Adjustment For Individual Socioeconomic Status Research Articles

Abstract 12275: Neighborhood Deprivation Predicts All-Cause and Cardiovascular Mortality in a Low-Income Population in the Southeastern United States

Background: Neighborhood disadvantage impacts individuals’ morbidity and mortality and contributes to health disparities, but prospective cohort data from individuals of low socioeconomic status (SES) are limited. Hypothesis: Greater neighborhood deprivation associates with higher all-cause and cardiovascular (CV) mortality beyond individual SES, lifestyle, and clinical factors in a multi-racial, low-income population. Methods: The Southern Community Cohort Study is a population-based cohort of mostly low SES individuals recruited from 12 southeastern US states between 2002-2009. Participant addresses were linked with a census tract-based neighborhood deprivation index (NDI) derived from neighborhood level income, education, employment, housing, and occupation data. Date and cause of death were ascertained via the National Death Index. Cox proportional hazard models were used to test associations between NDI and death adjusted for enrollment age, sex, self-reported race, education, income, insurance, smoking, physical activity, alcohol intake, diet, sleep duration, BMI, and diabetes, hypertension, depression, cancer, heart disease, and stroke. Results: Among 79,631 participants, median age was 51 years (25 th -75 th percentiles: 45-58), 69% were Black, and 60% were female. Over a median 13-year follow-up, 23,356 participants died, of which 7,214 (30.9%) were CV. With adjustment for age, sex, and race, per standard deviation (SD) increase in NDI was associated with a 19% increase in all-cause mortality (HR 1.19, 95% CI 1.18-1.21) and 16% increase in CV mortality (HR 1.16, 95% CI 1.13-1.19). Even with adjustment for individual SES, lifestyle, and clinical factors, NDI was associated with a 6% increased risk in all-cause mortality (HR per SD increase 1.06, 95% CI 1.03-1.08) and 8% increase in CV mortality (HR 1.08, 95% CI 1.05-1.11). NDI showed similar significant associations with all-cause and CV mortality in Black and White participants. Conclusion: Among low-income Americans, greater neighborhood deprivation associates with higher all-cause and CV mortality independent of individual SES, lifestyle, and clinical risk factors. More research is needed to examine factors underlying the health effects of neighborhood deprivation.

Associations of exposure to surrounding green, air pollution and traffic noise with mortality in a large national health survey

PDS 70: Green space, Johan Friso Foyer, Floor 1, August 28, 2019, 1:30 PM - 3:00 PM Background/Aim: Most previous studies investigated associations of mortality with air pollution, traffic noise and surrounding green focusing on single exposures. We evaluated associations of combined long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental mortality in a large health survey. Methods: A national health survey, conducted in 2012, covering personal characteristics, lifestyle and socio-economic status (SES), was linked to the Dutch longitudinal mortality database. Subjects of the survey who were 30 years or older on 1 January 2013 (n=339,633) were followed from 1 January 2013 to 31 December 2017. Subjects with missing lifestyle data were more likely to die during follow-up. We therefore applied multiple imputation of missing values using chained equations to impute missing values for potential confounders. We used Cox proportional hazard models to evaluate associations of residential surrounding green (the average Normalized Difference Vegetation Index (NDVI) in buffers of 300m and 1000m), annual average air pollutant concentrations (including particulate matter (PM10, PM2.5), NO2) and traffic noise with mortality. Results: In the 5-year follow-up, we observed 26,886 non-accidental deaths. After adjustment for individual SES, lifestyle factors, such as physical activity and smoking status, and neighborhood SES, we found no significant associations with non-accidental mortality for any of the exposures. For example, an interquartile range (IQR, 0.13) increase in NDVI 300m was associated with a HR of 0.99 (95% CI: 0.98, 1.01) in natural mortality, an IQR (7.6 µg/m3) increase in NO2 was associated with a HR of 0.99 (95% CI: 0.97, 1.01) and an IQR (7.4 dB) increase in road-traffic noise was associated with a HR of 0.99 (95% CI: 0.97, 1.01). Conclusion: We found no evidence for effects of long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental mortality in a large population based survey in the Netherlands.

