Temporal changes in the high-temperature-mortality association in the Netherlands and the potential impact of the implementation of the national heat plan.

Introduction: Climate change will lead to more frequent and extreme heatwaves in the coming decades. To mitigate the health impact of high temperatures, heat plans (HPs) have become widespread in Europe. Our aim was to evaluate temperature-mortality associations and estimate the temperature-related deaths in the Netherlands in the years before (2000-2009) and after (2010-2019) the first activation of the national HP. Methods: We obtained data about daily all-cause mortality (2000-2019) for the entire Dutch population, and by age, sex, neighborhood SES and urbanization. We linked daily maximum temperature based on 23 monitoring stations across the Netherlands. Time-series Poisson regression models with a distributed lag nonlinear model, adjusted for long-term and seasonal trends and day of the week, were used to assess relative risks (RR, 95% confidence intervals) in the warm months (May-September). Temperature-attributable mortality fractions for high temperature exposures (≥28.9°C) were calculated. Results: We observed positive associations between daily maximum temperature and mortality in 2000-2009 and in 2010-2019. Associations of high temperatures (28.9°C – 95 percentile) were weaker in 2010-2019 (RR: 1.07, 95%CI: 1.05, 1.09) than in 2000-2009 (RR: 1.17, 95%CI: 1.15, 1.20). The attenuation in temperature-mortality risk was strongest for the elderly, women and individuals living in low SES areas. The estimated mortality attributable fractions of high temperatures (≥28.9°C) were lower in 2010-2019 (0.72, 95%CI: 0.60, 0.84) than in 2000-2009 (1.21%, 95%CI: 1.07, 1.33). Conclusion: The impact of high temperatures on mortality attenuated in the Netherlands. This might be due to the implementation of the National HP, but other factors may have played a role as well.

Introduction: Neighborhood characteristics and physical activity levels may impact physical function. The present study examined the relationship between neighborhood socioeconomic status (NSES) and functional status impairment among older men and women and examined whether this relationship differed by physical activity. Hypothesis: Compared to those with high levels of NSES, participants with low NSES will have higher odds of functional impairment in late life. This association will be modified by physical activity. Methods: We constructed an aggregate measure of NSES using census-based indicators of wealth, education, and occupation and quantified distribution-based tertiles of low, middle, and high NSES among ARIC cohort participants in Visit 5 (2011-2013). We used the Rosow-Breslau scale to ascertain functional status (range 0-4; functional impairment defined as a score<4) during the 2016 annual telephone interview. Multivariable logistic regression was used to examine the association between NSES tertiles and functional status impairment adjusting for age, race, ARIC center, and sex. We tested for effect modification by AHA-defined physical activity (categorized as poor, intermediate, ideal based on weekly minutes of moderate-to-vigorous physical activity). We also tested for effect modification by sex, race, and age. Results: Among 4,439 participants (mean age: 75 (SD 5) years, 22% Black, 55% female), 1,788 (40%) had functional status impairment. In analyses adjusted for sex, race, and age, the odds of functional impairment among participants with low NSES were 1.86 (95% CI: 1.60, 2.16) times the odds of functional impairment among those with high NSES. There was evidence of effect measure modification by race (p=0.06) and age (p=0.07). In White participants, the odds of functional status impairment among participants with low NSES was 1.99 (95% CI: 1.69, 2.35) times the odds of functional impairment among those with high NSES. This association was attenuated in Black participants (OR: 1.38, 95% CI: 0.96, 2.00). In participants less than 74 years, the odds of functional status impairment among participants with low NSES was 2.17 (95% CI: 1.73, 2.72) times the odds of functional impairment among those with high NSES. This association was attenuated in participants 74 years and older (OR: 1.64, 95% CI: 1.34, 1.99). There was no evidence of effect modification by physical activity (p=0.20) nor sex (p=0.65). Conclusions: Low NSES is modestly associated with functional status impairment in older adulthood. This association appeared stronger in Whites compared to Blacks, and in those younger than 74 years.

