Background
Methods
Search strategy
Inclusion and exclusion criteria
Selection strategy
Data extraction and quality assessment
Results
Author, Year | Population | Outcome | Results | Risk of Bias |
---|---|---|---|---|
Cardiovascular diseases
| ||||
Age-adjusted mean stroke incidence rates: | ||||
Feigin et al., 2009 [24] | General population in HIC and LMIC | Incidence of stroke | HIC: 42 % reduction from 1970–79 to 2000–08 (p < 0.004); LMIC: >50 % increase from 1970–79 to 2000–08 (p < 0.0001) | Unclear |
Stroke mean incidence rates over time by age groups (1970–79 vs 2000–8): | ||||
HIC: 44 % (<75 y) and 41 % (> 75 y) reduction (both p < 0.0001); LMIC: 2-fold (< 75 y) and almost 4-fold (≥ 75 years) increase (p = 0.001 and p < 0.0001) | ||||
Fowkes et al. 2013 [16] | General population in HIC and LMIC | Prevalence of PAD | Prevalence of PAD was higher in women from LMIC than HIC at all ages up to 60–64 years, above which the prevalence was higher in HIC. Prevalence of PAD was higher in men from HIC than LMIC at all ages. | High |
Rate of change from 2000 to 2010 was 28.7 % in LMIC and 13.1 % in HIC. | ||||
Galobardes et al., 2006 [15] | General population mostly in HIC | Incidence or prevalence of overall CVD, CHD, stroke, other CVD subtypes | 9 out of 9 prospective studies found a higher incident risk of CVD among those with low childhood SES. | High |
7 of 11 case-control studies showed an association of low childhood SES and risk for MI, angina, or stroke. | ||||
5 cross-sectional studies found a higher prevalence of CHD among those with low childhood SES. | ||||
HR for stroke incidence: | ||||
Kerr et al., 2011 [23] | General population mostly in HIC (all but 1 study) | Incidence of stroke | Unadjusted Meta-analysis (low vs high) Education, occupation or income: 1.67, 95 % CI: 1.46–1.91 | Unclear |
Meta-analysis adjusted for grouped vascular risk factors (low vs high) Education, occupation or income: 1.31, 95 % CI: 1.16–1.48 | ||||
RR for acute MI: | ||||
Manrique-Garcia et al., 2011 [22] | General population in HIC and LMIC | Incidence of acute MI | Meta-analysis across countries (low vs high) Education: 1.34, 95 % CI: 1.22–1.47; Occupation: 1.35. 95 % CI: 1.19–1.53; Income: 1.71, 95 % CI: 1.43—2.05 | Unclear |
HIC (low vs high) Education: 1.39, 95 % CI: 1.25–1.55; Occupation: 1.41, 95 % CI: 1.25–1.59; Income: 1.76, 95 % CI: 1.46–2.12 | ||||
LMIC (low vs high) Education: 1.16, 95 % CI: 0.97–1.39; Occupation: 0.51, 95 % CI: 0.27–0.99; Income:1.46, 95 % CI: 0.60–3.54 | ||||
Pollitt et al., 2005 [17] | General population from HIC | Incidence of CVD (MI, IHD, carotid IMT; CHD, AP), stroke | 8 out of 9 studies found a higher incident risk of CVD among those with low childhood SES, but only few studies reported inverse adjusted (CVD risk factors and/or adult SES) associations. 2 out of 2 studies showed no significant associations between stroke risk and childhood SES. 1 study found an association between cumulative life course exposure to low SES conditions and increased CVD outcome. | High |
Sposato et al., 2012 [21] | General population in HIC, MIC, and LIC | First-ever incidence of stroke | Lower PPP-aGDP correlated with higher incident risk of stroke (ρ = -0.661, p = 0.027). | Unclear |
Lower PPP-aTHE correlated with higher incident risk of stroke (ρ = -0.623, p = 0.040). | ||||
There were no correlations between unemployment rate and risk of stroke incidence (ρ = -0.492, p = 0.12). | ||||
Cancers
| ||||
Adam et al., 2008 [11] | Children in HIC | Incidence of childhood leukaemia | Two studies showed an increased risk of leukaemia in children from deprived areas, 4 studies showed a decreased risk of leukaemia in children from deprived areas or lower SES, 1 study found SES not to be a determinant of leukaemia in children. | High |
RR for lung cancer incidence: | ||||
Sidorchuk et al., 2009 [26] | General population in HIC and MIC | Incidence of lung cancer | Meta-analysis, adjusted for smoking, RR (low vs high) Education: 1.61, 95 % CI: 1.40–1.85; Occupation: 1.48, 95 % CI: 1.34–1.65; Income: 1.37, 95 % CI: 1.06–1.77 | Unclear |
