The relationship of socioeconomic status and gender to the occupational choices of grade 12 students

A growing number of Cambodian children without legal documentary evidence of date of birth are vulnerable to exploitation. This study aimed to evaluate the applicability of southern Chinese reference dataset for dental age estimation on Cambodian children and young adults of different socioeconomic status. Dental panoramic tomographs (DPT) of 371 Cambodian children and young adults belonging to lower and higher socioeconomic status (SES) groups were analyzed. All the left maxillary and mandibular permanent teeth including the third molars were scored based on Demirjian's classification of tooth development stages. Chronological age (CA) was calculated from the date of birth and date of exposure of radiograph. The mean age of attainment for each stage of development was obtained from the southern Chinese reference dataset. Dental age (DA) was calculated by averaging the mean age scores for all the teeth. Paired t-test and correlation analysis were conducted to measure associations between the chronological age and the dental age for males and females in the lower and higher socio-economic status groups. Underestimation of age was observed in both SES groups using the southern Chinese reference dataset. For the higher SES group, the difference between the chronological and dental age (CA-DA) was 0.26 years for females and 0.11 years for males. The difference was statistically significant only in females (p < 0.05). In the low SES group, the results showed a difference of 0.07 years in females and 0.01 years in males; the differences were not statistically significant in both sexes (p > 0.05). A strong correlation was observed between the CA and DA in both sex and SES groups ranging from 0.969 to 0.988 (p < 0.05). The southern Chinese dental reference dataset can be used to estimate the age of undocumented Cambodian male and female children and young adults of both higher and lower SES.

Thyroid cancer incidence is increasing, potentially due to enhanced diagnostic practices. However, access to healthcare may be dependent on socioeconomic status (SES) and race/ethnicity. Consequently, certain segments of the population may experience thyroid cancer overdiagnosis as a result of greater access to and use of enhanced diagnostic technology. The current study examined trends by SES in thyroid cancer incidence at the census tract level from 1995 to 2008 for the population of Texas, as well as by racial/ethnic subgroup. Joinpoint regressions were used to examine incidence trends over time by SES for the study population, and for the non-Hispanic white, non-Hispanic black, and Hispanic subgroups separately. Other race/ethnicities were not adequately represented for subgroup analyses. There were 22,390 incident thyroid cancer cases (65.0% white, 6.7% black, 24.3% Hispanic, 4.1% Asian/other races; 85.9% papillary histology). The low SES group experienced a steady increase in incidence since 1995 (6.7% per year, p<0.05), whereas incidence among the high SES group has increased at a rate of 8.6% per year since 1999 (p<0.05). The joinpoint projected incidence trends for the low and high SES groups were significantly different (p=0.047). Whites experienced a steady increase in incidence over time among both high and low SES groups (7.6% per year p<0.05), whereas blacks and Hispanics of higher SES had a much more pronounced increase in incidence over time relative to their lower SES counterparts (blacks=12.8% vs. 4.1%; Hispanics=11.2% vs. 8.3%, p<0.05). For blacks and Hispanics, joinpoint projected incidence trends for the low and high SES groups were significantly different from one another (p<0.001-0.004). These results identify groups experiencing the greatest problem of increasing thyroid cancer incidence, and raise concern that greater access to healthcare may be accompanied by thyroid cancer overdiagnosis. A dual focus on delineating and preventing disease-related causal factors and focusing clinical attention on avoiding overdiagnosis among certain populations (e.g., high SES) may be advisable to address thyroid cancer in Texas. Clinicians are encouraged to adhere to ATA/NCCN guidelines when choosing patients for thyroid ultrasound, selecting which nodules to examine, and deciding which patients should proceed to biopsy.

