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This study aimed to develop and validate a predictive nomogram model applicable to depression risk in stroke patients. Participants from the NHANES database (n = 1097) were enrolled from 2005 to 2018; 767 subjects were randomly assigned to the training cohort, and the remaining subjects composed the testing cohort. A nomogram containing the optimal predictors identified by the least absolute shrinkage and selection operator (LASSO) and logistic regression methods was constructed to estimate the probability of depression in stroke patients. To evaluate the performance of the nomogram, the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA) and internal validation were utilized. Age, family income, trouble sleeping, coronary heart disease, and total cholesterol were included in the nomogram after filtering predictive variables. The AUCs of the nomogram for the training and testing cohorts were 0.782 (95 % CI = 0.742–0.821) and 0.755 (95 % CI = 0.675–0.834), respectively. The calibration plot revealed that the predicted probability was extremely close to the actual probability of depression occurrence in both the training and testing cohorts. DCA revealed that the nomogram model in the training and testing cohorts had a net benefit when the risk thresholds were 0–0.59 and 0–0.375, respectively. This study was limited by the absence of clinical external validation, which hindered the estimation of the nomogram's external applicability. In addition, this study has a cross-sectional design. A novel nomogram was successfully constructed and proven to be beneficial for identifying individuals at high risk for depression among stroke patients. • Age, family income, trouble sleeping, CHD, and TC are key risk factors for developing depression in stroke patients. • The nomogram, based on above five factors, accurately and effectively predicts depression risk in patients with stroke. • The nomogram holds the potential to discern high-risk individuals for depression among stroke patients and enhance prognosis. [ABSTRACT FROM AUTHOR]

Little is known about rates of COVID-19 vaccine uptake among youth with bipolar spectrum disorders (BSD). As such, the aim of this study is to assess rates and predictors of COVID-19 vaccine uptake among youth with BSD and their caregivers in the United States. Youth and their main caregiver were recruited from a large pragmatic study cohort. Youth who were aged 8–22 at the time of this data collection, had a bipolar-spectrum disorder diagnosis, had overweight or obesity, and were treated with a second-generation antipsychotic were invited to participate in an online survey and interview assessing the impact of the COVID-19 pandemic. A total of 453 surveys and 341 interviews were completed 07/2021–05/2022 by youth and their caregivers. Sixty-seven percent of caregivers and 63 % of youth reported receiving the COVID-19 vaccine. Vaccine uptake rates among youth and caregivers were highly correlated. Predictors of vaccine uptake among youth were older age and living in the Northeast Region of the United States. Predictors of caregiver vaccine uptake were male sex, higher annual household income and not having to quarantine due to COVID-19. The sample was small and not a full representation of a population with bipolar-spectrum disorders therefore, the results may not be generalizable. The study design and statistical method do not allow for causal inferences to be made. These findings may aid in targeting interventions to maximize COVID-19 and other vaccine uptake in youth with bipolar disorders and their families. • Youth and caregiver COVID-19 vaccination rates were highly correlated. • Midwestern youth were less likely to be vaccinated than youth from the Northeast. • Older youth had greater odds of COVID-19 vaccine uptake. [ABSTRACT FROM AUTHOR]

• A best‒worst scaling experiment with a randomized design is applied to elicit how consumer preferences vary by knowledge gap. • A better understanding of the purchase tax exemption with caps is found to contribute to more sustainable consumption. • The potential green consumption gap exists at both the purchase stage and an earlier step when gathering policy information. • Male, income level and risk aversion are related to a deeper understanding of green product related policy incentives. To reduce energy consumption and carbon emissions in the transportation sector, various incentives for promoting electric vehicle (EV) uptake have been implemented worldwide. However, little attention has been given to how individuals perceive EV-related policy incentives, and a knowledge gap may reduce the effectiveness of these incentives. The aim of this study is to discern how a deep understanding of fiscal incentives can also contribute to greater environmental benefits and how green product-related policy awareness is formed in developing countries. Taking a newly released purchase tax exemption for EVs in China as an example, this study compares consumer preferences over certain attribute levels of vehicles with and without detailed policy information via a randomized group design. A best‒worst scaling profile case experiment is embedded to elicit consumer preferences and detailed information about a newly released vehicle emission standard is also provided to avoid a knowledge gap on this regulation. The result shows that compared to the group without detailed policy information, those with information about tax exemption caps are significantly less attracted to hybrid EVs, larger sized and cheap vehicles. Heterogeneous preferences are observed for the attribute levels. Income level, family size and uncertain are found to be associated with various preference through a latent class logit model. A full understanding of the tax exemption policy with caps may raise the preference for battery EVs among individuals with higher income levels and more confident with their choice, and reduce the preference for large cars among individuals from relatively larger families in particular. Self-reported knowledge about this tax exemption policy and the released vehicle emission standard is also examined before the experiment. The results indicate that the awareness of fiscal policies is greater than the awareness of the emission regulation. Individuals who are less risk averse, have higher household income levels, are from regions with more fluently standard language use, or are male are found to have a deeper understanding of these policy incentives. To enhance individual's greener vehicle related policy awareness and further shape their preference towards sustainable consumption, employing social media to transmit policy information and improving confidence in greener vehicle uptake among target populations through well designed policy incentives, especially in less developed regions might be important for developing countries. [ABSTRACT FROM AUTHOR]

• Maryland enacted several policies to increase access to quality ECE from January 2015–March 2020. • Provider subsidy participation grew following elevated income limits and reimbursement rates. • Neighborhoods with lower-poverty density had greater increases in provider subsidy participation. • The percent of children using subsidies to attend higher-rated programs increased between 2018 and 2019. • Increased use of higher-rated ECE over time was not due to families changing providers. Documenting how federal and state child care policies increase equitable access to high-quality early care and education (ECE) for families with low- and moderate-incomes remains a challenge in part due to overlaps in policy enactment. This study used an interrupted time series analysis (ITSA) to describe changes to providers' participation in Maryland's child care subsidy program following implementation of a constellation of child care policies enacted between January 5, 2015, and March 2, 2020 (i.e., prior to the COVID-19 pandemic). Findings indicate a marked increase in the percentage of licensed family child care (FCC) and center-based providers serving children with a subsidy following increases in household income eligibility levels and provider reimbursement rates in 2018. Provider participation rates varied by neighborhood income level, with participation expanding more in neighborhoods with lower poverty density relative to their starting level in 2015. Changes in child participation rates by income eligibility mirrored changes in state subsidy policy: children residing in income-eligible households above 200 % federal poverty level represented 4.4 % of the child sample in 2018, 13 % in 2019, and 18 % in 2020. The proportion of children with a subsidy who used higher-rated ECE increased significantly between January 2018 and January 2020 for all racial/ethnic groups, income eligibility levels, and urbanicity categories. The majority (62 %) of children who stayed in the subsidy program between 2018 and 2019 stayed with their same provider, many of which obtained their first rating or increased their quality rating during this time frame in accordance with a new requirement for providers to participate in the state's quality rating system to receive a subsidy reimbursement. Implications for future research, policy, and practice are discussed. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the relationship between women's healthcare autonomy and the utilization of maternal healthcare services (MHS), including antenatal care services, the services of health professionals at the birth of a child, and facility-based delivery. This was a cross-sectional study. This study utilized data from the 2015 Afghanistan Demographic and Health Survey (AFDHS 2015), which included women aged 15–49 years who had given live birth within the five years before the survey. Multilevel logistic regression was used to estimate the adjusted odd ratios (AOR) for each outcome variable. Among respondents, 16.49% made at least four ANC visits, 52.57% of childbirth were assisted by a skilled birth attendant (SBA), and 45.60% of children were born in health facilities. Women with high healthcare autonomy, compared to medium and low, were more likely to use ANC (AOR 1.45; 95% CI = 1.26–1.67), SBA (AOR 1.15; 95% CI 1.02–1.29), and FBD (AOR 1.12; 95% CI 1.04–1.20). The association between women's healthcare autonomy and the use of maternal healthcare services (MHS) was positively and significantly moderated by household wealth and women's access to media. Women's higher healthcare autonomy was significantly and positively associated with MHS in Afghanistan. Policy and programs that encourage women's empowerment and awareness of the importance of MHS utilization should be initiated. [ABSTRACT FROM AUTHOR]

