Erosion of the Capital City Advantage in Child Survival and Reproductive, Maternal, Newborn, and Child Health Intervention Coverage in Sub-Saharan Africa

The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities and other urban and rural areas. We analyzed mortality data from 163 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020 and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality rates and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence, slower trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed.

Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging

The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.

Differences in nutritional status and level of physical activity among adolescents living in urban and rural areas of Montenegro - national study

BACKGROUND

Nutritional status and physical activity are important factors for adolescent health. These factors may vary by the place of residence. This study aims to assess the nutritional status and physical activity levels, as well as their variations by the place of residence.

METHODS

The sample consisted of 1503 adolescents (46.3% male; 53.7% female), with a mean age of 15.7 ± 0.7 years. Nutritional status was assessed using Body Mass Index (BMI), Waist-to-Height Ratio (WHtR), and Body Fat Percentage (BF). Physical activity levels were assessed using the PAQ-C questionnaire. Differences in nutritional status among adolescents living in urban and rural areas were analyzed using Chi-square test (p ≤ 0.05), while differences in physical activity levels were analyzed using an independent samples t-test (p ≤ 0.05).

RESULTS

In terms of BMI, 14.7% of males were overweight and 10.1% were obese, while 12% of female adolescents were overweight and 3.1% were obese. There were no differences in nutritional status among adolescents living in urban and rural areas (BMI, WHtR, BF). Male adolescents in rural areas had significantly higher physical activity levels compared to urban areas (p = 0.032). They showed higher activity scores during a spare time (p = 0.002), physical education classes (p = 0.002), little breaks (p = 0.007), and lunchtime (p = 0.034). Female adolescents showed significance only in spare time activity (p = 0.020).

CONCLUSION

The differences in nutritional status among adolescents living in urban and rural areas were not found. However, male adolescents living in urban areas showed lower physical activity levels than their rural counterparts. Strategies should be implemented to promote physical activity among adolescents in urban areas, and attention should be given to the further urbanization process to create improved conditions for engaging in physical activity.

The role of the cultural environment in the development of physical literacy and physical activity of Iranian children

BACKGROUND

The investigation of physical literacy (PL) and physical activity (PA) should be done in an ecological context because the socio-cultural situation can encourage or inhibit children's activity. The present study aimed to study the role of the cultural environment in the development of PL and PA in Iranian children.

METHODS

The statistical population consisted of Iranian children aged 8 to 12, of whom 270 students were recruited by cluster sampling from six provinces. They complete the Canadian Assessment of Physical Literacy 2 (CAPL-2) and the International Physical Activity Survey. To examine the cultural environment, the components of geographic location (west, south, central, east, and northwest), place of residence (downtown, suburban, and village), and gender (boys and girls) were used. A multivariate ANOVA analysis was used to analyze the data.

RESULTS

From the geographic location, the findings showed that students inhabit in the west and east of Iran have significantly higher scores than their counterparts living in the central, south, and northwest at PA and PL (P < 0.001). From the place of residence, we observed a higher level of PA and PL in children living in the village than in those living in the suburbs and downtown (P < 0.001). In terms of gender, boys have higher PL and PA scores (P < 0.001).

CONCLUSION

The findings demonstrate that socio-cultural factors, geographic location, place of residence, and gender have different impacts on children's PL and physical activity. Therefore, we suggest using ecologically appropriate decentralized planning in a physical education curriculum.

Link between unmet need and economic status in Bangladesh: gap in urban and rural areas

Background

Unmet need for family planning (FP) is a core concept in designing FP programmes and reduction of unmet need for FP can improve reproductive and maternal health services. Bangladesh is still away from achieving the target regarding unmet need for FP. This study aimed to explore the composite effect of economic status and place of residence on unmet need for FP among currently married women of reproductive age in Bangladesh after controlling the effect of other selected covariates.

