormone therapy and cognitive outcomes: The Women's Health Initiative Memory Study (WHIMS)

This review discusses major findings from the Women's Health Initiative Memory Study (WHIMS). WHIMS reported hormone therapy (HT) – conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA) – increased the risk for dementia (HR 1.76 [95% CI, 1.19–2.60]; P = 0.005) and global cognitive decline, with a mean decrement relative to placebo of 0.21 points on the Modified Mini Mental State Examination (3MS) (P = 0.006) in women age 65 and older.A subset of WHIMS participants joined the ancillary WHI Study of Cognitive Aging (WHISCA) trials, in which domain-specific cognitive tests and mood were measured annually. Compared with placebo, CEE + MPA had a negative impact on verbal memory over time (P = 0.01); and CEE-Alone was associated with lower spatial rotational ability (P ≤ 0.01) at the initial assessment, but the difference diminished over time.The ancillary WHIMS-MRI study measured subclinical cerebrovascular disease to possibly explain the negative cognitive findings reported by WHIMS and the increased clinical stroke in older women reported by the WHI. WHIMS-MRI reported that while CEE + MPA and CEE-Alone were not associated with increased ischemic brain lesion volume relative to placebo; both CEE + MPA and CEE-Alone were associated with lower mean brain volumes in the hippocampus (P = 0.05); frontal lobe (P = 0.004); and total brain (P = 0.07). HT-associated reductions in hippocampal volumes were greatest in women with baseline 3MS scores ≤90.     

Anthropometric factors, physical activity, and risk of non-Hodgkin's lymphoma in the Women's Health Initiative

Background: Incidence rates of non-Hodgkin's lymphoma (NHL) increased substantially in the United States and worldwide during the latter part of the 20th century, but little is known about its etiology. Obesity is associated with impaired immune function through which it may influence the risk of NHL; other factors reflecting energy homeostasis (height, abdominal adiposity, and physical activity) may also be involved. Methods: We examined the association of anthropometric factors and physical activity with risk of NHL and its major subtypes in a large cohort of women aged 50–79 years old who were enrolled at 40 clinical centers in the United States between 1993 and 1998. Over a mean follow-up period of 11 years, 1123 cases of NHL were identified among 158,975 women. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: Height at baseline was positively associated with risk of all NHL and with that of diffuse large B-cell lymphoma (HRs_q4vs.q1 1.19, 95% CI 1.00–1.43 and 1.43, 95% CI 1.01–2.03, respectively). Measures of obesity and abdominal adiposity at baseline were not associated with risk. Hazard ratios for NHL were increased for women in the highest quartile of weight and body mass index at age 18 (HRs_q4vs.q1 1.29, 95% CI 1.01–1.65 and 1.27, 95% CI 1.01–1.59, respectively). Some measures of recreational physical activity were modestly associated with increased risk of NHL overall, but there were no clear associations with specific subtypes. Conclusion: Our findings regarding anthropometric measures are consistent with those of several previous reports, suggesting that early life influences on growth and immune function may influence the risk of NHL later in life.     

Associations between household and neighbourhood socioeconomic status and systolic blood pressure among urban South African adolescents

Factors resulting in high risk for cardiovascular disease have been well studied in high income countries, but have been less well researched in low/middle income countries. This is despite robust theoretical evidence of environmental transitions in such countries which could result in biological adaptations that lead to increased hypertension and cardiovascular disease risk. Data from the South African Birth to Twenty cohort, Bone Health sub-sample (n = 358, 47% female), were used to model associations between household socioeconomic status (SES) in infancy, household/neighbourhood SES at age 16 years, and systolic blood pressure (multivariate linear regression) and risk for systolic pre-hypertension (binary logistic regression). Bivariate analyses revealed household/neighbourhood SES measures that were significantly associated with increased systolic blood pressure. These significant associations included improved household sanitation in infancy/16 years, caregiver owning the house in infancy and being in a higher tertile (higher SES) of indices measuring school problems/environment or neighbourhood services/problems/crime at 16 years of age. Multivariate analyses adjusted for sex, maternal age, birth weight, parity, smoking, term birth, height/body mass index at 16 years. In adjusted analyses, only one SES variable remained significant for females: those in the middle tertile of the crime prevention index had higher systolic blood pressure (β = 3.52, SE = 1.61) compared with the highest tertile (i.e. those with the highest crime prevention). In adjusted analyses, no SES variables were significantly associated with the systolic blood pressure of boys, or with the risk of systolic pre-hypertension in either sex. The lack of association between SES and systolic blood pressure/systolic pre-hypertension at age 16 years is consistent with other studies showing an equalization of adolescent health inequalities. Further testing of the association between SES and systolic blood pressure would be recommended in adulthood to see whether the lack of association persists.     