This work uses the vector-valued Bernoulli equation to build a nonlinear multi-variable grey Bernoulli model, which is available to describe the nonlinear relationship between the output variables. By using P a d e ´ approximation, the proposed model can be implemented with high time efficiency. Additionally, the Sine Cosine Algorithm is employed to determine the Bernoulli exponent, thereby enhancing prediction accuracy. To evaluate the predictive performance of the proposed model, three case studies using three real-world data sets with different features of predicting per capita household income, fuel prices and crude oil prices are carried out. The results are compared with three existing grey multi-input multi-output models. Experimental results demonstrate that the proposed model excels in handling nonlinear relationships between variables and has strong robustness against noise, consistently delivering lower error values, demonstrating superior predictive performance. • A nonlinear multi-variable grey Bernoulli model is proposed based on the Hadamard product. • Linear parameter estimation is carried out using the least squares method or the least norm method. • P a d e ´ approximation is used to compute the matrix exponential to improve the time efficiency. • The model is optimized using the Sine Cosine Algorithm. • The proposed model shows superior prediction performance compared with three other typical models. [ABSTRACT FROM AUTHOR]

We use representative data from household surveys in the euro area to describe differences in wages, income, consumption, wealth and liquid assets between households born in their country of residence ("natives") and those born in other EU and non-EU countries ("immigrants"). The differences in wealth and liquid assets are more substantial than the differences in wages, income and consumption: immigrants earn on average about 30% lower wages than natives and hold roughly 60% less net wealth. For all variables, only a small fraction of differences between natives and immigrants—around 30%—can be explained by differences in demographics (age, gender, marital status, education, occupation, sector of employment). Immigrants are more likely to be liquidity constrained: while we classify 17% of natives as "hand-to-mouth" (they hold liquid assets worth less than two weeks of their income), the corresponding share is 20% for households born in another EU country and 29% for those born outside the EU. Employment rates of immigrants are substantially more sensitive to fluctuations in aggregate employment. We discuss the implications of these findings for economic policies, including monetary, fiscal and pre-distribution policies. [ABSTRACT FROM AUTHOR]

• The past developments in cystic fibrosis (CF) treatment warrant a long-term description of the societal impact of the disease. Understanding how societal impact of CF has developed is important to inform health policies to prevent inequalities and secure the right to equal opportunities in life. • The present study describes the development in key socioeconomic factors across 30 years in people living with CF (pwCF) in Denmark, compared with the general population and an early onset chronic disease population. • The educational level of pwCF was similar to the two comparator cohorts indicating successful mitigation of negative effects. However, pwCF were less often in employment and more often permanently outside the labor force than the comparator cohorts. • PwCF had similar or higher personal or household income than the comparator cohorts. • The societal profile of the CF cohort and the comparator cohorts became more alike during the study period. Past and ongoing advancements in cystic fibrosis (CF) care warrant long-term analysis of the societal impact of the condition. This study aims to evaluate changes in key socioeconomic factors across three decades among people living with CF (pwCF), compared with both the general population and an early-onset chronic disease population. This nationwide, registry-based, matched cohort study included all pwCF ≥ 18 years in Denmark in the years 1990, 2000, 2010, and 2018. Each person living with CF was matched to five individuals in the general population and five individuals living with type 1 diabetes or juvenile arthritis based on age, sex, and municipality. The Danish adult CF population increased nearly fourfold from 88 in 1990 to 331 in 2018, and mean age increased by ten years. The educational level of pwCF was similar to the two comparator cohorts, while pwCF were less often in employment and more often permanently outside the labor force. Personal and household income levels of the CF cohort were higher than those of the comparator cohorts. The disadvantage in employment for pwCF remained, but, over time, the societal profiles of the one-year CF cohorts increasingly converged with those of the comparator cohorts, indicative of improved clinical management, extended life expectancy, and the supportive role of the Danish welfare system in reducing health inequalities. Further research should be done to evaluate the effects of the newly introduced modulator therapies on employment, considering the broader societal impact and impact on quality of life. [ABSTRACT FROM AUTHOR]

To compare the physical and mental health of sexual and gender minority (SGM) parents to SGM non-parents. A cross-sectional analysis using 2018–2020 data from The PRIDE Study, a national longitudinal cohort of SGM adults. We used Poisson regression adjusted for age, gender, relationship status, race/ethnicity, household income, and education to assess the association between parental status and each outcome. Among 9625 SGM participants, 1460 (15 %) were parents. Older participants were more likely to be parents: 2% of participants aged 18–30, 18% aged 30–39, and 38% aged 40+ were parents. In adjusted analyses, parenthood was associated with greater depression, anxiety, and post-traumatic stress symptoms as well as ever cigarette smoking. Among individuals assigned female sex at birth, parents were twice as likely to have been diagnosed with pelvic inflammatory disease compared to non-parents. There was no association between parenthood status and alcohol use, substance use, diabetes, HIV, hypertension, or autism. In this national cohort of SGM adults, parenthood was associated with differences in physical and mental health measures. Understanding how parenthood influences the health and well-being of the estimated 3 million SGM parents in the US will help our health systems support diverse families. [ABSTRACT FROM AUTHOR]

Anaplastic astrocytoma (AA) is an uncommon primary brain tumor with highly variable clinical outcomes. Our study aimed to develop practical tools for clinical decision-making in a population-based cohort study. Data from 2997 patients diagnosed with AA between 2004 and 2015 were retrospectively extracted from the Surveillance, Epidemiology, and End Results database. The Least Absolute Shrinkage and Selection Operator and multivariate Cox regression analyses were applied to select factors and establish prognostic nomograms. The discriminatory ability of these nomogram models was evaluated using the concordance index and receiver operating characteristic curve. Risk stratifications were established based on the nomograms. Selected 2997 AA patients were distributed into the training cohort (70%, 2097) and the validation cohort (30%, 900). Age, household income, tumor site, extension, surgery, radiotherapy, and chemotherapy were identified as independent prognostic factors for both overall survival (OS) and cancer-specific survival (CSS). In the training cohort, our nomograms for OS and CSS exhibited good predictive accuracy with concordance index values of 0.752 (95% CI: 0.741–0.764) and 0.753 (95% CI: 0.741–0.765), respectively. Calibration and decision curve analyses curves showed that the nomograms demonstrated considerable consistency and satisfactory clinical utilities. With the establishment of nomograms, we stratified AA patients into high- and low-risk groups, and constructed risk stratification systems for OS and CSS. We constructed two predictive nomograms and risk classification systems to effectively predict the OS and CSS rates in AA patients. These models were internally validated with considerable accuracy and reliability and might be helpful in future clinical practices. [ABSTRACT FROM AUTHOR]

Congenital myelomeningocele, or spina bifida (SB), is the predominant congenital anomaly of the central nervous system. Beyond its implications on neonatal mortality, SB impacts the long-term quality of life in affected children. This study sought to investigate the health-related quality of life (HRQoL) among children with SB treated at Ethiopia's leading pediatric neurosurgical facility. Set at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, this hospital-based cross-sectional study spanned from June 30 to September 30, 2022. It incorporated 232 children, using data gathered through interviewer-led questionnaires. The HRQoL was measured using the PedsQL 4.0, a 23-item generic scale. The study's participants had a median age of 5 years (interquartile range = 3 to 6 years). The aggregate mean scores on the PedsQL 4.0 tallied at 68.59 ± 18.01. The lowest scores emerged from queries on school participation, whereas physical and emotional functioning registered the highest scores. Through multiple regression analyses, variables such as family income, monthly household income, number of children, and the presence of a neurogenic bladder showed strong association with HRQoL. This study fills a gap in the literature providing information on the HRQoL and its associated factors for children with SB in low-resourced settings. We champion the proactive integration of quality-of-life metrics into neurosurgical care policy and practice. Given the enduring consequences of SB, interventions honing the HRQoL can steer children toward realizing their intrinsic and enhance societal participation and contribution. [ABSTRACT FROM AUTHOR]

