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AbstractObjectiveTo assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages.DesignMulti-cohort population based study.Setting37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017.Participants109 107 men and women aged 45-90 years.Main outcome measurePhysical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors.ResultsAccording to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors.ConclusionsThe independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors. We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. During 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98–1·11) for obesity in men and 2 ·17 (2·06–2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38–1·45 for men; 1·34, 1·28–1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21–1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking. Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.

Parental obesity is a predominant risk factor for childhood obesity. Family factors including socio-economic status (SES) play a role in determining parent weight. It is essential to unpick how shared family factors impact on child weight. This study aims to investigate the association between measured parent weight status, familial socio-economic factors and the risk of childhood obesity at age 9. Cross sectional analysis of the first wave (2008) of the Growing Up in Ireland (GUI) study. GUI is a nationally representative study of 9-year-old children (N = 8,568). Schools were selected from the national total (response rate 82%) and age eligible children (response rate 57%) were invited to participate. Children and their parents had height and weight measurements taken using standard methods. Data were reweighted to account for the sampling design. Childhood overweight and obesity prevalence were calculated using International Obesity Taskforce definitions. Multinomial logistic regression examined the association between parent weight status, indicators of SES and child weight. Overall, 25% of children were either overweight (19.3%) or obese (6.6%). Parental obesity was a significant predictor of child obesity. Of children with normal weight parents, 14.4% were overweight or obese whereas 46.2% of children with obese parents were overweight or obese. Maternal education and household class were more consistently associated with a child being in a higher body mass index category than household income. Adjusted regression indicated that female gender, one parent family type, lower maternal education, lower household class and a heavier parent weight status significantly increased the odds of childhood obesity. Parental weight appears to be the most influential factor driving the childhood obesity epidemic in Ireland and is an independent predictor of child obesity across SES groups. Due to the high prevalence of obesity in parents and children, population based interventions are required.

Background By 2025, adult obesity prevalence is projected to increase in 44 of 53 of European-region countries. Childhood obesity tracks directly onto adult obesity, and children of low socioeconomic position families are at disproportionately higher risk of being obese compared with their more affluent peers. A previous review of research from developed countries identified factors mediating this relationship. This systematic review updates and extends those findings specifically within the context of Ireland and the United Kingdom. Objective The aim of this systematic review is to summarise peer-reviewed research completed in Ireland and the United Kingdom between 2011–2021 examining mediators of socioeconomic differentials in adiposity outcomes for youth. Design An electronic search of four databases, Ovid MEDLINE, Embase, Web of Science and EBSCOhost was conducted. Quantitative studies, published in the English language, examining mediators of socioeconomic differentials in adiposity outcomes in youth, and conducted in Ireland and the United Kingdom between 2011–2021 were included. An appraisal of study quality was completed. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Following screening, a total of 23 papers were eligible for inclusion. Results indicate socioeconomic differentials for Ireland and the United Kingdom follow similar patterns to other developed countries and have similar mediating factors including early life and parent-level factors. However, this review identified additional factors that mediate the relationship, namely access to green space and favorable neighborhood conditions. Identifying these factors present further opportunities for potential interventions and confirm the requirement for tailored and appropriate research and interventions for Ireland and the United Kingdom. Conclusion This review identified several modifiable factors that should be considered when planning interventions aimed at reducing socioeconomic differentials in adiposity among youth in Ireland and the United Kingdom. Support was found for interventions to be made as early as possible in an at-risk child’s life, with the prenatal and preschool periods considered the most efficacious. Results were equivocal about the role of physical activity in the risk of childhood overweight and obesity. While multi-country analyses provide excellent overviews, country- or area-specific research may produce more nuanced, and potentially more powerful findings, which can help better inform policy responses and interventions.

