Neighborhood Socioeconomic Status and Distance From Home Address to Imaging Center Influence the Acuity of Brain MRI Findings.

Introduction: The use of potentially inappropriate medications (PIM), defined as medications for which the risk of adverse events outweighs the expected benefits, increases the risk of hospitalization, adverse drug events, and mortality in older adults. As socioeconomic status (SES) influences health care quality, the purpose of this study is to investigate whether PIM use differs by SES in older adults. Hypothesis: We hypothesized that low SES was independently associated with increased use of PIM. Methods: We studied participants (aged 66-90 years) who were on at least one medication at visit 5 (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) Study. We created a cumulative SES score, based on neighborhood SES (area deprivation index [ADI]) as well as individual SES (education and income). Because PIM for older adults defined by the 2019 Beers Criteria was extremely common (31% of the population), we focused on the use of two or more PIM. We used multivariable logistic regression to examine the associations between SES and PIM use ≥2. Results: Among 4927 participants (mean age of 75.6 (SD 5.1) years, 19.6% Black, and 57.8% female), 6.9% were on two or more PIMs. Overall, compared with individuals with high cumulative SES, those with lower SES had higher odds of PIM use in a dose-dependent manner (odds ratio [OR]: 1.40 [95% confidence interval (CI), 1.06-1.83] for middle cumulative SES; 1.83 [1.18-2.86] for low cumulative SES, Table ), adjusting for demographics and insurance type. For each SES component, low neighborhood SES (i.e., high ADI) and low education was significantly associated with higher odds of PIM use, but not income. Conclusions: We found that lower SES was associated with greater use of PIM among older adults, suggesting that there exist disparities in quality of care by SES. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse outcomes.

Lung cancer screening (LCS) offers a teachable moment for smoking cessation, but socioeconomic status (SES) may affect treatment success. This study assesses whether educational level or neighborhood SES are associated with smoking abstinence and completion of a smoking cessation intervention offered in the LCS context. This is a secondary analysis of a clinical trial (NCT03611881) testing the effectiveness of smoking cessation treatment for older smokers scheduled for LCS (N=615). Outcomes were self-reported 7-day smoking abstinence and study follow-up completion at 6-months. Independent variables were educational level (high school graduation or less [low] vs. post-high school education [high]); neighborhood SES (Area Deprivation Index [ADI], ranging 1 [low SES] to 100 [high SES] categorized as: highest 15% vs. remaining 85% scores), and a combination of both measures. Logistic regression models tested the association between outcomes and SES measures, adjusted for covariates. 32.7% of the sample had low educational level, and the mean sample ADI was 19.9 (SD: 12.8). Smoking cessation was higher among those with higher vs. lower neighborhood SES (15.7% vs. 7.4%, p-value=0.03). Study completion was lower among those with lower vs. higher educational level (78.1% vs. 84.5%, p=0.05). In multivariable models, these associations were not significant but individuals with high educational level and low neighborhood SES were more likely to complete the study than those with both low educational level and low neighborhood SES (OR: 6.04, 95%CI: 1.47-24.7). Smoking cessation in the LCS context might be improved by targeting community factors that affect neighborhood SES and educational level.

