Association Of Socioeconomic Factors Research Articles

Socio-economic inequalities in the breadth of internet use before and during the COVID-19 pandemic among older adults in England.

Understanding digital exclusion in older adults during the COVID-19 pandemic could help tailor responses to future outbreaks. This cohort study used data from older adults aged 60+ years in England who participated in wave nine (2018/2019) of the main English Longitudinal Study of Ageing (ELSA) survey, and/or wave one of the ELSA COVID-19 sub-study (June/July 2020). Using latent class analysis and latent transition analysis, we aimed to identify distinct subgroups of older adults characterised by different patterns of internet use pre- and intra-pandemic, explore the extent to which individuals remained in the same subgroup or transitioned to a different subgroup during the COVID-19 pandemic, and examine longitudinal associations of socio-economic factors (education, occupational class, and wealth) with latent class membership. Preliminary tests showed that the types of internet activities differed between men and women; therefore, subsequent analyses were stratified by biological sex. Three clusters (low, medium, and high) were identified in male participants at both timepoints. Among female participants, three clusters were distinguished pre-pandemic and two (low versus high) during the pandemic. The latent classes were characterised by participants' breadth of internet use. Higher education, occupational class, and wealth were associated with greater odds of membership in the medium and/or high classes, versus the low class, in men and women. A high degree of stability in latent class membership was observed over time. However, men experienced a stark decrease in online health information-seeking. Our results highlight that inequality regarding the range of functional and social opportunities provided by the internet prevailed during the pandemic. Policymakers should ensure that digital access and upskilling initiatives are equitable for all.

Measles, mumps, and rubella vaccination coverage: an ecological study of primary health care and socio-economic factors in Catalonia, Spain.

This study examined the association of socio-economic factors and the structure of primary care centres (PCCs) with measles, mumps, and rubella (MMR) vaccination coverage among the 8-year-old population in Catalonia, Spain. We conducted an ecological study to retrospectively assess the MMR vaccination-recorded status of children born in 2012, using public health data extracted in December 2020. For each of 300 PCCs serving 70,498 children, we calculated vaccination coverage rates from electronic health records and linked these rates to a composite deprivation index corresponding to the territory served by each PCC. We identified a relationship between unfavourable socio-economic factors and higher recorded vaccination coverage. On average, directly managed PCCs had higher vaccination coverage rates than indirectly managed PCCs. Greater utilisation of primary care services by the population was also associated with higher vaccination coverage rates. Further research is needed to generate knowledge valuable for informing more equitable child-vaccination service delivery models.

The Association of Socio-Economic Factors and Indigenous Crops on the Food Security Status of Farming Households in KwaZulu-Natal Province

Indigenous crops have been proposed as part of a solution for household food security and sustainable farming systems. However, they have been overlooked and underutilised by households and farmers despite their potential contribution to household food security. The objective of this paper was to determine the association of socio-economic factors and indigenous crops with the household food security of farming households. About 260 farming households were selected using a simple random sampling procedure. The food security status was measured through the use of the Household Food Insecurity Access Scale (HFIAS). The Chi-square test and extended ordered probit regression model assessed the relationship of socio-economic factors and indigenous crops with household food security status. The results from the HFIAS showed that farming households were largely in the mildly and moderately food-insecure categories, with 34.2% and 36.2% of the sampled farmers found in these categories, respectively. The Chi-square test showed a statistically significant relationship between food security status and socio-economic factors. Young men and everyone were perceived to be the ones likely to consume indigenous crops. Consumption of indigenous crops was perceived to be associated with food security. The results also showed that farming experience is likely to positively contribute to the food security status of the farming households. Selling indigenous crops in a formal market is perceived to be associated with food security compared to selling in an informal market. This study concludes that consuming indigenous crops is likely associated with improved food security. Identifying an appropriate market for sales of indigenous crops is imperative. Government, extension officers, and nutritionists must conduct training workshops to encourage households to grow, market and buy indigenous crops. Government and policymakers need to include indigenous crops in the national food and nutrition security policy and create formal markets for indigenous crops.

