Area-level Socioeconomic Position Research Articles

Socioecologic Factors and Racial Differences in Breast Cancer Multigene Prognostic Scores in US Women

Disproportionately aggressive tumor biology among non-Hispanic Black women with early-stage, estrogen receptor (ER)-positive breast cancer contributes to racial disparities in breast cancer mortality. It is unclear whether socioecologic factors underlie racial differences in breast tumor biology. To examine individual-level (insurance status) and contextual (area-level socioeconomic position and rural or urban residence) factors as possible mediators of racial and ethnic differences in the prevalence of ER-positive breast tumors with aggressive biology, as indicated by a high-risk gene expression profile. This retrospective cohort study included women 18 years or older diagnosed with stage I to II, ER-positive breast cancer between January 1, 2007, and December 31, 2015. All data analyses were conducted between December 2022 and April 2023. The primary outcome was the likelihood of a high-risk recurrence score (RS) (≥26) on the Oncotype DX 21-gene breast tumor prognostic genomic biomarker. Among 69 139 women (mean [SD] age, 57.7 [10.5] years; 6310 Hispanic [9.1%], 274 non-Hispanic American Indian and Alaskan Native [0.4%], 6017 non-Hispanic Asian and Pacific Islander [8.7%], 5380 non-Hispanic Black [7.8%], and 51 158 non-Hispanic White [74.0%]) included in our analysis, non-Hispanic Black (odds ratio [OR], 1.33; 95% CI, 1.23-1.43) and non-Hispanic American Indian and Alaska Native women (OR, 1.38; 95% CI, 1.01-1.86) had greater likelihood of a high-risk RS compared with non-Hispanic White women. There were no significant differences among other racial and ethnic groups. Compared with non-Hispanic White patients, there were greater odds of a high-risk RS for non-Hispanic Black women residing in urban areas (OR, 1.35; 95% CI, 1.24-1.46), but not among rural residents (OR, 1.05; 95% CI, 0.77-1.41). Mediation analysis demonstrated that lack of insurance, county-level disadvantage, and urban vs rural residence partially explained the greater odds of a high-risk RS among non-Hispanic Black women (proportion mediated, 17%; P < .001). The findings of this cohort study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive ER-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.

Assessment of census-tract level socioeconomic position as a modifier of the relationship between short-term PM2.5 exposure and cardiovascular emergency department visits in Missouri

IntroductionAmbient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures...

The distribution of registered occupational therapists, physiotherapists, and podiatrists in Australia.

In Australia, the distribution of occupational therapists, physiotherapists, and podiatrists density (per 10,000 population) by measure of location/rurality, usual resident population, and area-level socioeconomic status has not been described. To describe the national as well as states-and territories-wide distribution of registered allied health workforce-occupational therapists, physiotherapists, and podiatrists-by measures of rurality and area-level socioeconomic position in Australia. A linked data study that brings together (1) the location of health practitioners' principal place of practice from the Australian Health Practitioner Regulation Agency, (2) a measure of location/rurality-Modified Monash Model (MMM), and (3) an area-level measure of socioeconomic status-Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD). The provider-to-population ratio (i.e., density) of three Australia's allied health workforce (occupational therapists, physiotherapists, and podiatrists) was calculated according to the MMM classifications (i.e., Modified Monash 1-7) and IRSAD quintiles at state and national level. Nationwide, the density of occupational therapists and physiotherapists was highest in metropolitan areas (Modified Monash 1) and decreased with the increasing levels of the MMM categories. The national density of podiatrists was highest in Modified Monash 3 areas. The density of occupational therapists, physiotherapists, and podiatrists was highest in areas with IRSAD quintile 5 (i.e., the highest socioeconomic position) and decreased with the declining levels of the IRSAD quintiles nationwide. Moreover, there were notable disparities in the density of occupational therapists, physiotherapists, and podiatrists across each state and territory in Australia when stratified by the MMM classifications and IRSAD quintiles. There was uneven distribution of registered occupational therapists, physiotherapists, and podiatrists when stratified by measures of location/rurality and area-level socioeconomic status across Australian jurisdictions. The density of these three groups of allied health workforce tended to be more concentrated in metropolitan and most advantaged areas while remote and most disadvantaged areas exhibited less allied health workforce distribution across each state and territory.

