Socioeconomic status11/29/2022 ![]() Some have suggested it is economic inequality which accounts for most of the social inequality in obesity rates, 106 with the price elasticity of various foods decreasing with increasing income, 107 so that as consumers become more affluent they respond less to price changes in food. 102 The relationship between SES and obesity can vary by characteristics such as age, sex and ethnicity 103, 104 with an opposing relationship found in many lower-income countries where obesity can be considered a sign of affluence and lead to less healthy dietary behaviour. However, there is some evidence that women are more likely to adopt the BMI standard of the SES they move to later in life. 99 This relationship is found to be stronger for women than men 100 and is also true for children, 101 with SES in childhood a predictor of obesity in adulthood. Socioeconomic status (SES) (a measure of an individual's or family's social position relative to others) is linked to adiposity, 98 with those from lower SES backgrounds in high-income countries found to indulge in more obesogenic behaviours, such as eating more energy-dense food and being less physically active. Nick Townsend, Angela Scriven, in Public Health Mini-Guides: Obesity, 2014 Socioeconomic status 87–89 Over the 11-year period between 20, 14 serotypes represented 81% of all enterovirus isolates submitted from state and local public health laboratories to the National Enterovirus Surveillance System of the CDC ( Table 170.4). 86 In addition, periodic reappearances of the same enteroviral serotype may occur because the new enterovirus strain is poorly neutralized by antibodies raised in response to earlier strains. Indeed, time-series analysis and mathematical modeling of enterovirus infections in Japan over 15 years supports the theory that the number of susceptible individuals within the population determines when outbreaks occur. Some epidemic echovirus strains spread rapidly and exhaust susceptible individuals in the population beyond a critical mass necessary for continued transmission, whereas endemic strains that are recovered over a number of years may be associated with lower attack rates due to a moderate level of herd immunity in the population. The reasons why individual serotypes of enteroviruses appear and disappear and behave as either endemic or epidemic pathogens are not well understood. Infection with some serotypes such as CV-B6 and EV-69 is infrequently or rarely recognized. Global epidemics of nonpolio enteroviruses occasionally occur, such as the worldwide outbreak of E-9 disease in the late 1950s and the explosive pandemics of acute hemorrhagic conjunctivitis due to EV-C70 and CV-A24 in the 1980s. 77, 83 – 85 Wild-type polioviruses now circulate only in three countries (see Chapter 171), whereas vaccine strains are commonly isolated in countries that continue to use OPV for poliomyelitis prevention. Some prevalent serotypes are continuously isolated from year to year, 77 whereas others may emerge for the first time or reemerge after years of relative inactivity. In the United States, one to three enteroviral serotypes predominate in a given location in each season, although there is variation from one region to another and from year to year. The frequency with which different enterovirus serotypes cause infection varies markedly. Simultaneous infection by more than one serotype is common under these circumstances. 77, 80 Enteroviral infections are more prevalent among children of lower socioeconomic status, 81 probably because of crowding, poor hygiene, and opportunities for fecal contamination. 77 Rates of symptomatic enteroviral infection decrease after the second month of life 79 but remain higher for infants and toddlers compared with older children and adults. 76 Among nearly 26,737 enteroviral detections reported to the CDC for the years 1983–2003, 11.4% occurred in neonates. 76, 77, 78 Surveillance data from 2000–2014 documented that 34% of infections reported to the US Centers for Disease Control and Prevention (CDC) occurred in this age group. 76, 77 In the United States, attack rates for both infection and illness with nonpolio enteroviruses are highest in infants during their first year of life. The overwhelming majority of enteroviral infections occur in infants, children, and adolescents. Bennett MD, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 2020 Age and Socioeconomic Status ![]()
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