Area-level Socioeconomic Factors Research Articles

Area and individual level analyses of demographic and socio-economic disparities in COVID-19 vaccination uptake in Belgium

Vaccination has played a major role in overcoming the COVID-19 pandemic. However, vaccination status can be influenced by demographic and socio-economic factors at individual and area level.In the context of the LINK-VACC project, the Belgian vaccine register for the COVID-19 vaccination campaign was linked at individual level with other registers, notably the COVID-19 laboratory test results and demographic and socio-economic variables from the DEMOBEL database. The present article aims at investigating to which extent COVID-19 vaccination status is associated with area level and/or individual level demographic and socio-economic factors. From a sample of all individuals tested for SARS-CoV-2 (LINK-VACC sample) demographic and socio-economic indicators are derived and their impact on vaccination coverages at an aggregated geographical level (municipality) is quantified. The same indicators are calculated for the full Belgian population, allowing to assess the representativeness of the LINK-VACC sample with respect to the impact of demographic and socio-economic disparities on vaccination uptake.In a second step, hierarchical models are fitted to the individual level LINK-VACC data to disentangle the individual and municipality effects allowing to evaluate the added value of the availability of individual level data in this context.The most important effects observed at the individual level are reflected in the aggregated data at the municipality level. Multilevel analyses show that most of the demographic and socio-economic impacts on vaccination are captured at the individual level, although accounting for area level in individual level analyses improve the overall description.

Platform Urbanism and “Splintering Amenitization”: An Analysis of Canadian Cities

This article engages with the spatialities of platform urbanism by foregrounding where digital platforms are located in cities. Drawing on a geocoded data set of visible, material traces of platformization collected across neighborhoods in Toronto, Vancouver, and Montreal, we consider the influences that characteristics of urban built environments—including existing amenities, urban morphology, and area-level socioeconomic factors—have on platforms’ locations. Through a Poisson regression of these variables, we find that the presence of existing urban amenities most strongly explains the locations of material traces of urban platformization on the cityscape at the city block scale. We position platforms themselves as a novel amenity class that extends emplaced utility and lifestyle functions to urban residents. In so doing, we contend that the platformization of urban landscapes constitutes a form of “splintering amenitization,” wherein platformized urban amenities demonstrate spatial patterns of colocating with other, existing urban amenities in already amenity-rich areas to the exclusion of amenity-poor enclaves. This, we argue, is important because neighborhoods’ abilities to attract amenities are central to how enclaves both position themselves and compete for status within urban spatial hierarchies.

Impact of socioeconomic disparities on outcomes in adults undergoing allogeneic hematopoietic cell transplantation for acute myeloid leukemia.

Racial and socioeconomic disparities impact outcomes after chemotherapy and limit access to allogeneic hematopoietic cell transplantation (HCT) in acute myeloid leukemia (AML), yet studies have yielded mixed results on the influence of disparities on post-HCT outcomes. Therefore, we studied 1024 adults with AML who underwent allogeneic HCT between 5/2006 and 10/2021 at a single large university-affiliated cancer center. Collected data included non-biologic and demographic characteristics (including race/ethnicity, marital status, distance traveled, and household size), transplant- and disease-related characteristics, and area-level and individual-level socioeconomic factors (i.e., area deprivation index and occupational status). After multivariable adjustment, no socioeconomic- or non-biologic factors were associated with non-relapse mortality (NRM), overall survival (OS), relapse-free survival (RFS), or relapse except being married (associated with improved NRM: hazard ratio [HR] = 0.7 [0.50-0.97]) and having no insurance (associated with worse OS: HR = 1.49 [1.05-2.12] and RFS: HR = 1.41 [1.00-1.98]). Despite a relatively racially homogenous cohort, Asian race was associated with improved NRM (HR = 0.47 [0.23-0.93]) and American Indian/Alaskan Native race was associated with higher relapse risk (HR = 2.45 [1.08-5.53]). In conclusion, in our retrospective analysis, socioeconomic-, demographic-, and non-biologic factors had limited impact on post-HCT outcomes in AML patients allografted in morphologic remission. Further research is needed to investigate disparities among HCT-eligible patients.