EPH77 Association of Socioeconomic Position and Racial Disparities in Multigene Prognostic Score Measuring Breast Cancer Recurrence Risk

Poorer breast cancer (BC) prognosis has been strongly linked with lower socioeconomic position (SEP) and certain racial/ethnic groups. This study aims to determine whether area level socioeconomic position mediates racial/ethnic differences in BC recurrence risk among hormone receptor(HR+) and Human epidermal growth factor2 (HER2 -) negative BC patients.

Israeli COVID lockdowns mildly reduced overall use of preventive health services, but exacerbated some disparities

BackgroundDuring 2020, Israel experienced two COVID-19-related lockdowns that impacted the provision of primary and secondary preventive care.MethodsWe examined the month-by-month performance of selected preventive care services using data from Israel’s national Quality Indicators in Community Healthcare program. Process of care measures included hemoglobin A1c (HbA1c) testing, cholesterol testing, colon cancer screening and mammography. Intermediate outcome measures included low-density lipoprotein control and HbA1c control. Measures were stratified by sex and by area-level socioeconomic position (SEP). Diabetes and mammography are presented in this abstract due to space limitations.ResultsAnnual HbA1c testing among persons with diabetes decreased from 90.9% in 2019 to 88.0% in 2020. Performance of HbA1c tests during lockdown months was as low as half the usual amount. There were compensatory increases in testing during post-lockdown months that did not quite make up for the missed tests. In 2019, 9.0% of Israelis with diabetes had poor glycemic control (HbA1c ≥ 9.0); in 2020, it was 8.8%. In total, 4.5% fewer mammograms were performed in 2020 compared with 2019. Women in the lowest SEP level performed 10.4% fewer mammograms in 2020 than in 2019, while women in the highest SEP level performed 3.1% more mammograms.ConclusionsProlonged COVID lockdowns in 2020 were associated with marked decreases in the performance of preventive health services during those months. Compensatory spikes following the end of lockdowns partly, but did not completely, make up for the missed care. COVID lockdowns may have exacerbated socioeconomic disparities in some preventive health services.

Relationship between "Blue Space" Proximity and Children's Weight Status, Health Behaviors, and Health-Related Quality of Life among a Sample of Regional Victorian Primary School Children.

Background: Access to green space (e.g., parks and gardens) has been associated with child health and wellbeing, whereas blue space (e.g., coasts, lakes, and rivers) is understudied. Our aim was to determine whether proximity to the coast was associated with primary school children's weight status, modifiable health-related behaviors, and health-related quality of life (HRQoL). Methods: Exploratory cross-sectional analysis of baseline data from the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHOSTOPS) study, to estimate gender-specific differences in weight and behaviors across four bands of distance from the coast (<5 km, 5 to <25 km, 25 to <50 km, ≥50 km). Linear and logistic models, with robust standard errors, adjusted for school year level, area-level socioeconomic position and rurality, and allowing for distance by gender interaction were fitted on data from 1216 children (aged 8.5-13 years). Main outcomes were weight status (categorical), physical activity (PA) (categorical), and global HRQoL score (continuous). Results: Compared with girls living in towns ≥50 km from the coast, those living within 5 km had lower odds for overweight/obesity [odds ratio (OR) = 0.50; 95% confidence interval (CI): 0.37-0.67] and higher mean moderate-to-vigorous PA minutes (accelerometry) (β = 8.7; 95% CI: 2.0-15.5) and global HRQoL (β = 3.2; 95% CI: 1.4-5.0). Compared with boys living ≥50 km from the coast, those living within 5 km had higher odds of meeting self-reported PA guidelines (≥60 minutes/day) for ≥5 days (OR = 2.33; 95% CI: 1.75-3.10), and higher mean global HRQoL scores (β = 5.6; 95% CI: 1.9-9.3). Conclusions: Living close to the coast was associated with some favorable health outcomes and behaviors, which differed between girls and boys.

