Housing and health: new evidence using biomarker data

The biological embedding of social adversity: How adolescent housing insecurity impacts inflammation over time

BACKGROUND & PURPOSE

Adolescent housing insecurity is a dynamic form of social adversity that impacts child health outcomes worldwide. However, the means by which adolescent housing insecurity may become biologically embedded to influence health outcomes over the life course remain unclear. Therefore, we aimed to utilize life course perspectives and advanced causal inference methods to evaluate the potential for inflammation to contribute to the biological embedding of adolescent housing insecurity.

MATERIALS AND METHODS

Using prospective data from the Great Smoky Mountains Study, we investigated the relationship between adolescent housing insecurity and whole-blood spot samples assayed for C-reactive protein (CRP). Adolescent housing insecurity was created based on annual measures of frequent residential moves, reduced standard of living, forced separation from the home, and foster care. Annual measures of CRP ranged from 0.001 mg/L to 13.6 mg/L (median = 0.427 mg/L) and were log10 transformed to account for positively skewed values. We used g-estimation of structural nested mean models to estimate a series of conditional average causal effects of adolescent housing insecurity on CRP levels from ages 11 to 16 years and interpreted the results within life course frameworks of accumulation, recency, and sensitive periods.

PRINCIPAL RESULTS

Of the 1,334 participants, 427 [44.3 %] were female. Based on the conditional average causal effect, one exposure to adolescent housing insecurity from ages 11 to 16 years led to a 6.4 % (95 % CI = 0.69 - 12.4) increase in later CRP levels. Exposure at 14 years of age led to a 27.9 % increase in CRP levels at age 15 (95 % CI = 6.5 - 53.5). Recent exposures to adolescent housing insecurity (<3 years) suggested stronger associations with CRP levels than distant exposures (>3 years), but limited statistical power prevented causal conclusions regarding recency effects at the risk of a Type II Error.

MAJOR CONCLUSIONS

These findings highlight inflammation-as indicated by increased CRP levels-as one potential mechanism for the biological embedding of adolescent housing insecurity. The results also suggest that adolescent housing insecurity-particularly recent, repeated, and mid-adolescent exposures-may increase the risk of poor health outcomes and should be considered a key intervention target.

Social integration as a mediator of the association between housing tenure and health inequalities among China's migrants: A housing discrimination perspective

Due to the housing affordability crisis and institutional discrimination embedded in China's housing system, which refers to the unequal rights between homeowners and renters, migrant renters face greater social exclusion and health inequalities compared to migrant homeowners. Although housing tenure is considered an important determinant of health, along with other socioeconomic factors, the pathways underlying the association between housing tenure and health remain overlooked. Using data from the 2017 China Migrants Dynamic Survey of 62,268 participants, this study examined the mediating effects of social integration between housing tenure and self-rated health, and whether housing affordability moderated the mediating effects. Simple mediation models showed that social integration partly mediated the association between housing tenure and self-rated health. Moderated mediation models revealed that housing affordability moderated the association between housing tenure and social integration, and did not moderate the association between social integration and self-rated health. Compared with migrants living in affordable housing, the mediating effect of social integration was significantly smaller among migrants living in unaffordable housing. The results add knowledge to previous literature by uncovering the underlying mechanisms between housing tenure and health and linking housing studies to social inequalities in health. Our study suggested that diminishing housing discrimination and improving housing affordability could not only be beneficial for migrants' health but also be helpful to narrowing the health inequalities among migrants.

Are housing circumstances associated with faster epigenetic ageing?

BACKGROUND

Numerous aspects of housing are associated with health. However, the pathways between housing and health, particularly the psychosocial elements of housing, are less well understood. Epigenetic information alongside social survey data offers an opportunity to explore biological ageing, measured using DNA methylation, as a potential pathway through which housing affects health.

METHODS

We use data on housing and DNA methylation from the UK Household Longitudinal Study, linked with prior survey responses from the British Household Panel Survey, covering adults in Great Britain. We explore the association between epigenetic ageing and housing circumstances, both contemporary and historical, using hierarchical regression.

RESULTS

We find that living in a privately rented home is related to faster biological ageing. Importantly, the impact of private renting (coefficient (SE) 0.046 years (0.011) vs owned outright, p<0.001) is greater than the impact of experiencing unemployment (coefficient 0.027 years (0.012) vs employed, p<0.05) or being a former smoker (coefficient 0.021 years (0.005) vs never smoker, p<0.001). When we include historical housing circumstances in the analysis, we find that repeated housing arrears and exposure to pollution/environmental problems are also associated with faster biological ageing.

