Dataset Information

Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults.

ABSTRACT: OBJECTIVES:Health disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally large representative data, this study investigated the association between individual-level SES, area-level SES and their interaction with schizophrenia in Chinese adults from a multilevel perspective. SETTING:Household interviews in 734 counties (districts), 2980 towns (streets) and 5964 communities (villages) from 31 provinces, People's Republic of China, as part of the cross-sectional survey of Second China National Sample Survey on Disability. PARTICIPANTS:1 909 205 men and women aged 18 years old and above. PRIMARY AND SECONDARY OUTCOME MEASURES:A screen followed by clinical diagnosis was used to identify schizophrenia, and schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision (code F20). RESULTS:1-SD increase in individual SES was associated with decreased risk of schizophrenia (OR=0.45, 95% CI 0.43 to 0.46). 1-SD increase in area-level SES was associated with increased risk of schizophrenia (OR=1.30, 95% CI 1.24 to 1.37). The interaction of individual SES and area-level SES was statistically significant (OR=1.05, 95% CI 1.02 to 1.08); as the level of area SES increased, schizophrenia risk of lower SES people grew faster than the risk of higher SES people. CONCLUSIONS:Area-level SES is particularly important to mental health of low SES individuals, with low SES people in high SES counties having the highest risk of schizophrenia than other groups. Action to reduce SES disparities in schizophrenia will require attention to the area-level context of low SES adults.

SUBMITTER: Luo Y

PROVIDER: S-EPMC6731895 | biostudies-other | 2019 Sep

REPOSITORIES: biostudies-other

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Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults.

Luo Yanan Y Zhang Lei L He Ping P Pang Lihua L Guo Chao C Zheng Xiaoying X

BMJ open 20190904 9

<h4>Objectives</h4>Health disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally large representative data, this study investigated the association between individual-level SES, area-level SES and their interaction with schizophrenia in Chinese adults from a multilevel perspective.<h4>Setting</h4>Household interv ...[more]

PMID: 31488464

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Project description:BackgroundRecent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.MethodsRecord-linkage cohort study of 1.93 million people to examine the association between small-area socioeconomic deprivation and 12 CVDs. Health records covered primary care, hospital admissions, a myocardial infarction registry and cause-specific mortality in England (CALIBER). Patients were aged ?30 years and were initially free of CVD. Cox proportional hazard models stratified by general practice were used.FindingsDuring a median follow-up of 5.5 years 114,859 people had one of 12 initial CVD presentations. In women the hazards of all CVDs except abdominal aortic aneurysm increased linearly with higher small-area socioeconomic deprivation (adjusted HR for most vs. least deprived ranged from 1.05, 95%CI 0.83-1.32 for abdominal aortic aneurysm to 1.55, 95%CI 1.42-1.70 for heart failure; I2?=?81.9%, ?2?=?0.01). In men heterogeneity was higher (HR ranged from 0.89, 95%CI 0.75-1.06 for cardiac arrest to 1.85, 95%CI 1.67-2.04 for peripheral arterial disease; I2?=?96.0%, ?2?=?0.06) and no association was observed with stable angina, sudden cardiac death, subarachnoid haemorrhage, transient ischaemic attack and abdominal aortic aneurysm. Lifetime risk difference between least and most deprived quintiles was most marked for peripheral arterial disease in women (4.3% least deprived, 5.8% most deprived) and men (4.6% least deprived, 7.8% in most deprived); but it was small or negligible for sudden cardiac death, transient ischaemic attack, abdominal aortic aneurysm and ischaemic and intracerebral haemorrhage, in both women and men.ConclusionsAssociations of small-area socioeconomic deprivation with 12 types of CVDs were heterogeneous, and in men absent for several diseases. Findings suggest that policies to reduce deprivation may impact more strongly on heart failure and peripheral arterial disease, and might be more effective in women.

Project description:To investigate the independent relationship of individual- and area-level socio-economic status (SES) with the presence and severity of visual impairment (VI) in an Asian population.Cross-sectional data from 9993 Chinese, Malay and Indian adults aged 40-80 years who participated in the Singapore Epidemiology of eye Diseases (2004-2011) in Singapore. Based on the presenting visual acuity (PVA) in the better-seeing eye, VI was categorized into normal vision (logMAR≤0.30), low vision (logMAR>0.30<1.00), and blindness (logMAR≥1.00). Any VI was defined as low vision/blindness in the PVA of better-seeing eye. Individual-level low-SES was defined as a composite of primary-level education, monthly income<2000 SGD and residing in 1 or 2-room public apartment. An area-level SES was assessed using a socio-economic disadvantage index (SEDI), created using 12 variables from the 2010 Singapore census. A high SEDI score indicates a relatively poor SES. Associations between SES measures and presence and severity of VI were examined using multi-level, mixed-effects logistic and multinomial regression models.The age-adjusted prevalence of any VI was 19.62% (low vision = 19%, blindness = 0.62%). Both individual- and area-level SES were positively associated with any VI and low vision after adjusting for confounders. The odds ratio (95% confidence interval) of any VI was 2.11(1.88-2.37) for low-SES and 1.07(1.02-1.13) per 1 standard deviation increase in SEDI. When stratified by unilateral/bilateral categories, while low SES showed significant associations with all categories, SEDI showed a significant association with bilateral low vision only. The association between low SES and any VI remained significant among all age, gender and ethnic sub-groups. Although a consistent positive association was observed between area-level SEDI and any VI, the associations were significant among participants aged 40-65 years and male.In this community-based sample of Asian adults, both individual- and area-level SES were independently associated with the presence and severity of VI.

Dataset Information

Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults.

Publications

Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults.

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