Artificial intelligence (AI) is increasingly applied to health care, yet concerns about fairness persist, particularly in relation to sociodemographic disparities. Previous studies suggest that socioeconomic status (SES) and sex may influence AI model performance, potentially affecting groups that are historically underserved or understudied. This study aimed to (1) assess algorithmic bias in AI-driven dementia prediction models based on SES and sex (biological sex), (2) compare the utility of an individual-level SES measure (the Housing-Based Socioeconomic Status [HOUSES] Index) versus an area-level measure (the Area Deprivation Index) for bias detection, and (3) evaluate the effectiveness of an oversampling technique (the Synthetic Minority Oversampling Technique for Nominal and Continuous features) for bias mitigation. This study used data from two population-based cohorts: the Mayo Clinic Study on Aging (n=3041) and the Rochester Epidemiology Project (n=19,572). Four AI models (random forest, logistic regression, support vector machine, and Naïve Bayes) were trained using a 5-year observation window of structured electronic health record data to predict dementia onset within the subsequent 1-year window. Fairness and model performance were assessed using the balanced error rate (BER) across intersecting SES-sex subgroups. The Synthetic Minority Oversampling Technique for Nominal and Continuous features algorithm was applied to the training data to balance the representation of SES groups. Across both cohorts, individuals with lower SES generally exhibited higher BERs (worse performance) than high SES groups, confirming the presence of bias. In the MCSA cohort, males with high SES, as indicated by the HOUSES Index, consistently exhibited the lowest BERs across all evaluated models. Balancing the training data based on a specific SES measure showed a trend toward reducing the BER disparity when evaluated using that same measure. However, this targeted improvement demonstrated nonuniversal benefits; in some cases, it exacerbated disparities when evaluated using other, unbalanced SES measures. This pattern suggests that fairness interventions are not universally beneficial across different definitions of the protected attribute. While the balancing approach improved fairness in model performance for lower SES groups, it often came at the cost of a slight reduction in overall model performance. However, an exception was observed in the MCSA cohort when balancing based on the HOUSES Index using logistic regression, support vector machine, and Naïve Bayes, where the performances of both the high and low SES groups improved. This research highlights the importance of incorporating sociodemographic context into AI modeling in health care. The choice of SES measure may lead to different assessments of algorithmic bias. The HOUSES Index, as a validated individual-level SES measure, may be more effective for bias mitigation than area-level measures. Future AI development should integrate bias mitigation strategies to ensure models do not reinforce existing disparities in health outcomes.

This study investigated the effectiveness of a storytelling-based morphological intervention program on the language and literacy knowledge and reading motivation of kindergarten children from low and mid socioeconomic status (SES) backgrounds. It also explored how these groups compared in change scores against a non-intervened high SES group. Employing a cluster randomization approach, this study included 158 kindergarten children, comprising intervention and comparison groups from low and mid SES backgrounds, as well as a non-intervened high SES group. Assessments were conducted on morphological awareness (MA), print concepts, vocabulary, and reading motivation. Children in the intervention groups showed better performance in MA and print concept scores than those in their respective comparison groups. The mid SES intervention group also displayed significant improvement in vocabulary and motivation scores compared to its counterpart. When examining the effects of SES on change scores, the low SES intervention group achieved superior results in vocabulary and print concept scores compared to both the mid SES intervention and the non-intervened high SES groups. For reading motivation, the mid SES group outperformed the low SES group. The morphological intervention program using storytelling positively impacts both the literacy skills and reading motivation of kindergarten children, especially those from low and mid SES backgrounds. This study emphasizes the significance of designing interventions that cater to the distinct educational needs of children from different SES backgrounds.