The association of depressive symptoms and female sexual functioning in the menopause transition: a cross-sectional study.

Sexual dysfunction is very common among middle-aged females. Several factors are considered to influence sexual functioning, including reproductive aging and associated physiological changes as well as life stressors, mental health, and other socioeconomic influences. The objectives of this study are to evaluate the effect of current depressive symptoms on sexual functioning during menopause and to further analyze whether socioeconomic status, age, and antidepressant usage impact this association. Perimenopausal and postmenopausal women aged 40 to 65 years seeking treatment from a specialized menopause clinic completed a self-report survey with the main outcome measure being the 19-item Female Sexual Function Index quantifying sexual dysfunction. We used the 10-item Center for Epidemiological Studies Depression Scale to estimate a major depressive episode. Statistical analyses were completed to assess the potential associations of socioeconomic factors, age, and antidepressant usage. Of the 269 participants, 61.3% met criteria for a major depressive episode and 67.0% had low sexual function. As predicted, women currently experiencing depressive symptoms had a greater risk of low sexual function during perimenopause and postmenopause. Antidepressant usage, low household income, being postmenopausal, and age also predicted low sexual function. Among perimenopausal and postmenopausal women, current depressive symptoms were associated with low sexual function. A biopsychosocial approach should be considered when exploring effective treatment strategies for sexual concerns among midlife women.

Investigating the individual and joint effects of socioeconomic status and lifestyle factors on mild cognitive impairment in older Italians living independently in the community: results from the NutBrain study

ObjectivesDespite extensive research, a clear understanding of the role of the interaction between lifestyle and socioeconomic status (SES) on cognitive health is still lacking. We investigated the joint association of socioeconomic factors in early to midlife and lifestyle in later life and Mild Cognitive Impairment (MCI). DesignObservational cross-sectional study. SettingNutBrain study in northern Italy. Participants773 community-dwelling adults aged 65 years and older (73.2 ± 6.0 SD, 58.6% females) participating in the NutBrain study (2019–2023). MeasurementsThree SES indicators (home ownership, educational level, occupation) and five lifestyle factors (adherence to Mediterranean diet, physical activity, smoking habits, social network, leisure activities) were selected. Each factor was scored and summed to calculate SES and healthy lifestyle scores; their joint effect was also examined. The association with MCI was assessed by logistic regression controlling for potential confounders. Sex-stratified analysis was performed. ResultsIn total, 24% of the subjects had MCI. The multivariable logistic model showed that a high SES and a high lifestyle score were associated with 81.8% (OR0.182; 95%CI 0.095−0.351), and 44.1% (OR0.559; 95%CI 0.323−0.968) lower odds of having MCI, respectively. When examining the joint effect of SES and lifestyle factors, the cognitive benefits of a healthy lifestyle were most pronounced in participants with low SES. A healthier lifestyle score was found to be significantly associated with lower odds of MCI, only in females. ConclusionsAccording to our findings, SES was positively associated with preserved cognitive function, highlighting the importance of active lifestyles in reducing socioeconomic health inequalities, particularly among those with a relatively low SES. Trial registrationTrial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).

Socioeconomic impacts on damage risk from typhoons in mega-urban regions in China: A case study using Typhoons Mangkhut and Lekima

Due to climate change, typhoons are becoming more frequent and destructive and thus increasingly threaten property and life. Many studies have discussed the relationships between disaster losses and socioeconomic development but have paid little attention to those relationships within mega-urban regions. This study aims to explore how socioeconomic factors affect disaster losses in mega-urban regions in China. Specifically, using data about Typhoons Mangkhut and Lekima, we established the association of socioeconomic factors with the affected population and economic losses caused by typhoons. Subsequently, we examined the significant differences of socioeconomic impacts among the cities proper and metro-rings within mega-urban regions and in non-mega-urban regions. Our results showed that higher per capita income, higher population density, higher percentage of females, and higher education level, are associated with fewer disaster losses. When the different areas were compared, we found that metro-rings suffered the largest population and economic losses. Also, the metro-rings’ high immigration rates, low education levels, and uncoordinated planning and management abilities, all contributed to its high disaster risk. Our results both provide insight into regional variations within mega-urban regions affected by typhoons and identify the distinctiveness exhibited by metro-rings, where high exposure and vulnerability make them the areas with the highest disaster risk. These results can help mega-urban regions in China institute viable measures for their most vulnerable areas to prevent disasters triggered by typhoons.

