Impact of cancer diagnosis on life expectancy by area-level socioeconomic groups in New South Wales, Australia: a population-based study

Objective: Improvement in cancer survival over recent decades has not been accompanied by a narrowing of socioeconomic disparities. This study aimed to quantify the loss of life expectancy(LOLE) resulting from a cancer diagnosis and examine disparities in LOLE based on area-level socioeconomic status(SES).Methods: Data were collected for all people between 50 and 89 years of age who were diagnosed with cancer, registered in the NSW Cancer Registry between 2001 and 2019, and underwent mortality follow-up evaluations until December 2020. Flexible parametric survival models were fitted to estimate the LOLE by gender and area-level SES for 12 common cancers.Results: Of 422,680 people with cancer, 24% and 18% lived in the most and least disadvantaged areas, respectively. Patients from the most disadvantaged areas had a significantly greater average LOLE than patients from the least disadvantaged areas for cancers with high survival rates, including prostate [2.9 years(95% CI: 2.5±3.2 years) vs. 1.6 years(95% CI: 1.3±1.9 years)] and breast cancer [1.6 years(95% CI: 1.4±1.8 years) vs. 1.2 years(95% CI: 1.0±1.4 years)]. The highest average LOLE occurred in males residing in the most disadvantaged areas with pancreatic [16.5 years(95% CI: 16.1±16.8 years) vs. 16.2 years(95% CI: 15.7±16.7 years)] and liver cancer [15.5 years(95% CI: 15.0±16.0 years) vs. 14.7 years(95% CI: 14.0±15.5 years)]. Females residing in the least disadvantaged areas with thyroid cancer [0.9 years(95% CI: 0.4±1.4 years) vs. 0.6 years(95% CI: 0.2±1.0 years)] or melanoma [0.9 years(95% CI: 0.8±1.1 years) vs. 0.7 years(95% CI: 0.5±0.8 years)] had the lowest average LOLE.Conclusions: Patients from the most disadvantaged areas had the highest LOLE with SES-based differences greatest for patients diagnosed with cancer at an early stage or cancers with higher survival rates, suggesting the need to prioritise early detection and reduce treatment-related barriers and survivorship challenges to improve life expectancy.

Socioeconomic traits and the risk of Barrett’s esophagus and gastroesophageal reflux disease: A Mendelian randomization study

BACKGROUND Previous observational studies have shown that the prevalence of gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)is associated with socioeconomic status.However,due to the methodological limitations of traditional observational studies,it is challenging to definitively establish causality.AIM To explore the causal relationship between the prevalence of these conditions and socioeconomic status using Mendelian randomization(MR).METHODS We initially screened single nucleotide polymorphisms(SNPs)to serve as proxies for eight socioeconomic status phenotypes for univariate MR analysis.The inverse variance weighted(IVW)method was used as the primary analytical method to estimate the causal relationship between the eight socioeconomic status phenotypes and the risk of GERD and BE.We then collected combinations of SNPs as composite proxies for the eight socioeconomic phenotypes to perform multivariate MR(MVMR)analyses based on the IVW MVMR model.Furthermore,a two-step MR mediation analysis was used to examine the potential mediation of the associations by body mass index,major depressive disorder(MDD),smoking,alcohol consumption,and sleep duration.RESULTS The study identified three socioeconomic statuses that had a significant impact on GERD.These included household income[odds ratio(OR):0.46;95% confidence interval(95%CI):0.31-0.70],education attainment(OR:0.23;95%CI:0.18-0.29),and the Townsend Deprivation Index at recruitment(OR:1.57;95%CI:1.04-2.37).These factors were found to independently and predominantly influence the genetic causal effect of GERD.Furthermore,the mediating effect of educational attainment on GERD was found to be mediated by MDD(proportion mediated:10.83%).Similarly,the effect of educational attainment on BE was mediated by MDD(proportion mediated:10.58%)and the number of cigarettes smoked per day(proportion mediated:3.50%).Additionally,the mediating effect of household income on GERD was observed to be mediated by sleep duration(proportion mediated:9.75%)CONCLUSION This MR study shed light on the link between socioeconomic status and GERD or BE,providing insights for the prevention of esophageal cancer and precancerous lesions.

Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Association and potential mediators between socioeconomic status and childhood obesity in China:findings from a national cohort study

Objective:Socioeconomic status(SES)is associated with childhood obesity,but the underlying factors remain unknown.This study aimed to identify mediators that may explain SES disparities in childhood obesity in China.Methods:Nationally representative longitudinal data from the China Education Panel Survey of 11 o019 children(13.03±0.79)collected from 2013-2014 to 2016-2017 academic years.Overweight/obesity was defined using Chinese national body mass index cut-points.Principal component analysis was used to convert the four SES indicators(maternal and paternal education,and occupation)into one comprehensive variable.Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models.Results:The prevalence of overweight/obesity was 12.8%,and was higher in boys than in girls(17.8%vs.7.6%,P<0.001)at baseline.Among boys,relative risk(RR)of obesity was 1.23(95%CI:1.09 to 1.40,P<O.001)for per unit change in SES.There was no significant association between obesity and SES among girls.Mediation analyses showed that among boys,birth weight,being the only child in the family and children's selfperceived weight status mediated 70.0%of the effects of SES on obesity.No mediation effect was detected in girls.Conclusions:Chinese boys are more likely to be overweight or obese than girls.SES may impact childhood obesity through birth weight,being the only child in the family and children's self-perceived body weight status in boys,but not in girls.More attention should be made to address childhood obesity in high SES families among boys.Interventions targeting at these mediators are needed.

The Association of Socioeconomic Status with the Burden of Cataract-related Blindness and the Effect of Ultraviolet Radiation Exposure: An Ecological Study

Objective To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability(YLD) rates and to determine whether ultraviolet radiation(UVR) levels modify the effect of socioeconomic status on this health burden.Methods National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease(GBD) study 2017. The human development index(HDI) from the Human Development Report was used as a measure of socioeconomic status.Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument(OMI)dataset of the National Aeronautics and Space Administration(NASA).Results Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95%confidence interval(CI): 60%–93%, P < 0.001] than countries with a low HDI;for high-HDI countries, the proportion was 76%(95% CI: 53%–88%, P < 0.001), and for medium-HDI countries, the proportion was48%(95% CI: 15%–68%, P = 0.010;P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden(P value for interaction = 0.047).Conclusion Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.

The association between socioeconomic status and visual disability among older adults in China

AIM: To investigate the association between socioeconomic status(SES) and visual disability(VD) among older Chinese adults. METHODS: We obtained data from the Second National Sample Survey on Disability, conducted in China in 2006. A total number of 192 375 older adults(aged≥65 y) were screened for suspected VD via interviews with trained examiners. Those who screened positively for VD were referred to ophthalmologists to obtain a final diagnosis. RESULTS: VD was prevalent among 7.29% of Chinese adults aged 65 and older, and was higher in rural areas(8.71%) than in urban areas(4.82%). After adjusting for SES indicators and covariates, we found that lesseducated older adults were more likely to suffer from VD, with an odds ratio(OR) of 2.50(95%CI: 2.26-2.82) for illiterates, compared with those who graduated from senior high school or above. Older adults who were in the lowest income quintile were more at risk of VD, with an OR of 1.81(95%CI: 1.68-2.95), compared with adults in the highest income quintile. In urban areas, when compared with adults who graduated from senior high school or above, those who did not continue their education after junior high school, primary school, or those who were illiterate, were more likely to suffer from VD, with an OR of 1.35(95%CI: 1.51-1.59), 1.84(95%CI: 1.60-2.12), and 2.63(95%CI: 2.27-3.04), respectively. Lower levels of income were statistically significant when associated with VD. In rural areas, adults who were illiterate had an OR of 2.21(95%CI:1.75-2.79) when compared to adults with senior high school or above education level. Per capita, household income remained significantly associated with VD. Older adults who were ≥85, female, single, and residing in rural areas were associated with higher risks of VD. CONCLUSION: Individual-level SES among the elderly, in the form of education and income, is associated with VD among elderly Chinese adults in both urban and rural areas; however, the association is stronger in rural areas. Further studies are still required to explore the mechanism behind the relationships.