Much of the burden of non-communicable disease in high-income countries is attributable to harmful engagement with health behaviours. Evidence suggests that these behaviours may be better understood, and more amenable to intervention, if analysed as clusters of behaviours rather than individual behaviours. To date, research on the clustering of health behaviours has focused on the consequences of multi-engagement as opposed to the potential shared antecedent or contemporaneous processes. Moreover, adolescence is a critical period for the development of health behaviours, yet there remain more studies on the clustering of health behaviours in adulthood, when patterns of behaviour are likely already crystallised. Drawing from a nationally representative longitudinal dataset of young people living in the Republic of Ireland, latent- class analysis was used to identified clusters of the health behaviours: diet quality, levels of physical activity, screentime, tobacco smoking and underage alcohol consumption, for the first time in this context. We theorised potential social determinants for engagement with the distinct clusters of behaviours and evaluated these theories empirically using multinominal logistic regression. Our findings indicate that, what are typically termed, 'lifestyle' behaviours (diet, physical activity and screentime) tend to co-occur rather than appear in isolation. These lifestyle behaviours appear to be relatively independent of tobacco smoking and underage alcohol consumption, which we term 'substance use.' We demonstrate that the experience of periodic, but mostly persistent poverty (approx. nine years), is associated with membership of clusters characterised by lifestyle behaviours, while reporting oppositional values is distinctly associated with membership of clusters characterised by substance use. Our results support the much-established relationship between income poverty and harmful health behaviours related to lifestyle that is evidenced when looking at these behaviours individually and thereby provides further empirical evidence for the theories on 'fundamental causes' of health inequalities and the 'social exclusion framework.' We find an association between oppositional values and substance use behaviours, and furthermore that oppositional values tend to be highest among the income poorest adolescents. We highlight a concurrent influence for substance use in adolescence, which is also relevant for addressing inequalities in health behaviour engagement.

Internationally, caesarean section (CS) rates are rising. However, mean rates of CS across providers obscure extremes of CS provision. We aimed to quantify variation between all maternity units in Ireland. Two national databases, the National Perinatal Reporting System and the Hospital Inpatient Enquiry Scheme, were used to analyse data for all women delivering singleton births weighing ≥500g. We used multilevel models to examine variation between hospitals in Ireland for elective and emergency CS, adjusted for individual level sociodemographic, clinical and organisational variables. Analyses were subsequently stratified for nullipara and multipara with and without prior CS. The national CS rate was 25.6% (range 18.2% ─ 35.1%). This was highest in multipara with prior CS at 86.1% (range 6.9% ─ 100%). The proportion of variation in CS that was attributable to the hospital of birth was 11.1% (95% CI, 6.0 ─ 19.4) for elective CS and 2.9% (95% CI, 1.4 ─ 5.6) for emergency CS, after adjustment. Stratifying across parity group, variation between hospitals was greatest for multipara with prior CS. Both types of CS were predicted by increasing age, prior history of miscarriage or stillbirth, prior CS, antenatal complications and private model of care. The proportion of variation attributable to the hospital was higher for elective CS than emergency CS suggesting that variation is more likely influenced by antenatal decision making than intrapartum decision making. Multipara with prior CS were particularly subject to variability, highlighting a need for consensus on appropriate care in this group.

There are a large number of studies which show social class differentials in educational test scores and results from an early age. Cultural explanations based on working-class 'resistance' to learning activities or class differences in 'cultural capital' are often put forward to explain differentials in educational test scores. In this article we first discuss why these processes cannot account for the pattern of class differences, given the empirical patterns observed before setting out and then testing two alternative theories that purport to explain class differences in educational performance: the family investment model (FIM) and the family stress model (FSM). Empirical expectations from these theories are defined and then tested using data from four waves of the Millennium Cohort Study, a nationally representative sample of children from the United Kingdom. Structural equation models with mediation are used to quantify the direct and indirect effects of social class acting via cognitive ability and child psychological adjustment. Our models account for between 81 and 93 per cent of the effect of social class on teacher assessments of child educational performance. Approximately two-thirds of the effect of social class on educational performance at age 7 years are mediated by differential child cognitive ability and 15 per cent by psychological adjustment. The mechanisms in the FIM and FSM models strongly interact suggesting that a hybrid model may be more useful. Processes central to the FSM but acting through the child's cognitive ability are key in determining educational differentials across social class groups.