Methods

The study used the data extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017–2018, which is a nationally representative survey implemented using a stratified two-stage cluster sample design. A total of 13,031 currently married women of reproductive age were included in the final analysis. Binary logistic regression model has been employed to identify the factors influencing the unmet need for FP. Model-I investigated the effect of composite variable place-wealth on unmet need for FP and Model-II examined the effect of place-wealth on unmet need for FP after adjusting for the effect of other selected covariates. The Odds Ratios with p-values were reported to identify significant covariates.

Results

The rate of unmet need for FP was 15.48%. The composite factor of economic status and place of residence had significant influence on unmet need for FP in both models. Generally, rural women were significantly more likely to have unmet need for FP than their urban counterparts. In particular, women from rural areas and belong to rich families had the highest likelihoods of unmet need for FP. The other selected covariates also had significant influence on unmet need for FP.

Conclusion

This study shows that rural women had higher odds of unmet need for FP than urban women. The healthcare providers and stakeholders should take necessary actions to motivate women to use contraceptive specially the women who are residing in the rural areas.

Orthogeriatric co-management: differences in outcome between major and minor fractures

PURPOSE

Literature shows that orthogeriatric co-management improves the outcomes of patients with hip fractures. Corresponding research with more diverse fragility fracture groups is lacking. Therefore, an examination was performed prospectively as a 2 year-follow-up on an orthogeriatric co-managed ward, comparing relevant outcome parameters for major and minor fragility fractures.

METHODS

All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included and their injuries, orthogeriatric parameters such as the Barthel Index (BI), Parker Mobility Score (PMS) and place of residence (POR). Patients were separated into two groups of either immobilizing major (MaF) or non-immobilizing minor (MiF) fractures. 2 years later, a follow-up was conducted via telephone calls and questionnaires mailed to patients and/or their relatives.

RESULTS

740 (574 major vs. 166 minor injuries) patients were initially assessed, with a follow-up rate of 78.9%. The in-house, 1-year, and 2-year-mortality rates were 2.7, 27.4, and 39.2%, respectively. Mortality was significantly higher for MaF in the short term, but not after 2 years. On average, during the observation period, patients regained their BI by 36.7 points (95% CI: 33.80-39.63) and PMS was reduced by 1.4 points (95% CI: 1.16-1.68). No significant differences were found in the readmission rate, change in BI, PMS or POR between the MaF and MiF groups.

CONCLUSION

The relevance of orthogeriatric treatment to improving functional and socioeconomic outcomes was confirmed. The similarity of the results from both fracture groups emphasizes the need for a multidisciplinary approach also for minor fractures.

Prevalence and risk factors for depression and anxiety in adult patients with epilepsy: Caregivers' anxiety and place of residence do mater

OBJECTIVES

This study was aimed to assess the prevalence of anxiety and depression and the possible contributions of the caregiver's anxiety and depression, disease status, and socio-demographic characteristics to psychopathological comorbidities among adult patients with epilepsy.

METHODS

A total of 262 participants (131 adult patient-caregiver pairs) were enrolled in this study. The Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A) were applied to evaluate the depression and anxiety status among adult patients with epilepsy and their caregivers, respectively. We collected caregivers' anxiety and depression, patients' sociodemographic characteristic data, and disease status as independent variables using stepwise multiple linear regression analysis that were correlated to the degree of anxiety and depression among these adult patients with epilepsy.

RESULTS

Among adult patients with epilepsy, 46 (35.11%) subjects showed anxiety symptoms (HAM-A scores > 6), and 48 (36.64%) had depression symptoms (HAM-D scores > 6). Caregivers' anxiety levels and place of residence were significant independent predictors of both anxiety and depression levels among adult patients with epilepsy.

CONCLUSIONS

Adult patients with epilepsy are at a high risk of suffering from anxiety and depression. Caregivers' anxiety and place of residence are definite independent predictors for anxiety and depression severity among adult patients with epilepsy. Therefore, clinicians should be careful in closely monitoring the psychological status of adult patients with epilepsy and their caregivers. Furthermore, the government and medical institutions should increase educational awareness about epilepsy and its cure, especially among adult patients with epilepsy who live in rural areas and consider offering a multidisciplinary management program to improve these patients' psychological status.

Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Introduction

Since the arise of orthogeriatric co-management patients’ outcome and survival has improved. There are several assessment parameters that screen the precondition of orthogeriatric patients including mobility, activities of daily living, comorbidities, place of residence and need for care just to name a few. In a 2-year follow-up on an orthogeriatric co-managed ward the fracture-independent predictive value of typical assessment parameters and comorbidities on the associated mortality was examined.

Methods

All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included. No fracture entity was preferred. Emphasis was set on following parameters: age, gender, Parker-Mobility Score (PMS), Barthel Index (BI), Charlson-Comorbidity Index (CCI), dementia, depression, sarcopenia, frequent falling, length of stay (LOS), care level (CL) and place of residence (POR). In a 2-year follow-up the patients’ death rates were acquired. SPSS (IBM Corp., Armonk, New York, USA) and Cox regression was used to univariately analyze the expression of the mentioned parameters and mortality course over 2 years from discharge. In a multivariate analysis intercorrelations and independent relationships were examined.

Results

A follow-up rate of 79.6% by assessing 661 patients was achieved. In the univariate analysis linear inverse correlation between PMS and BI and mortality and a linear positive correlation between CCI and higher mortality were observed. There was also a significant relationship between lower survival and age, dementia, sarcopenia, frequent falling, higher institutionalized place of residence and higher CL. No univariate correlation between 2-year mortality and gender, depression and LOS was found. In the multivariate Cox regression, the only independent risk factors remaining were lower PMS (HR: 1.81; 95%CI: 1.373–2.397), lower BI (HR: 1.64; 95%CI: 1.180–2.290) and higher age per year (HR: 1.04; 95%CI: 1.004–1.067).

Conclusion

Age, PMS, BI, CCI, preexisting dementia, sarcopenia, frequent falling, POR and CL are univariate predictors of survival in the orthogeriatric context. An independency could only be found for PMS, BI and age in our multivariate model. This underlines the importance of preexisting mobility and capability of self-support for the patient’s outcome in terms of survival.

Place of residence before and place of discharge after femoral neck fracture surgery are associated with mortality: A study of 1238 patients with at least three years' follow-up

BACKGROUND

Femoral neck fractures constitute a major public health challenge. The risk of death after surgery depends chiefly on the patient's general health and comorbidities. No studies assessing place of residence are available. The objectives of this study were to determine whether mortality differed according to the patient's previous place of residence and to the place of discharge, and to describe the complications occurring after femoral neck fracture surgery.

HYPOTHESIS

After femoral neck fracture surgery, the place of discharge is associated with the risk of death, and the complication rate is high.

METHODS

This single-centre retrospective study included 1241 adults who sustained a true femoral neck fracture between 2006 and 2016 and were followed up for at least 3 years. The following data were collected: age at the time of the fracture, sex, hospital stay length, place of residence before and after the fracture, characteristics of the fracture, type of treatment, time from the fracture to surgery, and whether anticoagulant therapy was given. We then recorded data on mortality and complications.

RESULTS

The 3-year mortality rate was 36.0±1.4% (95%CI, 33.3-38.7). Place of residence before the fracture was strongly associated with mortality: the risk of death was higher in patients who lived in care homes (hazard ratio [HR], 2.18) or were hospitalised (HR, 1.78) and lower in patients who lived at home (HR, 0.46). The risk of death was also higher in patients discharged to care homes (HR, 1.82) or to hospitals (HR, 1.90) and lower in patients discharged home (HR, 0.30). All these differences were statistically significant (p<0.0001).

CONCLUSION

Place of residence and likely place of discharge should be evaluated as soon as the patient is admitted to the emergency department, in order to provide the best information possible to the patient and family and to establish the most appropriate treatment strategy. Patient self-sufficiency is a major parameter that should be preserved to the extent possible.

