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Cardboard floor: about the barriers for social progression and their impact on the representativeness of epidemiological studies
  1. Jorge Arias-de la Torre1,2,
  2. Jose M Valderas3,
  3. Fernando G Benavides2,4,
  4. Jordi Alonso2,5,6
  1. 1 Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
  2. 2 CIBERESP, Spain
  3. 3 Health Services and Policy Research Group, Academic Collaboration for Primary Care, University of Exeter Medical School, Exeter, UK
  4. 4 Department of Experimental and Health Sciences, Center for Research in Occupational Health. Pompeu Fabra University., Barcelona, Spain
  5. 5 Health Services Reserch Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
  6. 6 Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
  1. Correspondence to Jorge Arias-de la Torre, Psychological Medicine, King’s College London, London SE5 8AF, UK; Jorge.arias_de_la_torre{at}

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A continuum of socioeconomic status ranging from the least to the most privileged persons is evidenced in population studies, with profound implications for health and care.1 Individuals in the most disadvantaged social group suffer from extreme poverty and face several specific challenges to their health and healthcare.2 They frequently cannot meet their most basic needs (including their physiological needs, most acutely exemplified by homelessness) and are at a higher risk of health problems and accelerated ageing due to unhealthy habits (eg, unhealthy diet and drug consumption), harmful environmental and biological factors and social isolation.1–4 As a result, the most socially disadvantaged persons have higher rates of premature mortality, especially caused by suicide and violence, and higher prevalence of all types of diseases, particularly infectious diseases and mental disorders.2 5 Besides, care for chronic conditions is compromised for this population group, which relies to a substantial degree in emergency care, particularly in health systems that do not guarantee universal health coverage.5

Even considering the relative size of the most deprived extreme of the social continuum (eg, about 0.5% of the UK adult population in 2018 was considered homeless),6 the scale of …

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  • Contributors All authors (JA-T, JMV, FGB and JA) were involved in all phases of the development of this manuscript, from the initial idea to the review and acceptance of the final draft for submission.

  • Funding The present work is partially funded by the Medical Research Council (MR/S028188/1). This article represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.