Background Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover. Purpose The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia. Methods Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked. Results Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups. Conclusion This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship

Objectives: To describe the trends in contraceptive provision in general practice in the Netherlands from 1971-1996 and to investigate whether there has been a difference in contraceptive prevalence according to socioeconomic status.Subjects and setting: Patients in four general practices in and around Nijmegen, the Netherlands, from 1971 to 1996 totalling 83,616 female patient years and 82,237 male patient years.Method: Data on contraceptive provision were obtained from the Nijmegen Continuous Morbidity Registration Project. This project has been running since 1971 in the study general practices. Trends in first prescription of oral contraceptives, insertion of the intra-uterine device (IUD) and referral for male and female sterilisation were described for the different socioeconomic status groups. Trends in repeat oral contraceptive prescription, prevalence of IUD use and sterilisation prevalence were also described.Results: Oral contraceptives were the main contraceptive provided throughout the time period studied. Oral contraceptive prescription rates peaked in the mid-1970s before declining. Increases in sterilisation referral and IUD insertion rates then followed. The high socioeconomic status (SES) group has consistently had the lowest rates of first and repeat prescriptions of oral contraceptives. In the 1970s the highest incidence and prevalence of sterilisation was in the low SES group, whereas by the 1980s it was seen in the high SES group. Until the late 1980s, IUD insertion rates and prevalence were consistently lower in the low SES group. By 1996 prevalence in all three groups was similar.Conclusion: Trends in contraceptive use appear to have been dictated primarily by trends in oral contraceptive use. Differences according to SES emerged; these varied from those observed in other countries. Eur J Gen Pract 1999;5:54-8.

The distribution of subcutaneous fat at the triceps and subscapular skinfold sites is described for four groups of children living in Guatemala. These groups are high socioeconomic status (SES) children of Ladino (mixed Spanish and Indian) ancestry, high SES children of European ancestry, low SES Ladino children, and very low SES Indian children. The method of Healy and Tanner (1981) is used, employing regression and principal components analysis of log transformed skinfold values to divide "fatness" into two uncorrelated variables: size (amount of fat) and shape (fat pattern). Significant differences exist between groups in size, with lower SES groups having less fat than higher SES groups. No significant difference in fat pattern exists between the high SES Ladino and high SES European children. Significant differences do exist between the high SES groups and the low SES groups. The relative amount of subscapular fat increases from the high SES Ladinos and high SES Europeans, to the low SES Ladinos, to the very low SES Indians. In the high SES European and high SES Ladino samples, girls have significantly more arm fat than boys. There is no significant difference in fat patterning between boys and girls in the two low SES samples. Finally, the relative amount of subscapular fat tends to increase with age in all four samples. These results indicate that fatness and fat patterning are independent anatomical characteristics, SES influences fat patterning; low SES children of both Ladino and Indian ancestry show greater reductions in arm fat than in trunk fat compared to high SES children, sexual dimorphism in fat patterning is SES dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

182 The Impact of Socioeconomic Status on the Outcomes of Transcatheter Aortic Valve Implantation (TAVI)

Socioeconomic status and stress-induced increases in interleukin-6

Commentary: Jumping the gun or asleep at the switch: is there a middle ground?

BackgroundChildren from low socioeconomic status (SES) households are more likely to have lower self-esteem, and parents with higher self-esteem are more likely to engage in favorable parenting practices. Therefore, parental self-esteem plays a critical role in child development. This study examined the association between childhood SES and current self-esteem among parents raising preschool-aged children.MethodsAn online survey was conducted in September 2023 with 1,200 parents of children aged 3-6 years. Childhood SES was assessed using a five-point scale and categorized into three groups (low, middle, high). Current self-esteem was measured using the Japanese version of the Rosenberg Self-Esteem Scale (RSES-J). Multiple regression analyses were conducted: Model 1 adjusted for gender and age; Model 2 additionally adjusted for current SES (living conditions, education, employment); and Model 3 further adjusted for depressive symptoms using the K6 scale.ResultsOf the participants, 21.0% were classified as having low childhood SES. The mean RSES-J scores were 24.0 (SD = 5.6), 25.4 (SD = 4.8), and 26.7 (SD = 5.6) for the low, middle, and high childhood SES groups, respectively. In Model 1, both the low and middle SES groups had significantly lower self-esteem than the high SES group (β = -0.208, p < 0.001; β = -0.134, p < 0.001). In Model 2, only the low SES group remained significant (β = -0.121, p < 0.001). In Model 3, both the low and middle groups remained statistically significant (β = -0.081, p = 0.005; β = -0.061, p = 0.038).ConclusionsChildhood SES was significantly associated with current self-esteem among parents, even after adjusting for adult SES and depressive symptoms. These findings suggest that the intergenerational transmission of poverty may lead to lower self-esteem in both children and their parents. Addressing childhood poverty and strengthening protective factors such as social support are essential to breaking the cycle of disadvantage.Key messages• Self-esteem scores were higher among fathers than mothers, and were consistently higher among those with higher SES levels in both childhood and adulthood.• The results highlight that early socioeconomic disadvantage can have enduring effects on adult self-esteem, stressing the importance of early intervention.