The 'income inequality hypothesis' holds that beyond a certain level of gross domestic product (GDP) per capita, the association between absolute income, health and mortality weakens, and the distribution of income across a society becomes more important as a determinant of a range of outcomes including average mental and physical health. Recent reviews suggest that the empirical reality of the income inequality hypothesis is now established but fierce debate remains about what explains the association. In this article we describe three hypotheses that have emerged in the literature to explain the association—the social capital, the status anxiety and the neo-materialist hypotheses before operationalizing each, and testing their ability to explain the relationship between income inequality measured using the GINI coefficient and mental well-being measured using the WHO5 scale. We use multi-level models and data from the European Quality of Life Survey which contains information from 30 countries and over 35,000 individuals. Results give most support to the status anxiety and social capital hypotheses and almost no support to the neo-materialist hypothesis. Measures representing the social capital hypothesis reduce the coefficient measuring income inequality by 55% in high GDP countries and render it insignificant as well as providing the best fitting model as measured by AIC and BIC value. However, variables representing the status anxiety hypothesis reduce the income inequality coefficient by more in lower GDP countries.

BackgroundHeight is regarded as a marker of early-life illness, adversity, nutrition and psychosocial stress, but the extent to which differences in height are determined by early-life socioeconomic circumstances, particularly in contemporary populations, is unclear. This study examined socioeconomic differences in children’s height trajectories from birth through to 21 years of age in four European countries.MethodsData were from six prospective cohort studies—Generation XXI, Growing Up in Ireland (infant and child cohorts), Millennium Cohort Study, EPITeen and Cardiovascular Risk in Young Finns Study—comprising a total of 49 492 children with growth measured repeatedly from 1980 to 2014. We modelled differences in children’s growth trajectories over time by maternal educational level using hierarchical models with fixed and random components for each cohort study.ResultsAcross most cohorts at practically all ages, children from lower educated mothers were shorter on average. The gradient in height was consistently observed at 3 years of age with the difference in expected height between maternal education groups ranging between −0.55 and −1.53 cm for boys and −0.42 to −1.50 cm for girls across the different studies and widening across childhood. The height deficit persists into adolescence and early adulthood. By age 21, boys from primary educated maternal backgrounds lag the tertiary educated by −0.67 cm (Portugal) and −2.15 cm (Finland). The comparable figures for girls were −2.49 cm (Portugal) and −2.93 cm (Finland).ConclusionsSignificant differences in children’s height by maternal education persist in modern child populations in Europe.

Objective Poor-quality diet, regarded as an important contributor to health inequalities, is linked to adverse health outcomes. We investigated sociodemographic and lifestyle predictors of poor-quality diet in a population sample. Design A cross-sectional analysis of the Survey of Lifestyle, Attitudes and Nutrition (SLÁN). Diet was assessed using an FFQ (n 9223, response rate = 89 %), from which a dietary score (the DASH (Dietary Approaches to Stop Hypertension) score) was constructed. Setting General population of the Republic of Ireland. Subjects The SLÁN survey is a two-stage clustered sample of 10 364 individuals aged 18 years. Results Adjusting for age and gender, a number of sociodemographic, lifestyle and health-related variables were associated with poor-quality diet: social class, education, marital status, social support, food poverty (FP), smoking status, alcohol consumption, underweight and self-perceived general health. These associations persisted when adjusted for age, gender and social class. They were not significantly altered in the multivariate analysis, although the association with social support was attenuated and that with FP was borderline significant (OR = 1·2, 95 % CI 1·03, 1·45). A classical U-shaped relationship between alcohol consumption and dietary quality was observed. Dietary quality was associated with social class, educational attainment, FP and related core determinants of health. Conclusions The extent to which social inequalities in health can be explained by socially determined differences in dietary intake is probably underestimated. The use of composite dietary quality scores such as the DASH score to address the issue of confounding by diet in the relationship between alcohol consumption and health merits further study.