CONCLUSION

Our results suggest that challenging housing circumstances negatively affect health through faster biological ageing. However, biological ageing is reversible, highlighting the significant potential for housing policy changes to improve health.

The double burden of precariousness: linking housing, employment, and perceived stress - a cross-sectional study

Employment precariousness is widely recognised as a social determinant of health and a chronic stressor. Yet precariousness extends beyond employment, into other aspects of life. Using a multidimensional social pathways approach, this study examines the synergistic effects of employment and housing precariousness on self-perceived stress. This study uses the PRESSED dataset (N = 255) derived from the Barcelona Health Survey, which collects data on stress using the Perceived Stress Scale (PSS). Employment precariousness was operationalized using the Employment Precariousness Scale (EPRES) and a multidimensional indicator of housing precariousness was constructed. Generalized structural equation modelling was used to estimate associations between these indicators and self-perceived stress measured by Perceived Stress Survey (PSS), after accounting for sociodemographic variables. Employment and housing precariousness were positively associated with self-perceived stress (OR = 3.23 ; p = 0.002) (OR = 4.28 ; p = 0.065) respectively. The mediating effect of housing precariousness accounted for 16% of the total effect of employment precariousness on stress after controlling for sociodemographic variables. Furthermore, we find that both precarious conditions were unequally distributed by age, sex educational level, and place of birth in the sample. We conclude that employment and housing precariousness are important chronic stressors and that a social pathway approach is needed.

Effects of Housing Deprivation on Health: Empirical Evidence from Spain

Severe housing deprivation rates in Spain have tripled in just four years, affecting 3.4% of the population in 2020, with a higher incidence among the low-income population (9.2%). Despite the social aspect of the problem, minimal research has been carried out in Spain on the effects that the various forms of housing deprivation have on health. This study analyzes the impact of housing deprivation on health outcomes, with the objective of achieving results that facilitate the creation of improved public policies. Microdata are used from the Living Conditions Survey carried out by the National Institute of Statistics for the period 2009-2019, and several multilevel logistic regression models are presented to control for possible regional differences. The results show that the elements with the greatest effect on objective health are noise, leaks and harmful temperatures in housing. In addition, environmental factors, such as pollution, neighborhood crime and the number of units in a given apartment building, can be added to the list. As a result, we conclude that there are certain structural and environmental elements in housing and the environment in which is located that have a more intense impact on objective health and on the subjective perception of a person's state of health.

Aging, frailty, and design of built environments

Before developing agriculture, herding or metallurgy, humans occupied most of the world. Multiple socioculturally-based responses supported their migration, including building shelters and constructing niches to limit environmental stressors. Sheltered settings provided social support and security during stressful times, along with opportunities for injured, aging, and frail members to survive. Modern built environments are designed for similar purposes, to support human growth, development, reproduction, and maintenance. However, extended survival in modern settings has costs. With age, muscle (sarcopenia) and bone loss (osteopenia, osteoporosis), along with somatic, physiological, and sensory dysfunction, reduce our physical capabilities, increase our frailty, and impede our abilities to interface with built and natural environments and manufactured artifacts. Thereby, increasing our dependence on built environments to maintain autonomy and quality of life.

What follows is a conceptual review of how frailty may limit seniors within modern built environments. It suggests age-related frailty among seniors provides specific data for those designing environments for accessibility to all users. It is based in human ecological theory, and physiological and gerontological research showing senescent alterations, including losses of muscle, bone, and sensory perceptions, produce a frail phenotype with increasing age limiting our mobility, activity, use of space, and physical abilities. As an individual phenotype, frailty leads to age-related physical and performance declines. As a physiological assessment, frailty indices amalgamate individual measures of functional abilities into a single score. Such frailty indices increase with age and differ betwixt individuals and across groups. To design built environments that improve access, usability, and safety for aging and frail citizens, today’s seniors provide living samples and evidence for determining their future abilities, limitations, and design needs. Designing built environments to accommodate and improve the quality of human-environment interactions for frail seniors will improve usability and accessibility for most user groups.