Hospital Capabilities Associated With Behavioral Health Integration Within Emergency Departments.

To identify hospital capabilities associated with behavioral health (BH) processes in emergency departments (EDs). Six hundred two hospital responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2017 American Hospital Association Annual Survey data. Separate multivariable regressions estimated how hospital capabilities (the use of quality improvement methods, approaches to disseminate best patient-care practices, barriers to using care delivery innovations, and inpatient beds for psychiatric or substance use) were associated with each of 4 ED-based BH processes: mental health and substance use disorder screening, team-based approaches to BH, telepsychiatry, and direct referrals to community-based BH clinicians. Models controlled for hospital structural characteristics and area-level socioeconomic factors. Most hospitals screened for BH conditions and provided direct referrals to community-based BH clinicians. Approximately half of the hospitals used a team approach to BH. A minority had implemented telepsychiatry. Each additional process used to disseminate best patient-care practices was associated with more screening for BH conditions (an increase of 4.07 points on the screening index, P <0.01) and greater likelihood of using a team approach to BH [4.41 percentage point ( P <0.01) increase]. Hospitals reporting more barriers to the use of care delivery innovations reported less screening and use of a team approach [a decrease of 0.15 points on the screening index ( P <0.01) and 0.28 percentage points reduction in likelihood of team approach use ( P <0.001) for 1-point increase in the barrier index]. Research and interventions focused on removing innovation barriers or adding processes to disseminate best practices offer a path to accelerate BH integration in hospital EDs.

Deaths of despair in England: an observational study of local authority mortality data

BackgroundDeaths of Despair (DoD) are socially patterned causes of death encompassing drug and alcohol misuse and suicide. DoDs are strongly associated with socioeconomic disadvantage. England has high levels of inequalities, so we hypothesised the existence of marked geographical variations in DoD. We aimed to yield new knowledge on the spatial distribution of DoD, and area-level socioeconomic factors that predict DoD risk in England. MethodsThis observational study was conducted using ICD-10 coded deaths for 307 local authorities in England during 2019–21. Deaths were grouped to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The mean contributions of each of these causes to the total number of DoD in England were calculated with Poisson exact confidence intervals. Standardised mortality ratios (SMRs) for DoD were generated for each local authority population. A multivariable regression model for DoD risk was developed using 25 socioeconomic variables. FindingsAn estimated 46 200 people lost their lives due to DoD between Jan 1, 2019, and Dec 31, 2021. Regional SMRs ranged from 57·4 (SD 16·1) in London to 144·1 (SD 26·8) in the northeast of England (p<0·0001). Alcohol-specific deaths were the largest contributor of DoD, accounting for 44·1% of DoD (95% CI 43·5–44·8), followed by drug-related death (28·1%, 27·7–28·6) and suicide (27·7%, 27·2–28·2). Living in the North, living alone, White British ethnicity, lower inward migration, economic inactivity, income deprivation in older people, employment in elementary occupations, unemployment, and education deprivation in adults were significantly associated with higher DoD rates in England. InterpretationDoD in England are spatially patterned, with northern regions experiencing a considerably higher burden of mortality from these avoidable causes. A key limitation is ecological bias. This study provides novel insights into area-level risk factors for DoD in England. FundingNational Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM).

