Social Determinants of Polypharmacy in First Generation Mexican Immigrants in the United States

INTRODUCTION

Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults.

METHODS

Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data.

RESULTS

Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs).

CONCLUSION

Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.

Arithmetic, reading and writing performance has a strong genetic component: A study in primary school children

Even children attending the same primary school and taught by the same teacher differ greatly in their performance. In the Netherlands, performance at the end of primary school determines the enrollment in a particular level of secondary education. Identifying the impact of genes and the environment on individual differences in educational achievement between children is important. The Netherlands Twin Register has collected data on scores of tests used in primary school (ages 6 to 12) to monitor a child's educational progress in four domains, i.e. arithmetic, word reading, reading comprehension and spelling (1058 MZ and 1734 DZ twin pairs), and of a final test (2451 MZ and 4569 DZ twin pairs) in a large Dutch cohort. In general, individual differences in educational achievement were to a large extent due to genes and the influence of the family environment was negligible. Moreover, there is no evidence for gender differences in the underlying etiology.