Cold homes and mental health harm: Evidence from the UK Household Longitudinal Study

Cold homes are associated with a range of serious health conditions as well as excess winter mortality. Despite a comparatively mild climate cold homes are a significant problem in the UK, with a recent estimate finding that over one-quarter of low-income households had been unable to adequately heat their home in winter 2022. The magnitude of cold housing in a country that benefits from a mild climate indicates indifference towards, or acceptance of, a significant minority of people living in inadequate conditions on the part of policy makers. Cold homes are therefore a source of social harm. Recent changes to the household energy price cap, the rising cost of living, the ongoing effects of the benefit cap, and below inflation uprating to social security benefits is likely to greatly exacerbate this issue. In this research we use data from the UK Household Longitudinal Study to explore whether living in a cold home causes mental health harm. We control for mental distress and housing temperature on entry to the survey in order to account for the potentially bi-directional relationship. Multilevel discrete-time event history models show that the transition into living in a home that is not suitably warm is associated with nearly double the odds of experiencing severe mental distress for those who had no mental distress at the beginning of the survey; and over three times the odds of severe mental distress for those previously on the borderline of severe mental distress. These results show the significant costs of failing to ensure that people are able to live in homes in which they are able to live comfortably by even the most basic standards. These costs will be felt not just individually, but also more broadly in terms of increased health spending and reduced working.

Exploring the Interactions between Housing and Neighbourhood Environments for Enhanced Child Wellbeing: The Lived Experience of Parents Living in Areas of High Child Poverty in England, UK

Children's health can be affected by the interrelated characteristics of the physical and social environment where they live, including housing quality, neighbourhood characteristics and the local community. Following a systems-based approach, this exploratory project sought to understand how the needs and aspirations associated with the home environment can work in synergy with, or be exacerbated by, other aspects of the local area. The study recruited parents of children aged 2-12 years old from two local authorities in England with high levels of child poverty: Tower Hamlets in East London, and Bradford District in West Yorkshire. Thematic analysis of participant interviews highlighted ten themes and opportunities for improvements. The evidence presented in this research emphasises how environmental quality issues within and outside the home, compounded further by delays in repairs and reduction in service standards, as well as affordability issues, are likely to deeply affect the wellbeing of an entire generation of disadvantaged children whose parents can feel disempowered, neglected and often isolated when attempting to tackle various dimensions of inequalities. Interventions which can improve the quality of housing, and access to space and services, are urgently needed, including initiatives to support and empower families and local communities, especially those prioritising opportunities for action.

COVID-19 Post-Exposure Evaluation (COPE) Study: Assessing the Role of Socio-Economic Factors in Household SARS-CoV-2 Transmission within Campania Region (Southern Italy)

Campania is the sixth poorest region of Italy, and it is the region with the highest income inequality. The secondary attack rates of SARS-CoV-2 among households are found to be substantially heterogeneous among published studies and are influenced by socio-economic factors. We conducted a retrospective study to describe the role of socio-economic factors in the household transmission of SARS-CoV-2 among patients living in Campania Region and referring to "Federico II" Hospital. We interviewed 413 subjects followed-up for COVID-19 between the 8 March 2020 and the 24 May 2021 with the aim to collect demographic, clinical, economic, and social data regarding their household and the index cases. The variables associated with SARS-CoV-2 attack rate higher than 50% among households were higher age (p = 0.023) and higher Charlson Comorbidity Index of the index case (p = 0.023) and, for household characteristics, higher number of families per house (p = 0.02), location of the houses in Naples' suburbs (Chi² = 5.3, p = 0.02) and in Caserta City area (Chi² = 4, p = 0.04), and renting the house compared to owning it (Chi² = 5.83, p = 0.01). This study confirms the finding described by other authors that household transmission of SARS-CoV-2 is correlated with the income inequality of the analyzed geographical area as well as with the indicators of health and economic wealth of the families, and this correlation also applies to the Campania Region.

A longitudinal analysis of the relationship between housing insecurity and physical health among midlife and aging adults in the United States

Rationale

A large body of work demonstrates the impact of housing instability on health by exploring the effects of evictions and homelessness on psychological wellbeing of young adults and children. However, limited research leverages national longitudinal data to examine whether and how experiences of a range of housing insecurity events, rather than just eviction or homelessness, affect physical health among midlife and older adults.

Objective

The current study examines (1) prevalence of housing insecurity among midlife and older adults by age and race, (2) linkages between housing insecurity experiences and facets of physical health, and (3) age and race moderations on these effects.