Area-level geographic and socioeconomic factors and the local incidence of SARS-CoV-2 infections in Queensland between 2020 and 2022

ObjectiveCalculate the incidence of SARS-CoV-2 (COVID-19) infection notifications and the influence of area-level geographic and socioeconomic factors in Queensland using real-time data from the COVID-19 Real-time Information System for Preparedness and Epidemic Response (CRISPER) project. Design and settingPopulation-level ecological study and spatial mapping of the incidence of COVID-19 infection notifications in Queensland, by postcode, 2020–2022. Main outcome measuresProportions and distribution of COVID-19 infection notifications by year, age-group, socioeconomic disadvantage, and geospatial mapping. Incidence rate ratios (IRRs) were calculated. ResultsBetween 28 January 2020 and 30 June 2022, a total of 609,569 cases of COVID-19 associated with a Queensland postcode were recorded. The highest proportion of cases occurred in 2022 (96.5%), and in the 20- to 24-year age category (IRR = 1.787). In non–Major City areas, there was also a higher incidence of COVID-19 cases in lower socioeconomic areas (IRR = 0.84) than in higher socioeconomic areas (IRR = 0.66). ConclusionsQueensland experienced its highest proportion of COVID-19 cases once domestic and international borders opened. However, geographic and socioeconomic factors may have still contributed to a higher incidence of COVID-19 cases across some Queensland areas. Implications for Public HealthAlthough Australia has moved from the emergency response phase of the COVID-19 pandemic, we need to ensure ongoing prevention strategies target groups and areas that we have identified with the highest incidence.

Effects of school-level and area-level socio-economic factors on elementary school student COVID-19 infections: a population-based observational study

ObjectivesTo estimate the variability of the cumulative incidence of SARS-CoV-2 infections among elementary school students attributable to individual schools and/or their geographic areas, and to ascertain whether socio-economic characteristics of...

Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study

BackgroundFine particulate matter (PM2.5) is a well-recognized risk factor for premature death. However, evidence on which PM2.5 components are most relevant is unclear. MethodsWe evaluated the associations between mortality and long-term exposure to eight PM2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM2.5 mass. ResultsOf 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03–1.05), RF-Si (1.01; 1.00–1.02), SLR-K (1.03; 1.02–1.04), and RF-K (1.06; 1.05–1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality. ConclusionsWe present novel results of the relevance of different PM2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.

Association and Interaction of Genetics and Area-Level Socioeconomic Factors on the Prevalence of Type 2 Diabetes and Obesity.

Quantify the impact of genetic and socioeconomic factors on risk of type 2 diabetes (T2D) and obesity. Among participants in the Mass General Brigham Biobank (MGBB) and UK Biobank (UKB), we used logistic regression models to calculate cross-sectional odds of T2D and obesity using 1) polygenic risk scores for T2D and BMI and 2) area-level socioeconomic risk (educational attainment) measures. The primary analysis included 26,737 participants of European genetic ancestry in MGBB with replication in UKB (N = 223,843), as well as in participants of non-European ancestry (MGBB N = 3,468; UKB N = 7,459). The area-level socioeconomic measure most strongly associated with both T2D and obesity was percent without a college degree, and associations with disease prevalence were independent of genetic risk (P < 0.001 for each). Moving from lowest to highest quintiles of combined genetic and socioeconomic burden more than tripled T2D (3.1% to 22.2%) and obesity (20.9% to 69.0%) prevalence. Favorable socioeconomic risk was associated with lower disease prevalence, even in those with highest genetic risk (T2D 13.0% vs. 22.2%, obesity 53.6% vs. 69.0% in lowest vs. highest socioeconomic risk quintiles). Additive effects of genetic and socioeconomic factors accounted for 13.2% and 16.7% of T2D and obesity prevalence, respectively, explained by these models. Findings were replicated in independent European and non-European ancestral populations. Genetic and socioeconomic factors significantly interact to increase risk of T2D and obesity. Favorable area-level socioeconomic status was associated with an almost 50% lower T2D prevalence in those with high genetic risk.