Poor feeding practices among young children lead to malnutrition, and the poor are at a greater risk than the better off groups. Child-feeding practices in various socio-economic strata, especially in urban settings, have not yet been well studied in Indonesia. This study aims to explore the feeding practices of 12-23 months old children from different socio-economic status (SES) groups. A cross-sectional survey was conducted, which included low (n 207), medium-high (n 205), medium-low (n 208) and high SES households (n 194) in forty-three villages within thirty-three sub-districts of Bandung city. Two non-consecutive 24 h recall and eight core indicators of child-feeding practices were assessed through interviews. The results showed that children from the high SES group were more likely to be exclusively breast-fed and to continue breast-feeding up to 1 year of age, met minimum dietary diversity and minimum acceptable diet, and also consumed Fe-rich or Fe-fortified foods. In contrast, children from low SES consumed more energy-rich food (grain) but fewer foods from the other food groups. Consumption of major nutrients differed across the SES groups. Inadequate nutrition was higher among children from the lower SES groups. Fortified foods were consumed by a larger proportion of children from the high SES group and contributed considerably to their overall nutrient intake. This study shows that young children's feeding practices were not adequate, most notably among the low SES households. However, after adjusting with potential confounders, there was not enough evidence to conclude SES as a risk factor for feeding practice.

This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979-2003), which includes overall declines in male suicide from 1998. Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979-2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban-rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles). Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban-rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20-34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P<0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994-1998 to 48.6 in 1999-2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20-34 years). This study shows that SES differentials in suicide persisted in Australia for most of the period 1979-2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs.

Development of selective attention in preschool-age children from lower socioeconomic status backgrounds

This study investigates secular trends in ischaemic heart disease (IHD) and stroke mortality by socioeconomic status (SES) in Australia to determine if absolute and relative differences between low and high SES areas have changed over time. IHD and stroke mortality data for adults aged 35-74 years and corresponding population data from Australian censuses for 1979-2006 were stratified into quintiles using an area-based measure of SES and analysed by quinquennia (and 2004-06). IHD and stroke (rates per 100,000) adjusted for age, country of birth, and rurality were compared across SES strata (separately by sex) using Poisson regression. Mortality declined monotonically over the study period in all SES groups and both sexes. Absolute differences between low and high SES groups narrowed for IHD in females (27 to 23 per 100,000) and stroke in males and females (16 to 13, and 13 to 7 per 100,000, respectively), although absolute differences widened for IHD in males (52 to 63 per 100,000). Relative declines were greater in high compared to low SES groups for IHD (28% average quinquennial decline in high SES; compared with 21% in low SES for males; 30% and 21% for females), and for stroke (25% average quinquennial decline in high SES; 21% in low SES for males; 26% and 23% for females). Differences in mortality rates between lower and higher SES groups narrowed for both IHD (in females) and stroke (in males and females) from 1979-2006, indicating that the epidemic decline is now at a late stage when low SES groups are benefiting more, in absolute terms, than high SES groups. However males in the lower SES groups are still at an earlier stage of the epidemic decline in IHD mortality.