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Social capital or vulnerability: Which has the stronger connection with selected U.S. health outcomes? SSM Popul Health 2021; 15:100812. [PMID: 34141850 PMCID: PMC8188049 DOI: 10.1016/j.ssmph.2021.100812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 11/27/2022] Open
Abstract
We tested associations between social capital or vulnerability and health outcome measures of adult obesity, adult diabetes, and life expectancy at the county level in the United States with data from 2015 to 2018. This ecological cross-sectional study utilized secondary data from four open access databases: The Geography of Social Capital (U.S. Congress, 2018), County Health Rankings (2018), CDC's Behavioral Risk Factor Surveillance System (BRFSS, 2018) and the Kaiser Family Foundation (KFF, 2015). Our dependent variables were adult obesity, adult diabetes, and life expectancy. We identified the highest and lowest states' prevalence for each of three health outcomes in each of the four U.S. regions—Northeast, South, Midwest, and West. Each dependent variable was assessed using a sample of 32 counties (N = 32). Data analysis consisted of bivariate and regression analysis. Our results showed that the most consistent measure of “vulnerability” linked significantly to all three health conditions studied was percent births to unmarried women (Obesity p < .001; Diabetes p = .049; Life Expectancy p = .019). The most consistent measure of “social capital” linked to all three health conditions was recreation establishments per 1,000 inhabitants (Obesity p = .006; Diabetes p = .005; Life Expectancy p = .018). We concluded that measures of vulnerability were strongly associated with obesity, diabetes, and life expectancy when compared with social capital indicators. However, measures of social capital consistently accounted for the second-greatest proportion of the variance. Social and community contexts should be constantly addressed by both public health governmental- and scholarly-research agendas in the United States. Marital status of women strongly predicts obesity, diabetes, and life expectancy. Religious congregations were negatively associated to both obesity and diabetes. The higher the number of recreational establishments, the lower obesity and diabetes.
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Gupta R, Kaur M, Islam S, Mohan V, Mony P, Kumar R, Kutty VR, Iqbal R, Rahman O, Deepa M, Antony J, Vijaykumar K, Kazmi K, Yusuf R, Mohan I, Panwar RB, Rangarajan S, Yusuf S. Association of Household Wealth Index, Educational Status, and Social Capital with Hypertension Awareness, Treatment, and Control in South Asia. Am J Hypertens 2017; 30:373-381. [PMID: 28096145 DOI: 10.1093/ajh/hpw169] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/22/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Hypertension control rates are low in South Asia. To determine association of measures of socioeconomic status (wealth, education, and social capital) with hypertension awareness, treatment, and control among urban and rural subjects in these countries we performed the present study. METHODS We enrolled 33,423 subjects aged 35-70 years (women 56%, rural 53%, low-education status 51%, low household wealth 25%, low-social capital 33%) in 150 communities in India, Pakistan, and Bangladesh during 2003-2009. Prevalence of hypertension and its awareness, treatment, and control status and their association with wealth, education, and social capital were determined. RESULTS Age-, sex-, and location-adjusted prevalence of hypertension in men was 31.5% (23.9-40.2%) and women was 32.6% (24.9-41.5%) with variations in prevalence across study sites (urban 30-56%, rural 11-43%). Prevalence was significantly greater in urban locations, older subjects, and participants with more wealth, greater education, and lower social capital index. Hypertension awareness was in 40.4% (urban 45.9, rural 32.5), treatment in 31.9% (urban 37.6, rural 23.6), and control in 12.9% (urban 15.4, rural 9.3). Control was lower in men and younger subjects. Hypertension awareness, treatment, and control were significantly lower, respectively, in lowest vs. highest wealth index tertile (26.2 vs. 50.6%, 16.9 vs. 44.0%, and 6.9 vs. 17.3%, P < 0.001) and lowest vs. highest educational status tertile (31.2 vs. 48.4%, 21.8 vs. 42.1%, and 7.8 vs. 19.2%, P < 0.001) while insignificant differences were observed in lowest vs. highest social capital index (38.2 vs. 36.1%, 35.1 vs. 27.8%, and 12.5 vs. 9.1%). CONCLUSIONS This study shows low hypertension awareness, treatment, and control in South Asia. Lower wealth and educational status are important in low hypertension awareness, treatment, and control.
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Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | | | - Prem Mony
- Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India
| | - Rajesh Kumar
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omar Rahman
- School of Life Sciences, Independent University, Dhaka, Bangladesh; and
| | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, India
| | - Justy Antony
- Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India
| | | | - Khawar Kazmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh; and
| | - Indu Mohan
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Raja Babu Panwar
- Administrative Office, Rajasthan University of Health Sciences, Jaipur, India
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
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