Causal nature of neighborhood deprivation on individual risk of coronary heart disease or ischemic stroke: A prospective national Swedish co-relative control study in men and women

We studied the association between neighborhood socioeconomic status (SES) and incidence of coronary heart disease (CHD) or ischemic stroke in the total population and in full- and half-siblings to determine whether these associations are causal or a result from familial confounding. Data were retrieved from nationwide Swedish registers containing individual clinical data linked to neighborhood of residence. After adjustment for individual SES, the association between neighborhood SES and CHD showed no decrease with increasing genetic resemblance, particularly in women. This indicates that the association between neighborhood SES and CHD incidence is partially causal among women, which represents a novel finding.

Abstract 310: Neighborhood Socioeconomic Context Predicts Cardiac Rehabilitation Participation Above and Beyond Individual Socioeconomic Status

Background: Cardiac rehabilitation (CR) is underutilized in the United States, with less than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but the effect of neighborhood socioeconomic context on CR use has not been described. We investigated the association of CR participation with neighborhood socioeconomic context in the Southern Community Cohort Study (SCCS). Methods: The SCCS is a prospective cohort study of 84,569 largely poor adults in the southeastern United States, of which 52,117 participants have Medicare or Medicaid claims. Using these claims data, we identified SCCS participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery or cardiac valve surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a previously validated neighborhood deprivation index. This index was derived using 11 census-tract level variables including median household value and percentage of households with public assistance income. We used multivariable-adjusted logistic and Cox regression to evaluate the association of CR participation with neighborhood socioeconomic context and mortality. Results: A total of 4456 SCCS participants (56% female, 59% Black) were eligible for CR at a mean age of 60.5 + 9.1 years and an average of 4.0 + 2.5 years after study enrollment. CR utilization was low as expected, with 308 subjects (6.9%) participating in CR programs. CR participation is inversely associated with all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.39-0.70, p=<0.0001) and cardiovascular disease (CVD) mortality (HR 0.38, 95% CI 0.22-0.65, p=<0.001) after multivariable adjustment. Neighborhood socioeconomic context is strongly associated with CR participation after adjustment for individual socioeconomic status (educational level and household income) as well as rural status (Table). Conclusions: Neighborhood socioeconomic context predicts CR participation in addition to individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.

Socioeconomic status, child enrichment factors, and cognitive performance among preschool-age children: Results from the Follow-Up of Growth and Development Experiences study

Lower cognitive performance is associated with poorer health and functioning throughout the lifespan and disproportionately affects children from lower socioeconomic status (SES) populations. Previous studies reporting positive associations between child home enrichment and cognitive performance generally had a limited distribution of SES. We evaluated the associations of SES and child enrichment with cognitive performance in a population with a wide range of SES, particularly whether enrichment attenuates associations with SES. Children were sampled from a case-control study of small-for-gestational-age (SGA) conducted in a public hospital serving a low SES population (final n=198) and a private hospital serving a middle-to-high SES population (final n=253). SES (maternal education and income) and perinatal factors (SGA, maternal smoking and drinking) were obtained from maternal birth interview. Five child home enrichment factors (e.g. books in home) and preschool attendance were obtained from follow-up interview at age 4.5 years. Cognitive performance was assessed with the Differential Ability Scales (DAS), a standardized psychometric test administered at follow-up. SES and enrichment scores were created by combining individual factors. Analyses were adjusted for perinatal factors. Children from the public birth hospital had a significantly lower mean DAS general cognitive ability (GCA) score than children born at the private birth hospital (adjusted mean difference -21.4, 95% CI: -24.0, -18.7); this was substantially attenuated by adjustment for individual SES, child enrichment factors, and preschool attendance (adjusted mean difference -5.1, 95% CI: -9.5, -0.7). Individual-level SES score was associated with DAS score, beyond the general SES effect associated with hospital of birth. Adjustment for preschool attendance and home enrichment score attenuated the association between individual SES score and adjusted mean DAS-GCA among children born at both of the hospitals. The effect of being in the lower compared to the middle tertile of SES score was reduced by approximately a quarter; the effect of being in the upper compared to the middle tertile of SES score was reduced by nearly half, but this comparison was possible only for children born at the private hospital. A child's individual SES was associated with cognitive performance within advantaged and disadvantaged populations. Child enrichment was associated with better cognitive performance and attenuated the SES influence. Health care providers should reinforce guidelines for home enrichment and refer children with delays to early intervention and education, particularly children from disadvantaged populations.

