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      A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore

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          Abstract

          Introduction

          It is well-established that low socioeconomic status (SES) influences one’s health status, morbidity and mortality. Housing type has been used as an indicator of SES and social determinant of health in some studies. In Singapore, home ownership is among the highest in the world. Citizens who have no other housing options are offered heavily subsidised rental housings. Residents staying in such rental housings are characterised by low socioeconomic status. Our aim is to review studies on the association between staying in public rental housing in Singapore and health status.

          Methods

          A PubMed and Scopus search was conducted in January 2017 to identify suitable articles published from 1 January 2000 to 31 January 2017. Only studies that were done on Singapore public rental housing communities were included for review. A total of 14 articles including 4 prospective studies, 8 cross-sectional studies and 2 retrospective cohort studies were obtained for the review. Topics addressed by these studies included: (1) Health status; (2) Health seeking behaviour; (3) Healthcare utilisation.

          Results

          Staying in public rental housing was found to be associated with poorer health status and outcomes. They had lower participation in health screening, preferred alternative medicine practitioners to western-trained doctors for primary care, and had increased hospital utilisation. Several studies performed qualitative interviews to explore the causes of disparity and concern about cost was one of the common cited reason.

          Conclusion

          Staying in public rental housing appears to be a risk marker of poorer health and this may have important public health implications. Understanding the causes of disparity will require more qualitative studies which in turn will guide interventions and the evaluation of their effectiveness in improving health outcome of this sub-population of patients.

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          Hypertension and socioeconomic status.

          Itamar Grotto, Michael Huerta-Hartal, Yehonatan Sharabi (2008)
          The impact of socioeconomic status on hypertension is complicated and unclear. In this article, we review the findings of recently published studies pertaining to the association between socioeconomic status and hypertension. Specifically, we focus on several potentially modifiable modes of pathogenesis involved in this association, including education, occupation, and social environment. We also review several mechanisms through which the effects of socioeconomic status on hypertension may be mediated. Several modifiable socioeconomic determinants, such as education and occupation, are associated with hypertension. Additional socioeconomic status markers such as urban or rural dwelling and individual, local or national economic conditions are also associated with hypertension, although these associations are complicated and at times somewhat contradictory. Possible explanations for this impact include awareness of hypertension prevention and control and better accessibility and adherence to medical treatment among higher socioeconomic status groups, as well as low birth weight and higher job strain among lower socioeconomic status groups. Low socioeconomic status is associated with higher blood pressure. There is a need to develop and test culturally appropriate interventions to reduce the prevalence of hypertension among these populations to minimize the resultant cardiovascular morbidity and mortality.
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            Living arrangements, social networks and depressive symptoms among older men and women in Singapore.

            Chetna Malhotra, Truls Østbye, Angelique Chan … (2011)
            To examine the association of living arrangements and social networks outside the household with depressive symptoms among older men and women, ascertain if these relationships differ between older men and women, and investigate whether the association of living arrangements with depressive symptoms varies by strength of social networks. Data for 4489 community-dwelling Singaporeans, aged 60 years and older, from a recent nationally representative survey were analyzed. Depressive symptoms were assessed using the 11-item CES-D (Center for Epidemiologic Studies) scale, social networks through Lubben's revised social network scale, and living arrangements through household composition. Analysis was stratified by gender, and descriptive and multivariate statistics were used to assess the risk of depressive symptoms by living arrangements and social networks, adjusting for age, ethnic group, education, housing type, functional status, number of chronic diseases and involvement in social activities. Women had higher depressive symptom scores than men. Living alone and living with at least 1 child (no spouse) (relative to living with spouse and children), and weak social networks outside the household were associated with higher depressive symptom scores among both men and women. Men living alone with weak social networks outside the household had higher depressive symptom scores than those with strong networks. The findings have implications regarding the importance of strengthening non-familial social networks of older adults, particularly for those living alone. Copyright © 2010 John Wiley & Sons, Ltd.
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              Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore

              Liang Wee, LE. Wee, Wei Xin Yeo … (2012)
              Background/Aims: Neighborhood socioeconomic status (SES) can affect cognitive function. We assessed cognitive function and cognitive impairment among community-dwelling elderly in a multi-ethnic urban low-SES Asian neighborhood and compared them with a higher-SES neighborhood. Methods: The study population involved all residents aged ≥60 years in two housing estates comprising owner-occupied housing (higher SES) and rental flats (low SES) in Singapore in 2012. Cognitive impairment was defined as <24 on the Mini Mental State Examination. Demographic/clinical details were collected via questionnaire. Multilevel linear regression was used to evaluate factors associated with cognitive function, while multilevel logistic regression determined predictors of cognitive impairment. Results: Participation was 61.4% (558/909). Cognitive impairment was found in 26.2% (104/397) of residents in the low-SES community and in 16.1% (26/161) of residents in the higher-SES community. After adjusting for other sociodemographic variables, living in a low-SES community was independently associated with poorer cognitive function (β = –1.41, SD = 0.58, p < 0.01) and cognitive impairment (adjusted odds ratio 5.13, 95% CI 1.98–13.34). Among cognitively impaired elderly in the low-SES community, 96.2% (100/104) were newly detected. Conclusion: Living in a low-SES community is independently associated with cognitive impairment in an urban Asian society.
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                Author and article information

                Contributors
                Catherine Qiu Hua Chan: catherine.chan.q.h@sgh.com.sg
                Kheng Hock Lee: lee.kheng.hock@singhealth.com.sg
                Lian Leng Low: low.lian.leng@singhealth.com.sg
                Journal
                Journal ID (nlm-ta): Int J Equity Health
                Journal ID (iso-abbrev): Int J Equity Health
                Title: International Journal for Equity in Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1475-9276
                Publication date (Electronic): 2 April 2018
                Publication date PMC-release: 2 April 2018
                Publication date Collection: 2018
                Volume: 17
                Electronic Location Identifier: 39
                Affiliations
                [1 ]ISNI 0000 0000 9486 5048, GRID grid.163555.1, Department of Family Medicine & Continuing Care, , Singapore General Hospital, ; Singapore, Singapore
                [2 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Family Medicine, , Duke-NUS Medical School, ; Singapore, Singapore
                [3 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Family Medicine Academic Clinical Program, , SingHealth Duke-NUS, ; Singapore, Singapore
                Article
                Publisher ID: 751
                DOI: 10.1186/s12939-018-0751-y
                PMC ID: 5879561
                PubMed ID: 29609592
                SO-VID: bab53e74-95a9-4e47-826f-1c53e5ab7ae4
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 September 2017
                Date accepted : 20 March 2018
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Health & Social care
                Keywords: public rental housing,low socioeconomic,health status,singapore
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: public rental housing, low socioeconomic, health status, singapore

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