Risk factors for early-onset lung cancer in Korea: analysis of a nationally representative population-based cohort.

We examined the associations of socioeconomic factors, health behaviors, and comorbidities with early-onset lung cancer. The study included 6,794,287 individuals aged 20-39 years who participated in a Korean national health check-up program from 2009 to 2012. During the follow-up period, 4,684 participants developed lung cancer. Multivariable Cox regression analysis was used to estimate the independent associations of potential risk factors with incident lung cancer. Older age (multivariable hazard ratio [mHR], 1.13; 95% confidence interval [CI], 1.12 to 1.14) and female sex (mHR, 1.62; 95% CI, 1.49 to 1.75) were associated with increased lung cancer risk. Current smoking was also associated with elevated risk (<10 pack-years: mHR, 1.12; 95% CI, 1.01 to 1.24; ≥10 pack-years: mHR, 1.30; 95% CI, 1.18 to 1.45), but past smoking was not. Although mild alcohol consumption (<10 g/day) was associated with lower lung cancer risk (mHR, 0.92; 95% CI, 0.86 to 0.99), heavier alcohol consumption (≥10 g/day) was not. Higher income (highest vs. lowest quartile: mHR, 0.86; 95% CI, 0.78 to 0.94), physical activity for at least 1,500 metabolic equivalent of task-min/wk (vs. non-exercisers: mHR, 0.83; 95% CI, 0.69 to 0.99) and obesity (vs. normal weight: mHR, 0.89; 95% CI, 0.83 to 0.96) were associated with lower lung cancer risk, whereas metabolic syndrome was associated with increased risk (mHR, 1.13; 95% CI, 1.03 to 1.24). In young adults, age, female sex, smoking, and metabolic syndrome were risk factors for early-onset lung cancer, while high income, physical activity, and obesity displayed protective effects.

Discussion to: Association of socioeconomic factors with the receipt of neoadjuvant therapy for patients with non–small cell lung cancer

Discussion to: Association of socioeconomic factors with the receipt of neoadjuvant therapy for patients with non–small cell lung cancer

Abstract 11897: Admission Rates for Pediatric Supraventricular Tachycardia From the Emergency Department Are Affected by Primary Insurance Payor: An Analysis of the NEDS Database

Introduction: Supraventricular tachycardia (SVT) is the most common arrhythmia in children and often requires emergency department (ED) care. Recent data highlight disparities in access to care for pediatric patients with SVT, though the association of socioeconomic factors with ED outcomes remains unclear. Hypothesis: Outcomes of ED encounters for pediatric SVT will differ by insurance payor. Methods: We performed a retrospective cohort study utilizing encounter-level data from the 2006-2018 US Nationwide Emergency Department Sample (NEDS). All encounters for patients age 0-18 years with a primary diagnosis of SVT were evaluated, excluding those with diagnoses of congenital heart disease or cardiomyopathy. The primary exposure was insurance payor: private vs. public. The primary outcome was hospital admission/transfer. Secondary outcomes included inpatient length of stay (LOS), procedures (cardioversion, catheter ablation), and mortality. Logistic regression models evaluated the association of payor with outcomes, including the following covariates: age, hospital teaching status, hospital region, patient residence, and patient income. Results: A total of 38,896 ED encounters were analyzed: median age 11.5 years (IQR 6-15); 48% male; 53% private payor, 38% public payor. Encounters with public payor had a higher rate of admit/transfer than private (24% vs. 18%, p&lt;0.0001). There were no differences in LOS (2.5 days public vs. 1.8 days private, p= 0.6) or procedures by payor; there were no mortalities. In multivariate analysis, public payor was an independent predictor of admission/transfer (OR 1.6, 95% CI 1.2-2.2). Patient age was also associated with admission/transfer, with all age groups less likely to undergo admission/transfer compared to age &lt; 1 year: age 1-4, OR 0.3, 95% CI 0.2-0.6; age 5-8, OR 0.1, 95% CI 0.1-0.2; age 9-12, OR 0.1, 95% CI 0.1-0.2; age 13-18, OR 0.1, 95% CI 0.1-0.2. Conclusions: This analysis demonstrates that public payor is associated with higher rates of hospital admission/transfer for pediatric SVT, independent of age. Though we cannot evaluate why publicly insured patients are admitted more often, it may be due to more severe illness caused by delays in care for SVT. If so, this should be a target for intervention.