Neighbourhood socioeconomic status and individual lung cancer risk: Evaluating long-term exposure measures and mediating mechanisms

Neighbourhood socioeconomic status (SES) has been associated with numerous chronic diseases, yet little information exists on its association with lung cancer incidence. This outcome presents two key empirical challenges: a long latency period that requires study participants' residential histories and long-term neighbourhood characteristics; and adequate data on many risk factors to test hypothesized mediating pathways between neighbourhood SES and lung cancer incidence. Analysing data on urban participants of a large Canadian population-based lung cancer case-control study, we investigate three issues pertaining to these challenges. First, we examine whether there is an association between long-term neighbourhood SES, derived from 20 years of residential histories and five national censuses, and lung cancer incidence. Second, we determine how this long-term neighbourhood SES association changes when using neighbourhood SES measures based on different latency periods or at time of study entry. Third, we estimate the extent to which long-term neighbourhood SES is mediated by a range of individual-level smoking behaviours, other health behaviours, and environmental and occupational exposures. Results of hierarchical logistic regression models indicate significantly higher odds of lung cancer cases residing in the most compared to the least deprived quintile of the long-term neighbourhood SES index (OR: 1.46; 95% CI: 1.13–1.89) after adjustment for individual SES. This association remained significant (OR: 1.38; 1.01–1.88) after adjusting for smoking behaviour and other known and suspected lung cancer risk factors. Important differences were observed between long-term and study entry neighbourhood SES measures, with the latter attenuating effect estimates by over 50 percent. Smoking behaviour was the strongest partial mediating pathway of the long-term neighbourhood SES effect. This research is the first to examine the effects of long-term neighbourhood SES on lung cancer risk and more research is needed to further identify specific, modifiable pathways by which neighbourhood context may influence lung cancer risk.

Associations of Fast Food Restaurant Availability With Dietary Intake and Weight Among African Americans in the Jackson Heart Study, 2000–2004

We examined the associations of fast food restaurant (FFR) availability with dietary intake and weight among African Americans in the southeastern United States. We investigated cross-sectional associations of FFR availability with dietary intake and body mass index (BMI) and waist circumference in 4740 African American Jackson Heart Study participants (55.2 ± 12.6 years, 63.3% women). We estimated FFR availability using circular buffers with differing radii centered at each participant's geocoded residential location. We observed no consistent associations between FFR availability and BMI or waist circumference. Greater FFR availability was associated with higher energy intake among men and women younger than 55 years, even after adjustment for individual socioeconomic status. For each standard deviation increase in 5-mile FFR availability, the energy intake increased by 138 kilocalories (confidence interval [CI] = 70.53, 204.75) for men and 58 kilocalories (CI = 8.55, 105.97) for women. We observed similar associations for the 2-mile FFR availability, especially in men. FFR availability was also unexpectedly positively associated with total fiber intake. FFR availability may contribute to greater energy intake in younger African Americans who are also more likely to consume fast food.

Neighborhood Socioeconomic Status in Relation to 10‐Year Weight Gain in the Black Women's Health Study

We prospectively assessed the association of neighborhood socioeconomic status (SES) with 10-year weight change and with incident obesity among 48,359 women in the Black Women's Health Study (BWHS). Lower neighborhood SES was significantly associated with 10-year weight gain after adjustment for individual SES and behavioral variables, such as physical activity and caloric intake. Low neighborhood SES was also associated with increased incidence of obesity during 10 years of follow-up among women of normal weight at baseline (BMI <25kg/m(2)). The associations were most evident among BWHS participants who had graduated from college. These prospective data suggest that lower neighborhood SES contributes to overweight and obesity in African-American women.

Failure of antibiotics in a case of staphylococcal bacteriaemia.

<h3>Objective:</h3> To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. <h3>Methods:</h3> The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003–2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. <h3>Results:</h3> After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05–1.56) in quartile 3 to 1.38 (1.13–1.68) in quartile 2 to 1.56 (1.26–1.92) in quartile 1 (<i>p</i> &lt; 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (<i>p</i> = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. <h3>Conclusions:</h3> Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants.