Social Determinants of Cancer Disparities

Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.

Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity

Background

This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle.

Methods

Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias.

Results

Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%).

Conclusions

These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13340-4.

Do the socioeconomic context and the European geographical area modify parental influences on smoking experimentation among adolescents?

Adolescent smoking is a major public health problem. While the socioeconomic status (SES) of the neighbourhood and that of the family are known to play a role in smoking onset and progression, it is not clear whether it modifies the association between parental influences and adolescent behaviour. The purpose of this study is to investigate family correlates of adolescent smoking experimentation and to explore the modifying role of socioeconomic context and European geographical area in a sample of European adolescents. This is a secondary analysis of the baseline survey of the European Drug Addiction Prevention (EU-Dap) trial which took place in seven European countries and involved 7079 students. School SES was used as indicator of socioeconomic context. European countries were aggregated in two geographical areas: North-Central and South. The associations between parental, family factors, and adolescents smoking experimentation were analysed through multilevel mixed-effect logistic regression models, stratified by school SES and European geographical area. Parental smoking, permissiveness towards tobacco, family conflicts, problematic relationships, low connectedness, and low parental control were significantly associated with adolescent smoking experimentation. Paternal smoking was a stronger correlate of adolescent smoking in low SES schools, while maternal smoking in high SES schools. Parental permissiveness was a stronger correlate in low SES schools. Family conflicts and low parental control were correlates only in low SES schools. The associations did not substantially differ between European geographical areas, with the exception of parental smoking that was a stronger correlate in the North, and parental control that was a correlate only in the South of Europe. To reduce inequalities in tobacco-related outcomes, prevention efforts in low socioeconomic contexts appear to be a public health priority. Parental smoking, permissiveness, family relationships, and connectedness should be addressed in preventive programs.

Sports facilities, socio-economic context and overweight among the childhood population in two southern European cities: a cross sectional study

BACKGROUND

To evaluate relationship between socio-economic environment and overweight in Madrid and Barcelona, adjusting for possible confounding factors.

METHODS

We obtained three indicators which reflected socio-economic context, namely, unemployment rate, percentage of population with tertiary education, and percentage with a second home. The design is a cross sectional study. The association with overweight was estimated using odds ratios by multilevel logistic regression. The statistical analysis, data synthesis, or model creation was performed from the 2017. In all, 707 children from 21 districts of Madrid and 474 children from 10 districts of Barcelona were analysed.

RESULTS

In Madrid, standardised ORs for personal and family characteristics were 1.17, 1.53 and 1.57 by reference to unemployment rate and percentages of population with a university education and second home. After adjustment, only the OR obtained with unemployment rate decreased, specifically by 58%. In Barcelona, the following ORs were obtained: 1.80 with unemployment rate; 1.80 with population having a university education; and 1.86 with population having a second home. After being standardised, these ORs decreased by 14% in the case of unemployment rate, 10% in the case of population with a university education, and 9% in the case of population with a second home.

CONCLUSIONS

Overweight displayed a risk gradient in Madrid and Barcelona alike. This risk of overweight is not accounted for by physical inactivity and could, in part, be due to the availability of sports facilities.

Urban Growth, Land-use Efficiency and Local Socioeconomic Context: A Comparative Analysis of 417 Metropolitan Regions in Europe

The present study presents a multidimensional analysis of land-use efficiency in terms of per-capita built-up area over 417 metropolitan regions from 27 European countries. The study period encompasses two urban phases including economic expansion (2000-2007) and crisis (2008-2015). Multiple geographical gradients were identified as relevant predictors of land-use efficiency across Europe. The socioeconomic variables most associated with high land-use efficiency were per-capita disposable income (in Western, Atlantic and Central Europe) and income growth during 2000-2007 (in Eastern Europe), indicating that wealthier cities are characterized by higher land-use efficiency. Land-use efficiency increased in contexts with diversified urban landscapes.