Method

This study employs regression models to examine whether experiences of housing insecurity affect self-rated physical health and chronic physical conditions among midlife and older adults (N = 2598) leveraging two waves of the National Study of Midlife in the United States (MIDUS).

Results

Models revealed that housing insecurity experiences predicted poorer self-rated physical health and additional chronic conditions, even when controlling for previous physical health. Moderation analyses indicated that housing insecurity has a stronger relationship with chronic conditions among midlife adults as compared to older adults, and among Black adults as compared to white adults. These results suggest that experiences of housing insecurity leave adults vulnerable to compromised physical health, and that housing insecurity experiences may be particularly detrimental to the health of midlife Black adults.

Conclusions

This research adds to the extant literature by introducing a comprehensive measure of housing insecurity experiences, and contributes to a life course perspective regarding how housing insecurity can affect physical health. This research has implications for policy that addresses housing insecurity as a public health concern, especially in the aftermath of the 2008 recession and the economic and housing crisis caused by the COVID-19 pandemic.

The Effect of Built Environment on Physical Health and Mental Health of Adults: A Nationwide Cross-Sectional Study in China

At present, there is a lack of research examining the relationships between the built environment and health status from a social epidemiological perspective. With this in mind, the present study aimed to explore the construct validity of housing/neighborhood conditions and evaluate the associations between the built environment and self-rated health among Chinese residents. To conduct the analysis, data from 4906 participants were derived from the 2016 China Labor-force Dynamics Survey (CLDS). Specifically, we used exploratory factor analysis to identify construct of housing/neighborhood factors and performed principal component regression (PCR) to assess the relationship between the built environment and both self-rated physical health and mental health. This process identified five common factors that corresponded to the built environment, including housing affordability, housing quality, neighborhood services, neighborhood physical environment, and perceived environment. The regression results suggested that housing affordability was negatively related to health status. Meanwhile, the services, physical environment, and perceived environment of neighborhoods were related to positive health outcomes. The influence of housing on health exhibits group heterogeneity: respondents in the 41 to 65 age group were most vulnerable to poor built environments. Whilst the results indicated that housing factors and neighborhood conditions were related to health outcomes, their influence varied across different age groups. Future interventions should be intentionally designed to target housing affordability and neighborhood factors, which may include the provision of housing assistance programs and planning layouts.

Household Tenure and Its Associations with Multiple Long-Term Conditions amongst Working-Age Adults in East London: A Cross-Sectional Analysis Using Linked Primary Care and Local Government Records

Multiple long-term conditions (MLTCs) are influenced in extent and nature by social determinants of health. Few studies have explored associations between household tenure and different definitions of MLTCs. This study aimed to examine associations between household tenure and MLTCs amongst working-age adults (16 to 64 years old, inclusive). This cross-sectional study used the 2019−2020 wave of an innovative dataset that links administrative data across health and local government for residents of a deprived borough in East London. Three definitions of MLTCs were operationalised based on a list of 38 conditions. Multilevel logistic regression models were built for each outcome and adjusted for a range of health and sociodemographic factors. Compared to working-age owner-occupiers, odds of basic MLTCs were 36% higher for social housing tenants and 19% lower for private renters (OR 1.36; 95% CI 1.30−1.42; p < 0.001 and OR 0.81, 95% CI 0.77−0.84, p < 0.001, respectively). Results were consistent across different definitions of MLTCs, although associations were stronger for social housing tenants with physical-mental MLTCs. This study finds strong evidence that household tenure is associated with MLTCs, emphasising the importance of understanding household-level determinants of health. Resources to prevent and tackle MLTCs among working-age adults could be differentially targeted by tenure type.

Rent Burden and Depression Among Mothers: an Analysis of Primary Caregiver Outcomes

Using national longitudinal survey data from the Fragile Families & Child Wellbeing Study (FFCWS), this study builds on existing knowledge about housing insecurity, female caregivers, and well-being. The study analyzed the relationship between housing cost burdens (HCB) and depression among a sample (N = 399) of predominantly (67.6%) Black non-Hispanic mothers and other female primary caregivers. A generalized estimating equation (GEE) model yielded results that indicate housing cost burden among mothers and other female primary caregivers has a statistically significant association with meeting symptoms of depression and liberal criteria for depression as measured by the CIDI-SF survey instrument. This study contributes to the knowledge base of health outcomes related to housing cost burden by providing a unique analysis of the association of depression and housing cost burden at an unprecedented scale by using data from several consecutive waves of survey responses of a large, multi-city, longitudinal study. The findings hold implications that may inform future policy and research concerning the affordable housing crisis, which disproportionately affects mothers and other female heads of household. Considering the prevalence of housing cost burden in the USA and the disproportionate indications of depression found among housing burdened mothers/female caregivers, the findings of this study may hold implications for housing and health policies that address U.S. communities as diverse as the wide range of communities from which the FFCWS respondents were drawn.