Associations of Socioeconomic Factors and Unhealthy Lifestyles with Allostatic Load: A Meta-analysis.

Allostatic load (AL) is a biological tool for objectively assessing chronic stress and has been discussed inconsistently for its correlation with socioeconomic factors and unhealthy lifestyles. Therefore, this meta-analysis was performed to explore the impact of socioeconomic factors and unhealthy lifestyles on AL. Different databases, including Web of Science, PubMed, EBSCOhost, Embase, CNKI, VIP, SinoMed, and Wanfang, were searched from inception to June 6, 2023. A total of 25 studies, reporting the correlations of seven socioeconomic factors and three unhealthy lifestyles with AL, were finally included. The pooled odds ratios (OR) and 95% confidence intervals (CIs) were examined using random-effect and fixed-effect models. Literature quality, heterogeneity, and publication bias were evaluated. The meta-analysis showed a significantly increased risk of high AL in the older individuals as compared to the younger ones (OR = 1.05, 95% CI 1.04-1.06), in the individual with low education as compared to those with high education (OR = 1.25, 95% CI 1.05-1.48), and in the individuals with low physical activities as compared to those with high physical activities (OR = 1.44, 95% CI 1.26-1.64). This meta-analysis also showed a significantly decreased risk of high AL in the individuals with high income as compared to those with low income (OR = 0.77, 95% CI 0.71-0.83) and in women as compared to men (OR = 0.80, 95% CI 0.80-0.81). This meta-analysis showed older people, men, and people having low physical activity, low income, and low education were more likely to have a high AL. This meta-analysis was registered on the PROSPERO database with trial registration number CRD42022326105. Instead of providing information at registration, we added an author (Tingyu Mu), who provided critical revisions to the paper in this meta-analysis.

Subnational inequalities in YLLs and associated socioeconomic factors: a disease burden study

Abstract Background Health inequalities are an unjust and avoidable problem. This study examines subnational geographical inequalities in all-cause years of life lost (YLLs) and the association of socioeconomic factors in pre-coronavirus European Economic Area (EEA) countries. Methods In this ecological study complimented with a longitudinal analysis, demographic and socioeconomic data for 1390 small regions and 285 basic regions of 32 EEA countries were extracted from Eurostat. Age-standardised YLL rates per 100,000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease Study. Inequalities were assessed using the Gini coefficient (GC) and slope index of inequality (SII). The association between socioeconomic factors by YLLs were assessed using negative binomial mixed models in 2019. Findings Over the period 2009-2019, YLLs have decreased in almost all subnational regions. The GC of YLLs across EEA regions was 14% for females (95% CI = 13·5 to 14·6%) and 17% for males (CI = 16·1 to 17·5%). Greece (GC = 10·1%, CI = 7·8 to 2·5%) and Belgium (GC = 10·8%, CI = 9·5 to 12·0%) had the highest relative inequalities in YLLs for women and men, respectively. Subnational regions with the lowest income (incident rate ratio (IRR)=1·39, CI = 1·23 to 1·58) and levels of educational attainment (IRRfemales=1·19, CI = 1·13 to 1·26; IRRmales=1·22, CI = 1·16 to 1·28), and highest poverty risk (IRR=1·18, CI = 1·12 to 1·25) were associated with increased YLLs, with stronger associations observed in Central and Eastern Europe. Interpretation Differences in YLLs remain within and between EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing specific health inequities to improve overall disease burden within the EEA. Key messages • The study highlights the need for public health policies targeted at the subnational level to reduce health inequalities in the EEA. • The study describes the effect of existing public health policies targeting socioeconomic factors.