Objectives: Increased preoperative shoulder dislocations correlate with recurrent instability and greater glenoid bone loss. Initial instability events can result in 6.8% glenoid bone loss and subsequent instability episodes can result in greater than 20% glenoid bone loss. Glenoid bone loss exceeding critical levels (>13.5%) can lead to further instability and decreased outcomes following arthroscopic labral repair. Low socioeconomic status (SES) indicators, such as high Area Deprivation Index (ADI) and non-commercial insurance, correlate with longer delays to orthopaedic care. ADI is a validated and publicly available measure ranking neighborhoods by socioeconomic disadvantage using 17 variables from the American Community Survey Five Year estimates, and recent studies have found that the combination of ADI and insurance status estimates the largest variability in the social deprivation of orthopedic patients. The goal of this study is to correlate between SES indicators, delays in care, and preoperative glenoid bone loss. We hypothesized higher national ADI and non-commercial insurance would correlate with more severe bone loss and longer delays in the treatment course of patients with anterior shoulder instability. Methods: 339 Bankart repair patients were chart reviewed for demographics, course of care, residency, and insurance status. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and patients’ home addresses. Exclusion criteria included prior ipsilateral shoulder surgeries (N=16), non-viewable imaging (N=97), greater than 5 years from initial injury to surgery (N=46), and low-quality magnetic resonance imaging (N=34). Ten patients with workers’ compensation or charity insurance status were also excluded due to the low numbers in these groups. Glenoid bone loss was measured using the Best-fit circle method on high-quality MRIs (i.e. Fast imaging employing steady-state acquisition (FIEST). Researchers were blinded to SES when measuring glenoid bone loss and during inter- and intraobserver reliability testing. Interobserver reliability was .910, while intraobserver reliability was .948. Prior to evaluating the association between national ADI, time to imaging, and glenoid bone loss, a scatterplot was generated to qualitatively assess the nature of the relationship. A curve fitting tool determined that non-linear regression with a quadratic function best characterized the association between national ADI and glenoid bone loss. Treatment course and glenoid bone loss were compared between insurance types using one-way ANOVAs. Treatment course was defined as time from first instability event to MRI, first instability event to surgery, and MRI to surgery. The relationship between ADI and treatment course was assessed via Pearson’s correlation coefficients. Finally, Fisher’s exact test was used to compare critical bone loss between insurance statuses, while critical bone loss status was also compared with treatment course and ADI using one-way ANOVAs. Results: 146 patients (23.3% female; 22.4±7.0 years-old; ADI=16.1%±15.3%) were included in retrospective review. Overall, patients experienced 9.12%±6.63% glenoid bone loss and 49 patients (27.4%) had critical levels. A significant quadratic association between ADI and bone loss (R2=0.392, p<0.001) was observed. Individuals with Medicaid insurance experienced greater bone loss compared to commercial insurance (commercial=8.58%±6.69%, Medicaid=11.78%±6.30%, p=0.003). Critical bone loss was more likely with higher national ADI (p<0.001) and Medicaid insurance (OR=2.49, CI=1.02-6.09). While no difference in treatment characteristics was seen between insurance status, ADI was associated with longer times from injury to MRI (r=0.24) and injury to surgery (r=0.26). Individuals with critical bone loss experienced longer times from injury to MRI (p=0.07), but not with injury or MRI to surgery (p=0.12; p=0.79). Conclusions: Patients with low SES indicators, such as high ADI and non-commercial insurance, are associated with greater and critical levels of glenoid bone loss. Patients with higher ADI also saw delays in treatment and diagnostic imagining, with patients' delays in obtaining imaging being associated with critical bone loss. Further research on the association between SES and functional outcomes for anterior instability patients is needed.

Association of individual and neighborhood socioeconomic status with outcomes of a smoking cessation intervention provided in the lung cancer screening setting.

Race and socioeconomic factors affect outcomes in breast cancer. We aimed to assess the effect of race and neighborhood socioeconomic status (SES) on overall survival and treatment patterns in patients with metastatic breast cancer (MBC). This is a retrospective cohort study involving patients (N = 1246) with distant breast cancer metastases diagnosed at UPMC Magee Women's Breast Cancer Clinic from 2000-2017. Overall survival and treatment patterns were compared between races (Blacks and whites) and SES groups (defined using Area Deprivation Index). Low SES, but not tumor characteristics, was associated with Black race (P < 0.001) in the study population. Low SES (Median [Interquartile Range, IQR] survival 2.3[2.2-2.5] years vs high SES 2.7[2.5-3.1] years, P = 0.01) and Black race (Median [IQR] survival 1.8[1.3-2.3] years, vs white 2.5[2.3-2.7] years P = 0.008) separately were associated with worse overall survival in patients with MBC. In the Cox Proportional Hazard model with SES, race, age, subtype, number of metastases, visceral metastasis, and year of diagnosis as covariates, low SES (Hazard ratio 1.19[1.04-1.35], P = 0.01), but not Black race (Hazard ratio 1.19[0.96-1.49], P = 0.12), independently predicted overall survival in MBC. Moreover, patients from low SES neighborhoods and Black race received fewer lines of chemotherapy than high SES and whites. In conclusion, low neighborhood SES is associated with worse outcomes in patients with MBC. Poor outcomes in Black patients with MBC, at least in part is driven by socioeconomic factors. Future studies should delineate the interplay between neighborhood SES, race, and their effects on tumor biology in MBC.