The correlation between socioeconomic status and health self-management in the elderly

Purpose:To determine the correlation between socioeconomic status and health selfmanagement in the elderly and to provide a scientific basis for the promotion of healthy ageing.Methods:We recruited 6173 people aged
60 years from three regions in Hebei Province using the multi-stage stratified cluster sampling method.The participants were surveyed using questionnaires.Results:The health self-management behaviours of elderly people differed with the area of residence,education level,and personal monthly income.An ordered probit model showed that behaviours were better in elderly people who lived in urban areas,who were educated to college level or higher,and with higher monthly incomes(p<0.05).Conclusion:Socioeconomic status plays a decisive role in health self-management in the elderly.We suggest appropriate measures for promoting health self-management among the elderly.

Relationship between Children’s Body Mass Index and Parents’ Obesity and Socioeconomic Status: A Multilevel Analysis Applied with Luxembourg Data

Obesity in children is a health crisis because the problem is increasing in most developed countries. This study measures the relationship between body mass index (BMI) of children aged 7 - 12 years residing in Luxembourg and the weight and socioeconomic status of their parents. The data used are from the 2007 Socio-Economic Panel Liewen zu L?tzebuerg/European Union-Statistics on Income and Living Conditions survey, which covers a population of approximately 10,000 people. The study sample includes 775 children whose weight and height were recorded to calculate their BMI. The descriptive analysis with the socioeconomic distribution of the children’s BMI and the multilevel logistic regression of the probability to be in overweight or obese were performed. The mean BMI of children was 17.4 kg/m2 for boys and girls. The prevalence of overweight was 21.2% (including 3% who were obese). Weight status, educational level, physical activity, and eating habits of parents were associated with BMI in children. Furthermore, children of foreign nationality had 2.9 times more risk to be overweight or obese than other children of Luxembourg nationality (OR = 2.90, 95%CI: 1.38 - 6.10). Children living in household with at least one parent who was obese were 6.51 times more likely to be in overweight or obese compared to those in household with both parents normal (OR = 6.51, 95%CI: 2.48 - 17.08). Overall, nationality and weight status of parents were the main determinants of children’s weight status. Promoting healthy diets and regular physical activity and educating parents on the consequences of overweight and obesity on children’s health in adulthood are effective strategies to control overweight and obesity.

The associations between socioeconomic status and obesity in Korean children from 1998 to 2009

Increasing interests have been shown in associations between socioeconomic status (SES) and obesity in relation to health inequality. The research objectives were 1) to examine associations between SES and child obesity (including overweight) in Korea over 10 years and 2) to explore possible underlying mechanisms of relationships between SES and obesity. This study used the nationally representative data (KNHA-NES) from 1998, 2005, to 2009. Children (10-18 year-old) were grouped by household income (low, middle-low, middle-high and high) adjusted for the number of family members. Z-scores of height, weight, and BMI for each child were calculated from measured anthropometric data using the 2007 Korean national growth charts. No statistically significant associations were found, however, changes in association patterns were noted. The lower SES group showed shorter height as well as lighter weight among Korean children. More research should be conducted to understand the effects of socioeconomic status on child obesity.

Causal relationships between survival rates, dietary and lifestyle habits, socioeconomic status and physical, mental and social health in elderly urban dwellers in Japan: A chronological study

Life expectancy was well known to associate with lifestyle habits, socioeconomic condition, and three health-related dimensions (physical, mental and social health status). However, the causal effect relationship among these variables remains unclear. The purpose of this study was to determine the causal relationships among health and life conditions, socioeconomic status, dietary and lifestyle habits and three health-related dimensions in elderly urban dwellers in Tokyo, Japan. Of 16,462 eligible elderly individuals aged 65 years and older, 13,195 participants responded to the questionnaire survey conducted in September 2001 (a response rate of 80.2%). A follow-up survey was conducted in September 2004 and a total of 8162 survivors were followed until the end of August 2007 through the municipal resident's registry. Exploratory factor analysis defined five latent variables based on the 13 observed variables. From a cross-lagged effects variation model using structural equation modeling, causal relationships were analyzed using longitudinal data obtained at the 2001 and 2004 survey and the number of survival days between 2004 and 2007. After estimating a best-fit model, we discovered that health and life conditions were not determined by current dietary and lifestyle habits, which many studies showed. However, the conditions were more directly affected by three health-related dimensions three years earlier, and indirectly affected by educational attainment and previous annual income as well. The current model suggests that it might be of great importance for elderly individuals to emphasize the maintenance of psychological well being, physical activity, social communication and participation, as well as income, rather than focusing on improvements in diet and health-related lifestyles per se.