Housing Poverty and Healthy Aging in China: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Although prior research on the housing-health linkage suggested that those with poor housing conditions are more likely to report poor health, it is dominated by Western studies and offers little evidence on the housing-health relation in China. Scarce is empirical evidence on the potentially detrimental impact of either qualitative or quantitative housing poverty on health outcomes, especially for seniors in China. This paper aims to fill this void by using data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) to provide a comprehensive analysis of the demographic, socioeconomic, and behavioral factors that contribute to changes in healthy aging among Chinese adults aged 60 and over.

METHODS

Data collected from 8839 adults aged 60 and over in the 2011 and 2015 CHARLS (3732 in 2011 and 5107 in 2015) were used. We first used six blood-based biomarkers to construct a composite measure of the Chinese Healthy Aging Index (CHAI, ranging from 0 (healthiest) to 12 (unhealthiest)) and then assessed the psychometric properties of the CHAI score, including acceptability, internal consistency, convergent validity, discriminative validity and precision. In addition, we employed both mean-based Blinder-Oaxaca and unconditional quantile regression decomposition to decompose the change in healthy aging within the 2011-2015 period.

RESULTS

We overall identified a decrease in CHAI score from 5.69 in 2011 to 5.20 in 2015, which implies an improvement in healthy aging during this period. Our linear decomposition revealed that dependent on the type of measure used (whether quality, quantity, or combined quality-quantity), housing poverty explained 4-8% of the differences in CHAI score. Our distributional decompositions also highlighted an important role for housing poverty in the change in healthy aging, accounting for approximately 7-23% of the explained portion. Within this latter, the relative contribution of housing quantity and quality poverty was more pronounced at the median and upper end of the CHAI distribution. We also found household expenditure to be significantly associated with healthy aging among older Chinese adults and made the largest contribution to the improvement in healthy aging over time.

CONCLUSIONS

The association between housing poverty and CHAI is independent of household expenditure. Regardless of type, housing poverty is positively associated with a decrease in healthy aging. Thus, improved housing conditions boost healthy aging, and housing amelioration initiatives may offer the most effective solution for augmenting healthy aging in China. Improvement of flush toilets and the access to potable water and a separate kitchen require particular attention. Since high-density congested housing has a negative impact on healthy aging, more attention can also be paid to improvements in the available space for older people. Especially at an institutional level, the government may extend the housing policy from a homeownership scheme to a housing upgrading scheme by improving housing conditions.

The Internet of Things in Geriatric Healthcare

There is a significant increase in the geriatric population across the globe. With the increase in the number of geriatric people and their associated health issues, the need for larger healthcare resources is inevitable. Because of this, healthcare service-providing industries are facing a severe challenge. However, technological advancement in recent years has enabled researchers to develop intelligent devices to deal with the scarcity of healthcare resources. In this regard, the Internet of things (IoT) technology has been a boon for healthcare services industries. It not only allows the monitoring of the health parameters of geriatric patients from a remote location but also lets them live an independent life in a cost-efficient way. The current paper provides up-to-date comprehensive knowledge of IoT-based technologies for geriatric healthcare applications. The study also discusses the current trends, issues, challenges, and future scope of research in the area of geriatric healthcare using IoT technology. Information provided in this paper will be helpful to develop futuristic solutions and provide efficient cost-effective healthcare services to the needy.

Household and area-level social determinants of multimorbidity: a systematic review

BACKGROUND

No clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population.

METHODS

Six databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281).

RESULTS

41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated.

CONCLUSION

Improving our understanding of broader social determinants of multimorbidity-particularly at the household level-could help inform strategies to tackle multimorbidity.