Variation in the relationship between BMI and survival by socioeconomic status in Great Britain

We investigate the relationship between obesity and survival, and the extent to which this relationship varies by socioeconomic status (SES). The underlying model is based on the “Pathways to health” framework in which SES affects health by modifying the relationship between lifestyles and health. We use data from the British Health and Lifestyle Survey (1984–1985) and the longitudinal follow-up in June 2009, and run parametric Gompertz survival models to investigate the association between obesity and survival, also accounting for interactions between obesity and both age and SES. Generally we find that obesity is negatively associated with survival, and that SES is positively associated with survival, in both men and women. The interactions between obesity and SES predict survival among women but not among men. Obesity compared with normal weight is associated with a reduction in survival of 3.3, 3.2 and 2.8 years in men aged 40, 50 and 60 years, respectively. Corresponding numbers among women in the lowest SES group are 13.1, 9.7 and 6.1 years, respectively; in the highest SES group they are 6.2, 3.1 and 0.1 years, respectively, a difference of approximately 6 years between the highest and lowest SES groups.     

Body size phenotypes and inflammation in the Women's Health Initiative Observational Study

Individuals with "metabolically benign" obesity (obesity unaccompanied by hypertension, dyslipidemia, and diabetes) are not at elevated 10-year risk of cardiovascular disease (CVD) compared to normal weight individuals. It remains unclear whether these obese individuals or normal weight individuals with clustering of cardiometabolic factors display heightened immune activity. Therefore, we characterized levels of acute-phase reactants (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count), adhesion molecules (E-selectin, vascular cell adhesion molecule-1), and coagulation products (fibrinogen, plasminogen activator inhibitor-1 (PAI-1)) among four body size phenotypes (normal weight with 0/1 vs. ≥2 metabolic syndrome components/diabetes and overweight/obesity with 0/1 vs. ≥2 metabolic syndrome components/diabetes) in cross-sectional analyses of 1,889 postmenopausal women from the Women's Health Initiative Observational Study (WHI-OS) nested case-control stroke study. Higher levels of all three inflammatory marker categories were found among women with overweight/obesity or ≥2 metabolic syndrome components or diabetes. Compared to normal weight women with 0 or 1 metabolic syndrome components, normal weight women with ≥2 metabolic syndrome components or diabetes were more likely to have ≥3 inflammatory markers in the top quartile (multivariate odds ratio (OR) 2.0, 95% confidence interval (CI): 1.3-3.0), as were overweight/obese women with 0 or 1 metabolic syndrome components (OR 2.3; 95% CI: 1.5-3.5). Overweight/obese women with ≥2 metabolic syndrome components or diabetes had the highest OR (OR 4.2; 95% CI: 2.9-5.9). Despite findings that metabolically benign obese individuals are not at increased 10-year risk of CVD compared to normal weight individuals, the current results suggest that overweight/obese women without clustering of cardiometabolic risk factors still possess abnormal levels of inflammatory markers.     

Evaluation of the effect of systolic blood pressure and pulse pressure on cognitive function: the Women's Health and Aging Study II

Background

Evidence suggests that elevated systolic blood pressure (SBP) and pulse pressure (PP) in midlife is associated with increased risk for cognitive impairment later in life. There is mixed evidence regarding the effects of late life elevated SBP or PP on cognitive function, and limited information on the role of female gender.

Methods/Principal Findings

Effects of SBPand PPon cognitive abilities at baseline and over a 9-year period were evaluated in 337 non-demented community-dwelling female participants over age 70 in the Women''s Health and Aging Study II using logistic and Cox proportional hazards regression analyses. Participants aged 76–80 years with SBP≥160 mmHg or PP≥84 mmHg showed increased incidence of impairment on Trail Making Test-Part B (TMT, Part B), a measure of executive function, over time when compared to the control group that included participants with normal and pre-hypertensive SBP (<120 and 120–139 mmHg) or participants with low PP (<68 mmHg) (HR = 5.05 [95%CI = 1.42, 18.04], [HR = 5.12 [95%CI = 1.11; 23.62], respectively). Participants aged 70–75 years with PP≥71 mmHg had at least a two-fold higher incidence of impairment on HVLT-I, a measure of verbal learning, over time when compared to participants with low PP (<68 mmHg) (HR = 2.44 [95%CI = 1.11, 5.39]).