SesIndexCreatoR:An R Package for Socioeconomic Indices Computation and Visualization

In order to study social inequalities, indices can be used to summarize the multiple dimensions of the socioeconomic status. As a part of the Equit’Area Project, a public health program focused on social and environmental health inequalities;a statistical procedure to create (neighborhood) socioeconomic indices was developed. This procedure uses successive principal components analyses to select variables and create the index. In order to simplify the application of the procedure for non-specialists, the R package SesIndexCreatoR was created. It allows the creation of the index with all the possible options of the procedure, the classification of the resulting index in categories using several classical methods, the visualization of the results, and the generation of automatic reports.

Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma

Chronic Hepatitis B is a highly prevalent disease worldwide and is estimated to cause more than 800000 annual deaths from complications such as cirrhosis and hepatocellular carcinoma(HCC).Although universal hepatitis B vaccination programs may have reduced the incidence and prevalence of chronic hepatitis B and related HCC,the disease still imposes a significant healthcare burden in many endemic regions such as Africa and the Asia-Pacific region.This is especially concerning given the global underdiagnosis of hepatitis B and the limited availability of vaccination,screening,and treatment in low-resource regions.Demographics including male gender,older age,ethnicity,and geographic location as well as low socioeconomic status are more heavily impacted by chronic hepatitis B and related HCC.Methods to mitigate this impact include increasing screening in high-risk groups according to national guidelines,increasing awareness and health literacy in vulnerable populations,and developing more robust vaccination programs in under-served regions.

Socioeconomic inequalities in the use of delivery care services in Bangladesh: a comparative study between 2004 and 2007

The study explores inequalities in the utilization of delivery care services in different administrative divisions in Bangladesh, by key socioeconomic factors. It estimates the extent of the relationship between women’s socioeconomic inequalities and their place of delivery during 2004 and 2007. Trends in relation to place of delivery in relation to residency and education over a period of thirteen years (1993-2007) have also been measured. The study analyzed the trends and patterns in utilization of institutional delivery care among mothers, using data from the Bangladesh Demographic Health Survey (BDHS) conducted during 1993-2007. The data was disaggregated by area of residence in different divisions in Bangladesh. Bi-variate analyses, concentration curves and multivariate logistic regression were employed in the analysis of the data. The study indicated slow progress in the utilization of institutional delivery care among mothers in Bangladesh between 1993 and 2007. Large variations in outcome measures were observed among the different divisions. Multivariate analyses suggested growing inequalities in utilization of delivery care services between different economic groups and parents with different educational levels. The use of institutional delivery care remains substantially lower among poor and less educated rural mothers in Bangladesh, irrespective of age and employment. Further studies are recommended to explore the specific causes relating to the non-utilization of institutional delivery care.

Parenting preschoolers with autism: Socioeconomic influences on wellbeing and sense of competence

BACKGROUND Previous research suggests that parents raising a child with autism experience higher levels of psychological distress than parents of typically developing children and parents of children with other developmental disorders. Little is known, however, about the intersection between the effects of socioeconomic status(SES) on the wellbeing and sense of parental competency of parents of preschoolers with autism and how it relates to child symptom severity.AIM To examine the relationship between their child's symptom severity, SES, as measured by neighbourhood advantage and occupational status, on the psychological wellbeing and perceived parenting competence among parents of preschoolers with autism.METHODS Parents of 117 preschool-aged children with a diagnosis of autism spectrum disorder(ASD), 107 mothers and 54 fathers, completed questionnaires about their child's symptoms of ASD and functioning, their own perceptions of their wellbeing and parental competence on entry to an early intervention program in Sydney, Australia. Parents also provided demographic information pertaining to their occupation, level of education attained and address(postcode). All children were also assessed for their severity of symptoms using the Autism Diagnostic Observation Schedule. The Australian Socioeconomic Index of occupationalstatus as a measure of familial SES and the Index of Relative Socio-economic Advantage and Disadvantage as a measure of neighbourhood advantage were used to examine the impact of SES on parental sense of competence and wellbeing.RESULTS Compared to normative populations, both mothers and fathers in our sample reported significantly higher levels of parenting sense of efficacy but lower levels of interest in the parenting role. Mothers also displayed higher levels of satisfaction. Both mothers and fathers displayed higher levels of depression than normative populations with mothers also reporting greater levels of stress and anxiety. Child symptom severity was associated with maternal parenting competency with these relationships amplified among mothers with higher familial SES and who lived in areas of greater neighbourhood advantage.Increased adaptive functioning was associated with better maternal wellbeing,particularly among mothers who lived in areas of greater neighbourhood advantage. Contrastingly, paternal parenting competence was generally not influenced by child adaptive functioning or symptom severity, although for those in higher familial SES brackets, children's symptom severity and maladaptive symptoms were negatively related to paternal sense of parenting efficacy. There was a trend towards moderate relationships between lower familial SES and greater depression, stress and anxiety among fathers, but no relationship with their child's ASD symptom severity or functioning.CONCLUSION SES differentially impacts wellbeing and sense of parenting competence and its relationship to the impact of child symptoms for mothers and fathers of preschoolers with autism.

Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank

Background Socioeconomic status(SES)inequity was recognized as a driver of some certain infectious diseases.However,few studies evaluated the association between SES and the burden of overall infections,and even fewer identified preventable mediators.This study aimed to assess the association between SES and overall infectious diseases burden,and the potential roles of factors including lifestyle,environmental pollution,chronic disease history.Methods We included 401,009 participants from the UK Biobank(UKB)and defined the infection status for each participant according to their diagnosis records.Latent class analysis(LCA)was used to define SES for each participant.We further defined healthy lifestyle score,environment pollution score(EPS)and four types of chronic comorbidities.We used multivariate logistic regression to test the associations between the four above covariates and infectious diseases.Then,we performed the mediation and interaction analysis to explain the relationships between SES and other variables on infectious diseases.Finally,we employed seven types of sensitivity analyses,including considering the Townsend deprivation index as an area level SES variable,repeating our main analysis for some individual or composite factors and in some subgroups,as well as in an external data from the US National Health and Nutrition Examination Survey,to verify the main results.Results In UKB,60,771(15.2%)participants were diagnosed with infectious diseases during follow-up.Lower SES[odds ratio(OR)=1.5570]were associated with higher risk of overall infections.Lifestyle score mediated 2.9%of effects from SES,which ranged from 2.9 to 4.0%in different infection subtypes,while cardiovascular disease(CVD)mediated a proportion of 6.2%with a range from 2.1 to 6.8%.In addition,SES showed significant negative interaction with lifestyle score(OR=0.8650)and a history of cancer(OR=0.9096),while a significant synergy interaction was observed between SES and EPS(OR=1.0024).In subgroup analysis,we found that males and African(AFR)with lower SES showed much higher infection risk.Results from sensitivity and validation analyses showed relative consistent with the main analysis.Conclusions Low SES is shown to be an important risk factor for infectious disease,part of which may be mediated by poor lifestyle and chronic comorbidities.Efforts to enhance health education and improve the quality of living environment may help reduce burden of infectious disease,especially for people with low SES.

Socioeconomic Distribution of Health and Health Care Utilization in a New Town in Hong Kong, China

Objectives To assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China. Methods Illness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between socioeconomic indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age. Results Significant positive associations were noted between low household income and diabetes mellitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor. Conclusion This study did not demonstrate a unidirectional socioeconomic gradient in healt

The Effect of the Family’s Socioeconomic Factors on Nutrition of Elementary School Children

Introduction: Anthropometric indices are used for assessing the nutrition status of people and societies. The indices determine the growth of the child’s nutrition status, his socioeconomic status and his quality of life. This research aims to study the anthropometric indices of elementary school children in the Iranian city of Piranshahr using the Body Mass Index (BMI) and waist circumference in the first six months of 2011. Methods: In this descriptive-analytical cross-sectional study, 1803 students aged between 7 and 11 in Piranshahr were studied. Multi-stage cluster sampling was used. The research setting was an elementary school in Piranshahr. Demographic data were collected through interviews and record in questionnaires. A Secca stadiometer was used to measure the height of each student standing without shoes (accuracy of 0.1 centimeter). The weight was measured using a spring scale with an accuracy of 0.1 kilogram with the least possible clothes on. The weight was divided by the square of height (square meter) to calculate BMI. To determine overweight and obesity, BMI percentiles of Center for Disease Control (CDC) were used. In order to use appropriate tests, the normality and equality of variances were measured by Leven and K-S tests, respectively. Results: The study found that 231 children (12.8%) were at risk of overweight and 96 children (5.3%) were overweight. Conclusion: There was a meaningful difference between boys and girls in terms of nutrition status of BMI, father’s higher education level, shortness, abdominal obesity and family history of obesity, and father’s jobs