From street address to survival: Neighborhood socioeconomic status and pancreatic cancer outcomes

Neighborhood Socioeconomic Status, Health Insurance, and CKD Prevalence: Findings From a Large Health Care System

African American (AA) populations experience persistent health disparities in the USA. Low representation in bio-specimen research precludes stratified analyses and creates challenges in studying health outcomes among AA populations. Previous studies examining determinants of bio-specimen research participation among minority participants have focused on individual-level barriers and facilitators. Neighborhood-level contextual factors may also inform bio-specimen research participation, possibly through social norms and the influence of social views and behaviors on neighbor's perspectives. We conducted an epidemiological study of residents in 5108 Chicago addresses to examine determinants of bio-specimen research participation among predominantly AA participants solicited for participation in the first 6years of ChicagO Multiethnic Prevention and Surveillance Study (COMPASS). We used a door-to-door recruitment strategy by interviewers of predominantly minority race and ethnicity. Participants were compensated with a $50 gift card. We achieved response rates of 30.4% for non-AA addresses and 58.0% for AA addresses, with as high as 80.3% response among AA addresses in low socioeconomic status (SES) neighborhoods. After multivariable adjustment, we found approximately 3 times the odds of study participation among predominantly AA addresses in low vs. average SES neighborhoods (odds ratio (OR) = 3.06; 95% confidence interval (CI) = 2.20-4.24). Conversely, for non-AA addresses, we observed no difference in the odds of study participation in low vs. average SES neighborhoods (OR = 0.89; 95% CI = 0.69-1.14) after multivariable adjustment. Our findings suggest that AA participants in low SES neighborhoods may be recruited for bio-specimen research through door-to-door approaches with compensation. Future studies may elucidate best practices to improve bio-specimen research participation among minority populations.

Numerous studies have examined the role of socio-economic status on physical activity, obesity, and cognitive performance in youth or older adults, but few studies have examined the role of neighborhood socio-economic status (NSES) on motor or cognitive performance in kindergarten children. This study aimed to examine whether lower NSES (measured by the social data atlas) was associated with lower motor and inhibitory control performance in kindergarten children. One hundred twenty-nine preschoolers were recruited from eight kindergartens in low and high NSES areas in Stuttgart, one of Germany's largest metropolitan areas. Motor functioning (Movement Assessment Battery for Children, MABC-2; Manual Dexterity, Aiming and Catching, and Balance) and inhibitory control (Flanker Task, Go/NoGo Task) were assessed in a sample of 3- to 6-year-old children within a cross-sectional study. Children from a low NSES background showed the expected difficulties in inhibitory control and motor performance, as indicated by poorer performance than children from a high NSES background. Sex-specific analysis revealed girls from low NSES areas to have the lowest fine motor control; children with low NSES reach a Developmental Coordination Disorder at-risk status of 13% (boys and girls), in contrast to children with high SES (boys 9.1%, girls 0.0%). Motor performance and inhibitory control correlated positively with regard to the group from a low NSES background. Researchers and practitioners are advised to develop a more nuanced picture of motor and academic achievement in heterogeneous neighborhoods when designing early intervention programs, particularly with regard to sex differences, with the most significant disadvantage to girls with lower NSES.

BackgroundThe incidence of early-onset colorectal cancer has increased markedly over the past decade. Although established for older adults, there are limited data on socioeconomic and racial disparities in screening, treatment, and outcomes in this distinct group. MethodsAdults with primary colorectal cancer diagnosed at age <50 were identified from the Surveillance, Epidemiology, and End Results database. The exposure of interest was neighborhood socioeconomic status based on the Yost Index, a census-tract level composite score of neighborhood economic health. Univariate analysis was performed with χ2 analyses. Logistic regression models were created to evaluate the association of neighborhood socioeconomic status (Yost Index quintile) with metastasis at presentation and surgical intervention. Kaplan–Meier and Cox proportional hazards models were created. ResultsIn total, 45,660 early-onset colorectal cancer patients were identified; 16.8% (7,679) were in the lowest quintile of neighborhood socioeconomic status. Patients with the lowest neighborhood socioeconomic status were 1.13 times (95% confidence interval 1.06–1.21) more likely to present with metastases and had lower survival (hazard ratio 1.45, 95% confidence interval 1.37–1.53) compared to those with the highest neighborhood socioeconomic status. Non-Hispanic Black patients were more likely to present with metastatic disease (odds ratio 1.11, 95% confidence interval 1.05–1.19), less likely to undergo surgery for localized or regional disease (odds ratio 0.48, 95% confidence interval 0.43–0.53), and had lower survival (hazard ratio 1.21, 95% confidence interval 1.15–1.27) than non-Hispanic White patients. ConclusionSocioeconomic and racial disparities in early-onset colorectal cancer span diagnosis, treatment, and survival. As the disease burden of early-age onset colorectal cancer increases, interventions to boost early diagnosis and access to surgery are necessary to improve survival among minorities and patients with low neighborhood socioeconomic status.