Within the field of pediatric neurosurgery, insurance status has been shown to be associated with surgical delay, longer time to referral, and longer hospitalization in epilepsy treatment, myelomeningocele repair, and spasticity surgery.1,2 The aim of this study was to investigate the association of insurance status with inpatient adverse events (AEs), length of stay (LOS), and costs for newborns diagnosed with intraventricular hemorrhage (IVH). A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample database. Patients with a primary diagnosis of intraventricular hemorrhage were identified using ICD-10-CM diagnostic and procedural codes. Patients were categorized based on insurance status: Medicaid or Private Insurance (PI). Multivariate logistic regression analyses were used to identify the impact of insurance status on extended LOS (defined as >75th percentile of LOS) and exorbitant cost (defined as >75th percentile of cost). Demographics differed significantly between groups, with the majority of newborns in the PI cohort being White (Medicaid: 35.8% vs. PI: 60.3%, P < 0.001) and the majority of Medicaid patients being in the 0–25th quartile of household income (Medicaid: 40.9% vs. PI: 12.9%, P < 0.001). While insurance status was not independently associated with increased odds of extended LOS or exorbitant cost, Medicaid patients had a greater mean LOS and total cost of admission than PI patients. Demographic characteristics, mean LOS, and mean total cost differed significantly between Medicaid and PI patients, indicating potential disparities based on insurance status. However, insurance status was not independently associated with increased healthcare utilization, necessitating further research in this area of study. [ABSTRACT FROM AUTHOR]

The motives behind transfers from adult children to parents hold significance in the well-being of the elderly. In the context of China's land titling program, we utilize a dominant child model to study the trade-off between altruism and exchange motives. Based on data from the China Health and Retirement Longitudinal Study, this paper employs the endogenous switching model to investigate the effects of land titling on children's pecuniary and time transfers. The results of the average treatment effect on the treated (ATT) indicate that for children whose parents receive land titling, land titling has significantly increased their pecuniary transfers while decreasing their time transfers. Mechanism analysis reveals that the land titling program results in higher parental income by incentivizing parents to rent out their land and engage in off-farm employment. These findings reveal the exchange motive, suggesting that children provide transfers out of concern about their parents' wealth. Heterogeneous analysis demonstrates that both sons and daughters lean towards exchange motives. Land titling effects are pronounced among children without siblings, those from parental households with lower land per capita, and those with higher income. [ABSTRACT FROM AUTHOR]

This article presents a novel explanation for why demand for redistribution may not respond to information on low intergenerational mobility on average. Conducting a survey experiment in Austria, we show that the average treatment effect on perceptions is mostly driven by high-income individuals while low-income individuals hardly react. Using data from two related survey experiments, we document similar heterogeneity in Germany, the United States, Italy, and Sweden, while France and the United Kingdom appear to exhibit different dynamics. The low-income group, which has the strongest incentive to increase demand for redistribution, makes few adjustments to its beliefs. This may explain the frequently observed persistence of redistributive preferences. We observe that demand for redistribution remains unchanged on average and across income groups in the five countries with differential belief updating by income. Conversely, a more substantial increase in demand for redistribution seems to occur in France, where all income groups update their beliefs similarly. Further, we provide suggestive evidence that low-income individuals update their beliefs more in less ego-relevant contexts, indicating motivated beliefs. • We document strong heterogeneity in social mobility belief updating by income. • Low-income earners adjust their beliefs much less than high-income earners. • This may explain why demand for redistribution can be unresponsive to information. • Using two other surveys, we replicate this pattern in four out of six countries. • We provide suggestive evidence that motivated beliefs may explain our result. [ABSTRACT FROM AUTHOR]

Poverty measurement using durable ownership data is an attempt to infer income constraints by observing consumption choices. But what drives household spending choices on durable goods? How do these choices relate to poverty and class? What does it mean to be 'relatively' poor and why should we care to measure it? In this paper, we propose an economic theory of household decision-making that links these questions using a novel wealth-begets-wealth mechanism. We show that the steady state distribution of total (accumulated) household durable expenditures in this model exhibits natural clusters (classes). Furthermore, certain households may be vulnerable to a long run 'poverty of opportunities', being unable to access any of the channels of income generation available in society. Our model shows that relative poverty can be understood as the endogenous outcome of an intergenerational process that perpetuates unequal access to opportunities. This finding has novel implications for the measurement of poverty, which has traditionally hinged on definitions that assume exogenous (often arbitrary) cutoffs. The contribution of this paper also lies in its novel methodology, viz., formulating a theoretical model as the foundation of a data-generating process for synthetic observations, using patterns observed therein to inform the process of poverty measurement. The methodology delivers a framework for generating testable hypotheses around the long-run effect of policy changes (such as income transfers or education subsidies) on relative poverty – an approach that can be applied generally to understand the observed behaviour of economic agents in complex dynamic settings. [ABSTRACT FROM AUTHOR]

We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations. This was a population-based prospective cohort study. We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors. Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES. Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether family poverty over the early childhood, adolescent, and adult periods of the life course independently predicts experiences of intimate partner violence (IPV) in adulthood. This was a birth cohort study in Brisbane, Australia, with pregnant women recruited at their first booking-in visit and their children, followed up to 30 and 40 years of age. Family income was obtained from the mother when the child was 6 months, 5 and 14 years of age. Offspring reported their own family income at 21, 30, and 40 years of age. The offspring completed the Composite Abuse Scale at 30 and 40 years. Adjusted logistic regression models are used to predict experiences of IPV at 30 (n = 2157) and 40 (n = 1438) years. The findings at 30 and 40 years of age are consistent. Only poverty experienced concurrently with the assessment of IPV is strongly associated. At the 40-year follow-up, family poverty predicts higher ratios of all four forms of IPV; severe combined abuse (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.24, 4.05), physical abuse (OR = 3.37, 95% CI = 1.95, 5.82), emotional abuse (OR = 2.09, 95% CI = 2.58, 8.57) and harassment (OR = 4.70, 95% CI = 2.58, 8.57). Concurrent family poverty is strongly and consistently associated with patterns of IPV. These associations are for cross-sectionally collected data with the prospectively collected data not replicating these findings. Although it is not possible to identify a specific causal pathway, the findings suggest that the immediate consequences of poverty are strongly associated with IPV. Programmes that address poverty reduction provide the best prospect for reducing societal levels of IPV. [ABSTRACT FROM AUTHOR]

Several countries in different global regions are implementing lung cancer (LC) screening programmes. This study aimed to estimate the proportion of the Chilean population ≥15 years who are at high risk of developing LC. Cross-sectional study. Data from the Chilean National Health Survey were used in this study. Information on age and history of tobacco consumption were retrieved to estimate national and regional proportions of the Chilean population ≥15 years who are at high risk of developing LC, according to the inclusion criteria in the NELSON trial, NLST trial and USPSTF2021 recommendations. Stratified analyses were performed by sex and quartiles of monthly household income. An estimated 292,158 (2.2%; 95% confidence interval [CI] 1.6–2.8), 174,196 (1.3%; 95% CI 0.9–1.7) and 404,751 (3.1%; 95% CI 2.4–3.8) of Chileans are at high risk of LC according to NELSON and NLST trial inclusion criteria and USPSTF2021 recommendations, respectively. Proportions of males who are at high risk were higher in comparison to females. The highest proportion of people who are at high risk was found in the lowest household income quartile. Regionally, the lowest percentage of Chileans who are at high risk was found in La Araucanía and the highest in Magallanes y Antártica. There is a relevant number of Chileans who are at high risk of developing LC. Policymakers in Chile should enhance tobacco control efforts to reduce the prevalence of tobacco smoking and also explore the implementation of LC screening programmes to reduce the burden of LC. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of the accumulation of tangible capital, ICT and intangible capital assets like software and databases or R&D on employment growth and the changes in labour income shares at the country-industry level. The econometric analysis is derived from a Cobb–Douglas production function taking into account the stylised fact that the capital–output ratios are rather constant or increasing over time with the latter being the case particularly for ICT and intangible assets. The accumulation of tangible assets like machinery and transport equipment then has a relatively strong positive relation to employment growth. Further in line with the theoretical outline, the accumulation of ICT assets or intangible assets are less strongly related to employment growth. Both these conjectures are confirmed econometrically. The impact on labour income shares is mixed, but generally small. • Capital–output ratios are increasing with capital accumulation of ICT and intangible asset types. • Accumulation of tangible capital is positively related to employment growth. • ICT and intangible capital accumulation is also positively but only weakly linked to employment growth. • Impact on labour income shares is mixed and small. [ABSTRACT FROM AUTHOR]