70-OR: Association of Diabetes Screening with Demographic, Neighborhood Level Census, and Area Gentrification Characteristics

Research assessing predictors of preventive screening often focuses on individual patient factors, despite known relationships between neighborhood environment and health. Using a retrospective cohort study of 519,826 patients meeting US Preventive Service Task Force guideline recommendation for screening for prediabetes and type 2 diabetes (age 35-70 years and BMI ≥25) from Kaiser Permanente Northern California in 2018, we used logistic regression to assess the relationship between diabetes screening and census neighborhood tract-level measures, and area gentrification measures developed by the Urban Displacement Project, controlling for age, sex, race, ethnicity, and BMI. Thirty-eight percent of patients were screened for diabetes. Patients aged 60-70 years had higher odds of diabetes screening compared to patients aged 35-39 years (OR: 2.73, 95% CI: 2.67-2.78) . Men had lower odds of screening compared to women (OR: 0.91, 0.90-0.92) . Asian patients had higher odds of screening compared to White patients (OR 1.44, 1.42-1.46) . Patients with BMI ≥40 had higher odds of screening compared to patients with BMI 25-29.9 (OR: 1.34, 1.30-1.37) . Patients living in census tracts with the lowest median values of homes (OR: 0.93, 0.90-0.96) and with the lowest median household income (OR: 0.95, 0.91-0.99) had lower odds of diabetes screening compared to those in census tracts with the highest values. Patients living in census tracts classified as Ongoing Displacement/Low Income Susceptible to Displacement had lower odds of screening (OR: 0.96, 0.93-0.98) compared to those living in stable moderate mixed income tracts. We found insufficient screening rates and that gentrification and area-level socioeconomic factors were associated with lower diabetes screening, even after adjusting for individual demographic and clinical factors. Health care systems should consider addressing social needs and community resources as a path to improving preventive care. Disclosure T.Thomas: None. W.T.Dyer: None. L.A.Rodriguez: None. J.Schmittdiel: None. Funding Kaiser Permanente Northern California Community Benefit Programs; The Permanente Medical Group (TPMG) Delivery Science Fellowship Program; National Institute of Diabetes and Digestive and Kidney Diseases grant T32DK11668401. Dr. Schmittdiel received additional support from the NIDDK-funded Health Delivery Systems Center for Diabetes Translational Research (1P30 DK92924) .

Area‐level social and economic factors and the local incidence of SARS‐CoV‐2 infections in Victoria during 2020

ObjectiveTo examine associations between area‐level socio‐economic factors and the incidence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections in Victoria during 2020.Design, settingPopulation‐level ecological study of the incidence of SARS‐CoV‐2 infections in Victoria, by postcode, 1 March ‒ 13 August 2020.Main outcome measuresRelationships between the incidence of SARS‐CoV‐2 infections by postcode (Department of Health and Human Services data published on The Age website), and demographic, education level, ethnic background, economic and employment‐related factors, housing‐related factors, and social disadvantage (Australian Bureau of Statistics data for 2014–19), expressed as incidence rate ratios (IRRs).ResultsDuring the study period, 15 482 SARS‐CoV‐2 infections with associated postcodes were recorded in Victoria. Incidence was higher for metropolitan than regional postcodes (418.3 v 62 infections per 100 000 population; IRR, 6.2; 95% CI, 4.6–8.2). In regional postcodes, incidence rose with mean household size (per person: IRR, 7.30; 95% CI, 4.37–12.2), unemployment proportion (per percentage point: IRR, 1.50; 95% CI, 1.33–1.69), and proportions for whom rent (IRR, 1.15; 95% CI, 1.07–1.22) or mortgage repayments (IRR, 1.22; 95% CI, 1.15–1.28) exceeded 30% of household income. In metropolitan areas, incidence increased with unemployment proportion (IRR, 1.14; 95% CI, 1.05–1.23) and proportion without paid leave (IRR, 1.22; 95% CI, 1.02–1.45). Incidence also increased with proportion speaking languages other than English at home (regional: IRR, 1.08; 95% CI, 1.06–1.11; metropolitan: IRR, 1.01; 95% CI, 1.002–1.02) and with Indigenous Australian proportion (metropolitan only: IRR, 1.91; 95% CI, 1.10–2.73).ConclusionsSocio‐economic factors may have contributed to the non‐homogeneous incidence of SARS‐CoV‐2 infections across Victoria during 2020.

