Dataset Information

Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage.

ABSTRACT: There are numerous studies that show an increased incidence of cardiovascular disease with increasing levels of socio-economic disadvantage. Exposures that might influence the relationship include elements of the built environment and social systems that shape lifestyle risk behaviors. In Canberra (the Australian capital city) there has been a particular housing policy to create 'mixed-tenure' neighborhoods so that small pockets of disadvantage are surrounded by more affluent residences (known as a 'salt-and-pepper' pattern). This may contribute to a scatter of higher incidence rates in very small areas in this population that may be obscured if aggregated data are used. This study explored the effect of changing the scale of the spatial units used in small area disease modelling, aiming to understand the impact of this issue and the implications for local public health surveillance.The residence location of hospitalized individuals were aggregated to two differently scaled area units. First, the Australian Bureau of Statistics Statistical Area 2 (SA2) which is normally used as the basis for deidentification and release of health data. Second, these data were aggregated to a smaller level: the Statistical Area 1 (SA1). Generalized Additive Models with penalized regression splines were used to assess the association of age-sex-standardized rates for cardiovascular disease hospital admissions with disadvantage.The relationships observed were different between the two types of spatial units. The SA1 level exposure-response curve for rates against the disadvantage index extended in a linear fashion above the midrange level, while that found at SA2-level suggested a curvilinear form with no evidence that rates increased with higher disadvantage beyond the midrange.Our result supports findings of other work that has found disadvantage increases risk of cardiovascular disease. The shape of the curves suggest a difference in associations of cardiovascular disease rates with disadvantage scores between SA1 versus SA2. From these results it can be concluded that scale of analysis does influence the understanding of geographical patterns of socio-economic disadvantage and cardiovascular disease morbidity. Health surveillance and interventions in Canberra should take into account the impact of the scale of aggregation on the association between disadvantage and cardiovascular disease observed.

SUBMITTER: Hanigan IC

PROVIDER: S-EPMC5705072 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage.

Hanigan Ivan C IC Cochrane Thomas T Davey Rachel R

PloS one 20171128 11

<h4>Background</h4>There are numerous studies that show an increased incidence of cardiovascular disease with increasing levels of socio-economic disadvantage. Exposures that might influence the relationship include elements of the built environment and social systems that shape lifestyle risk behaviors. In Canberra (the Australian capital city) there has been a particular housing policy to create 'mixed-tenure' neighborhoods so that small pockets of disadvantage are surrounded by more affluent ...[more]

PMID: 29182618

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Project description:Breast cancer remains a major cause of morbidity and mortality among women in the US, and despite numerous studies documenting racial disparities in outcomes, the survival difference between Black and White women diagnosed with breast cancer continues to widen. Few studies have assessed whether observed racial disparities in outcomes vary by insurance type e.g. Medicare/Medicaid versus private insurance. Differences in coverage, availability of networked physicians, or cost-sharing policies may influence choice of treatment and treatment outcomes, even after patients have been hospitalized, effects of which may be differential by race.The aim of this analysis was to examine hospitalization outcomes among patients with a primary diagnosis of breast cancer and assess whether differences in outcome exist by insurance status after adjusting for age, race/ethnicity and socio-economic status.We obtained data on over 67,000 breast cancer patients with a primary diagnosis of breast cancer for this cross-sectional study from the 2007-2011 Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS), and examined breast cancer surgery type (mastectomy vs. breast conserving surgery or BCS), post-surgical complications and in-hospital mortality. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals.Black patients were less likely to receive mastectomies compared with White women (OR: 0.80, 95% CI: 0.71-0.90), regardless of whether they had Medicare/Medicaid or Private insurance. Black patients were also more likely to experience post-surgical complications (OR: 1.41, 95% CI: 1.12-1.78) and higher in-hospital mortality (OR: 1.57, 95%: 1.21-2.03) compared with White patients, associations that were strongest among women with Private insurance. Women residing outside of large metropolitan areas were significantly more likely to receive mastectomies (OR: 1.89, 95% CI: 1.54-2.31) and experience higher in-hospital mortality (OR: 1.74, 95% CI: 1.40-2.16) compared with those in metropolitan areas, regardless of insurance type.Among hospitalized patients with breast cancer, racial differences in hospitalization outcomes existed and worse outcomes were observed among Black women with private insurance. Future studies are needed to determine factors associated with poor outcomes in this group of women, as well as to examine contributors to low BCS adoption in non-metropolitan areas.

Project description:BackgroundLower socioeconomic status is associated with poorer wellbeing among children. Identifying how children participate in after-school activities and how after-school activities are associated with wellbeing may inform interventions to improve wellbeing among children from low socioeconomic backgrounds. This study explored whether children's after-school activities varied by socioeconomic status and examined the associations between after-school activities and wellbeing in low socioeconomic status children.MethodsThis study analysed cross-sectional data from 61,759 school students in years 4 to 9 who completed the 2018 South Australian Wellbeing and Engagement Collection. Students reported the number of days per week they participated in 12 activities (after-school care, homework, music lessons or practice, youth organisations, sports, television, videogames, social media, reading, chores, arts and crafts, and socialising with friends) during the after-school period (3-6 pm) and their wellbeing (happiness, sadness, worry, engagement, perseverance, optimism, emotion regulation, and life satisfaction). Socioeconomic status was measured by parents' highest education level obtained from school enrolment data. Linear multilevel models were used to examine whether frequency of after-school activities varied by socioeconomic status. Multilevel ordered logit models were used to analyse the association between after-school activities and wellbeing amongst participants in the low socioeconomic status category.ResultsAfter-school activities differed according to socioeconomic status; high socioeconomic status children did more frequent sport, homework, and reading and low socioeconomic status children did more frequent screen-based activities (TV, videogames and social media). Among children from low socioeconomic status backgrounds, higher wellbeing was associated most consistently with more frequent sports participation, homework, reading and spending time with friends and less frequent videogames, social media and after-school care.ConclusionsChildren's wellbeing is positively associated with socioeconomic status. Amongst children from disadvantaged backgrounds, participating in sport, spending time with friends and getting less screen time may be protective for wellbeing. The results suggest that programming targeted at increasing sports participation and reducing screen time amongst children from low socioeconomic status backgrounds may support their wellbeing.

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Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage.

Publications

Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage.

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