Safety-Net Hospital Status Is Associated With Coronary Artery Bypass Grafting Outcomes at an Urban Academic Medical Center

IntroductionSocioeconomic disparities impact outcomes after cardiac surgery. At our institution, cardiac surgery cases from the safety-net, county funded hospital (CH), which primarily provides care for underserved patients, are performed at the affiliated university hospital. We aimed to investigate the association of socioeconomic factors and CH referral status with outcomes after coronary artery bypass grafting (CABG). MethodsThe institutional Adult Cardiac Surgery database was queried for perioperative and demographic data from patients who underwent isolated CABG between January 2014 and June 2020. The primary outcome was major adverse cardiovascular event (MACE), a composite of postoperative myocardial infarction, stroke, or death. Secondary outcomes included individual complications. Chi-square, Wilcoxon rank-sum, and logistic regression analyses were used to compare differences between CH and non-CH cohorts. ResultsWe included 836 patients with 472 (56.5%) from CH. Compared to the non-CH cohort, CH patients were younger, more likely to be Hispanic, non-English speaking, and be completely uninsured or require state-specific financial assistance. CH patients were more likely to have a history of tobacco and drug use, liver disease, diabetes, prior myocardial infarction, and greater degrees of left main coronary and left anterior descending artery stenosis. CH cases were less likely to be elective. The incidence of MACE was significantly higher in the CH cohort (16.3% versus 8.2%, P = 0.001). There were no significant differences in 30-d mortality, home discharge, prolonged mechanical ventilation, bleeding, sepsis, pneumonia, new dialysis requirement, cardiac arrest, or multiorgan system failure between cohorts. CH patients were more likely to develop renal failure and less likely to develop atrial fibrillation. On multivariable analysis, CH status (odds ratio 2.39, 95% confidence interval 1.25-4.55, P = 0.008) was independently associated with MACE. ConclusionsCH patients undergoing CABG presented with greater comorbidity burden, more frequently required nonelective surgery, and are at significantly higher risk of postoperative MACE.

Socioeconomic Factors, Movement Behavior Context, and Self-reported Physical and Mental Health in Adults Living in New York City

Objective: The purpose of this study was to examine the associations of socioeconomic factors, movement behavior context, and self-reported physical and mental health in adults living in New York City. Methods: Participants were adults from the Physical Activity and Transit Survey (N = 3811; 53.2% female). The dependent variables were items asking about the number of days the participant experienced poor physical and mental health. Independent variables were socioeconomic factors and items asking about the frequency of physical activity (PA) within certain contexts and rest/sleep behaviors. Weighted multivariable negative binomial regression models examined the associations. Results: More days of bicycling transit (IRR = 0.79, p = .001) and higher levels of household income (IRR range = 0.44-0.66, p &lt; .025) were associated with lower rates of poor physical health. More days of poor rest/sleep (IRR = 1.05, p &lt; .001) and labor PA (IRR = 1.10, p &lt; .001) were associated with higher rates of poor mental health, and higher household income (IRR range = 0.58-0.65, p &lt; .01) were associated with a lower rate of poor mental health. Conclusions: The strength and direction of associations with self-reported health varied according to PA context. Poor rest/sleep and low household income were strongly associated with both poor physical and mental health.