Neural Impact of Neighborhood Disadvantage in Traumatically-Injured Adults: A Multi-Modal Investigation

Over 13 percent of Americans live in a socioeconomically disadvantaged neighborhood. Chronic exposure to stressors, including socioeconomic stressors, are significantly associated with poor outcomes. Previous work has linked lower individual socioeconomic position to alterations in brain structure and function. However, the neural effects of area-level socioeconomic factors, such as neighborhood disadvantage, are unclear.

68415 Neural Impact of Neighborhood Disadvantage in Traumatically-Injured Adults: a Multi-Modal Investigation

ABSTRACT IMPACT: Neighborhood disadvantage was significantly associated with brain structure and function in trauma-exposed adults, providing evidence that contextual factors should be assessed in mental health research, particularly in high-risk populations. OBJECTIVES/GOALS: Over 13 percent of Americans live in a socioeconomically disadvantaged neighborhood. Previous work has linked lower individual socioeconomic position to alterations in brain structure and function. However, the neural effects of area-level socioeconomic factors, such as neighborhood disadvantage, are unclear. METHODS/STUDY POPULATION: We recruited two-hundred and fifteen traumatically-injured participants from an Emergency Department in southeastern Wisconsin. An Area Deprivation Index (ADI) score, a national measure of neighborhood socioeconomic disadvantage, was derived from each participant’s home address. Two-weeks post-trauma, participants underwent a battery of self-report measures and functional magnetic resonance imaging (fMRI) scans. Using a multi-modal approach, we investigated the impact of ADI on brain structure as well as neural activation during rest and during an emotional uncertainty task. We sought to disentangle the relationship between neighborhood and individual socioeconomic position and neural activity in the context of trauma. RESULTS/ANTICIPATED RESULTS: We demonstrated that neighborhood disadvantage is associated with decreased volume and alterations of resting state functional connectivity of structures implicated in affect processing, including the hippocampus, amygdala, and ventromedial prefrontal cortex. These results held even after controlling for relevant individual variables, including acute post-traumatic stress symptoms and years of education. Moreover, individuals from disadvantaged neighborhoods exhibited heighted activation of these same structures in response to aversive stimuli. Thus, brain regions critical for recognizing and processing negative stimuli are susceptible to the effects of area-level socioeconomic factors. DISCUSSION/SIGNIFICANCE OF FINDINGS: The results offer additional evidence that neurobiological mechanisms clarify how stress ‘gets under the skin’. Changes to key brain regions may explain why those living in disadvantaged neighborhoods are at a heighted risk of PTSD. Broadly, these findings should inform future policies and community-driven interventions aimed at reducing poverty.

Geographical variations of socioeconomic status and prostate cancer mortality in Taiwan

A population-wide study was conducted to determine the association between area-level socioeconomic status and prostate cancer mortality in Taiwan. Age-period-cohort analysis was performed to adjust the time-trend variation. The area-level socioeconomic factors included proportion with a higher education, average income tax, population density, and clinical workload. After adjustment for time-trend variations in age, period, and cohort, prostate cancer mortality was significantly lower in the groups with the highest higher education proportion (rate ratio 0.88; 95% Confidence Intervals 0.83-0.93), average income tax (RR 0.90; 95% CIs 0.86-0.94), and population density (RR 0.88; 95% CI 0.83-0.93). When all variables were incorporated into one model, the rate ratio of prostate cancer mortality was 0.92 (95% CIs 0.88-0.97) in the region with the highest average income tax level compared with that with the lowest level, but differences in the other socioeconomic factors were not significant. This study revealed a significantly lower prostate cancer mortality rate in areas with a high higher education proportion, average income tax level, and population density compared with areas of low socioeconomic status in Taiwan.

Associations between Individual-level and Area-level social disadvantage and oral health behaviours in Australian adolescents.