Conclusions/Significance

Our data suggest that elevated SBP or PP in older non-demented women increases risk for late-life cognitive impairment and that PP could be used when assessing the risk for impairment in cognitive abilities. These results warrant further, larger studies to evaluate possible effects of elevated blood pressure in normal cognitive aging.     

Weight change and cognitive function: findings from the Women's Health Initiative Study of Cognitive Aging

Although studies exploring relationships between obesity and cognitive impairment in the elderly are conflicting, literature suggests that overweight and obesity may be protective against cognitive impairment and dementia in older women. We examine the associations between changes in weight and waist circumference (WC) with global and domain-specific cognitive function in a large, well-defined cohort of 2,283 older, postmenopausal women (aged 65-79) prospectively followed through the Women's Health Initiative (WHI) Study of Cognitive Aging (WHISCA). We assessed the associations between changes in weight and WC collected up to 5 years before WHISCA enrollment and mean levels of global and domain-specific cognitive performance across an average of 5.4 years of subsequent follow-up. There was a lack of associations between weight and cognition in women who remained stable or gained weight. The only significant relationships observed were in association with weight loss (P ≤ 0.05), most likely signaling incipient disease. Moreover, cognition was not related to changes in WC. Relationships were largely independent of initial BMI, self-reported caloric intake or dieting. The lack of associations between weight gain and cognition in women is consistent with the existing literature.     

Social status,social context,and arterial blood pressure

As social change and economic development have proceeded, the prevalence of chronic diseases, especially cardiovascular diseases, has increased in the developing world. In part this is due to the adoption of diets and other health behaviors characteristic of industrialized nations; in part it is a function of changing social and economic circumstances. In this paper, we describe the development and testing of a model designed to account for social and economic effects on cardiovascular disease risk. The model incorporates the fact that global economic processes have made a lifestyle characterized by the consumption of Euroamerican material goods and information a basis for the assignment of social status in local communities. But economic change at the local level is rarely sufficient to provide a foundation for individuals' status aspirations. Hence, many individuals attempt to maintain a lifestyle inconsistent with their economic standing, a variable we term lifestyle incongruity. Here we describe how this factor is associated with higher blood pressure in a variety of settings and also how the effects of lifestyle incongruity can be modified in local contexts by social class and social role processes. This latter process, contextual modification, is illustrated by data from American Samoa. In this example, the association of lifestyle incongruity with blood pressure is examined in 30 male household heads and 26 spouses. After an examination of Samoan ethnography focused attention on the importance of age and gender differences as defining social contexts of intracultural variation, the model was modified to assess interactions between age and gender as they affect the association of lifestyle incongruity and blood pressure. Lifestyle incongruity is strongly associated with higher systolic and diastolic blood pressure for the younger household heads, minimally associated with blood pressure for older household heads, and only slightly associated with the blood pressure of their spouses. The regression coefficients for the lifestyle incongruity by age by sex interaction term was significant at P ≤ 0.01 for both systolic and diastolic blood pressure. The consistency of these results with expectations based on the ethnographic record is emphasized in the interpretation. We feel that the lifestyle incongruity model represents an empirically successful attempt to link global political-economic processes, local social structure, and biological outcomes. Am J Phys Anthropol 102:55–66, 1997. © 1997 Wiley-Liss, Inc.     

Spatio-temporal modelling of the first Chikungunya epidemic in an intra-urban setting: The role of socioeconomic status,environment and temperature

Three key elements are the drivers of Aedes-borne disease: mosquito infestation, virus circulating, and susceptible human population. However, information on these aspects is not easily available in low- and middle-income countries. We analysed data on factors that influence one or more of those elements to study the first chikungunya epidemic in Rio de Janeiro city in 2016. Using spatio-temporal models, under the Bayesian framework, we estimated the association of those factors with chikungunya reported cases by neighbourhood and week. To estimate the minimum temperature effect in a non-linear fashion, we used a transfer function considering an instantaneous effect and propagation of a proportion of such effect to future times. The sociodevelopment index and the proportion of green areas (areas with agriculture, swamps and shoals, tree and shrub cover, and woody-grass cover) were included in the model with time-varying coefficients, allowing us to explore how their associations with the number of cases change throughout the epidemic. There were 13627 chikungunya cases in the study period. The sociodevelopment index presented the strongest association, inversely related to the risk of cases. Such association was more pronounced in the first weeks, indicating that socioeconomically vulnerable neighbourhoods were affected first and hardest by the epidemic. The proportion of green areas effect was null for most weeks. The temperature was directly associated with the risk of chikungunya for most neighbourhoods, with different decaying patterns. The temperature effect persisted longer where the epidemic was concentrated. In such locations, interventions should be designed to be continuous and to work in the long term. We observed that the role of the covariates changes over time. Therefore, time-varying coefficients should be widely incorporated when modelling Aedes-borne diseases. Our model contributed to the understanding of the spatio-temporal dynamics of an urban Aedes-borne disease introduction in a tropical metropolitan city.     

Women's childhood experience of parental separation and their subsequent health and socioeconomic status in adulthood

The long term consequences for women of parental divorce and separation in childhood are explored using data from a national, prospective, longitudinal survey. In comparison with women who suffered no parental loss, parental divorce is associated with lower educational attainment and occupational status, poorer mental health, higher alcohol consumption and higher rates of remarriage. Links with earlier signs of emotional disturbance and current levels of stress are explored.     

Girls' perception of neighborhood factors on physical activity, sedentary behavior, and BMI

Objective: The purpose of this study was to examine the association of perceived physical neighborhood factors with physical activity, sedentary behavior, and BMI among adolescent girls. Research Methods and Procedures: Sixth grade girls (n = 1554) completed a questionnaire on neighborhood factors (e.g., safety, esthetics, access to physical activity resources). The dependent variables included non‐school metabolic equivalent weighted moderate to vigorous physical activity (MW‐MVPA) and non‐school sedentary behavior, both measured using accelerometry, and BMI. Results: The following neighborhood factors were associated with lower BMI: seeing walkers and bikers on neighborhood streets, not having a lot of crime in the neighborhood, seeing other children playing outdoors, having bicycle or walking trails in the neighborhood, and access to physical activity facilities. The absolute contribution for the average girl for each of these neighborhood factors was relatively small, with none of these factors exceeding 0.8 kg/m² BMI units. The following neighborhood factors were associated with higher MW‐MVPA: having well‐lit streets at night, having a lot of traffic in the neighborhood, having bicycle or walking trails in the neighborhood, and access to physical activity facilities. Girls with ≥9 places to go for physical activity had 14.0% higher non‐school MW‐MVPA than girls with ≤4 places. Discussion: This study identified several neighborhood factors associated with non‐school MW‐MVPA and BMI, but none of the factors explored were associated with non‐school sedentary behavior. Of all of the neighborhood factors we examined, reporting more physically active destinations contributed the largest absolute amount to the average girl's non‐school MW‐MVPA, according to this cross‐sectional study.     

Farm background, socioeconomic status, and fertility: the two-generation hypothesis

This paper examines whether the effects of farm background on socioeconomic differentials in fertility are diminished among nonfarm couples. The data are for a sample of white ever-married women belonging to the 1901-1910 birth cohorts. The research provides another test of the 2 generation-urbanite hypothesis 1st advanced by the Goldberg studies of Detroit and Indianapolis. Unlike a number of other studies, the findings do not support the hypothesis. Thus, a number of questions arise concerning the results obtained by previous investigators in support of this hypothesis. Different types of samples measuring farm background and socioeconomic status may be plausible explanations for the differing results. It is also important to note that both the Detroit and Indianapolis samples can hardly be considered representative of US urban populations in the 1940s and 1950s. A further difficulty with the Detroit study was that Goldberg aggregated the data of a relatively large number of cohorts. The Indianapolis sample was constrained by the eligibility requirements of the original study. The difficulties of adequately testing Goldberg's hypothesis may have been compounded by the extension of the hypothesis to nationally representative samples. Moreover, The hypothesis was not supported when education was used as a measure of socioeconomic status in the Detroit study. Until other studies can be carefully replicated, definitive answers to such questions as to whether fertility differentials by socioeconomic status will disappear or have become attenuated must remain an unanswered question.     