MyPlate is a tool designed to educate the general US population on how to eat in alignment with the Dietary Guidelines for Americans; yet, there is a lack of data on who has heard of MyPlate over time. The objective of this analysis was to examine the prevalence of awareness of MyPlate within the US population and if awareness changes differentially over time. This study was a serial, cross-sectional survey. Three survey waves of data (2013-2018) were used from the National Health and Nutrition Examination Survey of adults aged 20 years or older (n = 17,023). Percentage of the US adult population who had heard of MyPlate was measured and stratified by sex, age, citizenship status, education, household food security status, income, receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, and receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits. Global Wald tests were used to assess whether prevalence of awareness of MyPlate differed by sociodemographic characteristics. Tests of homogeneity using likelihood ratio tests of nested logistic regression models were used to assess whether differences in awareness of MyPlate by various sociodemographic characteristics changed over time from 2013 to 2018. Twenty percent (19.5%) (n = 875) of the analytic sample of participants aged 20 years and older had heard of MyPlate in 2013-2014, 24.5% (n = 1,020) in 2015-2016, and 24.6% (n = 1,086) in 2017-2018. Awareness of MyPlate changed differentially over time (P value <.1) from 2013 to 2018 by income, household food security status, and receipt of SNAP benefits, with slower increases in awareness for households with lowest income over time, narrowing of differences in awareness by household food security status over time, and persistent differences in awareness by receipt of SNAP benefits over time. These results highlight the current low awareness of MyPlate, disparities in awareness of MyPlate immediately after implementation by sociodemographic characteristics, and increases in awareness over time at differential rates within levels of income, food security status, and ever receipt of SNAP benefits. Given that the Dietary Guidelines for Americans 2025-2030 are currently in development, new strategies should be considered to disseminate tools that translate the updated Dietary Guidelines in such a way that reach the general population equitably upon implementation within the United States. [ABSTRACT FROM AUTHOR]

• China's Anti-Monopoly Law (AML) has a positive impact on average labor wage. • Labor income share increases more in local state-owned and nonstate-owned enterprises. • AML effectively promotes industry competition and boosts the labor income share. • AML reduces market power, curbs monopoly profit, and increases the average labor wage. This study examines the impact of increased market competition on labor income share. We use the enactment of China's Anti-Monopoly Law as a quasi-natural experiment. The results reveal that the Anti-Monopoly Law has a significant positive effect on the labor income share of firms with higher market power. This is because the rising market competition, effected by the Anti-Monopoly Law, inhibits market power and increases average labor wages. Our findings are relevant for firms in provinces with higher administrative monopolies, with less competition, and under industries with less competition. [ABSTRACT FROM AUTHOR]

This paper investigates the implications of fiscal policy for labor income inequality through two causal channels. First, I estimate how fiscal policy reacts to negative income shocks happening at different points on the labor income distribution, to examine whether fiscal policy responds differently when there are changes in income for low-income earners, versus median-income earners or high-income earners. Secondly, I estimate the impact that various fiscal policies have on labor market income at the low, median, and high ends. I consider eight different fiscal policy variables, including four types of government transfer variables shown to be countercyclical, government consumption and government investment, and personal versus corporate tax revenue. Embedding each fiscal policy variable into a Bayesian structural vector autoregression, I estimate both the reaction of each fiscal policy variable to shocks to labor income at three points of the labor income distribution, and the impact of shocks to each fiscal policy variable on labor income along the same three points of the distribution. Impulse response functions show most fiscal policies are more responsive to shocks to the low end of the income distribution. The impulse response functions also show that it is often the median and upper-end of the income distribution that benefit most from fiscal expansions, leading to greater income inequality. The results also reveal that the fiscal policies most effective for boosting income at low income levels also lead to the largest increases in income inequality. Finally, I find that the fiscal policies most effective for stimulating labor income are also the least responsive to labor income shocks. [ABSTRACT FROM AUTHOR]

By means of counterfactual simulation methods, this paper quantifies the role of tax–benefit policies in mitigating the shock of the COVID-19 pandemic to household income in the European Union. The tax-benefit microsimulation model for the European Union EUROMOD is used to decompose changes in the income distribution into the effects of: (i) earnings losses due to COVID-19, (ii) automatic stabilizers, (iii) monetary compensation schemes introduced during the pandemic; and (iv) COVID-19-specific reforms to taxes and benefits implemented by European Union governments. The results show a great deal of heterogeneity between countries in terms of earnings losses and the effect of tax-benefit policies during the COVID-19 pandemic. In most countries, the largest contribution to cushioning the economic shock of the pandemic comes from monetary compensation schemes. Automatic stabilizers also play a role, mainly through the effects of social insurance contributions, taxes, and unemployment insurance benefits. Tax-benefit systems cushioned incomes to a large extent even among those most severely affected by the shock to earnings, with an important role for monetary compensation schemes, but also a larger stabilizing effect of unemployment insurance. Among automatic stabilizers, social assistance benefits played an important role in cushioning the income shock for the poorest quintiles among the most severely affected, but only in selected countries. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) refer to social and economic factors that influence a patient's health status. The purpose of this study was to investigate the impact of SDOH on preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and postoperative resource utilization following primary shoulder arthroplasty (SA). This retrospective chart review evaluated data from all patients who underwent primary SA (including anatomic, reverse, and hemiarthroplasty) at a single health system between May 2020 and May 2022. Patients without at least 6-month postoperative PROMIS questionnaires and those undergoing revision surgeries were excluded. The electronic medical record was used to identify SDOH for each patient, and PROMIS scores for Upper Extremity (PROMIS-UE), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed electronically at respective preoperative and postoperative visits. Univariate analysis using independent 2-group t -tests and Chi-squared tests were used to analyze the mean difference between patient groups based on SDOH. Multivariate linear regressions were performed with all predictors used in the univariate model using the least squares method. The study included 248 patients who underwent SA, with a mean age of 67.9 years. Caucasian patients were over-represented in the highest quartile of median household income (MHI) compared to Black patients (35.1% vs. 17.2%) who were over-represented in the lowest MHI quartile (37.9% vs. 8.3%). At 6-month postoperative, black patients had significantly lower UE (33.8 ± 6.2 vs. 38.1 ± 9.0; P =.03) and greater PI scores (59.1 ± 6.1 vs. 55.6 ± 8.6; P =.145) compared to Caucasian patients. Similarly, at 6-month follow-up, the lowest MHI quartile had lower UE (33.8 ± 7.7 vs. 39.6 ± 8.8; P =.01) and higher PI scores (58.7 ± 6.5 vs. 54.3 ± 8.2; P <.01) compared to the highest MHI quartile, and females demonstrated lower UE (36.3 ± 7.9 vs. 38.6 ± 9.8; P =.04) and higher D scores (46.2 ± 9.1 vs. 42.0 ± 8.6; P =.046) compared to males. Government/public insurance demonstrated lower UE (36.8 ± 8.0 vs. 39.8 ± 10.4; P =.03) and higher D scores (45.9 ± 9.2 vs. 40.6 ± 7.6; P =.03) compared to private insurance. At 12-month follow-up, females demonstrated lower UE scores compared to males (36.0 ± 10.2 vs. 40.1 ± 11.3; P =.03). Black patients harbored lower UE, PI, and D scores compared to Caucasian patients, although not statistically significant. Several socioeconomic factors such as race, gender, and insurance status are associated with differential outcomes after SA. Patients who are Black, female, current smokers, and from the lowest income quartile are associated with inferior PROMIS function, pain, and depression outcomes following SA. [ABSTRACT FROM AUTHOR]

Research indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking. Data was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders). The sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p =.077) nor suicide attempts (p =.17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men. Although the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk. This study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises. • Prevalences of suicidal thoughts and attempts in a large, representative cohort • Prevalence rates slightly higher among people with cancer than those without • Highest risk in individuals with uterus, cervix, and female genitalia cancer • Male gender, higher age and higher household income as important protective factors • Positive association of prevalence rates with 5 or more chronic diseases in men [ABSTRACT FROM AUTHOR]