Oral health behaviours are significant determinants of oral health. There is evidence that socioeconomic position influences oral health behaviours, but little is known about this association during adolescence. This study aims to investigate the association between social disadvantage (individual and area level) and oral health behaviours among Australian adolescents. This study utilized data from the Longitudinal Study of Australian Children (LSAC). The sample consisted of 2877 adolescents. Exposure measures were area-level social disadvantage (Socioeconomic Indexes for Areas) and parent-reported household income from Wave 5. Outcomes, measured in Wave 6, were three different adolescent-reported oral health behaviours: frequency of brushing, consumption of sugar-sweetened beverages (SSB) and dental visits. Associations between quintiles of each exposure and each oral health behaviour were tested by fitting multivariable logistic regression models. Household income and area-level disadvantage were associated with dental visits and brushing frequency. Associations between social disadvantage and consumption of SSBs were less apparent, with only the least disadvantaged adolescents having lower odds of consumption of SSBs compared to the most disadvantaged group. Individual and area-level socioeconomic factors are associated with dental visits, and frequency of brushing.Broad population-based strategies must be adopted to reduce intake of SSBs, however, targeted strategies are needed among more disadvantaged populations to address infrequent toothbrushing and irregular dental visits among adolescents.

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Although counties are the smallest geographic level for comprehensive health-care delivery analysis, little is known about county-level variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States. A total of 179,189 patients aged≥ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the Districtof Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with≥ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression. Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8%to 48.6%in the lowest decile of counties, to 74.3%to 91.7%in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25%absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status. Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors.

Area-level HIV risk and socioeconomic factors associated with willingness to use PrEP among Black people in the U.S. South

PurposeIn the United States (U.S.), southern states have the highest HIV incidence. Uptake of pre-exposure prophylaxis (PrEP) has been slow among Black people, particularly in the South. We know little about how area-level HIV risk influences one's willingness to use PrEP. Methods169 Black participants across 142 ZIP codes in the South completed the 2016 National Survey on HIV in the Black Community. We performed log-binomial regression to estimate the prevalence risk associated with residing in the upper 25th percentile of increases in new HIV diagnosis (2014–2015) within ZIP code and an individual's willingness to use PrEP, adjusting for individual and area-level covariates. ResultsParticipants were 68% female, mean age of 36 years, and 24% willing to use PrEP. Among the ZIP codes, 23% were within Atlanta, GA. The median increase in new HIV diagnoses was 25 per 100,000 population from 2014 to 2015 (IQR, 14–49). Participants living in ZIP codes within the upper 25th (compared-to-lower 75th) percentile of new HIV diagnoses were more willing to use PrEP (adjusted prevalence ratio (aPR) = 2.02, 95% CI = 1.06–3.86, P = .03). Area-level socioeconomic factors attenuated that association (aPR = 1.63, 95% CI = 0.78–3.39, P = .19). ConclusionsArea-level factors may influence PrEP uptake among Black people in the South.

Spatial patterning and correlates of self-harm in Manchester, England.

To investigate the spatial distribution of self-harm incidence rates, their socioeconomic correlates and sex/age differences using data on self-harm presentations to emergency departments from The Manchester Self-Harm Project (2003-2013). Smoothed standardised incidence ratios for index self-harm episodes (n = 14 771) and their associations with area-level socioeconomic factors across 258 small areas (median population size = 1470) in the City of Manchester municipality were estimated using Bayesian hierarchical models. Higher numbers and rates of self-harm were found in the north, east and far southern zones of the city, in contrast to below average rates in the city centre and the inner city zone to the south of the centre. Males and females aged 10-24, 25-44 and 45-64 years showed similar geographical patterning of self-harm. In contrast, there was no clear pattern in the group aged 65 years and older. Fully adjusted analyses showed a positive association of self-harm rates with the percentage of the unemployed population, households privately renting, population with limiting long-term illness and lone-parent households, and a negative association with the percentage of ethnicity other than White British and travel distance to the nearest hospital emergency department. The area-level characteristics investigated explained a large proportion (four-fifths) of the variability in area self-harm rates. Most associations were restricted to those aged under 65 years and some associations (e.g. with unemployment) were present only in the youngest age group. The findings have implications for allocating prevention and intervention resources targeted at high-risk groups in high incidence areas. Targets for area-based interventions might include tackling the causes and consequences of joblessness, better treatment of long-term illness and consideration of the accessibility of health services.