1042Trends in area-level socioeconomic inequalities of lung cancer mortality by age group in Japan: 1995-2014

Abstract Background During the long-term economic recession, health inequalities have been concerned in Japan. Among cancer mortality rates, the widest socioeconomic inequalities of municipal mortality was observed in lung cancer. Our aim was to examine the trends in the inequality by sex and age group. Methods We used the areal deprivation index (ADI) to determine area-level socio-economic position at the municipality level. We calculated age-standardised lung cancer mortality rate by sex, age group (&amp;lt;60/60-74/75+) and ADI quintile group using the vital statistics data. Joinpoint regression models were applied to estimate the average annual percentage changes for the last five years. We also calculated absolute index and relative index of inequalities. Results Among men, a clear socioeconomic gradient in lung cancer mortality was observed for all age groups, but among women, ‘J-shape’ gradients in which Q2 or Q3 had the lowest mortality were observed. For women aged 60-74 years, increasing trends of mortality were observed in more deprived groups (Q3-Q5). Men over 75 years showed noticeably decreasing trends in mortality, while women showed no decrease. Absolute inequalities in women were smaller than those in men, but relative inequalities showed widening trends for all age groups. Conclusions We identified widening area-level gaps in all age groups and stable/increasing trends in lung cancer mortality of the 60-74 year age group. Key messages It is important to monitor mortality trends and their gaps of lung cancer mortality among deprivation groups to identify vulnerable subpopulations in order to help tackle the health inequalities.

Area-level and family-level socioeconomic position and body composition trajectories: longitudinal analysis of the UK Millennium Cohort Study

SummaryBackgroundInequalities in the trajectories of body composition in childhood and adolescence have been infrequently studied. Despite the importance of environmental factors in obesity development, little research has looked at area-level socioeconomic position, independent of family socioeconomic position. We aimed to assess how inequalities in body composition develop with age.MethodsThe Millennium Cohort Study is a longitudinal study of 19 243 families who had a child born between 2000 and 2002 in the UK. Multilevel growth curve models were applied to examine change in fat mass index (FMI), fat free mass index (FFMI; using the Benn index), and fat mass to fat free mass ratio (FM:FFM), measured using Bioelectrical Impedance Analysis, from ages 7 years to 17 years by the Index of Multiple Deprivation (IMD) and household income at baseline.FindingsInequalities in FMI and FM:FFM ratio are evident at age 7 years and widen with age. At age 17 years, adolescents in the most disadvantaged IMD group had FMI 0·57 kg/mB (B=Benn parameter; 95% CI 0·43 to 0·70) higher and FM:FFM ratio 0·037 (95% CI 0·026 to 0·047) higher compared with the most advantaged group. Disadvantaged socioeconomic position is associated with higher FFMI but is reversed in adolescence after adjustment for FMI. Inequalities were greater in girls at age 7 years (mean FMI 0·22 kg/mB; 95% CI 0·13 to 0·32) compared with boys of the same age (0·05 kg/mB; –0·04 to 0·15, p=0·3), but widen fastest in boys, especially for FMI, in which there was over an 11 times increase in the inequality from age 7 years of 0·05kg/mB (95% CI –0·04 to 0·15) to 0·62 kg/mB at 17 years (0·42 to 0·82). Inequalities for the IMD were similar to income, and persisted at age 17 years independent of family socioeconomic position.InterpretationChildhood and adolescence is an important period to address inequalities in body composition, as they emerge and widen. Policies should consider FFM as well as FM, and inequalities in the environment.FundingMedical Research Council, Economic and Social Research Council.

The Healthiness of Food and Beverages on Price Promotion at Promotional Displays: A Cross-Sectional Audit of Australian Supermarkets.

Supermarket environments can strongly influence purchasing decisions. Price promotions are recognised as a particularly persuasive tactic, but the healthiness of price promotions in prominent in-store locations is understudied. This study compared the prevalence and magnitude of price promotions on healthy and unhealthy food and beverages (foods) displayed at prominent in-store locations within Australian supermarkets, including analyses by supermarket group and area-level socio-economic position. A cross-sectional in-store audit of price promotions on foods at key display areas was undertaken in 104 randomly selected stores from major Australian supermarket groups (Woolworths, Coles, Aldi and independents) in Victoria, Australia. Of the display space dedicated to foods with price promotions, three of the four supermarket groups had a greater proportion of display space devoted to unhealthy (compared to healthy) foods at each promotional location measured (end of aisles: 66%; island bins: 53%; checkouts: 88%). Aldi offered very few price promotions. Few measures varied by area-level socio-economic position. This study demonstrated that price promotions at prominent in-store locations in Australian supermarkets favoured unhealthy foods. Marketing of this nature is likely to encourage the purchase of unhealthy foods, highlighting the need for retailers and policy-makers to consider addressing in-store pricing and placement strategies to encourage healthier food environments.