HIC (low vs high) Education: 1.66, 95 % CI: 1.10–2.51; Occupation: 1.42, 95 % CI: 1.26–1.62; Income: 1.39. 95 % CI: 1.13–1.69 | ||||
MIC (low vs high) Education: 1.66, 95 % CI: 1.28–2.16; Occupation: 0.90, 95 % CI: 0.66–1.23; Income: 1.30, 95 % CI: 0.23–7.31 | ||||
Slatore et al., 2010 [25] | General population in the US | Incidence of lung cancer | 1 study found higher incidence rates of lung cancer for women and men from all age groups with Medicaid insurance compared to non-Medicaid. 1 study found higher incidence rates of lung cancer for Medicare patients alone compared to Medicaid/Medicare patients, but the effect was removed when the comparison group was restricted to patients covered by Medicaid >12 months before diagnosis. | Unclear |
RR for lung cancer incidence: | ||||
Uthman et al., 2013 [27] | General population in HIC, MIC, and LIC | Incidence of gastric cancer | Overall (low vs high) Education: 2.97, 95 % CI: 1.92–4.58; Occupation: 4.33, 95 % CI: 2.57–7.29; Income: 1.25, 95 % : 0.93–1.68; Combined SEP: 2.64, 95 % CI:1.05–6.63 | Unclear |
HIC (low vs high) Education: 2.65, 95 % CI 1.64–4.30; Occupation: 6.79, 95 % CI 3.42–13.50; Income: 1.09, 95 % CI: 0.76–1.56; Combined SEP: 4.50, 95 % CI: 0.84–24.16 | ||||
MIC (low vs high) Education: 5.11, 95 % CI 2.71–9.65; Occupation: 3.06, 95 % CI 2.10–4.8; Income: 1.48, 95 % CI: 0.61–3.58; Combined SEP: 1.36, 95 % CI: 0.52–3.60 | ||||
Type 2 diabetes
| ||||
RR for type 2 diabetes incidence: | ||||
Agardh et al., 2011 [28] | General population in HIC, MIC, and LIC | Incidence of type 2 diabetes | Overall (low vs high) Education: 1.41, 95 % CI: 1.28–1.51; Occupation: 1.31, 95 % CI: 1.09–1.57; Income: 1.40, 95 % CI: 1.04–1.88 | Unclear |
HIC (low vs high) Education: 1.45, 95 % CI: 1.28–1.63; Occupation: 1.31, 95 % CI: 1.05–1.63; Income: 1.40, 95 % CI: 0.81–2.42 | ||||
MIC (low vs high) Education: 1.59, 95 % CI: 1.28–1.97; Occupation: 1.27, 95 % CI: 0.96–1.68; Income: 1.39, 95 % CI: 1.06–1.82 | ||||
LIC (low vs high; n = 1); Education: –; Occupation: –; Income: RR 1.27, 95 % CI: 0.99–1.62 | ||||
Tamayo et al., 2010 [18] | General population in HIC and MIC | Incidence of type 2 diabetes in later life | 4 out of 6 studies showed an increased risk of type 2 diabetes in either girls or boys from low parental occupational status, 2 studies showed no association. For education, 2 out of 3 studies showed an increased risk of type 2 diabetes in children from low SES. 1 study showed no statistically significant association between type 2 diabetes incidence and childhood adversity. | High |
Chronic respiratory diseases
| ||||
Gershon et al., 2012 [29] | General population in HIC | Prevalence and incidence of COPD | 6 out of 8 studies found individuals of the lowest SES strata more likely to have or develop. | Low |
COPD than those of the highest (point estimates of OR ranging from 0.8–3.7, RII ranging from 2.2 to 3.2). |
Author, year | Population | Outcome | Results | Risk of Bias |
---|---|---|---|---|
Cardiovascular diseases
| ||||
Risk of mortality in heart failure: | ||||
Calvillo-King et al., 2012 [30] | Patients with heart failure in HIC | Mortality in heart failure after hospitalization (30 day) | Lower vs higher education: RR 1.05, 95 % CI: 0.98–1.12 (n = 1) | Unclear |
Lower vs higher neighbourhood SES: RR 1.13, 95 % CI: 0.92–1.38 (n = 1) | ||||
Medicaid insurance vs other: OR 0.66, 95 % CI: 0.3–1.4 (4 studies, result from one) | ||||
≤ 25 miles to hospital vs > 25 miles to hospital: OR 0.95, 95 % CI: 0.92–0.98 (n = 1) | ||||
Early case fatalities of total strokes (%): | ||||
Feigin et al., 2009 [24] | Patients with stroke in HIC and LMIC | Early case fatality of stroke (21 day to 1 month) | HIC: non-significant reduction from 35.9 % (1970–79) to 19.8 % (2000–08) | Unclear |
LMIC: non-significant reduction from 35.2 % (1980–89) to 26.6 % (2000–08) | ||||