The Australian Aboriginal Birth Cohort study: socio‐economic status at birth and cardiovascular risk factors to 25 years of age

To determine whether socio-economic status at birth is associated with differences in risk factors for cardiovascular disease - body mass index (BMI), blood pressure, blood lipid levels - during the first 25 years of life. Analysis of prospectively collected data. 570 of 686 children born to Aboriginal mothers at the Royal Darwin Hospital during 1987-1990 and recruited for the Aboriginal Birth Cohort Study in the Northern Territory. Participants resided in 46 urban and remote communities across the NT. The analysed data were collected at three follow-ups: Wave 2 in 1998-2001 (570 participants; mean age, 11 years), Wave 3 in 2006-2008 (442 participants; mean age, 18 years), and Wave 4 in 2014-2016 (423 participants; mean age, 25 years). Cardiovascular disease risk factors by study wave and three socio-economic measures at the time of birth: area-level Indigenous Relative Socioeconomic Outcomes (IRSEO) index score and location (urban, remote) of residence, and parity of mother. Area-level IRSEO of residence at birth influenced BMI (P<0.001), systolic blood pressure (P=0.024), LDL-cholesterol (P=0.010), and HDL-cholesterol levels (P<0.001). Remoteness of residence at birth influenced BMI (P<0.001), HDL-cholesterol (P<0.001), and triglyceride levels (P=0.043). Mother's parity at birth influenced BMI (P=0.039). Our longitudinal life course analyses indicate that area-level socio-economic factors at birth influence the prevalence of major cardiovascular disease risk factors among Indigenous Australians during childhood and early adulthood.

Abstract MP49: Lower Levels of County Housing Affordability Are Linked to Worse Cardiometabolic Risk Profiles in Middle-Aged and Older Adults

Introduction: Housing is a fundamental social determinant of health. Past studies have shown that high levels of unaffordable housing raise residents’ chances of moving, often redistributing individuals into socioeconomically disadvantaged neighborhoods and dwellings. This may simultaneously expose individuals to health-detrimental factors while limiting their exposure to health-promoting factors. Residents within unaffordable housing areas may also experience adverse physical and mental health outcomes through various psychosocial, behavioral and material pathways. Yet few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans. Hypothesis: We investigated the hypothesis that lower levels of county housing affordability are linked to higher odds of incident hypertension, diabetes, obesity, and depression. Methods: Using a nationally-representative sample of 3,722 middle-aged to older adults from the National Longitudinal Survey of Youths 1979 and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent, mortgage) between 2000 and 2008 and individual-level odds of incident hypertension, obesity, diabetes, and depression during the follow-up period 2008-2014. Incidence of hypertension and diabetes was assessed through survey-reported physician diagnosis. Obesity was defined as a BMI ≥ 30 kg/m 2 , and depression was measured using the 7-item Center for Epidemiologic Studies Depression Scale and designated based on a cut-off score of 7. We employed fixed effects logistic regression models to reduce bias due to time-invariant confounding. Results: Each percentage point increase in the median county-level percentage of household income spent on rent or mortgage was associated with a 17% increase in the odds (OR = 1.17, 95% CI = 1.00 to 1.39; p = 0.047) of incident hypertension, a 37% increase in the odds (OR = 1.37, 95% CI = 1.00 to 1.87; p = 0.049) of obesity, and a 15% increased odds (OR = 1.15, 95% CI = 1.01 to 1.31; p = 0.030) of depression, controlling for individual- and area-level demographic and socioeconomic factors. No association was observed for diabetes. These associations were stronger among renters than among homeowners, and in men compared to women. In sensitivity analyses, these findings were robust when we limited the sample to non-movers and when we used alternative depression score cut-points. Conclusions: Our findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help to reduce the population burden of cardiovascular disease.