Association of socioeconomic factors with the receipt of neoadjuvant therapy for patients with non–small cell lung cancer

BackgroundNeoadjuvant therapy (NT) will be increasingly used for patients with non–small cell lung cancer (NSCLC), particularly given the recent approval of neoadjuvant chemoimmunotherapy. Several barriers may prevent the uptake of NT and should be identified and addressed. We queried the National Cancer Database (NCDB) to determine predictors of the use of NT. MethodsUsing the NCDB (2006-2019), we identified 80,707 patients who underwent surgery for clinical stage II and III NSCLC. Sociodemographic and clinical factors were reviewed, and univariable and multivariable analyses were performed to identify associations with the uptake of NT. In propensity score–matched groups, survival was determined using the Kaplan-Meier method. ResultsAmong 80,707 eligible patients, 17,262 (21.4%) received NT. Clinical stage and node positivity were associated with receipt of NT. On multivariable analysis, factors associated with lower rates of NT included black race (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67-0.90), Charlson Comorbidity Index ≥2 (OR, 0.75; 95% CI, 0.67-0.85), Medicaid/Medicare insurance (OR, 0.82; 95% CI, 0.75-0.90), lower income level (OR, 0.79; 95% CI, 0.71-0.87), and treatment at a community center (OR, 0.81; 95% CI, 0.67-0.96). In an exploratory analysis, those patients who received NT had longer 5-year overall survival compared with those who did not (48.3% vs 46.0%; P < .001). ConclusionsRates of NT are relatively low for patients with clinical stage II/III NSCLC treated prior to recent chemoimmunotherapy trials. Socioeconomic barriers to the uptake of NT include race, insurance status, income, and area of residence. As NT becomes more widely offered, accessibility for vulnerable populations must be assured.

Association of Socioeconomic Factors and Severity of Bronchiolitis Hospitalizations.

It is unclear if socioeconomic status (SES) factors influence severity of illness of patients hospitalized with bronchiolitis. This study was conducted to identify SES factors including the Center for Disease Control and Prevention's Social Vulnerability Composite Index (SVI), estimated income, proportion of minority, proportion of living below poverty, insurance status, and number of household members associated with length of stay (LOS) and intensive care unit admission. Infants hospitalized at a tertiary care urban center for bronchiolitis were identified using International Classification of Diseases codes. Federal information processing system codes were identified from home address and paired with SVI and 2018 census tract. Other measures of SES were obtained from the Federal Financial Institutions Examination Council. Number of household members, insurance, age, sex, and history of prematurity were recorded from patient chart. Length of stay was modeled with mixed effects negative binomial regression and pediatric intensive care unit (PICU) admission with mixed effects logistic regression with random intercept at the census tract and adjustment for clinical factors. A total of 417 infants had median age of 144 days (interquartile range (IQR): 61, 357) and 136 (33%) were born premature. Median LOS was 62 hours (24, 136) with 97 (23%) patients admitted to the PICU. Median household members were 4 (4, 5). For each increase in household member, there was 7% increase in LOS (incidence rate ratio 1.07, 95% confidence interval: 1-1.14, P = .038). Social Vulnerability Composite Index, subcategories, insurance status, estimated income, percent of minority, and percent of poverty did not show any associations with length of hospitalization or PICU admission. Increasing number of household members may be associated with increased bronchiolitis hospital LOS. We find no associations with other SES measures.

Association of socioeconomic factors and dietary intake with sarcopenic obesity in the Korean older population.

This study investigated the relationship between socioeconomic factors, dietary intake, and sarcopenic obesity among older adults in Korea. Data from the seventh Korean National Health and Nutrition Examination Survey (2016-2018) were analyzed. The study included 3,690 participants (1,645 men and 2,045 women) aged 65 years and older. Sarcopenic obesity was defined as the coexistence of low muscle strength (handgrip strength <28 kg in men and <18 kg in women) and abdominal obesity (waist circumference >90 cm in men and >85 cm in women). Socioeconomic factors assessed included age, living status, residential area, employment, education, and family income level. Dietary intake was evaluated using the nutrient adequacy ratio and mean adequacy ratio derived from 24-h dietary recall data. Multiple logistic regression was used to identify factors associated with sarcopenic obesity. The prevalence rates of sarcopenic obesity were 6.5% in men and 17.4% in women. Low education levels were significantly associated with a higher prevalence of sarcopenic obesity in women, whereas lower family income levels were associated with an increased risk of sarcopenic obesity in men. In women, a lower mean adequacy ratio was significantly associated with a higher risk of sarcopenic obesity. Lower family income and education level are associated with a higher prevalence of sarcopenic obesity. Ad-ditionally, overall nutritional adequacy is inversely related to the prevalence of sarcopenic obesity, particularly in women.