Risking health for rental housing: Reviewing service access in the informal backyard rental sector

Informal backyard rentals (IBRs) constitute South Africa's fastest growing housing subsector, flourishing within a relative research vacuum and without national policy intervention to address the vulnerabilities of stakeholders to the health risks potentially presented. This article reviewed the literature on IBRs, focussing on past policies and interventions, general characteristics, infrastructure and service access to inform an analysis of potential health risks from the existing literature to guide future research and policy-making. Research followed a qualitative approach to review IBR literature dating after 2004. Relevant publications were identified from bibliographic databases using Boolean search logic and by reviewing citations in and later citations of these publications. Relevant secondary sources were also included. The review evidenced that IBRs have received increasing policy, but limited research attention, and that health hazards have been particularly neglected. Although issues such as shared water and sanitation, inappropriate waste disposal, poor hygiene practices, high densities and poor quality structures have been referenced extensively - alluding to risks and health concerns - few studies have focussed directly on health, risk and vulnerability. The risk analysis completed based on the literature made potential risks explicit, exemplified by references to specific conditions, such as HIV/AIDS, tuberculosis and the coronavirus pandemic, demonstrating pathogenic pathways, contamination and transmission risks conducive to poor health, infection and potential disaster. The review captured and updated the contemporary literature on IBRs, with the subsequent analysis providing a platform for future empirical research on health, infrastructure and IBRs to address potential risks towards positive change in future policies.

COVID-19 and ethnicity: A novel pathophysiological role for inflammation

INTRODUCTION

There have been recent mounting concerns regarding multiple reports stating a significantly elevated relative-risk of COVID-19 mortality amongst the Black and Minority Ethnic (BAME) population. An urgent national enquiry investigating the possible reasons for this phenomenon has been issued in the UK. Inflammation is at the forefront of COVID-19 research as disease severity appears to correlate with pro-inflammatory cytokine dysregulation. This narrative review aims to shed light on the novel, pathophysiological role of inflammation in contributing towards the increased COVID-19 mortality risk amongst the BAME population.

METHODS

Searches in PubMed, Medline, Scopus, medRxiv and Google Scholar were performed to identify articles published in English from inception to 18^th June 2020. These databases were searched using keywords including: 'COVID-19' or 'Black and Minority Ethnic' or 'Inflammation'. A narrative review was synthesized using these included articles.

RESULTS

We suggest a novel pathophysiological mechanism by which acute inflammation from COVID-19 may augment existing chronic inflammation, in order to potentiate a 'cytokine storm' and thus the more severe disease phenotype observed in the BAME population. Obesity, insulin resistance, cardiovascular disease, psychological stress, chronic infections and genetic predispositions are all relevant factors which may be contributing to elevated chronic systemic inflammation amongst the BAME population.

CONCLUSION

Overall, this review provides early insights and directions for ongoing research regarding the pathophysiological mechanisms that may explain the severe COVID-19 disease phenotype observed amongst the BAME population. We suggest 'personalization' of chronic disease management, which can be used with other interventions, in order to tackle this.

Mechanisms of life-course socioeconomic inequalities in adult systemic inflammation: Findings from two cohort studies

Disadvantaged socioeconomic conditions in childhood heighten systemic inflammatory levels in adulthood; however, life-course mechanisms underlying this association are largely unknown. In the present observational study, we investigated the roles of adulthood socioeconomic and lifestyle factors in mediating this association. Participants were from two prospective Swiss population-based cohorts (N = 5,152, mean age 60 years). We estimated the total effect of paternal occupational position on adult heightened systemic inflammatory levels (C-reactive protein>3 mg/L), and the indirect effects via adulthood socioeconomic positions (SEPs: education and occupational position), financial hardship, and lifestyle factors (body mass index, smoking status, physical inactivity, and alcohol consumption). We estimated odds ratio (OR) and proportion mediated using counterfactual-based mediation models. Individuals whose father had a low occupational position had an OR of 1.51 [95% confidence interval (CI): 1.25, 1.84] for heightened inflammation compared to their more advantaged counterparts. This was jointly mediated (33 [95% CI: 14, 69]%) by adulthood SEPs, whereby the pathway through education followed by occupational position mediated 30 [95% CI: 11, 64]%, while the pathway via occupational position only mediated 3 [95% CI: 4, 13]%. Individuals with the lowest life-course SEPs had an OR of 2.27 [95% CI: 1.71, 2.98] for heightened inflammation compared to having the highest life-course SEPs. This was jointly mediated (63 [95% CI: 44, 97]%) by financial hardship and lifestyle factors. Our study supports a cumulative effect of life-course SEPs on adult heightened systemic inflammation along the pathway paternal occupational position -> education -> adult occupational position. Financial hardship and lifestyle factors in adulthood mediate half of that effect.