Social drift/selection (i.e., mental health symptoms cause low economic status) and social causation theories (i.e., low economic status causes mental health symptoms) specify reciprocal relationships between economic status and mental health. Little is known regarding the disaggregation of within-person and between-person effects in the relationship between economic status and mental health in the long run. The current study sought to examine the reciprocal relationships between economic status and mental health over 20 years of adulthood, disaggregating within-person and between-person effects. Data were from three waves (7108 participants) of the Midlife Development in the United States study. Participants reported information about objective and subjective measures of economic status as well as a wide range of indicators of mental health on the positive dimension, including subjective, social, and psychological well-being, and on the negative side, depression, anxiety, panic attack, anhedonia, somatic amplification, alcohol abuse, and negative affect. Cross-lagged panel models were estimated. At between-person levels, both social drift/selection and social causation hypotheses were confirmed when considering subjective measures of economic status. When using objective measures of economic status (i.e., income), the results showed decreased support for social drift/selection and social causation hypotheses. At within-person levels, social drift/selection and social causation hypotheses were generally not supported, with some notable exceptions. Restriction of the sample to one country limits the generalizability of the findings. Social causation and social drift/selection processes act simultaneously mainly at a population level, but much less when considering individual changes. Policy and programs should be targeted at addressing inequality in income and mental health within a nation or a community. • Economic status and mental health in adulthood were examined. • The relative importance of social causation and social drift/selection was tested. • The investigation of between- or within-person effects yielded distinct results. • Economic status and mental health were related at the between-person level [ABSTRACT FROM AUTHOR]

Investigating the link between serum neurofilament protein (sNfL) levels and depression remains an area of limited understanding. This study explores the correlation in US adults and employs Mendelian randomization (MR) to ascertain causality. Our cross-sectional study analyzed data from participants aged 20 and above in the National Health and Nutrition Examination Survey (2013–2014). We employed a weighted multiple logistic regression model to examine the relationship between ln (sNfL) and depression. Restricted cubic splines (RCS) were used to visualize non-linear relationships. Stratified analyses examined associations between ln(sNfL) and depression in different subgroups. Subsequently, we conducted a two-sample bidirectional Mendelian randomization (MR) to assess the causal relationship between sNfL and depression. The inverse variance-weighted (IVW) method was utilized as the primary analysis. Among 1765 participants (mean age 45.19 years; 49.37 % male), 166 had depression with a Patient Health Questionnaire (PHQ-9) score ≥ 10. After adjusting for covariates, a positive correlation remained between sNfL and depression (OR 1.511, 95 % CI: 1.050–2.175). RCS curves indicated a non-linear association, with a turning point at 2.76 pg/ml. Stratified analyses revealed positive correlations in specific subgroups, with interactions involving age, race, family income, recreational activity, and ln(sNfL). MR using IVW found no significant causal relationship between sNfL and depression genetically (OR = 0.956, 95 % CI: 0.878–1.042), with reverse analysis yielding similar results (OR = 0.897, 95 % CI: 0.756–1.065). This cross-sectional study highlights a significant correlation between ln(sNfL) and depression. However, MR results indicate no causal relationship between sNfL and depression. • Significant positive correlation found between serum neurofilament protein levels and depression. • Subgroup analyses show correlation influenced by age, race, income, and recreational activity. • Mendelian randomization indicates no causal relationship between sNfL levels and depression. [ABSTRACT FROM AUTHOR]

To explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments. Secondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention. Thirty-three Hispanic/Latinx caregivers, predominantly of low income. Patterns in goal content and anticipated barriers and facilitators. Thematic analysis of goal sheets with a mixed inductive-deductive approach. Almost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers' perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members' eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation). Understanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators. [ABSTRACT FROM AUTHOR]

• Araujia sericifera appears to establish abundantly and indiscriminately throughout Johannesburg. • 48% and 11% of A. sericifera seeds germinated under shaded and full-sun conditions, respectively. • At a national scale, the distribution of A. sericifera is largely determined by human disturbance. The moth catcher vine, Araujia sericifera Brotero (Apocynaceae), is a prevalent invader in many countries worldwide, where it has been reported to be a significant threat to biodiversity and agriculture. However, limited knowledge exists surrounding the ecology, invasion and impacts of A. sericifera in South Africa, challenging the implementation of management efforts. Therefore, this study sought to understand the vine's invasion within a South African context. To determine the density of A. sericifera in response to ecological and socio-economic predictors, its abundance along roads in 42 Johannesburg suburbs was measured. Additionally, A. sericifera abundance was recorded on foot within two nature reserves in Johannesburg, where density estimates were found to be 29 times higher than those obtained via roadside surveys. At a local scale, there was no evidence to indicate that vegetation, urban cover, and median household income influence A. sericifera density, suggesting that the vine establishes indiscriminately across Johannesburg. To determine whether this opportunistic behaviour was reflected in the vine's recruitment, its emergence rates in response to shaded and full-sun conditions were investigated. Seedling emergence was higher under shaded conditions (47.8%) than under full-sun (11%). Using MaxEnt models, environmental variables affecting the plant's distribution in South Africa were identified. Human disturbance had a permutation importance of 85.6%, indicating that A. sericifera's establishment is largely driven by disturbance. While A. sericifera appears to be in its lag phase of invasion and is unlikely to invade natural ecosystems in the short term, its abundance in the two nature reserves suggests that management should be prioritised during this lag phase, prior to its potential expansion into less-disturbed areas. [ABSTRACT FROM AUTHOR]

During COVID-19, governments imposed restrictions that reduced pandemic-related health risks but likely increased personal and societal mental health risk, partly through reductions in household income. This study aimed to quantify the public's willingness to accept trade-offs between pandemic health risks, household income reduction, and increased risk of mental illness that may result from future pandemic-related policies. A total of 547 adults from an online panel participated in a discrete choice experiment where they were asked to choose between hypothetical future pandemic scenarios. Each scenario was characterized by personal and societal risks of dying from the pandemic, experiencing long-term complications, developing anxiety/depression, and reductions in household income. A latent class regression was used to estimate trade-offs. Respondents state a willingness to make trade-offs across these attributes if the benefits are large enough. They are willing to accept 0.8% lower household income (0.7-1.0), 2.7% higher personal risk of anxiety/depression (1.8-3.6), or 3.2% higher societal rate of anxiety/depression (1.7-4.7) in exchange for 300 fewer deaths from the pandemic. Results reveal that individuals are willing to accept lower household income and higher rates of mental illness, both personal and societal, if the physical health benefits are large enough. Respondents placed greater emphasis on maintaining personal, as opposed to societal, mental health risk and were most interested in preventing pandemic-related deaths. Governments should consider less restrictive policies when pandemics have high morbidity but low mortality to avoid the prospect of improving physical health while simultaneously reducing net social welfare. • During COVID-19, many governments imposed restrictions that reduced pandemic-related health risks but increased personal and societal mental health risk, partly through reductions in household income. • We show that respondents are willing to make trade-offs that reduce household income and increase personal and societal mental health risks if the perceived benefits are large enough. • Respondents are most concerned about pandemic-related deaths; respondents value a statistical life saved from pandemic-related policies at SGD 3.1 million, which is similar to that reported in other high-income countries. Governments should stress mortality reductions in conveying benefits of pandemic-related policies and consider less restrictive policies when pandemics have high morbidity but low mortality so as not to improve health while simultaneously reducing welfare through overly restrictive policies. [ABSTRACT FROM AUTHOR]

We propose an intertemporal consumption-saving model by exploring the implications of the Law of Small Numbers (LSN), a belief heuristic stating that any sample realization of a population should be representative of the population. First, the existence of the LSN reduces the precautionary savings demand. More importantly, we show that the LSN belief structure provides an alternative explanation for two fundamental anomalies in consumption theory: (1) excess sensitivity by showing that past changes in income predict future changes in consumption; and (2) excess smoothness by lowering consumption volatility and generating the empirical magnitude. [ABSTRACT FROM AUTHOR]

We develop a general equilibrium model of a small open economy with performance-pay worker compensation and occupational choice. We analytically and numerically examine the distributional effects of entrepreneurial talent and performance-pay contracts. Risk-neutral, more talented individuals become entrepreneurs, inducing workers to exert effort through incentive contracts. Entrepreneurial talent and worker effort significantly influence income inequality through complex general equilibrium channels. Economies with higher tariffs, more entrepreneurs, less skilled or more heterogeneous workers, and economies without worker effort, display higher income inequality measured by the top one percent income share and the Gini Coefficient. [ABSTRACT FROM AUTHOR]

