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Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis.

ABSTRACT: OBJECTIVE:To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach. METHODS:Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical and mental HRQoL. RESULTS:Residents from the least deprived neighbourhoods had higher physical HRQoL. Neighbourhood socioeconomic deprivation together with individual-level variables (age, gender and education) and health-related factors (smoking, alcohol consumption, sedentariness and chronic diseases) explained 98% of the total between-neighbourhood variance. Neighbourhood socioeconomic deprivation was significantly associated with physical health when comparing least and most deprived neighbourhoods (class 2-beta coefficient: -0.60; 95% confidence interval:-1.76;-0.56; class 3 -beta coefficient: -2.28; 95% confidence interval:-3.96;-0.60), and as neighbourhood deprivation increases, a decrease in all values of physical health dimensions (physical functioning, role physical, bodily pain and general health) was also observed. Regarding the mental health dimension, no neighbourhood clustering or contextual effects were found. However, as neighbourhood deprivation increases, the values of vitality and role emotional dimensions significantly decreased. CONCLUSION:Neighbourhood socioeconomic deprivation is associated with HRQoL, affecting particularly physical health. This study suggests that to improve HRQoL, people and places should be targeted simultaneously.

SUBMITTER: Rocha V

PROVIDER: S-EPMC5728480 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis.

Rocha Vânia V Rocha Vânia V Ribeiro Ana Isabel AI Severo Milton M Barros Henrique H Fraga Sílvia S

PloS one 20171213 12

<h4>Objective</h4>To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach.<h4>Methods</h4>Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical an ...[more]

PMID: 29236719

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Project description:BackgroundThe extent to which neighbourhood characteristics explain accumulation of health behaviours is poorly understood. We examined whether neighbourhood disadvantage was associated with co-occurrence of behaviour-related risk factors, and how much of the neighbourhood differences in the co-occurrence can be explained by individual and neighbourhood level covariates.MethodsThe study population consisted of 60 694 Finnish Public Sector Study participants in 2004 and 2008. Neighbourhood disadvantage was determined using small-area level information on household income, education attainment, and unemployment rate, and linked with individual data using Global Positioning System-coordinates. Associations between neighbourhood disadvantage and co-occurrence of three behaviour-related risk factors (smoking, heavy alcohol use, and physical inactivity), and the extent to which individual and neighbourhood level covariates explain neighbourhood differences in co-occurrence of risk factors were determined with multilevel cumulative logistic regression.ResultsAfter adjusting for age, sex, marital status, and population density we found a dose-response relationship between neighbourhood disadvantage and co-occurrence of risk factors within each level of individual socioeconomic status. The cumulative odds ratios for the sum of health risks comparing the most to the least disadvantaged neighbourhoods ranged between 1.13 (95% confidence interval (CI): 1.03-1.24) and 1.75 (95% CI, 1.54-1.98). Individual socioeconomic characteristics explained 35%, and neighbourhood disadvantage and population density 17% of the neighbourhood differences in the co-occurrence of risk factors.ConclusionsCo-occurrence of poor health behaviours associated with neighbourhood disadvantage over and above individual's own socioeconomic status. Neighbourhood differences cannot be captured using individual socioeconomic factors alone, but neighbourhood level characteristics should also be considered.

Project description:ObjectivesThe influence of neighbourhood deprivation on the risk of harmful alcohol consumption, measured by the separate categories of excess consumption and binge drinking, has not been studied. The study objective was to investigate the effect of neighbourhood deprivation with age, gender and socioeconomic status (SES) on (1) excess alcohol consumption and (2) binge drinking, in a representative population survey.DesignCross-sectional study: multilevel analysis.SettingWales, UK, adult population ?2.2 million.Participants58 282 respondents aged 18 years and over to four successive annual Welsh Health Surveys (2003/2004-2007), nested within 32 692 households, 1839 census lower super output areas and the 22 unitary authority areas in Wales.Primary outcome measureMaximal daily alcohol consumption during the past week was categorised using the UK Department of Health definition of 'none/never drinks', 'within guidelines', 'excess consumption but less than binge' and 'binge'. The data were analysed using continuation ratio ordinal multilevel models with multiple imputation for missing covariates.ResultsRespondents in the most deprived neighbourhoods were more likely to binge drink than in the least deprived (adjusted estimates: 17.5% vs 10.6%; difference=6.9%, 95% CI 6.0 to 7.8), but were less likely to report excess consumption (17.6% vs 21.3%; difference=3.7%, 95% CI 2.6 to 4.8). The effect of deprivation varied significantly with age and gender, but not with SES. Younger men in deprived neighbourhoods were most likely to binge drink. Men aged 35-64 showed the steepest increase in binge drinking in deprived neighbourhoods, but men aged 18-24 showed a smaller increase with deprivation.ConclusionsThis large-scale population study is the first to show that neighbourhood deprivation acts differentially on the risk of binge drinking between men and women at different age groups. Understanding the socioeconomic patterns of harmful alcohol consumption is important for public health policy development.