LEVEL OF EVIDENCE

IV.

Differences in overweight/obesity prevalence by demographic characteristics and self-weight misperception status

BACKGROUND & AIMS

Increasing the prevalence of overweight and obesity is one of the main concerns of health systems of the world. This research was conducted to estimate the prevalence of overweight/obesity and its related factors in the Eastern part of Iran.

METHODS

An analytical, cross-sectional study was conducted among 1048 inhabitants aged between 15 and 64 years who lived in Gonabad and Bajestan, two districts locating in the East of Iran, in 2016. A probability proportional to size stratified sampling was used to select the participants. We applied a checklist to collect the required data. Analyzing the data, we used t-test, χ2, and ANOVA. A significant level of 0.05 was considered in this study.

RESULTS

Total prevalence of overweight/obesity was 43.8%. There were significant associations between overweight/obesity and age (P < 0.001), sex (P = 0.008 in Gonabad, P = 0.004 in Bajestan), marital status (P < 0.001, in Gonabad, P = 0.001 in Bajestan), and job (P < 0.001). There was also a discrepancy between the participants' self-perception of weight and their real weight status.

CONCLUSION

The findings of the present study showed a high prevalence of overweight/obesity among women, government employees, and married individuals. Therefore, focusing on these groups in implementing weight control interventions is recommended. According to the high prevalence of obesity in housewives as well as the role of women to control the normal weight of their family members via providing healthy food, it seems that one of the most effective groups in the programs would be housewives. Besides, strengthening health literacy is recommended to eliminate self-weight misperception.

Systematic Review of the Literature of Factors Affecting the Exposure and the Levels of Lead in Human Breast Milk

Human milk may sometimes contain chemical contaminants, which could have adverse effects on neonates or nursing infants. Lead (Pb) is of considerable interest due to its toxicity and occurrence. Furthermore, it has been suggested that human milk is a significant potential source of lead exposure to nursing infants. A systematic literature search in PubMed, Science Direct, and Google Scholar databases was performed to identify relevant studies, published in English until 2017, that investigated and explored common factors affecting the level of lead in human milk among lactating women around the world. Forty-nine papers were rated and explored the effect of one or several factors on the level of lead in human milk from 28 countries and carried out over a wide time frame from 1983 to 2017 and through Europe, Asia, America, and Africa, reviewing more than 5,000 subjects. Place of residence, maternal age, stage of lactation, smoking habits, maternal dietary intakes, and parity were the mostly assessed factors among the studies and considered as the main factors affecting Pb levels in BM. Other factors were not studied well enough and considered minor because few surveys evaluated their impacts. However, the literature findings are very controversial.

Mental health and its influencing factors among left-behind children in South China: a cross-sectional study

BACKGROUND

With rapid development of China's economy, there were over 68.7 million left-behind children (LBC) in China whose mental health has become a problem of public concern. The present cross-sectional study aimed to investigate the status of mental health and its associated factors of LBC aged 3-16 years old in both rural and urban areas.

METHODS

A total of 4187 children (aged 3-16), including 1471 LBC and 2716 non-left-behind children (NLBC), were recruited from 50 communities (22 in urban areas and 28 in rural areas) in Guangdong, China in August, 2014. The mental health problems were assessed using the Strength and Difficulties Questionnaire (SDQ).

RESULTS

No statistically significant difference of SDQ subscales scores about difficulties were found between LBC and NLBC on the whole participants as well as in rural areas or in urban areas within the same age group after adjustments were made (all p > 0.05). However, compared with NLBC in the same areas, urban LBC tended to have higher prosocial behaviours scores, while rural LBC had the lowest prosocial behaviours scores not only in the whole age group but also in different age subgroups (p < 0.05). Besides, compared with urban LBC, rural LBC were not worse in SDQ subscales scores except for prosocial behaviour at 7-9 age group (p = 0.003). Furthermore, higher paternal educational level and longer duration of parental absence, were associated with less difficulties in both rural and urban LBC. Besides, shorter duration of talk per-time but higher communication frequency were associated with less difficulties in rural LBC.