Incidence of type 1 diabetes by socio-demographic characteristics among South Australian children: Whole-of-population study.

To describe and compare the incidence of type 1 diabetes (T1D) in South Australia by individual and area-level socio-economic characteristics among children aged ≤11 years. This is a whole-of-population, data linkage study (n = 231 685) conducted in South Australia, and included children born from 2002 to 2013, hospitalisation followed from 2002 to 2014. The study used de-identified, linked administrative hospitalisation, birth and perinatal data from the South Australian Early Childhood Data Project. Incidence was calculated by identifying T1D cases from T1D-related hospitalisations using International Classification of Disease, 10th Revision, Australian Modification diagnosis codes (E10, E101-E109). Overall, 333 children aged ≤11 years (173 boys) were identified as having T1D. The T1D incidence rate was 23.0 per 100 000 person-years (95% confidence interval (CI): 20.7-25.7), with no sex difference. T1D incidence was higher among children whose mothers were Caucasian, private patients and whose parents were employed. For example, T1D incidence was 26.0 per 100 000 (95% CI: 22.8-29.5) among children with both parents employed, compared to 20.0 per 100 000 (95% CI: 12.3-30.6) among children with both parents unemployed. There was no clear gradient in the association between area-level socio-economic position and T1D, with highest incidence for the fourth quintile (26.5 per 100 000 (95% CI: 20.9-33.1)). The most advantaged area (19.4 per 100 000 (95% CI: 13.8-26.5)) had lower incidence than the most disadvantaged area (23.5 per 100 000 (95% CI: 18.9-28.9)). T1D incidence rates differed depending on the measures of socio-economic characteristics. Individual-level indicators showed higher incidence among more advantaged children; however, there was no clear area-level socio-economic patterning of T1D.

Availability and placement of healthy and discretionary food in Australian supermarkets by chain and level of socio-economic disadvantage.

The current study aimed to investigate availability and placement of healthy and discretionary (less healthy) food in supermarkets in Victoria, Australia, and examine variation by supermarket chain and area-level socio-economic disadvantage. Cross-sectional supermarket audit. Measures included: (i) proportion of shelf space (in square metres) allocated to selected healthy and discretionary food and beverages; (ii) proportion of end-of-aisle, checkout and island bin displays containing discretionary food and beverages and (iii) proportion of space within end-of-aisle, checkout and island bin displays devoted to discretionary food and beverages. Metropolitan areas of Melbourne and Geelong, Australia. Assessment: June-July 2019. Random sample of 104 stores, with equal numbers from each supermarket group (Coles, Woolworths, Aldi and Independent stores) within strata of area-level socio-economic position. Proportion of shelf space devoted to selected discretionary foods was greater for Independent stores (72·7 %) compared with Woolworths (65·7 %), Coles (64·8 %) and Aldi (63·2 %) (all P < 0·001). Proportion of shelf space devoted to selected discretionary food for all Coles, Woolworths and Aldi stores was 9·7 % higher in the most compared with the least disadvantaged areas (P = 0·002). Across all stores, 90 % of staff-assisted checkout displays and 50 % of end-of-aisle displays included discretionary food. Aldi was less likely to feature discretionary food in end-of-aisle and checkout displays compared with other supermarket groups. Extensive marketing of discretionary food in all Australian supermarket chains was observed, which is likely to strongly influence purchasing patterns and population diets. Findings should be used to inform private and public sector policies to reduce marketing of discretionary food in supermarkets.

Socio-economic and Regional Differences in Walkability and Greenspace Around Primary Schools: A Census of Australian Primary School Neighbourhoods.