Evaluation of the etiologies and rehabilitation status of patients with blindness: A prospective observational study

Objective:Preventive measures and appropriate rehabilitation are important in reducing the social burden of blindness.This study was to evaluate the etiologies,proportions,and level of rehabilitation for patients with blindness.Materials and Methods:A prospective observational study with 1000 visually impaired patients was conducted.The data regarding age,gender,socioeconomic status(SES),etiologies,curable or incurable blindness(IB),treatments,awareness,and state of rehabilitation were collected and reviewed.Results:The ratio of curable to IB was 0.82:1.The proportion of blindness rises after 40,even while the proportion of curable blindness(CB)increases after 60.The male–female ratios were 1.25:1 and 1:1.66 in the cases of CB and IB,respectively.On the other hand,the male–female ratio for childhood blindness was 1.66:1.Cataracts(78.22%)were the most common cause of CB,whereas diabetic retinopathy(24%),corneal opacity(17.5%),and trauma(12.4%)were causes of IB.Patients with illiteracy,low SES,and female gender were more likely to develop IB.There were low enrollment rates at the blind school and poor rehabilitation,mainly because of a lack of knowledge.Conclusion:Diabetic retinopathy,corneal opacity,and trauma are the major causes of IB.IB and poor rehabilitation were more profound in women and were associated with illiteracy,low SES,and a lack of awareness.

“双减”背景下家校合作对中小学生发展质量的影响研究

家校协同提升中小学生发展质量是落实“双减”政策的重要举措。基于大规模的调查数据,构建“双减”之下中小学生发展质量指标体系,综合分析不同家校合作行为对中小学生发展质量的影响,并检验此种影响针对不同家庭社会经济地位的学生群体是否存在异质性。主要获得如下发现:(1)“双减”之下家校合作整体上能够提升中小学生发展质量,但参与决策、志愿服务和社区合作三类协同行为效果不佳。(2)家校合作能够提高不同家庭社会经济地位的中小学生的发展质量,且对于家庭社会经济地位较低的中小学生的回报率普遍更高,但对家庭社会经济地位较高中小学生的适负发展和高效发展未产生预期的积极效果。由此,建议进一步落实当好家长、相互交流和在家学习三类家校合作行动,优化参与决策、志愿服务和社区合作三类家校合作活动设计。同时密切关注不同家庭社会经济地位的中小学生及其家长的教育需求,个性化地加强家庭教育指导,从而提升中小学生发展质量,保障教育公平。

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years:findings from 19 sub-Saharan African countries

Background Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries.However,more remains to be known about how a patient’s socioeconomic status(SES)would affect the access to diagnosis of malaria.Methods In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey,we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries.Multivariable logistic regression was used to assess the associations between SES and two binary outcomes:the visit to a health facility and a blood test for fever.Stratified analyses were further conducted by the type of health facilities(public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities)for the latter outcome.Results Fifty-eight percent of the febrile children were taken to health facilities,among whom only 55%took blood tests.Compared to children from households in the highest wealth quintile,children in the lowest quintile were less likely to be taken to medical facilities[adjusted odds ratio(aOR)=0.775,95%confidence interval(CI):0.675–0.889].Parents with more than secondary education were more likely to seek care(aOR=1.830,95%CI:1.561–2.145)and to have blood tests(aOR=1.729,95%CI:1.436–2.082)for their febrile children than parents without formal education.The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles,while these probabilities remained the lowest at private primary healthcare facilities,ranging from 0.100(95%CI:0.074–0.127)to 0.139(95%CI:0.083–0.194)across parental education levels and from 0.104(95%CI:0.078–0.130)to 0.125(95%CI:0.090–0.160)across wealth quintiles.Conclusions Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries.These disparities were particularly evident in the private sector.Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.