Social Disparities in Cardiometabolic Health in Czechia and Venezuela Using the Allostatic Load Model

Abstract Background Subjects with lower socioeconomic status (SES) are exposed to higher levels of environmental stressors. The cumulative effects of chronic stressors on cardiometabolic health can be evaluated using the allostatic load (AL) score. Despite the accepted social gradient, clear relationships between social determinants and cardiometabolic health in populations with different socio-cultural contexts have been rarely explored. This study aimed to compare the relationships of social determinants with AL in different socioeconomic contexts: unstable Venezuela (VE) and stable Czechia (CZ). Methods 25-64 years old subjects from two cross-sectional population-based samples from CZ (2013-2014, n = 1579, 56% females) and VE (2014-2017, n = 1652, 70% females). The AL score (scaled 0-8) was calculated using 8 cardiometabolic biomarkers (BMI, waist circumference, systolic and diastolic blood pressure, total and HDL-cholesterol, triglycerides). Social characteristics included education in both countries, household income in CZ, and composite measure of SES based on source of income, household head's profession, motheŕs education, and housing conditions in VE. Ordinal regression was performed separately in men and women. Results In CZ, men and women with low education and women with low income were more likely to have higher score of AL compared to those with high education and income (OR 1.45, 2.29 and 1.69). In VE, women with low education and low SES were more likely to have higher AL (OR 1.47 and 1.51), while men with low education and low SES were less likely to have higher AL (OR 0.64 and 0.61), compared to those with high education and high SES. Independently of age, sex, and socioeconomic characteristics, Venezuelans were more likely to have higher AL than Czechs. Conclusions Associations of social position indices and cardiometabolic health (proxied by AL) differed between CZ and VE, most likely reflecting differences in social environment between the countries. Key messages Social gradients in cardiometabolic health differ among social environments. Social gradients in cardiometabolic health differ among sexes.


Background:
Precarious employment (PE) is a well-known social determinant of health and health inequalities, yet the effect of PE on mortality has not been explored sufficiently and high-quality longitudinal studies are lacking. When studying this effect, several methodological factors must be considered, one of them being the immortal time bias or prevalent user bias. A framework that helps us overcome these biases is the target trial. Therefore, the aim of this study is to estimate the causal effect of switching from precarious to standard employment (SE) on the 12-year risk of all-cause mortality among precariously employed workers aged 20-55 in Sweden.

Methods:
We emulated the target trial as a series of 11 target trials (starting at any year between 2005 and 2016), such that each individual may participate in multiple trials using Swedish register data (N = 251274). We classified individuals as: a) workers that at baseline (start) move from PE to SE and then followed while in SE or b) continuation of PE over follow-up. All-cause mortality was measured from 2006 to 2017. We pooled data for all 11 emulated trials and used pooled logistic regression to estimate intention-to-treat effects via hazard ratios and standardized survival curves.

Results:
The following results are preliminary. Individuals that continued on PE were 185,480 and those that initiated SE were 65,794. Over the 12-year follow-up, 1553 individuals died. The estimated observational analogue of the intentionto-treat 12-year survival difference for all cause-mortality between workers that continued on PE and those that initiated SE was of -0.2%, and the HR:0.82, 95%CI:0.72-0.94.

Conclusions:
The following conclusions are preliminary. According to our results, we find indication that shifting from PE to SE decreased the risk of death. Our study highlights the crucial role of decent employment conditions for health.

Key messages:
Changing from precarious to more decent employment conditions decreases the risk of death by any cause in a cohort of Swedish workers. This study provides evidence that precarious employment has also an effect on any cause mortality.

Background:
Subjects with lower socioeconomic status (SES) are exposed to higher levels of environmental stressors. The cumulative effects of chronic stressors on cardiometabolic health can be evaluated using the allostatic load (AL) score. Despite the accepted social gradient, clear relationships between social determinants and cardiometabolic health in populations with different sociocultural contexts have been rarely explored. This study aimed to compare the relationships of social determinants with AL in different socioeconomic contexts: unstable Venezuela (VE) and stable Czechia (CZ). Methods: 25-64 years old subjects from two cross-sectional populationbased samples from CZ (2013-2014, n = 1579, 56% females) and VE (2014-2017, n = 1652, 70% females). The AL score (scaled 0-8) was calculated using 8 cardiometabolic biomarkers (BMI, waist circumference, systolic and diastolic blood pressure, total and HDL-cholesterol, triglycerides). Social characteristics included education in both countries, household income in CZ, and composite measure of SES based on source of income, household head's profession, motheŕs education, and housing conditions in VE. Ordinal regression was performed separately in men and women.

Results:
In CZ, men and women with low education and women with low income were more likely to have higher score of AL compared to those with high education and income (OR 1.45, 2.29 and 1.69). In VE, women with low education and low SES were more likely to have higher AL (OR 1.47 and 1.51), while men with low education and low SES were less likely to have higher AL (OR 0.64 and 0.61), compared to those with high education and high SES. Independently of age, sex, and socioeconomic characteristics, Venezuelans were more likely to have higher AL than Czechs.

Conclusions:
Associations of social position indices and cardiometabolic health (proxied by AL) differed between CZ and VE, most likely reflecting differences in social environment between the countries. Key messages: Social gradients in cardiometabolic health differ among social environments. Social gradients in cardiometabolic health differ among sexes.

Background:
Most European countries implemented COVID-19 surveillance systems based notably on the number of diagnosed infections. Using this number as an indicator of epidemic severity is however problematic since it is influenced by testing modality. Indeed, differences in the frequency of infections are partly due to differences in detection rates rather than to changes in the risk of infection, leading to a ''surveillance bias''. Our goal was to estimate the magnitude of this bias in one region of Switzerland, using population-based seroprevalence as the best marker of epidemic severity.

Methods:
We used data from serosurveys carried out on random samples of the adult population after the 1st (Jul-Oct 2020) and the 2nd wave of the pandemic (Nov 2020-Feb 2021), before the start of the vaccination campaign. To assess the scale of surveillance bias, we assessed the burden of COVID-19 between 2 waves comparing seroprevalence with the number of diagnosed cases (positive PCR or antigen tests).

Conclusions:
Due to changes in testing modalities, the number of cases is problematic to assess the burden of COVID-19 in different phases of the pandemic. Accounting for surveillance bias is necessary for accurate public health surveillance. Key messages: Accounting for surveillance bias and critically interpreting surveillance data is essential for an accurate public health monitoring activity. The number of diagnosed cases cannot be used alone to assess the burden of COVID-19.

Methods:
A burden-eu working group of experts generated a list of potential reporting items based on existing literature, guidance for developing guidelines and consultations with BoD experts. To pilot the drafted product, we asked BoD experts and nonexperts to apply it to existing BoD studies. We received feedback and we revised the guidelines accordingly.

Results:
The guide for DALY calculation studies comprises about 25 items that should be reported in BoD studies. We included information about the study setting, data input sources including methods for data corrections, DALY-specific methods (e.g., YLL life table, YLD approach, disability weights etc), data analyses, and data limitations. We also included information on how users can compare their new estimates with previously available BoD estimates.

Conclusions:
We introduced a reporting instrument for DALY calculations that can be used to document input data and methodological design choices in BoD studies. The application of such guidelines will enhance usability of BoD estimates for decision-makers as well as global, regional, and national health experts.
Key messages: Application of reporting guidelines will increase consistency and transparency in reporting of BoD studies, thus enhancing usability of BoD estimates.
Reporting guidelines for BoD studies will serve as an educational tool for better understanding the complexity of DALY methodological design approaches.