Association of Socioeconomic Factors and Physical Activity with Health-Related Quality of Life in Italian Middle School Children: An Exploratory Cross-Sectional Study.

Health-related quality of life (HRQoL) provides a broad assessment of an individual's well-being and can serve as a good prognosticator of life's outcomes later for children and adolescents. Understanding the factors associated with HRQoL is crucial for promoting better health and life satisfaction. This study investigated the cross-sectional association of socioeconomic status, cardio fitness, and physical activity levels with HRQoL in 224 Italian early adolescents attending secondary school in the Emilia-Romagna region located in Northern Italy. In a multivariate path regression model, younger students and females reported a higher quality of life (β = -0.139, p = 0.015, 95% CI: -0.254--0.023 and β = 0.142, p = 0.019, 95% CI: 0.011-0.273, respectively). Having both parents employed and having a higher familiar educational status were also associated with a higher quality of life (β = 0.142, p = 0.013, 95% CI 0.027-0.257 and β = 0.133, p = 0.017, 95% CI 0.022-0.244, respectively). Greater engagement in routine physical activity levels from moderate to vigorous intensity was positively associated with quality of life (β = 0.429, p < 0.001, 95% CI: 0.304-0.554). Endurance (speed) was positively associated with quality of life (β = 0.221, p = 0.001, 95% CI: 0.087-0.355), and students with longer times on the shuttle run reported less quality of life (β = -0.207, p = 0.002, 95% CI: -0.337--0.077). These relations remained intact even when controlling for socioeconomic factors. The current findings reinforce the importance of promoting regular physical activity among younger children and also addressing socioeconomic status disparities to improve children's well-being. Future studies may want to consider expanding the array of measures used to assess physical activity and include additional measures assessing nutrition, cultural factors, and family functioning, all of which can influence a child's willingness to engage in physical activity and their well-being. The emphasis on fitness and physical activity and their contribution to a child's well-being should be the prime focus for stakeholders who work in the education, public health, and health policy sectors.

13-OR: Medication Use among Youth-Onset Diabetes in India—An Analysis of Socioeconomic Factors and Cost of Care

Background: Reported prevalence of youth-onset diabetes (15-30y) in India range from 1 to 1.5% with half the cases being diagnosed. National estimates indicate only 2 in 5 diagnosed cases are taking medication. Yet, data are scarce on the socio-economic predictors and financial burden associated with medication use in this population. Methods: Using data from the National Family Health Survey 2019-21 among youth (n = 4682) with diagnosed diabetes, we estimated the association of socio-economic factors (i.e., household wealth quintile, urbanicity, and household members with diagnosed diabetes) and medication use. We used robust survey-weighted Poisson regression adjusting for sex, age, high school completion and state fixed effects. Using the National Sample Survey 2017-18, we benchmarked the average cost of inpatient and outpatient diabetes medication among youth with diabetes (n = 120) as a proportion of national net per-capita income (Rs. 115,224). Results: Nationally, 1.2% (1.1 - 1.3) of youth 15-30 years old had diabetes, 75% of these cases were diagnosed and 30.9% (95%CI: 28.8, 33.0) of those diagnosed were talking medications. Urban residence (Prevalence ratio, PR: 1.30 [1.13, 1.51]) and increasing household wealth (highest (ref: lowest) 1.28 [1.02, 1.59]) were associated with higher medication use. A household member with diabetes was associated with lower medication use (0.45 [0.32, 0.63]). Out-of-pocket expenses corresponded to 47.0% (31.7, 62.3) of national per capita income. Medications accounted for 35.9% (22.9, 49.0) and 44.9% (33.1, 56.8) of the annual expenses for in-patient (Rs. 35511 [14935, 56088]) and out-patient (Rs. 18651 [9025, 28275]) care respectively. Conclusions: Out of pocket expense for persons with youth-onset diabetes in India is, on average, over 40% of per capita income, with medication cost being the biggest driver. These data call for social safety nets to protect family income of those with youth-onset diabetes in India. Disclosure J.Varghese: None. N.M.Varghese: None. K.Narayan: None. Funding National Institutes of Health (P30DK111024)