Galobardes et al., 2006 [15] | General population mostly in HIC | Overall CVD, CHD, stroke, angina, other CVD subtypes mortality | 19 out of 24 prospective studies found an association between low childhood SES and increased risk CVD mortality. In 5 out of 9 studies the association was stronger for stroke than CHD. | High |
Galobardes et al., 2004 [10] | General population mostly in HIC | Overall CVD, CHD and stroke mortality | 5 out of 9 studies found a higher risk of overall CVD mortality among those with low childhood SES, with results generally remaining statistically significant after adjustment for adult SES and/or adult CVD risk factors. | High |
7 out of 10 studies found a higher risk of CHD mortality among those with low childhood SES, although adult SES attenuated the association in some studies. 4 out of 6 studies found a higher risk of stroke mortality among those with low childhood SES. | ||||
Pollitt et al., 2005 [17] | General population and patients with CVD and stroke from HIC | CVD, stroke mortality | 11 out of 13 studies found a higher risk of CVD mortality among those with low childhood SES. Most associations remained statistically significant after adjustment for CVD risk factors and/or adult SES. | High |
3 out of 3 studies showed a higher risk of stroke mortality among those with low childhood SES. Adjustment for adjustment for CVD risk factors and/or adult SES had minor impact on the effect. | ||||
5 out of 5 studies reported an association between cumulative life course exposure to low SES conditions and increased CVD mortality. | ||||
Sposato et al., 2012 [21] | Patients with stroke in HIC, MIC, and LIC | 30-day case-fatality rates of stroke; intracerebral hemorrhages | Lower PPP-aGDP correlated with higher 30-day case-fatality rates of stroke (ρ = -0.713, p < 0.001) and a greater proportion of intracerebral hemorrhages (ρ = -0.689, p < 0.001). | Unclear |
Lower PPP-aTHE correlated with higher 30-day case-fatality rates of stroke (ρ = -0.701, p < 0.001) and a greater proportion of intracerebral hemorrhages (ρ = -0.643, p < 0.001). | ||||
There was no correlation between unemployment and 30-day case-fatality rates of stroke (ρ = 0.204; p = 0.32) and proportion of intracerebral hemorrhages (ρ = -0.258, p = 0.184). | ||||
Cancers
| ||||
Estimated survival of retinoblastoma: | ||||
Canturk et al., 2010 [31] | Patients with retinoblastoma in upper MIC, lower MIC, and LIC | Survival of retinoblastoma | Upper MIC: 79 % (range, 54–93 %); | Unclear |
Lower MIC: 77 % (range, 60–92 %) | ||||
LIC: 40 % (range, 23–70 %) → p = 0.001 | ||||
Galobardes et al., 2004 [10] | General population mostly in HIC | Overall cancer, lung cancer, other cancers mortality | 4 out of 5 studies found no association between overall cancer mortality and childhood SES, and the effect was removed by adjustment for adult SES in the remaining study. 3 out of 3 studies found a higher risk of lung cancer mortality among those with low childhood SES, although the association was largely explained by adults SES in 2 studies. 1 study showed no association of childhood SES with other smoking-related cancers. | High |
1 study found a higher risk of stomach cancer mortality among those with low childhood SES. 1 study found a higher risk of large-bowl and rectal cancer among those who had the poorest housing conditions during childhood. | ||||
There was no association between non-smoking related cancers (3 studies), prostate cancer (1 study) and malignant melanoma (1 study) mortality and childhood SES. | ||||
Gorey et al., 2009 [20] | Patients with breast cancer in the US and Canada | Breast cancer survival | Within Canada, there was no association between area-SES and breast cancer survival, a little survival disadvantage was only observed for lowest vs. highest income areas (pooled RR 0.94, 95 % CI 0.93–0.95). | High |
Within the US, breast cancer survival was consistently associated with area-SES. Women with breast cancer from low and middle income areas had survival disadvantage compared to women from high income areas (pooled RR ranging from 0.73, 95 % CI 0.72–0.74 for low to 0.96, 95 % CI 0.94–0.98 for middle income area). | ||||