Project description:Objectives(i) Quantify the relative association between child dental caries experience and maternal-reported child oral health-related quality of life (OHRQoL); (ii) examine whether that association differed according to family socioeconomic status (SES); and (iii) explore whether absolute OHRQoL varied by family SES at similar levels of child caries experience.MethodsThis study was a cross-sectional analysis of children in southern Brazil (n=456, mean age: 38 months) participating in an existing health centre-based intervention study. OHRQoL impact was quantified as mean score on the Brazilian Early Childhood Oral Health Impact Scale (ECOHIS) and compared over categories of caries experience (dmft: 0, dmft: 1-4, dmft: ≥5). Adjusted ECOHIS ratios between caries categories were calculated using regression modelling, overall and within socioeconomic strata defined by maternal education, social class and household income.ResultsCaries prevalence (dmft >0) was 39.7%, mean ECOHIS score was 2.0 (SD: 3.5), and 44.3% of mothers reported OHRQoL impact (ECOHIS score >0). Increasing child caries experience was associated with worsening child and family quality of life: ECOHIS scores were 3.0 times greater (95% CI: 2.0, 4.4) for children with dmft ≥5 vs dmft=0, a pattern that persisted regardless of family socioeconomic status (P for interaction: all >0.3). However, adjusted for dental status and sociodemographic characteristics, mean ECOHIS scores were lower when reported by mothers of less educational attainment (ratio: 0.7; 95% CI: 0.5, 1.0), lower social class (ratio: 0.7; 95% CI: 0.5, 1.0) or in lower income households (ratio: 0.8; 95% CI: 0.6, 1.3).ConclusionDental caries was associated with negative child and family experiences and lower OHRQoL across all social groups; yet, families facing greater disadvantage may report lesser quality-of-life impact at the same level of disease experience. Thus, subjective quality-of-life measures may differ under varying social contexts, with possible implications for service utilization, evaluating oral health interventions, or quantifying disease morbidity in low-SES groups.

Project description:BACKGROUND:There is limited knowledge on the mediating role of different health risk behavior on the relationship between social capital, socioeconomic status (SES), and health-related quality of life (HRQoL) in Chinese older adults. We conducted this study to (a) investigate the condition of health risk behaviors of the Chinese elderly, and (b) assess the relationship between SES, social capital, health risk behaviors, and HRQoL. METHODS:A sample of 4868 adults aged 60?years and older were included in this study, from the China's Health-related Quality of Life Survey for Older Adults 2018. Participants' demographic characteristics, SES (education level, family income), health risk behaviors (smoking, alcohol consumption, physical inactivity, unhealthy dietary behavior, unhealthy weight, and sleep disorder) were collected. Social capital and HRQoL were assessed by the 16-item Personal Social Capital Scale (PSCS-16) and WHOQOL-Old, respectively. Structural equation modeling (SEM) was applied to examine the associations between variables. RESULTS:The proportion of smoking, alcohol consumption, physical inactivity, unhealthy dietary behavior, unhealthy weight, and sleep disorder were 32.1, 36.3, 62.5, 45.7, 31.8, and 45.5%, respectively. Significant differences were observed in education level, family income, and social capital between elderly individuals with and without each of the six health risk behavior (all p-values <?0.05). Elderly individuals who reported smoking, physical inactivity, unhealthy dietary behavior, and sleep disorder had significantly lower HRQoL than those without these unhealthy behaviors (all p-values <?0.05). SEM analysis showed that SES and social capital positively associated with alcohol consumption. Social capital negatively associated with smoking, physical inactivity, unhealthy dietary behavior, and sleep disorder. SES negatively associated with smoking, physical inactivity, unhealthy dietary behavior, unhealthy weight, and sleep disorder. Smoking, physical inactivity, unhealthy dietary behavior, and sleep disorder correlated with poorer HRQoL. CONCLUSIONS:Chinese older adults demonstrated a high incidence of health risk behaviors, especially for physical inactivity (62.5%) and unhealthy dietary behavior (45.7%). Social capital and SES were correlated with the elderly's HRQoL, as well as with the health risk behaviors. Health risk behaviors played potential mediating role on the relationship between social capital, SES, and HRQoL in Chinese older adults.

Dataset Information

Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis.

Publications

Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis.

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