Francisco Tsz Tsun Lai

Socioeconomic Determinants of Multimorbidity: A Population-Based Household Survey of Hong Kong Chinese.

Introduction Multimorbidity has been well researched in terms of consequences and healthcare implications. Nevertheless, its risk factors and determinants, especially in the Asian context, remain understudied. We tested the hypothesis of a negative relationship between socioeconomic status and multimorbidity, with contextually different patterns from those observed in the West. Methods We conducted our study in the general Hong Kong (HK) population. Data on current health conditions, health behaviours, socio-demographic and socioeconomic characteristics was obtained from HK Government’s Thematic Household Survey. 25,780 individuals aged 15 or above were sampled. Binary logistic and negative binomial regression analyses were conducted to identify risk factors for presence of multimorbidity and number of chronic conditions, respectively. Sub-analysis of possible mediation effect through financial burden borne by private housing residents on multimorbidity was also conducted. Results Unadjusted and adjusted models showed that being female, being 25 years or above, having an education level of primary schooling or below, having less than HK

Socioeconomic influence on adolescent problematic Internet use through school-related psychosocial factors and pattern of Internet use

15,000 monthly household income, being jobless or retired, and being past daily smoker were significant risk factors for the presence of multimorbidity and increased number of chronic diseases. Living in private housing was significantly associated with higher chance of multimorbidity and increased number of chronic diseases only after adjustments. Conclusions Less advantaged people tend to have higher risks of multimorbidity and utilize healthcare from the public sector with poorer primary healthcare experience. Moreover, middle-class people who are not eligible for government subsidized public housing may be of higher risk of multimorbidity due to psychosocial stress from paying for the severely unaffordable private housing.

The association between types of regular primary care and hospitalization among people with and without multimorbidity: A household survey on 25,780 Chinese

Abstract The current literature on adolescent problematic Internet use (PIU) does not provide an adequately comprehensive picture of the possible dynamics between different aspects of life in the shaping of PIU. Particularly, it is currently unknown how socioeconomic background could exert indirect influences. Adolescents from particular social strata who require assistance remain unidentified. Based on Problem Behavior Theory, a conceptual model with three layers, namely socioeconomic indicators, school-related psychosocial variables and pattern of Internet use, was formulated and tested with the survey data of 744 students from two Hong Kong secondary schools. Path analysis was conducted to yield an explanatory model of PIU. Findings suggested two different roles socioeconomic background plays. First, it potentially exerts influence as an antecedent through intermediary determinants, such as educational stress. Second, it potentially moderates the mechanism. In particular, it was found that parental education and family income significantly moderate the association between the amount of Internet use and severity of PIU. According to these findings, public health policies could be more focused on adolescents belonging to certain social strata who require additional assistance. Also, school policies and parenting strategies could be better informed with reference to the relevant psychosocial variables and pattern of Internet use.

The independent role of deprivation in abdominal obesity beyond income poverty. A population-based household survey in Chinese adults

Using data collected from 25,780 Hong Kong citizens in a household survey, this study aimed to investigate the association between having regular source of primary care and hospitalization amongst people with and without multimorbidity (two or more chronic conditions). Potential interaction effects of regular primary care with multimorbidity were also examined. Results revealed a significant association between having regular source of primary care from General Practitioners and reduced hospitalization amongst respondents with multimorbidity (RR = 0.772; 95% CI = 0.667–0.894), adjusting for other potential confounding factors (i.e., socio-demographic factors and medical insurance and benefits). In contrast, having regular Specialist care was significantly associated with increased risk of hospitalization among both people with multimorbidity (RR = 1.619; 95% CI = 1.256–2.087) and without multimorbidity (RR = 1.981; 95% CI = 1.246–3.149), adjusting for potential confounders. A dose-response relationship between the number of chronic diseases and hospitalization was also observed, regardless of whether participants had regular source of primary care or not; relative risks and predicted probabilities for hospitalization were generally greater for those without regular source of primary care. Further studies are warranted to explore the role of healthcare system, informatics, organizational and practice-related factors on healthcare and functional outcomes.

Socioeconomic disparity in mortality risks widened across generations during rapid economic development in Hong Kong: an age-period-cohort analysis from 1976 to 2010

Background Individual-level deprivation takes into account the non-monetary aspects of poverty that neither income poverty nor socio-economic factors could fully capture; however, it has rarely been considered in existing studies on social inequality in obesity. Therefore, we examined the associations of deprivation, beyond income poverty, with both general and abdominal obesity. Methods A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed via face-to-face household interviews between 2014 and 2015. Deprivation was assessed by a Deprivation Index specific to the Hong Kong population. General obesity was defined as body mass index (BMI) ≥ 25 kg/m2, while abdominal obesity was defined as waist circumference (WC) ≥ 90 cm/80 cm for male/female. Multivariable binary logistic regressions were performed. Results Deprivation was independently associated with abdominal obesity (odds ratios (OR) = 1.68; 95% confidence intervals (CI): 1.27-2.22); however, no significant association was found with general obesity (OR=1.03; CI: 0.77-1.38). After additional adjustment for BMI, deprivation remained strongly associated with abdominal obesity (OR=2.00; CI: 1.41-2.83); and after further adjustment for WC, deprivation had a marginal inverse association with general obesity (OR=0.72; CI: 0.51-1.01). Conclusions Deprivation is an important risk factor of abdominal obesity and plays a critical role in capturing the preferential abdominal fat deposition beyond income poverty.

Socioeconomic Moderators of the Relationship Between Different Quitting Motives and Smoking Cessation in Hong Kong Men

PURPOSE Hong Kong has been one of the fastest growing postwar economies with substantial decline in mortality risks during the past decades. Nevertheless, it is unclear whether there is a socioeconomic disparity in the trends of mortality risks across generations. METHODS We conducted a series of sex-specific age-period-cohort analyses by neighborhood-level socioeconomic status (SES) using mortality data from 1976 to 2010 to examine the socioeconomic disparity of cohort effects. Outcomes included all-cause mortality and mortality from ischemic heart disease, other cardiovascular diseases (CVD), lung cancer, other cancers, respiratory diseases (RD), other medical causes, and external causes. RESULTS Age-standardized mortality rates declined in both sexes, with generally higher rates observed in those of lower SES. Socioeconomic disparity in the risks of all mortality outcomes emerged and widened starting from cohorts born around the 1930s-1940s. These results suggested that mortality risks associated with lower SES did not decline across generations as much as those associated with higher SES. CONCLUSIONS The share of health benefits brought by economic growth was notably unequal by SES with greater benefits for those of higher SES. More attention should be paid to postwar baby boomers of lower SES.

Erectile Dysfunction is Associated with Subsequent Cardiovascular and Respiratory Mortality in Cohort of 1,436 Chinese Elderly Men

To facilitate effective tobacco control, it is important to identify the socioeconomic strata in which different quitting motives are more strongly associated with cessation. This study aims to examine such a moderating role of socioeconomic background. A total of 2022 past or current daily smoking men from the Hong Kong Thematic Household Survey 2010 who had attempted for cessation were analyzed. Binary socioeconomic indicators, quitting motives, and 1-year abstinence were entered in an exploratory backward-stepwise log-linear model, followed by a binary logistic regression to estimate the probability of one-year abstinence in each socioeconomic stratum. Results suggest that the association between cessation and health motives is stronger in less educated men (P = .004) and nonmarried men (P = .003). The estimated probability of cessation ranges from 0.02 (95% CI = 0.00-0.06) to 0.96 (95% CI = 0.89-1.00). Accordingly, policy makers should educate less-educated men and nonmarried men about the adverse health impacts of tobacco use.