This study aimed to assess the trends of healthy aging and investigate its determinants in the middle-aged population. This was a longitudinal study. The sample comprised 3043 participants aged 45–59 years from the China Longitudinal Study of Health and Retirement 2011–2018. We plotted the prevalence across four waves and used ordered logistic models to investigate the determinants of cumulative times of healthy aging. We enrolled 3043 middle-aged people in our study. The prevalence of healthy aging is 28.2% at baseline but subsequently decreased to 19.72% at wave 4. Active socializing consistently ranked the lowest among the five dimensions. Participants with older age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94–0.97), low monthly income (OR = 0.82, 95% CI: 0.69–0.97) or lived in urban (OR = 0.81, 95% CI: 0.70–0.94) were less likely to have per time increase in healthy aging. Participants with more than primary school degree (OR = 1.79, 95% CI: 1.31–2.46), high life satisfaction (OR = 2.38, 95% CI: 1.86–3.06), and good self-report health (OR = 1.97, 95% CI: 1.66–2.34) were more likely to have healthy aging. The number of middle-aged individuals in China who achieved healthy aging is declining and eventually less than one in five, which was far from ideal. Particular attention should be paid to older, women, urban dwellers, individuals with low income, low life satisfaction or poor self-report health. It is urgent to develop public health policies to improve the health and well-being of the middle-aged population. [ABSTRACT FROM AUTHOR]

Autistic children are prone to experience heightened levels of distress and physiological reactivity to a range of sensory, social, and emotional stimuli. In line with this, multiple studies have demonstrated that autistic children have higher acute cortisol stress responses to adverse or threatening stimuli and altered cortisol awakening responses. However, few studies have examined whether this sensitivity may relate to heightened levels of chronic stress and persistently elevated hypothalamic-pituitary-adrenal (HPA) axis activity. The measurement of cortisol accumulation in hair is considered a non-invasive biomarker of chronic stress and has been associated with several childhood diseases. Here, we investigated whether hair cortisol concentration in a large sample of autistic children differed from non-autistic children, and after accounting for a range of child, parental and family-level characteristics. Hair cortisol concentration was measured in 307 autistic children and 282 non-autistic controls aged between 2 and 17 years recruited from four Australian states who participated in providing hair samples and demographic data to the Australian Autism Biobank. Independent samples t -test or one-way analysis of variance (ANOVA) were conducted to determine significant differences in the mean hair cortisol concentration (pg/mg) between potential covariates. Primary analysis included multivariable regression modelling of the collapsed sample to identify variables that were significantly associated with hair cortisol concentration after controlling for covariates. We also accounted for the potential interaction of multiple biological (e.g., age, sex, BMI) and psychosocial characteristics at the level of the child, the mother and the father, and the family unit. Our findings suggest that the diagnosis of autism was not a significant predictor of chronic stress, as measured by hair cortisol concentration. However, findings of the multivariable regression analysis showed that key factors such as area of residence (Queensland vs Victorian state of residence) and decrease in child's age were significantly associated with higher hair cortisol concentration whereas lower family income was significantly associated with higher hair cortisol concentration. To our knowledge, this is the first study to show that socioeconomic factors such as family annual income affect hair cortisol status in autistic children, indicating that the psychosocial environment may be a potential mediator for chronic stress in autistic children just as it has been demonstrated in non-autistic children. • Largest study internationally measuring hair cortisol levels among autistic children. • Diagnosis of autism alone was not a significant predictor of chronic stress. • Child's age, residence and family income were significant risk factors for stress. • Findings suggest autistic children are impacted by family psychosocial stressors. [ABSTRACT FROM AUTHOR]

People with psychotic disorders are at increased risk of experiencing involuntary hospital admissions relative to other psychiatric patients. Within this group, refugees and other minority groups may be at even greater risk. However, little is known about the role of migration background in the risk of involuntary admissions around the time of first psychosis-related treatment. We utilized nationwide administrative data from Denmark covering the period 2006–2018. We included all persons aged 18–35 years in first treatment for psychotic disorders [inpatient and hospital-based outpatient settings (N = 11,871)]. We estimated odds ratios (OR) of any involuntary inpatient admission within three months of first treatment using logistic regression, and rate ratios (RR) of further involuntary admissions, total number of involuntary admissions, and days of involuntary care among patients initially admitted involuntarily using Poisson regression. We compared refugees with majority peers (native-born with native-born parent), other migrants, and descendants of non-refugee migrants. Compared with the majority group, refugees, non-refugee migrants and descendants were at increased risk of involuntarily admissions (OR range = 2.12–2.69). Differences in sex, age, education, household income and family situation did not explain these disparities. In contrast, the risk of subsequent involuntary care did not differ between groups (RR range = 0.77–1.31). The findings highlight the need to review if and why processes of needs detection and voluntary treatment enrolment are less effective for minorities in Denmark. Further studies should investigate the pathways to care across population groups to inform interventions that address disparities. [ABSTRACT FROM AUTHOR]

• Among Korean adults ≥65y, 25% of men and 36% of women had low muscle strength. • Only 16% of Korean adults met the recommended nutrient intake of dietary vitamin C. • Dietary vitamin C intake was correlated with handgrip strength in Korean women. • Korean women ≥65y with low dietary vitamin C had a higher risk of possible sarcopenia. Although vitamin C is one of the most important antioxidants, its effect on muscle quality is not fully understood. Therefore, we hypothesized that low dietary vitamin C intake is associated with low muscle strength. To test the hypothesis, a single 24-h dietary recall and handgrip strength test of 10,883 younger adults 19-64 y and 3,961 older adults ≥65 y from the seventh Korea National Health and Examination Survey (KNHANES VII 2016-2018) was analyzed by multivariable linear and logistic regression models, and low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Approximately 15.5% of Korean adults met the recommended intake of dietary vitamin C, and those with higher dietary vitamin C intake had higher total energy and protein intake. After adjusting for confounding variables, including age, body mass index, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical condition, and dietary intake of protein, vitamin E, and β-carotene, dietary vitamin C was correlated with maximal handgrip strength in younger women 19-64 y (β = 0.002; SE = 0.001; P -value =.026) and older women ≥65 y (β = 0.005; SE = 0.002; P -value =.013). Among older women ≥65 y, those in the lowest quartile of dietary vitamin C intake had a higher risk of low muscle strength compared to those in the highest quartile after adjustment of confounding factors (odds ratio, 2.16; 95% confidence interval, 1.49-3.15). These results imply that adequate dietary vitamin C intake may reduce the risk of sarcopenia in older Korean women. Dietary vitamin C was shown to be inversely associated with the risk of low muscle strength in older Korean women. Although no association between the two variables among younger men 19-64 y, older men ≥65 y, and women 19-64 y was observed, older Korean women ≥65 y in the lowest quartile of vitamin C intake had significantly higher odds of low muscle strength compared to those in the highest quartile with adjustment for confounding variables (OR, 2.16; 95% CI, 1.49-3.15). [Display omitted] [ABSTRACT FROM AUTHOR]

Studies examining the relationship among hospital case volume, socioeconomic determinants of health, and patient outcomes are lacking. We sought to evaluate these associations in the surgical management of intracranial meningiomas. We queried the National Inpatient Sample (NIS) database for patients who underwent craniotomy for the resection of meningioma in 2013. We categorized hospitals into high-volume centers (HVCs) or low-volume centers (LVCs). We compared outcomes in 2016 to assess the potential impact of the Affordable Care Act on health care equity. Primary outcome measures included hospital mortality, length of stay, complications, and disposition. A total of 10,270 encounters were studied (LVC, n = 5730 [55.8%]; HVC, n = 4340 [44.2%]). Of LVC patients, 62.9% identified as white compared with 70.2% at HVCs (P < 0.01). A higher percentage of patients at LVCs came from the lower 2 quartiles of median household income than did patients at HVCs (49.9% vs. 44.2%; P < 0.001). Higher mortality (1.3% vs. 0.9%; P = 0.041) was found in LVCs. Multivariable regression analysis showed that LVCs were significantly associated with increased complication (odds ratio, 1.36; 95% confidence interval, 1.30–1.426, P <0.001) and longer hospital length of stay (odds ratio, –0.05; 95% confidence interval, –0.92 to –0.45; P <0.001). There was a higher proportion of white patients at HVCs in 2016 compared with 2013 (67.9% vs. 72.3%). More patients from top income quartiles (24.2% vs. 40.5%) were treated at HVCs in 2016 compared with 2013. This study found notable racial and socioeconomic disparities in LVCs as well as access to HVCs over time. Disparities in meningioma treatment may be persistent and require further study. [ABSTRACT FROM AUTHOR]