Socio-economic inequality in the physical activity environment surrounding primary schools may contribute to socio-economic gradients in physical activity and childhood obesity levels. Using a cross-sectional study design, ordinary least squares and logistic regressions were fitted to assess variation in walkability and greenspace within 1km of primary schools (n = 7133) according to area-level socio-economic position (SEP) and remoteness. Effect modification by school location (major cities or regional/remote) was assessed through stratified analyses. Walkability scores significantly increased from low to high school neighbourhood SEP (p < 0.01) and from remote/very remote to major city locations (p < 0.01). Greenspace area (hectares) in the school neighbourhood was greater in highest compared to lowest SEP areas (β = 18.75, 95%CI 6.63, 30.87) and less in major cities compared to remote/very remote locations (β = -23.9, 95%CI -39.7, -8.1). Schools in highest SEP areas and major cities had higher odds of having any greenspace in their neighbourhood, compared to those in lowest SEP and remote/very remote locations (OR 5.93, (95% CI 4.50, 7.05), OR 20.19, (95% CI 16.05, 25.39) respectively). Stratified results (major cities or regional/remote locations) found the highest SEP school neighbourhoods had higher walkability scores and more greenspace compared to lowest SEP school neighbourhoods in both strata, although overall SEP gradient in walkability and greenspace area only remained in major cities. Walkability and greenspace infrastructure in the school neighbourhood could be improved in areas of lower SEP so that all school children have the opportunity for physical activity.

Area-level socioeconomic disparity trends in nutritional status among 5–6-year-old children in Israel

ObjectiveThis study aimed to assess area-level socioeconomic position (SEP) disparities in nutritional status, to determine whether disparities differed by sex and to assess whether nutritional status and disparities changed over...

Long-term exposure to ultrafine particles and cause-specific mortality in the Rome Longitudinal Study

OPS 51: Air pollution and mortality: what’s new? Beatrix Theater, August 26, 2019, 4:30 PM - 5:30 PM Background/Aim: Few studies evaluated the association between long-term exposure to ultrafine particles (UFP) and mortality. We aimed to study the association between UFP and mortality in a large administrative cohort (Rome Longitudinal Study, RoLS) and to evaluate whether the role of UFP is independent of other exposures. Methods: We selected 1,009,434 30+ year olds living in the Rome urban area, and we followed them from 2001 to 2013. We used land use regression models for PNC (particle number concentrations) as proxy for UFP, NO2, PM2.5, PM2.5 absorbance (as proxy for soot), and zinc component of PM2.5 (as proxy for non-tail-pipe emissions). We used the acoustic model SoundPLAN7.4 to assess road traffic noise indicators (Lden, Lnight). All exposures were attributed to the residential address of each subject. We analyzed non-accidental, cardiovascular, and ischemic heart disease (IHD) mortality. We applied Cox proportional hazard models adjusted for age, sex, education, place of birth, marital status, occupation, area-level socioeconomic position. We performed single-pollutant and two-pollutant models. Results: The average population exposure was 16,014 (interquartile range, iqr=2,659) n/cm3 PNC, 47 (iqr=8) µg/m3 NO2, 20 (iqr=2) µg/m3 PM2.5, 2.8 (iqr=0.3) 10–5/m PM2.5-absorbance, 25 (iqr=3.4) ng/m3 PM2.5-Zn, 61 (iqr=11) dB. The correlation between UFP and the other exposures ranged from 0.45 (UFP-noise) to 0.61 (UFP-PM2.5). We observed 166,787 deaths for non-accidental causes, 69,034 for cardiovascular causes, and 25,092 for ischemic heart disease. We estimated an increase in non-accidental (Hazard Ratio [HR]=1.010, 95%CI:1.004-1.016), cardiovascular (HR=1.029, 95%CI:1.020-1.038), and IHD (HR=1.032, 95%CI:1.016-1.047) mortality, per iqr increments in PNC. Results were robust to adjustment for all other exposures for cardiovascular and IHD mortality. For non-accidental mortality, adjustment for NO2 and PM2.5-absorbance substantially decreased the PNC effect estimates. Conclusions: We found an effect of UFP exposure on cardiovascular mortality independent of the concomitant exposure to other air pollutants and traffic noise.

Low socioeconomic position and neighborhood deprivation are associated with uncontrolled asthma in elderly.