Use of Cardioprotective Antidiabetic Medications in Adults With and Without Cardiovascular Disease, 2015 to March 2020.

Certain glucagon-like peptide-1 receptor (GLP-1) agonists and sodium-glucose cotransporter-2 inhibitors (SGLT2-inhibitors) can reduce cardiovascular risk in individuals with type 2 diabetes and cardiovascular disease (CVD). However, these medications can be expensive, potentially limiting their use. Objectives: The primary objective was to characterize the use of cardioprotective GLP-1 agonists and SGLT2-inhibitors among adults with diabetes with and without CVD. The secondary objective was to investigate the association of socioeconomic factors and health care utilization with the use of these medications. Adults aged ≥20 years old with self-reported diabetes, A1c ≥6.5%, or fasting glucose ≥126 mg/dL were identified using the 2015 to March 2020 National Health and Nutrition Examination Survey. The primary outcome was the use of cardioprotective GLP-1 agonists or SGLT2-inhibitors compared in individuals with and without CVD. Secondary analyses included identification of socioeconomic factors and health care utilization associated with the use of cardioprotective antidiabetic medications, stratified by CVD status. Weighted analyses were conducted to account for the complex survey design. Use of cardioprotective antidiabetic medications was higher in adults with CVD compared to those without CVD (7.8% vs. 4.6%, P = 0.02), which was driven by the use of cardioprotective SGLT2-inhibitors (4.6% versus 1.9%, P = 0.002). Lower income level and less frequent health care visits within the past year were associated with lower likelihood of using these medications. Despite preferential use in individuals with diabetes and CVD, the prevalence of cardioprotective antidiabetic medication use remains relatively low. Disparities in use appear to exist based on income level and health care utilization.

Socioeconomic Risk Factors for Preterm Birth in Manipur, Northeast India: A Community-Based Study

AbstractBackground Preterm birth (PTB) is one of the world's leading health concerns, affecting both the mother and the children. This study was undertaken to determine the prevalence and socioeconomic factors associated with PTB among the Meitei women of Manipur.Materials and Methods A community-based cross-sectional study was conducted in postpartum Meitei women of Manipur. Participants were 126 postpartum women that gave birth to a singleton live-born infant and were classified as women giving birth before 37 weeks of gestation (PTB) and women giving birth at ≥37 weeks (term). Data were compared using univariate analysis, and the association of socioeconomic factors with PTB was determined through multivariate logistic regression using Statistical Package for Social Sciences 25 version software program, and statistical significance was taken at a p-value &lt; 0.05.Results The overall prevalence of PTB is 23.01%, of which 13.79% are of extremely preterm. This study revealed a significant association of PTB with mother's occupation (adjusted odds ratio [AOR] = 4.46, 95% confidence interval [CI]: 1.40–14.26, p = 0.012), tobacco consumption during pregnancy (AOR = 2.90, 95% CI: 1.01–8.33, p = 0.048), having family history of PTB (AOR = 3.14, 95% CI: 1.09–9.04, p = 0.034), and early age at menarche (AOR = 4.26, 95% CI: 1.49–12.12, p = 0.007).Conclusion The study highlights the high prevalence of PTB and its association with various socioeconomic factors. Such community-specific studies should be performed to understand the differential risk factors of PTB to control premature death in under 5 years children and to promote women's reproductive health.