This study aimed to provide subjective well-being (SWB) population norms in Hungary and explore the contribution of explanatory factors of SWB inequality among the Hungarian adult general population. The data originated from a large representative internet-based cross-sectional survey in Hungary, which was conducted in 2020. We applied validated multi-item instruments for measuring SWB, namely Satisfaction With Life Scale (SWLS) and World Health Organization-Five Well-Being Index (WHO-5). Multiple linear regressions were used to examine the relationship between demographic-socioeconomic-health status and both well-being instruments. The concentration index (CI) was used to measure the degree of income-related inequality in well-being. A total of 2001 respondents were enrolled with the means ± SD WHO-5 scores and SWLS scores of 0.51 ± 0.21 and 0.51 ± 0.23, respectively. Higher household income, higher educational level, better general health status, and absence of chronic morbidity were significant positive predictors for both WHO-5 and SWLS scores. The CI of WHO-5 scores was lower than that of SWLS scores in the total sample (0.0480 vs 0.0861) and in subgroups by gender (male, 0.0584 vs 0.1035; female, 0.0302 vs 0.0726). The positive CI values implied a slight pro-rich SWB inequality in this population. The regression analyses showed a positive association of SWB with having a higher household income and a better general health status. This is the first representative study in Hungary to compare population norm of 2 well-being instruments and analyze well-being inequality. Slight pro-rich inequality was found consistently with both SWB measures. Our findings support the need for health and social policies that effectively tackle inequalities in Hungary. • This is the first study to explore the degree of income-based SWB inequality in the representative Hungarian population. • The concentration indices and the concentration curves for both well-being scores implied a slight pro-rich distribution. • The Hungarian health economic guideline prioritizes quality of life as a primary measure of health technology outcomes; however, it is imperative to recognize that public health interventions can have broader implications on various facets of well-being beyond just health. Therefore, in decision-making processes concerning funding allocations, it is essential to consider the holistic impact of interventions. [ABSTRACT FROM AUTHOR]

This study investigated the associations of occupational physical activity and active transport with depressive symptoms, stratified by income range, among Brazilian working adults. This cross-sectional study drew on data from the 2019 Brazilian National Health Survey. We used the Patient Health Questionnaire (PHQ-9) to assess depressive symptoms in working adults aged 18–65 years, with physical activities (occupational physical activity and active transport) self-reported through a specially developed questionnaire. Crude and adjusted logistic regression models were fitted. Individuals at the highest level of occupational physical activity (odds ratio [OR] 1.35; 95% confidence interval [95% CI] 1.19–1.53) and at the moderate level of active transport to work (OR 1.66; 95% CI 1.24–2.22) returned increased odds of depressive symptoms as compared with those who were inactive in these domains. Stratified by income group, light active transport to work (OR 0.57; 95% CI 0.34–0.95) in the lower income group (Range 1) was associated with lower odds of depressive symptoms. On the other hand, individuals at the highest level of active transport to work returned higher odds of depressive symptoms in the low- and intermediate-income groups, Ranges 3 and 4 (OR 1.92; 95% CI 1.22–3.00 and OR 2.91; 95% CI 1.71–4.95, respectively). Our results suggest that occupational physical activity and active transport may be a risk factor for depressive symptoms. They also point to differences in this relationship by income range. Further studies are needed to pursue the analysis of how specific domains of physical activity contribute to depressive symptoms. [ABSTRACT FROM AUTHOR]

The relationships between socioeconomic status (SES) and blood pressure changes among older adults in China remain unclear. This study aimed to examine the associations between SES and rates of blood pressure changes among Chinese older adults. Community-based, prospective, longitudinal cohort study. This study included 13,541 participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey between 2002 and 2018. SES was assessed by educational level, occupation, household yearly per capita income, and financial support. The estimated annual changes (EACs) of blood pressure were computed as the difference in blood pressure levels between any two adjacent surveys divided by the time interval. Associations between SES and EACs of blood pressure were evaluated using generalised estimating equations. Lower SES was significantly associated with greater annual increases of blood pressure among Chinese older adults. The effect of SES on EACs of blood pressure was more pronounced among non-hypertensive participants. Compared to EACs among non-hypertensive participants with high SES, multivariable-adjusted EACs among those with low SES increased by 0.57 mmHg (95% confidence interval [CI]: 0.16, 0.99), 0.32 mmHg (95% CI: 0.07, 0.57), and 0.40 mmHg (95% CI: 0.13, 0.66) for systolic blood pressure, diastolic blood pressure, and mean arterial pressure, respectively. This study revealed strong associations between SES and EACs of blood pressure among Chinese older adults, especially in the non-hypertensive population. Findings suggest that prevention strategies for hypertension should pay more attention to the older population with low SES. [Display omitted] [ABSTRACT FROM AUTHOR]

Low socioeconomic status (SES) is a well-recognized risk factor for depression. However, the relationship between the timing of exposure to disadvantaged SES in childhood and depression in adolescence remains to be explored. We examined the differential influence of SES in early childhood, late childhood and adolescence on adolescent depression by modeling life course models. We used longitudinal data from the China Family Panel Studies (N = 2245). SES was measured using average household income (objective SES) and maternal subjective SES and grouped into three time points: 5–8 years, 9–12 years, and 13–16 years of age. The main outcome was depression at 13–16 years of age. Structured linear regression analysis was used to predict depression by low SES over the three time periods. A partial F test was used to compare the nested life course models to the saturated model. Among objective SES permutations, approximately 24.63 % of the adolescents had low SES in all periods, and 73.63 % had low SES in at least one period. Among subjective SES permutations, approximately 5.48 % of the adolescents had low SES in all periods, and 54.65 % had low SES in at least one period. Regardless of objective SES or subjective SES, the accumulation of risk (relaxed) model was the best-fit model. In this model, chronic low SES exposure in late childhood was the best predictor. We suggest that interventions targeting the late childhood period may have a practical effect on reducing depression in adolescents. • The accumulation of risk (relaxed) model best explains how socioeconomic status relates to depression. • The duration of low socioeconomic status during childhood increased the risk of depression in adolescence. • Persistent low socioeconomic status in late childhood best predicts adolescent depression. [ABSTRACT FROM AUTHOR]

• We measured three dimensions of access to early care and education (ECE):demand-adjusted slots, cost burden, and quality. • Each measure was spatially based, describing the ECE resources available within reasonable proximity to a child's home. We repeated the measurements based on a 5-mile drive, a 10-mile drive, and a 30-min public transit commute. Access was measured for each residential lot in the state, then aggregated to the census tract level. • Using county, tract-level median income, population density, and ethnic composition as predictors, we found evidence for both disparities and equity. Some aspects of access favored urban and wealthier communities and those with higher shares of East Asians or Whites. However, the strategic location of Head Start, public pre-K and classrooms sponsored by a private philanthropy resulted in some low-income communities having among the best ECE access in the state. This study addresses the issue of equitable access to early care and education (ECE) taking the state of Hawaiʻi as an example. We used spatially-based measures of demand-adjusted slots, cost burden relative to family income, and quality that quantified the supply of ECE services within a five-mile drive, a ten-mile drive, and a 30-min public transit commute from a family's home. Multivariate spatial modeling techniques were used to predict ECE access at the community level, with median income, county of location, population density, and community ethnic composition as predictors. Results revealed some disparities, such as better slot capacity in areas that were densely populated or had a high share of persons of East Asian heritage. We also found promising results relating to slots and quality in low-income communities. The strategic location of Head Start, public preK, and classrooms sponsored by a local philanthropy created conditions where some low-income communities had very favorable access to ECE slots and high-quality programs, relative to the state overall. The spatial methods used in this study are flexible and can be adapted to answer any number of questions about access to community resources for young children and families at different levels of geographic granularity. [ABSTRACT FROM AUTHOR]