While uncontrolled asthma in adults is frequent in Europe, the impact of socioeconomic position (SEP) was little investigated. We aimed to investigate the respective association of individual- and area-level SEP with uncontrolled asthma among French elderly women. Analyses were conducted in the Asthma-E3N study, among participants with current asthma (i.e., asthma attacks, treatment, or symptoms in previous year). Asthma control was evaluated using Asthma Control Test (uncontrolled: score ≤19); SEP was defined at both individual- and area-level, using educational level (low, medium, high), the French Deprivation index (tertiles defined at national level), and by merging them in a combined-SEP index. Associations between SEP and asthma control were estimated for 2258 women by logistic regression adjusted for age. Analyses were stratified by asthma controller medication use estimated through a drug reimbursement database. Women were 70 years on average and 24% had uncontrolled asthma. A low educational level (11%) was associated with an increased risk of uncontrolled asthma [odds ratio (95% confidence interval) = 1.9 (1.4,2.6)], especially among women not using controller medication [3.1 (1.9,5.1)]. Using the combined-SEP index, the highest risk of uncontrolled asthma was observed among women with the most disadvantaged socioeconomic profile (low educational level and low-SEP neighborhood) [2.5 (1.5,4.2)]. Women with low SEP had more often uncontrolled asthma, which might be partly explained by inadequate asthma treatment. To achieve the best management of asthma for elderly patients, a specific attention should be given not only to disadvantaged population and neighborhoods, but also to disadvantaged populations in affluent neighborhoods.

Shedding Some Light in the Dark-A Comparison of Personal Measurements with Satellite-Based Estimates of Exposure to Light at Night among Children in the Netherlands.

Background:Exposure to light at night (LAN) can perturb the biological clock and affect sleep and health. Previous epidemiological studies have evaluated LAN levels measured by satellites, but the validity of this measure as a proxy for personal LAN exposure is unclear. In addition, outdoor satellite-measured LAN levels are higher in urban environments, which means that this measure could potentially represent a proxy for other, likely urban, environmental exposures.Objectives:We evaluated correlations of satellite-assessed LAN with measured bedroom light levels and explored correlations with other environmental exposures, in particular, air pollution, green space, and area-level socioeconomic position (SEP).Methods:We compared satellite measurements with evening and nighttime bedroom measurements of illuminance (in units of lux) for 256 children, and we evaluated correlations between satellite-based measures and other urban exposures such as air pollution, area-level SEP, and surrounding green space for 3,021 children.Results:Satellite-measured LAN levels (nanowatts per centimeter squared per steradian) were not correlated with measured evening or nighttime lux levels [Spearman correlation coefficients () to 0.04]. There was a weak correlation with measurements during the darkest time period if parents and their children reported that outdoor light sometimes or usually influenced indoor light levels (, ). In contrast, satellite-measured LAN levels were correlated with air pollution ( with , with ), and surrounding green space ( for green space within of the home). A weak correlation with area-level SEP was also observed ().Conclusions:Outdoor satellite-assessed outdoor LAN exposure levels were correlated with urban environmental exposures, but they were not a good proxy for indoor evening or nighttime personal exposure as measured in our study population of 12-y-old children. Studies planning to evaluate potential risks from LAN should consider such modifying factors as curtains and indoor lighting and the use of electronic devices and should include performing indoor or personal measurements to validate any exposure proxies. The moderate-to-strong correlation of outdoor LAN with other environmental exposures should be accounted for in epidemiological investigations. https://doi.org/10.1289/EHP3431

Health insurance and education: major contributors to oral health inequalities in Colombia

BackgroundHealth inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the...

HIV-Related Medical Mistrust, HIV Testing, and HIV Risk in the National Survey on HIV in the Black Community

Black Americans are greatly affected by HIV disparities and exhibit high levels of medical mistrust, including HIV conspiracy beliefs, a form of mistrust around HIV's origin and treatment. A 2002–2003 national survey of Black Americans found that 48% believed that “HIV is a manmade virus." However, the extent to which such beliefs remain widespread is unknown. Moreover, HIV conspiracy beliefs have been associated with greater HIV risk, but have also been associated with a higher testing likelihood—and no research to date has attempted to explain these seemingly contradictory findings. We obtained updated data on prevalence and correlates of HIV conspiracy beliefs from the US National Survey on HIV in the Black Community, a nationally representative e-mail survey of 868 Black individuals aged 18–50 years (February–April 2016). Substantial percentages agreed that HIV is man-made (31%) and that the government is withholding a cure for HIV (40%). HIV conspiracy beliefs and HIV risk were both significantly associated with a higher HIV testing likelihood. The association between HIV conspiracy beliefs and HIV testing was significantly mediated by individual-level HIV risk (73% of total effect), but not by area-level socioeconomic position (an ecological determinant of higher HIV prevalence). Mistrust remains high among Black Americans, but the association of mistrust with prevention behaviors is complex. People who do not trust the public health system may also be at greater risk—and thus, more likely to get tested, potentially due to greater access to community-based testing venues that engage higher risk populations.