Contemporary changes in structural dynamics and socioeconomic drivers of inland fishery in China

Dynamics of inland fishery remain poorly understood despite their increasing socioeconomic importance and rapid growth. Here we analyze the changes in the dynamics of Chinese traditional and new inland fisheries by examining 26 years (1991-2016) of reported annual catch and mean trophic level in relation to socioeconomic development in China at provincial level. Results from spatial panel linear models indicate a significant correlation between socioeconomic and fishery variables, strongly suggesting that the development of these fisheries is nested in the socioeconomic context specific to each province. A preference towards higher trophic level species (i.e., investment in quality) is revealed under a status of socioeconomic wealth, while a focus on production (i.e., quantity) is observed when population, and therefore food demand, increases. By providing novel evidence on the links between large-scale dynamics in production and trophic structure of a country's inland fishery and the socioeconomic context driving the fish demand and consumption, our work represents an important contribution towards a broader assessment and management of inland fishery resources.

Contextual Socioeconomic Disadvantage and Adolescent Suicide Attempts: A Multilevel Investigation

Multilevel research on whether and how contextual socioeconomic disadvantage affects adolescent suicidal behaviors is scarce. Using data from the first two waves (1994/95 and 1996) of the National Longitudinal Study of Adolescent to Adult Health (N = 13,335; 49.63% girls; M_age = 15.02 years), this study examined (1) the association between area-level socioeconomic disadvantage and adolescent suicide attempts over and above individual-level socioeconomic factors, (2) the moderating role of gender, and (3) the mediating roles of contextually relevant stressors and available psychosocial resources. The results revealed that area-level socioeconomic disadvantage increased the risk of attempting suicide even after adjusting for individual-level socioeconomic status, especially for boys. Consistent with the stress process perspective, reports of exposure to violence and lack of safety explain this contextual effect. National suicidal behavior prevention strategies across the U.S. should recognize the strong association with the socioeconomic context, along with individual-level risk factors.

Breakfast, nutritional status, and socioeconomic outcome measures among primary school students from the City of Salta: A cross-sectional study

INTRODUCTION

Socioeconomic context and family dynamics are determining factors when considering eating habits and nutritional status among students. It has been demonstrated that skipping breakfast or having a light breakfast has an unfavorable impact on nutritional status.

OBJETIVE

To establish a relationship among breakfast, sociodemographic outcome measures, and nutritional status among students attending public schools in the urban and peri-urban areas of the City of Salta.

POPULATION AND METHODS

Descriptive, crosssectional study. Purposive, non-probability sampling of students attending urban and periurban primary schools (aged 9-13, boys and girls). Outcome measures: breakfast at home (habit, "enKid" breakfast quality, frequency, duration), nutritional status (body mass index, Z-score, World Health Organization), and sociodemographic outcome measures (family type, level of education, employment, parents' breakfast habit, commensality). Analysis of frequency, associations, logistic regression, odds ratio, confidence interval, p < 0.05, WHO AnthroPlus and SPSS v18 software.

RESULTS

Two hundred and eighty-three students were assessed; 49.8% attended urban schools. Overweight or obesity was observed in 46.0%. Also, 55.1% skipped breakfast at home on the day of the assessment; among those who did have breakfast, 79.5% had a poor or very-poor quality meal. Among those who skipped breakfast, 40.7% of the girls and 54.7% of the boys were overweight or obese. A greater socioeconomic vulnerability and a higher percentage of students who attended school without having breakfast were observed in peri-urban schools.

CONCLUSIONS

Eventually, the probability of skipping breakfast was associated with having a large family, absence of parental breakfast habit, a low level of maternal education, having breakfast alone, and being obese.

Twenty years of socioeconomic inequalities in premature mortality in Barcelona: The influence of population and neighbourhood changes

The objective of this study was to analyse trends in socioeconomic inequalities in premature mortality in Barcelona from 1992 to 2011, accounting for population changes. We conducted a repeated cross-sectional study of the Barcelona population (25-64 years) using generalized linear mixed models for trend analysis, and found that socioeconomic inequalities in premature mortality persisted between neighbourhoods, but tended to diminish. However, the reduction in inequality was related to an increase in the number of foreign-born individuals mainly in socioeconomic disadvantaged neighbourhoods, in which the decrease in premature mortality was more marked. To study trends in geographical inequalities in mortality, it is essential to understand demographic changes occurred in different places related to local levels of deprivation.