Background: Financial toxicity (FT) depicts the burden of cancer treatment-costs and is associated with lower quality-of-life and survival in breast cancer survivors. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT.Study Design: A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients. Chart reviews were used to obtain patient information while FT was identified using a validated instrument. Patients’ home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. Tertile ADI groups enabled statistical analysis and multivariate logistic regression models were developed to determine the independent effects of geospatial location and FT.Results: A total of 568 surgical breast cancer patients were included. Univariate analyses showed significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. Following multivariate analysis, advanced cancer stage (OR 2.26, CI: 1.15-4.44), and escalating ADI (OR 1.012, CI:1.005-1.020) were associated with worsening FT. Increasing age (OR 0.976, CI: 0.96- 0.992), marital status (OR 0.458, CI: 0.299-0.699), receipt of bilateral mastectomy (OR 0.558, CI: 0.323-0.964) were protective of FT. Increasing ADI was also significantly associated with use of coping strategiesConclusion: FT was significantly associated with areas of higher socioeconomic deprivation as measured by the ADI. However, rurality was not found to be a significant predictor of FT. ADI may be used to facilitate pre-operative screening of at-risk populations and the deployment of community-based interventions to alleviate FT. Multivariate logistic regression analysis results. Citation Format: Joseph P Corkum, Victor Zhu, Victor Agbafe, Carrie Chu, Jessica Suarez Colen, Rachel Greenup, Anaeze C. Offodile. Area deprivation index and rurality in relation to financial toxicity among breast cancer surgical patients - Investigating geospatial differences in risk profiles [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-13.

Associations between neighborhood socioeconomic status, readmission, and mortality for patients with cancer: A nationwide cohort study.

Neighborhood-level socioeconomic status and outcomes in patients with localized pancreatic adenocarcinoma treated with first-line FOLFIRINOX

Category: Ankle Arthritis; Trauma Introduction/Purpose: Total ankle arthroplasty (TAA) is increasing in popularity as a viable alternative to arthrodesis in the management of ankle osteoarthritis. Existing disparities in patients' access to and utilization of TAA, as well as unequal insurance payor reimbursements have significant public health implications. Equitable medical coverage hinges on the interplay between socioeconomic factors and quality metrics. Limited information exists regarding geospatial trends in the utilization of TAA and medical insurance payor types. The Area Deprivation Index (ADI) illustrates relative socioeconomic conditions of neighborhoods and can elucidate variations in payor types. Our study analyzes the geospatial trends in medical reimbursement types and TAA utilization across Southwestern Pennsylvania whether a significant association between neighborhood socioeconomic conditions, as measured by the ADI, and reimbursement type exists. Methods: Institutional review board approval was obtained (IRB 20020136). Data from an institution-based registry was prospectively collected and queried for patients who underwent TAA for ankle osteoarthritis between 2017 and 2021. Demographics including age, sex, race, home address, and insurance payor type were collected. Home addresses were converted to geographic coordinates using Google Maps API and visualized with R-Tool geospatial mapping based on insurance payor. The Pennsylvania ADI dataset from 2020-2021 was obtained, was obtained, providing ADI comprised of cores for 9,740 block groups. Home addresses were additionally geocoded to census block groups. Correlation analyses and ANOVA with Post Hoc Tukey analyses were performed to analyze geospatial trends among Medicare, Medicaid, commercial and self-pay insurance payors based on ADI scores. Results: The cohort consisted of 278 patients who underwent TAA, with a mean age of 65 ± 9 years, 156 (56%) were males, and 266 (96%) were White. Among the reimbursements, 161 (54%) were covered by Medicare, 100 (36%) had commercial insurance, 14 (5%) had Medicaid insurance, and 3 (1%) were self-pay insurance payors. The mean national ADI scores for Medicare, commercial, Medicaid, and self-pay insurance payors were 62.07 ±21.96, 57.28 ±22.36, 75.5 ±20.08 and 83 ±11.36 respectively, and mean state ADI were 5.66 ±2.64, 5.17 ±2.64, 7.5 ±2.59 and 8.33 ±1.53 respectively. ANOVA demonstrated significant differences among state ADI (p = 0.005) and national ADI (p = 0.008) scores, with significant differences additionally found between commercial and Medicaid reimbursements at the national and state level. Conclusion: This study identified disparities in TAA utilization among insurance payor populations in Southwestern Pennsylvania. Our study found significant differences among varying ADIs and insurance payor types in patients undergoing TAA procedures. Our findings demonstrate that more disadvantaged neighborhoods in Southern Pennsylvania have lower TAA utilization, and increased rates of commercial and Medicaid insurance payor types. A larger sample size is necessary to validate the results of this study.

