European Congress of Epidemiology – “Crises, epidemiological / Revue d’Épidémiologie et de Santé Publique 66S (2018) S233–S276
Session 9–Social epidemiology Thursday the 5th of July, 2018 – 10:30 am–12:00 am S9.1
The association between socioeconomic deprivation and old-age survival in five European countries–A cross-national ecological analysis A.I. Ribeiro a,∗ , E. Krainski b , M. Sá Carvalho c , C. Pornet d , G. Launoy e , F. Pina c a EPIUNIT, Public health Institute University of Porto (ISPUP), Porto, Portugal b The Norwegian University for Science and Technology, Trondheim, Norway c FIOCRUZ, Rio de Janeiro, Brazil d Public Health Department - Regional Health Agency of Normandy, Caen, France e U1086 Inserm, University of Caen Normandy, CHU de Caen, Caen, France ∗ Corresponding author. E-mail address:
[email protected] (A.I. Ribeiro) Introduction Geographical differences in the spatial distribution of old-age survival exist in Europe and might be attributed to socioeconomic deprivation. In this study, we aimed to estimate the association between socioeconomic deprivation and old-age survival in Europe and investigate whether it varies by country and gender. Methods Our study incorporated five countries (Portugal, Spain, France, Italy, and England) and a total of 1911 small areas. A ten-year survival rate expressing the proportion of population aged 75–84 years who reached 85–94 years old was calculated at area-level for 2001–11. To estimate associations, we used Bayesian spatial models and a transnational measure of socioeconomic deprivation. Additionally, attributable/prevention fractions were calculated. Results Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a clear dose-response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were weaker/absent. We projected that the elimination of socioeconomic differences between areas would increase survival by 7.1% and even a slight reduction in socioeconomic differences would mean a 1.6% higher survival in these countries. Conclusions Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.054 S9.2
Socioeconomics differences in absolute cardiovascular disease risk and treatment: Opportunities for reducing inequalities in cardiovascular events in the population
E. Paige ∗ , J. Welsh , J. Agostino , B. Calabria , E. Banks , R. Korda National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia ∗ Corresponding author. E-mail address:
[email protected] (E. Paige) Introduction A large number of cardiovascular disease (CVD) events in the population can be prevented through appropriate management of absolute CVD risk. CVD disproportionately affects socioeconomically disadvantaged individuals, challenging efforts to reduce overall CVD morbidity and mortality in the population. While there are demonstrated links between socioeconomic position and CVD morbidity and mortality, population-level data on variations in absolute CVD risk and treatment are needed to inform interventions and policies to prevent CVD and address inequalities. We estimated absolute and relative
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socioeconomic inequalities in absolute CVD risk and the use of guidelinerecommended medications in the Australian population to identify opportunities to reduce inequalities in CVD events. Methods We used cross-sectional representative population-based data on 4751 men and women aged 45–74 from the 2011–12 Australian National Health Survey, including interview, physical measurement and blood and urine sample data. We used Poisson regression with robust standard errors to calculate prevalence differences (PD) and ratios (PR) for prior CVD, high 5-year absolute risk of a primary CVD event and guideline-recommended medication use, in relation to socioeconomic position measured by highest level of education attained. The models were adjusted for age and sex and then additionally for region of residence and region of birth. Weights were applied to the prevalence estimates to account for the sampling strategy and non-response, and a series of sensitivity analyses were done to assess whether the results were robust to using alternative measures of socioeconomic position. Results Overall, 9.3% of participants had prior CVD and 11.0% had high absolute risk of a primary CVD event. Thirty-four percent of those with prior CVD and 22% of those at high absolute risk of a primary CVD event were using guideline-recommended medications. After adjusting for age and sex, the prevalence of prior CVD and high absolute risk of a primary CVD event increased linearly with decreasing socioeconomic position (test for trend, P = 0.005 and P = 0.001, respectively). People with the lowest (no post-school qualifications) compared to the highest (university degree) socioeconomic position had 1.6 (95% confidence intervals [CI]: 1.1, 2.2) times the prevalence of prior CVD (10.7% vs 6.7%, respectively) and 1.6 (95% CI: 1.2, 2.2) times the prevalence of high absolute risk of a primary CVD event (12.6% vs 7.7%, respectively). In absolute terms, the prevalence of prior CVD and of high absolute risk of a primary CVD event were 4 and 5 percentage points higher, respectively, among the most disadvantaged within the population. Among people with prior CVD those with low compared to high socioeconomic position were 2.1 (95% CI: 1.3, 3.5) times more likely to use lipid- and blood pressure-lowering and antithrombotic medications as recommended in clinical guidelines. Among those at high primary risk there was no clear relationship between socioeconomic position and use of preventive medications. Results were not materially different when additionally adjusted for region of residence and region of birth, or when socioeconomic position was ascertained using measures of income and area-level disadvantage. Conclusion In this nationally representative population-based Australian study, the prevalence of prior CVD and high absolute CVD risk increased with increasing levels of disadvantage. Socioeconomic differentials in high absolute risk of CVD, combined with low treatment levels among high risk individuals, indicates substantial potential to prevent CVD and reduce inequalities in CVD events through appropriate management of high absolute risk in the population. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.055 S9.3
Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status T. Gram Petersen a,∗ , A.M. Nybo Andersen a , T. Lange a , P. Uldall b , S. Fredsted Villadsen a , I. Forthun c a Department of Public Health, University of Copenhagen, Copenhagen, Denmark b Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark c Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ∗ Corresponding author. E-mail address:
[email protected] (T. Gram Petersen) Introduction The proportion of births by immigrants has been increasing rapidly in Denmark during the last decades. Children of immigrants have higher risk of being born preterm and with low birth weight, which are strong determinants for cerebral palsy (CP), compared with children born to Danish women. Objective To investigate differences in risk of CP between children of Danish-born mothers and children of immigrants and to explore to what degree