Teenage fertility, socioeconomic status and infant mortality

This paper examines the relationship between infant mortality and a complex measure of socioeconomic status for evidence of diminution. In data on counties in the US with a minimum of 20 infant deaths over the 5-year period 1971-75, no evidence of a declining relationship between socioeconomic status and infant mortality was found. Both level of community affluence and racial composition of the population exerted direct effects on levels of infant deaths. In addition, both socioeconomic status and racial composition exhibited indirect effects which operated through teenage childbearing. When total infant mortality was subdivided, teenage fertility serves as a mediating variable in the link between socioeconomic status and neonatal mortality, but not for the postneonatal components. Given the nearly equivalent total effect of socioeconomic status on infant mortality, it is concluded that the classic division into neonatal (supposedly a function of biological and genetic agents) and postneonatal (traditionally attributed to social and environmental agents), may be too crude to allow the contemporary effects of the socioenvironmental milieu to be evaluated effectively.     

Socioeconomic status and incident type 2 diabetes mellitus: data from the Women's Health Study

Objectives

We prospectively examined whether socioeconomic status (SES) predicts incident type II diabetes (diabetes), a cardiovascular risk equivalent and burgeoning public health epidemic among women.

Methods

Participants include 23,992 women with Hb_A1c levels <6% and no CVD or diabetes at baseline followed from February 1993 to March 2007. SES was measured by education and income while diabetes was self-reported.

Results

Over 12.3 years of follow-up, 1,262 women developed diabetes. In age and race adjusted models, the relative risk of diabetes decreased with increasing education (<2 years of nursing, 2 to <4 years of nursing, bachelor''s degree, master''s degree, and doctorate: 1.0, 0.7 [95% Confidence Interval (CI), 0.6–0.8], 0.6 (95% CI, 0.5–0.7), 0.5 (95% CI, 0.4–0.6), 0.4 (95% CI, 0.3–0.5); p_trend<0.001). Adjustment for traditional and non-traditional cardiovascular risk factors attenuated this relationship (education: p_trend = 0.96). Similar associations were observed between income categories and diabetes.

Conclusion

Advanced education and increasing income were both inversely associated with incident diabetes even in this relatively well-educated cohort. This relationship was largely explained by behavioral factors, particularly body mass index.     

Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts

Background

Differences in morbidity and mortality between socioeconomic groups constitute one of the most consistent findings of epidemiologic research. However, research on social inequalities in health has yet to provide a comprehensive understanding of the mechanisms underlying this association. In recent analysis, we showed health behaviours, assessed longitudinally over the follow-up, to explain a major proportion of the association of socioeconomic status (SES) with mortality in the British Whitehall II study. However, whether health behaviours are equally important mediators of the SES-mortality association in different cultural settings remains unknown. In the present paper, we examine this issue in Whitehall II and another prospective European cohort, the French GAZEL study.

Methods and Findings

We included 9,771 participants from the Whitehall II study and 17,760 from the GAZEL study. Over the follow-up (mean 19.5 y in Whitehall II and 16.5 y in GAZEL), health behaviours (smoking, alcohol consumption, diet, and physical activity), were assessed longitudinally. Occupation (in the main analysis), education, and income (supplementary analysis) were the markers of SES. The socioeconomic gradient in smoking was greater (p<0.001) in Whitehall II (odds ratio [OR]  = 3.68, 95% confidence interval [CI] 3.11–4.36) than in GAZEL (OR  = 1.33, 95% CI 1.18–1.49); this was also true for unhealthy diet (OR  = 7.42, 95% CI 5.19–10.60 in Whitehall II and OR  = 1.31, 95% CI 1.15–1.49 in GAZEL, p<0.001). Socioeconomic differences in mortality were similar in the two cohorts, a hazard ratio of 1.62 (95% CI 1.28–2.05) in Whitehall II and 1.94 in GAZEL (95% CI 1.58–2.39) for lowest versus highest occupational position. Health behaviours attenuated the association of SES with mortality by 75% (95% CI 44%–149%) in Whitehall II but only by 19% (95% CI 13%–29%) in GAZEL. Analysis using education and income yielded similar results.

Conclusions

Health behaviours were strong predictors of mortality in both cohorts but their association with SES was remarkably different. Thus, health behaviours are likely to be major contributors of socioeconomic differences in health only in contexts with a marked social characterisation of health behaviours. Please see later in the article for the Editors'' Summary