Lower socioeconomic status is not associated with worse 2-year outcomes following reverse total shoulder arthroplasty

Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT. A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients using survey data retrospectively collected between January 2018 and June 2019. Chart reviews were used to obtain patient information, and FT was identified using the COmprehensive Score for Financial Toxicity questionnaire, which is a validated instrument. Patients' home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. ADI was analyzed in tertiles for univariate statistical analyses, and as a continuous variable to develop multivariable logistic regression models to evaluate the independent associations of geospatial location with FT. A total of 568 surgical breast cancer patients were included. Univariate analyses found significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. In multivariable analysis, advanced cancer stage (odds ratio [OR] 2.26, 95% CI 1.15 to 4.44) and higher ADI (OR 1.012, 95% CI 1.01 to 1.02) were associated with worsening odds of FT. Increasing age (continuous) (OR 0.976, 95% CI 0.96 to 0.99), married status (vs unmarried) (OR 0.46, 95% CI 0.30 to 0.70), and receipt of bilateral mastectomy (OR 0.56, 95% CI 0.32 to 0.96) were protective of FT. FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.

Greater socioeconomic deprivation predicts worse functional status two years after orthopaedic surgery, but not magnitude of change from baseline.

Potentially inappropriate medication (PIM) use is an important public health problem, particularly among older adults who may need multiple pharmacologic therapies for various chronic conditions. As socioeconomic status (SES) affects the quality of healthcare that individuals receive, SES may be associated with the use of PIM in older adults. This study aimed to determine whether low SES is associated with increased use of PIM. We studied 4927 participants (aged 66-90 years) who were on at least one medication at visit five (2011-2013) of the Atherosclerosis Risk in Communities Study. We created a cumulative SES score categorized as high (7-9), middle (3-6), and low (0-2) based on education, income, and area deprivation index. We use multivariable logistic regression to examine the associations between SES and use of two or more PIM for older adults, defined by the 2019 Beers Criteria. A total of 31.0% and 6.9% of the participants used one or more PIM and two or more PIM, respectively. After adjusting for demographic characteristics and insurance type, low cumulative SES score was associated with significantly greater use of two or more PIM (odds ratio [OR]=1.83 [95% confidence interval (CI) 1.18-2.86]), as was middle cumulative SES score (OR=1.40 [95% CI 1.06-1.83]), compared to high cumulative SES score. The results remained significant after further adjusting for comorbidities and medication burden for low cumulative SES score (OR=1.66 [95%CI 1.02-2.71]). We found that lower SES was associated with greater use of PIM among older adults independent of their medication burden and comorbidities, suggesting socioeconomic disparities in quality of medication management. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse drug events.

Socioeconomic Status Not Associated With Worse Outcomes After Open Lower Extremity Revascularization

PurposeDiabetes mellitus (DM) is a global pandemic metabolic disorder. In recent years, the amount of medical resources required for the treatment of diabetes has increased as diabetes rates have gradually risen. The combined effects of individual and neighbourhood socio-economic status (SES) on DM survival rates are still not clear, especially in patients of working age. In this paper, we aim to analyze the combined effects of neighbourhood and individual SES on DM survival rates in patients of working age in Taiwan.MethodsThe study of 23,781 people who were diagnosed with DM by using population—based study between 2002 and 2006. Each sample was followed up for 4 years or as a sensor case. We defined Individual SES and neighbourhood SES by each patient’s job category and household income which characterized as advantaged or disadvantaged. Then we compared the survival rates by SES group used Cox proportional hazards model for adjust risk factors.ResultsThe 4-year overall survival rates of diabetic patients were worst for those with low individual SES who living in advantaged neighbourhoods. After adjustment for patient characteristics, DM patients with high individual SES living in disadvantaged neighbourhoods had the same risk of mortality as those patients with high individual SES living in advantaged neighbourhoods (hazard ratio: 1.11; 95% confidence interval [CI]: 0.81–1.51). The study found that DM patients with low individual SES who live in disadvantaged areas had a greater risk of mortality than those with high SES (odds ratio: 2.57; 95% CI: 2.04–3.24). There were significant differences in survival rates between patients with high individual SES and patients with low individual SES. In contrast, the results did not statistically significant differences in survival rates between advantaged and disadvantaged neighbourhood SES groups.ConclusionDM patients with low individual SES had the worst survival rate, regardless of whether they were living in a high or low SES neighbourhood area. The competitive cause of death, i.e., the fact that complications, rather than DM itself, are often the cause of death, may be the reason for the inverse relationship found between the effects of individual SES and neighbourhood SES on DM survival. We conclude that the socio-economic gradient in survival among DM patients may be the result of differences in access to medical treatment and attributes related to individual SES.