Resilience, an individual’s ability to successfully adapt to adversity, is a multifaceted outcome that may be affected by individual and community factors. A comprehensive examination of resilience by race and neighborhood socioeconomic status (NSES) among women aged 80+ is needed to better understand longevity in diverse populations. Women aged 80+ in 2011, in the Women’s Health Initiative (WHI) study were included. Resilience was measured using the 3-item Brief Resilience Scale, with higher scores indicating better resiliency. Descriptive statistics and multivariable linear regression examined the association of demographic, psychosocial, and health variables with resilience by race (White, Black, Asian) and NSES. The majority of participants (n=29,367, median age=84.0) were non-Hispanic White (91.4%), and had multimorbidities (66%). There were no significant differences by race on mean resiliency scores (p=0.06). Mean resilience was higher among women with higher NSES (low NSES=3.94±0.83, moderate NSES=3.95±0.82, high NSES=4.00±0.81; p< 0.001). Optimism (p< 0.001), social support (p< 0.01), and physical/mental symptom burden (p< 0.05) were significant correlates of resilience among Asian, Black, and White women. Self-rated health (p< 0.001), depressive symptoms (p< 0.001), optimism (p< 0.001), social support (p< 0.001), physical/mental symptom burden (p< 0.001), and body mass index (p< 0.001) were significant correlates of resilience across women with low, moderate, and high NSES. Age was significantly associated with resilience among women with moderate (β=-0.004, p=0.019) and high NSES (β=-0.005, p=0.045). This study found several common correlates of resilience across race and NSES among women aged 80+ in the WHI. Future research to enhance resilience, such as through psychosocial and behavioral interventions, is warranted.

The implications of neighborhood socioeconomic status on surgical management and mortality in malignant phyllodes patients in the Surveillance, Epidemiology, and End Results program

Defining region-specific heatwave in China based on a novel concept of “avoidable mortality for each temperature unit decrease”

Background: The relationship between temperature and mortality is well established and has been investigated including as well as excluding external causes. In some countries in Eastern Europe external mortality is substantial and deaths due to external causes is the third largest cause of mortality in Estonia after cardiovascular disease and cancer. Death rates owing to external causes might reflect behavioural changes among a population and have been less investigated. The aim for the current study was to investigate any association between temperature and external mortality in Estonia. Methods: We collected daily information on deaths from external causes (ICD-10 diagnoses codes V00-Y99) and daily maximum temperatures for the time period 1997–2013. The relationship between daily maximum temperature and mortality was investigated using a Poisson regression combined with a distributed lag nonlinear model considering lag-times of up to ten days. Results: We found significantly increased external cause mortality on hot (same day only) and cold days (lag of 1–3 days). The cumulative Relative Risks for heat (increase in temperature from the 90th to the 99th percentile for lag01) was 1.18 (95% Confidence Interval: 1.08–1.28) and for cold (decrease from the 10th to 1st percentile for lag04) 1.17 (1.01–1.36). Mortality displacement was not present in our data. Conclusion: Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme temperature and should be investigated further, because such deaths have a severe impact on public health and years of life lost, especially in Eastern Europe where external mortality rates are high.

The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00–Y99) and maximum temperatures over the period 1997–2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1–3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14–1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03–1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.

PDB62 INTERACTION OF HOUSEHOLD AND NEIGHBORHOOD SOCIOECONOMIC STATUS IN THE CHILDHOOD OBESITY EPIDEMIC IN THE UNITED STATES

Associations between the built environment and emotional, social and physical indicators of early child development across high and low socioeconomic neighbourhoods

Objective We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23). Conclusions In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.