Low socioeconomic status has been linked to increased mortality. However, the impacts of poverty, alone or combined with health behaviors, on mortality and life expectancy have not been adequately investigated. Data from the Southern Community Cohort Study was used, including nearly 86,000 participants recruited during 2002–2009 across 12 US southeastern states. Analysis was conducted from February 2022 to January 2023. During a median follow-up of 12.1 years, 19,749 deaths were identified. A strong dose-response relationship was found between household incomes and mortality, with a 3.3-fold (95%CI=3.1–3.6) increased all-cause mortality observed for individuals in the lowest income group (<$15,000/year) compared with those in the highest group (≥$50,000/year). Within each income group, mortality monotonically increased with declining healthy lifestyle score. Risk was significantly lower among those in the lowest income but healthiest lifestyle group, compared to those with the highest income but unhealthiest lifestyle (HR=0.82, 95%CI=0.69–0.97). Poor White participants appeared to experience higher all-cause mortality than poor Black participants. Life expectancy was more than 10.0 years shorter for those in the lowest income group compared with those in the highest income group. Poverty is strongly associated with increased risk of death, but the risks could be modestly abated by a healthier lifestyle. These findings call for a comprehensive strategy for enhancing a healthy lifestyle and improving income equality to reduce death risks, particularly among those experiencing health disparities due to poverty. [ABSTRACT FROM AUTHOR]

Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. Having a college degree or more (b = −0.32; 95% CI: −0.46, −0.17), higher income (b = −0.06; 95% CI: −0.11, −0.01), and greater wealth (b = −0.11; 95% CI: −0.16, −0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities. [ABSTRACT FROM AUTHOR]

Research suggests that coming from a lower economic background compromises social integration at school, yet the precise mechanisms underlying this link remain unknown. Therefore, this study examined the effect of household income on friendship network dynamics among classmates in a large sample of Swedish youths (n = 4787 from 235 classes, m age = 14.65, 51% girls, and 33% immigrant background), using multilevel longitudinal social network analysis. Over time, students from poorer households were less often selected as a friend by classmates and they less often initiated or maintained friendship ties than students from higher income households. Furthermore, different conceptualizations of income relative to classmates did not impact friendship formation tendencies. The findings indicate that theories of relative income do not extend understanding of students' friendship formation beyond processes related to absolute income. In addition, this study suggests that the social integration of students from low-income households could be boosted by both promoting their agency in forming friendships and preventing exclusion by classmates. • Students from poorer households have fewer friends than students from higher income households. • A third of the "friendship gap" is explained by household income. • Income position relative to classmates does not play a role. • Thus, theories of relative income position shaping social processes are not supported. [ABSTRACT FROM AUTHOR]

The prevalence of autistic-like behaviors is increasing worldwide, both in developed and developing countries. With a high disease burden and complex developmental causes, there has been much interest in the etiology of the disease, and there is a lack of evidence on the relationship between caregiver-child interaction and autistic-like behaviors. This study investigated the association between caregiver-child interaction and children's autistic-like behaviors during early childhood. The subjects of this study were 171 kindergartens selected from the Longhua Child Cohort Study (LCCS), and a total of 40,237 children around the age of three were included. Sociodemographic characteristics, family income, and frequency of interaction between caregivers and children were all filled in by the child's primary caregiver, and the adapted Chinese Autism Behavior Checklist was used to assess children's autism-like behaviors. Tobit Regression and ancovariance analysis (ANCOVA) were used to measure the relationship between caregiver-child interactions (family and social activities) and autism-like behaviors, with a two-tailed p value of <0.05 being significant. Tobit regression analyses found that in the 0–1 year age group, different frequencies of singing activities by caregivers with children (<3 times per week, 3–6 times per week, 6 times or more per week) were significantly negatively associated with autistic-like behaviors in a dose-response manner (B values of −0.323, −0.381, −0.544, all p < 0.0001); in the 1–3 year age group, different frequencies of reading interactions by caregivers with children (<3 times per week, 3–6 times per week, 6 times or more per week) were also significantly negatively associated with autistic-like behaviors in a dose-response manner (B values of −0.388, −0.632, −0.956, all p < 0.0001), and similar associations were found in singing and chatting interactions. Our findings suggest that higher frequencies of early caregiver-child interactions are associated with lower levers of autistic-like behaviors in children around the age of three years. • More early caregiver-child interactions are linked to fewer autistic-like behaviors in children around age three. • Increasing the frequency of reading to children between the ages of 1-3 years led to the greatest decrease in ABC scores. • Findings underscore the importance of public health interventions to encourage caregivers to frequently interact with the children. [ABSTRACT FROM AUTHOR]

• Food insecure women are more likely to have metabolic syndrome than food secure women. • Very low food security was not associated with metabolic syndrome for men. • More research is needed to fully understand the role of gender in food insecurity and chronic disease. The primary objective of this study was to examine the association between food security status and metabolic syndrome (MetS) using a nationally representative dataset. We hypothesized that food insecurity would be associated with an increased odds of having MetS. This was a cross-sectional analysis of data from the 2005–2006 to 2015–2016 National Health and Nutrition Examination Survey data collection cycles. Food security was measured using the US Food Security Survey Module. Presence of MetS was determined using the National Cholesterol Education Program Adult Treatment Panel III criteria. The association between food insecurity and MetS was examined using logistic regression models stratified by sex and adjusted for poverty to income ratio, age, race, marital status, educational attainment, smoking status, and body mass index. After adjusting for covariates, men with marginal (odds ratio, 1.64; 95% confidence interval [CI], 1.22–2.20) and low (odds ratio, 1.33; 95% CI, 1.02–1.73) food security had a higher odds of having MetS than men with full food security; however, this association was lost among men with very low food security. For women, very low food security was associated with a 1.61 times greater odds of having MetS (95% CI, 1.16–2.25). These results suggest that food insecurity is generally associated with an increased prevalence of MetS for women, but not necessarily for men. These findings highlight the need to address rising food insecurity rates, while also highlighting the need for further research to fully elucidate the role of gender and sex in food insecurity and chronic disease. This secondary data analysis examined the association between food security and metabolic syndrome (MetS) using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2016. The highest odds of MetS were found among women with very low food security and men with marginal food security. Very low food security was not associated with an increased odds of MetS for men, suggesting that there may be gender differences in how food security affects risk of chronic disease. [Display omitted] [ABSTRACT FROM AUTHOR]

We investigated whether socioeconomic inequalities in young adolescents' mental health are partially due to the unequal distribution of childhood obesity across socioeconomic positions (SEP), i.e. differential exposure, or due to the effect of obesity on mental health being more detrimental among certain SEPs, i.e. differential impact. We studied 4660 participants of the Generation R study, a population-based study in the Netherlands. SEP was estimated by mother's education and household income at age five of the child. We estimated the contribution of the mediating and moderating effects of high body fat percentage to the disparity in mental health. This was done through a four-way decomposition using marginal structural models with inverse probability of treatment weighting. Comparing children with the least to most educated mothers and the lowest to highest household income, the total disparity in emotional problems was 0.98 points (95%CI:0.35–1.63) and 1.68 points (95%CI:1.13–2.19), respectively. Of these total disparities in emotional problems, 0.50 points (95%CI:0.15–0.85) and 0.24 points (95%CI:0.09–0.46) were due to the differential exposure to obesity. Obesity did not contribute to disparities in behavioural problems. Addressing the heightened obesity prevalence among children in low SEP families may reduce inequalities in emotional problems in early adolescence. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors. [ABSTRACT FROM AUTHOR]

Studies on sedentary behavior among adolescents in Africa are limited, hindering public health initiatives. The aim of this study was to examine the prevalence, age, gender, country's income level, and sub-regional disparities of sedentary behavior among adolescents in Africa. Cross sectional. Adolescents who participated in the Global School-based Student Health Survey from the 23 participating African countries were included in the study. Sedentary behavior was assessed with a self-reported questionnaire. A meta-analysis using random effect modeling was used to estimate the prevalence, age, gender, country's income level, and sub-regional disparities of sedentary behavior. Sixty three thousand six hundred thirty five adolescents (12–17 years) were included in the analysis. The prevalence of sedentary behavior was 30% (95% CI: 27%–34%) and significantly higher among adolescents in Southern Africa and East Africa compared to adolescents in West Africa and North Africa (Q = 25.15; P < 0.001). No disparities were found for age (Q =1.51; P = 0.22), gender (Q = 0.10; P = 0.75), country's income level (Q = 4.37; P = 0.11), and survey year (Q = 1.03; P = 0.31). The results were heterogeneous between countries. The results suggest that a significant proportion of adolescents in Africa engage in sedentary behavior, with the highest prevalence found in Southern Africa and East Africa. This highlights the need for context-specific policy design and interventions to increase physical activity engagement and limit sedentary behavior among adolescents in Africa. [ABSTRACT FROM AUTHOR]