Slatore et al., 2010 [25] | Patients with lung cancer in the US | Lung cancer mortality | 4 out of 4 studies showed a higher risk for lung cancer mortality for Medicaid insurance vs. other or private insurance. 2 studies showed mixed results on the association between Medicare vs Medicaid/Medicare and lung cancer mortality. 1 study showed a higher risk for lung cancer mortality for Medicare insurance and no insurance compared to private insurance. 2 studies showed no association between lung cancer mortality and insurance status. 1 study found mixed results for lung cancer mortality and different Medicare schemes. | Unclear |
Chronic respiratory diseases
| ||||
Galobardes et al., 2004 [10] | General population mostly in HIC | COPD mortality | 1 study did not find an association between higher COPD mortality and overcrowding. | High |
Gershon et al., 2012 [29] | Patients with COPD in HIC | COPD mortality | Individuals of the lowest SES consistently had significantly higher mortality from COPD than those of the highest, except for 1 study (out of 5) where income was not associated with COPD mortality. | Low |
Author, year | Population | Outcome | Results | Risk of Bias |
---|---|---|---|---|
Obesity
| ||||
Prevalence (overweight [obesity]) in urban area (n = 1): | ||||
Ekpenyong and Akpan, 2013 [19] | Adults in Nigeria | Prevalence of overweight and obesity | Low SES: 24.8 % [12.9 %]; Medium SES: 18.9 % [5.7 %]; High SES: 14.6 % [4.9 %] | High |
Prevalence: | ||||
Papandreou et al., 2008 [13] | Children and adults in Mediterranean countries | Prevalence of obesity | Children HIC vs MIC: 11.5 % vs 3.9 % (p = 0.071) [m]; 7.2 % vs 3.2 % (p = 0.074) [w] | High |
Adults HIC vs MIC: 20.1 % vs 22.0 % (p = 0.62) [m]; 24.4 % vs 30.2 % (p = 0.368) [w] | ||||
Shrewsbury and Wardle, 2008 [12] | Children in HIC | Prevalence of childhood obesity | 19 out of 45 studies found higher obesity prevalence rates among those with low SES (all indicators), 12 studies found no and 14 varied associations. | High |
15 out of 20 studies found higher obesity prevalence rates among those with low education, 1 study found no, and 4 varied associations. | ||||
5 out of 13 studies found higher obesity prevalence rates among those with low occupation, 6 studies found no, and 2 varied associations. | ||||
4 out of 11 studies found higher obesity prevalence rates among those with low income, 3 studies found no, and 4 varied associations. | ||||
2 out of 5 studies found higher obesity prevalence rates among those with low SES (composite measures), 1 study found no, and 2 varied associations. | ||||
2 out of 7 studies found higher obesity prevalence rates among those with low neighbourhood SES, 3 studies found no, and 2 varied associations. | ||||
Tamayo et al., 2010 [18] | General population in HIC | Prevalence or incidence of overweight and obesity in later childhood/life | 5 studies showed no direct or a small influence of education on later childhood overweight and obesity, 2 studies showed an increased risk for overweight and obesity in the lowest education strata. | High |
No or small associations between occupation and overweight or obesity were found in 4 studies, of which 2 reported on adult overweight and obesity. 2 studies reported an increased risk of later childhood overweight and obesity in the lowest occupation strata. | ||||
3 studies observed effects regarding income discrepancies and later childhood overweight and obesity, 2 studies showed no associations. | ||||
Prevalence ratios (NHANESa data): | ||||
Wang and Beydoun, 2007 [14] | US adults and children | Prevalence of overweight and obesity | Adults (obesity) Low vs high SES: 1.6 (m), 3.4 (w) in 1971–74; 1.1 (m), 1.3 (w) in 1999–2000. | High |
Children aged 2–9 y (overweight) Low vs high SES: 1.9 (m), 0.8 (f) in 1971–75; 1.8 (m), 1.0 (f) in -1999–2002. | ||||
Children aged 10–17 y (overweight) Low vs high SES: 0.8 (m), 2.0 (f) in 1971–75; 1.1 (m), 1.6 (f) in 1999–2002. |