CONCLUSIONS

The present study demonstrated that in general, no difference of mental health problems were found between LBC and NLBC. Besides, longer duration of parental absence, shorter duration of talk per time but more communication frequency, and higher paternal educational level tend to have better development of mental health. The findings reinforce the importance of the stability of caregivers and the effective parent-child communication for Chinese rural LBC.

Low Maternal Vitamin D and Calcium Food Intake during Pregnancy Associated with Place of Residence: A Cross-Sectional Study in West Sumatran Women, Indonesia

BACKGROUND

There is a high prevalence of vitamin D deficiency in pregnancy worldwide, and variable availability of vitamin D-rich foods may affect the adequacy of vitamin D food intake in different regions.

AIM

We analysed the relationship between place of residence and maternal food intake of vitamin D and calcium in West Sumatra, Indonesia.

METHODS

This cross-sectional study was conducted in 203 pregnant women. Data collection was carried out in four districts in West Sumatra - two in coastal locations and two in mountainous locations - with subjects divided into groups based on their place of residence. The dietary intakes of pregnant women were assessed through a semi-quantitative food-frequency questionnaire (SQ-FFQ).

RESULTS

The means of maternal vitamin D and calcium food intake were 7.92 ± 5.26 µg/day and 784.88 ± 409.77 mg/day, respectively. There were no reports of vitamin D supplement intake during pregnancy. A total of 86.7% and 89.7% of the study subjects had low vitamin D and calcium food intake status, respectively. There was a significant association between maternal vitamin D intake and place of residence (p = 0.02) and significant different mean levels of vitamin D food intake with the place of residence (9.04 vs 6.55 µg/day; p = 0.01). Mothers who had higher education levels had adequate calcium food intake (p = 0.015; OR: 0.295; 0.116-0.751).

CONCLUSION

Low maternal vitamin D and calcium food intake were found to be common in West Sumatra, Indonesia and their differed between those residents in mountainous and in coastal areas.

Place of residence & financial hardship: the situation of people with spinal cord injury

BACKGROUND

Even with universal health coverage, people with long-term medical conditions can face financial hardship. However, financial hardship can be not only the result of an increase in health care costs; it has other socio-economic determinants that can cause social inequalities in terms of health. This study aims to estimate the impact of the place of residence on the financial hardship of people with spinal cord injury (SCI) in Switzerland. Switzerland is an interesting case to analyze because of its political system, where each of the 26 cantons is autonomous and responsible for raising its own income (through taxes) and providing public services.

METHODS

Using cross-sectional data from the Swiss Spinal Cord Injury Cohort Study (SwiSCI), this paper estimates the probability of financial hardship by place of residence. The data set, recorded between 2011 and 2013, comprises information from 1549 participants aged 16 years and older, living with SCI.

RESULTS

The results show that people face different probabilities of financial hardship, depending on their place of residence. In general, people in the French-speaking cantons have a higher probability of financial hardship compared with people living in the German- or Italian-speaking cantons. People in the cantons of Geneva and Graubünden have almost five times the probability of financial hardship, compared with people in the canton with the lowest probability of financial hardship, Zug.

CONCLUSIONS

The place of residence is a determinant of the financial situation of a household where a member deals with a long-term health condition. The differences might arise due to variations in health care costs, the tax burden and social support system, which are regulated and administered by each canton.