Shedding Some Light in the Dark - Validity of Using Satellite Measurements to Estimate Light at Night Exposure

Background: Exposure to light at night (LAN) can perturb the biological clock and affect sleep and health. Several epidemiological studies have evaluated LAN levels measured by satellites, but the validity of this measure as a proxy for personal LAN exposure is unclear. Also, outdoor light at night measured by satellites displays higher levels in urban environments, which means that this measure could potentially represent a proxy for other, likely urban, environmental exposures.Objectives: We evaluated correlations of satellite-assessed LAN with measured bedroom light levels, and explored correlations with other environmental exposures, in particular air pollution, green space and area-level socio-economic position.Methods: We compared satellite measurements with nighttime bedroom measurements in illuminance (Lux) in 251 children and additionally evaluated correlations to other urban exposures such as air pollution, area-level socio-economic position and surrounding green in 3021 children.Results: Satellite-measured LAN levels (nanoW/cm2/sr) were not correlated with bedroom-measured Lux (Spearman corr. coeff. -0.02). There was a weak correlation if parents reported influence of outdoor light on indoor light levels (rS&amp;#61;0.31). Satellite-measured LAN levels were correlated to air pollution (rS&amp;#61;0.76 with NO2, rS&amp;#61;0.71 with PM10) surrounding green (rS&amp;#61;-0.68 for green space within 1km of the home), and weakly to area-level socio-economic position (rS&amp;#61;0.24).Conclusions: Our study results indicate that outdoor satellite-assessed LAN levels are not a good proxy for nighttime personal exposure in bedrooms, but rather a proxy for other urban exposures. Studies planning to evaluate potential risks from LAN should therefore consider modifying factors such as curtains and indoor lighting and perform indoor or personal measurements to validate their exposure proxies. Other environmental exposures should be accounted for in epidemiological investigations.

Quantifying inequalities in mortality in Australia: the value of linked Census-morality data

IntroductionMortality rates are higher in disadvantaged communities. However, accurate quantification of inequalities in Australia has been limited by data availability. The Australian Bureau of Statistics has recently created a resource linking Death Registrations to Australian Census data, enabling quantification of mortality by whole-of-population individual-level measures.&#x0D; Objectives and ApproachWe present the first analysis of linked Deaths Registrations to Census data, which quantifies mortality inequality in Australia in relation to individual-level socioeconomic position (SEP), and compares these estimates to those based on area-level-SEP measures. The Deaths Registrations-Census file contains deaths within 13 months of the 2011 Census date, linked probabilistically to 2011 Census data. We used Poisson regression to quantify inequalities according to education, weighted to adjust for relative under- and over-representation of selected subpopulations. We compared these inequality estimates with those based on area-SEP measures. We also examined the effect of missing Census data.&#x0D; ResultsMortality rates decreased with education in all age groups (25-44, 45-64, 65-84, 85+ years), for both males and females. Estimates of relative inequality decreased with age, while estimates of absolute inequalities increased. Total excess deaths associated with lower education were highest in those aged 64-84 years. Inequality estimates for education were higher than those for area-SEP in the youngest age groups (25-45 years), but were lower in the 45-64 age group. Socioeconomic gradients in education remained apparent among individuals within each area-SEP quintile, highlighting the socioeconomic variation among individuals within these area-based socioeconomic groups. The proportion of deaths with missing education data increased with age and area-level SEP; however there was little difference in the area-based inequality estimates across subgroups with and without education missing.&#x0D; Conclusion/ImplicationsThe newly-created linked Deaths Registrations-Census file, accessible through the virtual ABS Datalab, is a rich resource for generating evidence on mortality. The data show mortality inequalities in education across all age groups and within quintiles of area-level SEP and indicate area-based measures are inadequate for fully capturing inequality.