The association between socioeconomic status and health-related quality of life among Polish postmenopausal women from urban and rural communities

In recent years, more scholarly attention has been paid to a growing range of geographic characteristics as antecedents of inequalities in women's health and well-being. The purpose of this study was to evaluate differences in health-related quality of life between rural and urban Polish postmenopausal women. Using a data set from a reproductive health preventive screening of 660 postmenopausal women aged 48-60 years, inhabitants of Wielkopolska and Lublin provinces, the association of place of residence, socioeconomic status and lifestyle factors with health-related quality of life (the SF-36 instrument) was evaluated using ANCOVA models and multiple logistic regression analysis with backward elimination steps. A consistent rural-to-urban gradient was found in all indices of physical health functioning and well-being but not in vitality, social functioning, emotional role and mental health scales with women in large cities being likely to enjoy the highest and those in villages the lowest quality of life. The rural-urban disparities in health-related quality of life were mediated by women's socioeconomic status. The likelihood of worse physical and mental functioning and well-being was 2-3 times greater for the low socioeconomic status rural women than their counterparts from more affluent urban areas. The educational attainment and employment status were the most powerful independent risk factors for health-related quality of life in both rural and urban women. Better understanding of the role of socioeconomic status that acts as a mediator in the association between area of residence and health-related quality of life may be useful in developing public health policies on health inequalities among women at midlife.

Associations of neighborhood environment with brain imaging outcomes in the Australian Imaging, Biomarkers and Lifestyle cohort

INTRODUCTION

"Walkable" neighborhoods offer older adults opportunities for activities that may benefit cognition-related biological mechanisms. These have not previously been examined in this context.

METHODS

We objectively assessed neighborhood walkability for participants (n = 146) from the Australian Imaging, Biomarkers and Lifestyle study with apolipoprotein E (APOE) genotype and two 18-month-apart brain volumetric and/or amyloid β burden assessments. Linear mixed models estimated associations of neighborhood walkability with levels and changes in brain imaging outcomes, the moderating effect of APOE ε4 status, and the extent to which associations were explained by physical activity.

RESULTS

Cross-sectionally, neighborhood walkability was predictive of better neuroimaging outcomes except for left hippocampal volume. These associations were to a small extent explained by physical activity. APOE ε4 carriers showed slower worsening of outcomes if living in walkable neighborhoods.

DISCUSSION

These findings indicate associations between neighborhood walkability and brain imaging measures (especially in APOE ε4 carriers) minimally attributable to physical activity.

Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study

In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10-18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent's sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES.

CONCLUSION

The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments.

Treatment and survival disparities in lung cancer: the effect of social environment and place of residence

OBJECTIVE

The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of treatment, and five-year survival for patients diagnosed with non-small cell lung cancer (NSCLC).

METHODS AND MATERIALS

This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employed for five outcome variables: unstaged and late stage disease at diagnosis; receipt of treatment (surgery, chemotherapy, and radiation); and survival following diagnosis. The social and geographical variables of interest were census tract (CT) poverty level, CT-level educational attainment, and CT-level geographic residency status.

RESULTS

Compared to urban residents, rural and suburban residents had increased odds of unstaged disease (suburban OR=1.23, 95% CI: 1.11-1.37; rural OR=1.63, 95% CI: 1.45-1.83). In this study, rural participants had lower odds of receiving radiotherapy (OR=0.89, 95% CI: 0.82-0.96) and chemotherapy (OR=0.92, 95% CI: 0.85-0.99). Living in CTs with lower educational levels was associated with decreasing odds of receiving both surgery (lowest educational level OR=0.67, 95% CI: 0.59-0.75) and chemotherapy (lowest educational level OR=0.74, 95% CI: 0.68-0.81). Living in areas with higher concentration of deprivation (high level of deprivation HR=1.04, 95% CI: 1.01-1.09) and lower levels of education (lowest educational level HR=1.12, 95% CI: 1.07-1.17) was associated with poorer survival. Rural residents did not show poorer survival when treatment was controlled and they even presented a lower risk of death for early stage disease (HR=0.90, 95% CI: 0.82-0.99).

CONCLUSION

This study concludes that where NSCLC patients live can, to some extent, explain treatment and prognostic disparities. Public health practitioners and policy makers should be cognizant of the importance of where people live and shift their efforts to improve lung cancer outcomes in rural areas and neighborhoods with concentrated poverty.