Bottom 10th Percentile Research Articles

Development and validation of the four-item Concise Aging adults Smell Test to screen for olfactory dysfunction in older adults.

Olfactory dysfunction (OD) in the elderly is common and associated with numerous comorbidities, yet often underrecognized. This study sought to develop an instrument for widespread screening of this condition. Demographic factors, comorbidities, and olfactory-related questions were examined in a focus group (N=20) and development cohort (N=190). The 4-item Concise Aging adults Smell Test (4-CAST) screening instrument was then developed to predict OD on Sniffin Sticks testing. An independent validation cohort (N=147) was then examined to confirm ability of the 4-CAST to predict OD on Smell Identification Test 40 (SIT40). The most important variables for predicting olfactory loss in older subjects were age, type II diabetes status, Visual Analog Scale (VAS) of overall rating of smell, and VAS of impact of smell upon safety. In the development cohort, the 4-CAST model yielded predictive probability (area under the curve) of 0.805 (p<0.001) for predicting the bottom 25th percentile on Sniffin Sticks. Results were similar in the validation cohort, as the 4-CAST accurately classified 83.8% subjects (area under the curve [AUC] 0.789, p<0.001) in the bottom 25th percentile of SIT40 testing. The 4-CAST was able to accurately classify 89.4% of subjects with anosmia. The 4-CAST is a quick screening instrument for predicting OD in older adults and has similar performance characteristics in independent populations using the two most common validated olfactory tests. Given the high prevalence of unrecognized olfactory loss in this population, this can be a useful tool for practitioners to determine which subjects may benefit from more extensive olfactory testing.

Evaluating the Regional and Demographic Variations in Dementia-Related Mortality Trends in the United States: 1999 to 2020.

Dementia, a term for a range of cognitive impairments impacting memory, thinking, and social abilities, represents a formidable challenge to healthcare systems worldwide. Analysing the temporal trends in dementia-related mortality among individuals, identifying the populations at high risk, and guiding the implementation of tailored interventions to address the escalating effects of dementia on public health. Data from CDC WONDER database was examined from 1999 to 2020 for the four causes of dementia mortality: unspecified dementia (F03), Alzheimer's disease (G30), vascular dementia (F01), and other degenerative diseases of nervous system not elsewhere classified (G31). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by geographic region, year, age groups, sex, and race/ethnicity. A total of 4,077,973 reported deaths were related to dementia from 1999 to 2020 in the United States. The greatest proportion of deaths was associated with Alzheimer's disease (45.9%), followed by unspecified dementia (43.8%). Very low proportion of deaths were associated with vascular dementia (4.9%) or other neurodegenerative diseases (5.3%). The AAMR increased in two distinct periods: a steep incline from 1999 to 2010 (APC: 6.95, 95% CI: 6.00-7.90), followed by a modest incline till 2020 (APC: 1.41, 95% CI: 0.80-2.04). Overall, females had a higher AAMR than males. AAMRs were highest among NH Whites patients and lowest in NH Asians or Pacific Islanders. A significant geographical difference was also observed among different US census regions. Nearly equal AAMRs were seen in non-metropolitan areas and metropolitan areas. States with AAMRs in the top 90th percentile included South Carolina, North Carolina, Maine, Tennessee, Georgia, and Alabama while states with AAMRs in the bottom 10th percentile included South Dakota, Florida, Hawaii, New Jersey, District of Columbia, and New York (33.1). Individuals aged above 85 had the highest AAMRs. Most deaths occurred in nursing homes and least in hospice facilities. The dementia related deaths are continuously increasing. Highest AAMRs were observed among the NH White people, females, and in the southern areas of the United States. People aged 85+ were most affected. To stop the rising death rates, targeted interventions and awareness are required for both prevention and treatment of dementia.

Demographical and Regional Trends of HIV-Related Mortality Among Young Adults in the United States From 1999-2020.

BackgroundHIV remains a leading cause of death in the U.S. Previous research has examined mortality patterns among older adults with HIV, revealing regional and demographic disparities. This study aims to assess demographic and regional trends in HIV-related mortality among young adults from 1999 to 2020. MethodologyCDC WONDER database was used to identify young adults aged 15-44 where HIV was mentioned as either underlying or contributory cause of mortality between 1999 and 2020, using the B20-B24 codes from the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Age adjusted mortality rates (AAMRs) per 100,000 population and Annual percentage change (APC) were determined. ResultsThe AAMRs for HIV in young adults consistently declined from 1999-2018, followed by a period of stability from 2018-2020 (APC: 0.5%; 95% CI, -7.4 to 9.0), with 64% deaths occurred in medical facilities. Overall, males had a twice AAMR than females (Female: 2.22, 95% CI 2.19-2.24; Male: 5.19, 95% CI 5.15-5.23). Non-Hispanic (NH) Blacks had seven-fold higher mortality rates than Whites (AAMR 14.88 vs. 2.036). The Southern region experienced three-fold higher mortality compared to the Midwest. Metropolitan adults had a two-fold higher AAMR than non-metropolitan adults. States in the top 90th percentile for HIV-related mortality, including Mississippi, Maryland, Florida, Louisiana, and the District of Columbia, exhibited six times higher mortality compared to states in the bottom 10th percentile, such as North Dakota, Idaho, Wyoming, Montana, and Utah. ConclusionTo address these disparities and ensure continued progress, urgent measures are required.

Trends in Patient-Reported Physical Function After Hip Fracture Surgery.

Background Hip fractures carry significant morbidity and mortality, yet studies assessing post-surgical functional recovery from the patient's perspective are scarce, lacking benchmarks against age-matched populations. This study aimed to identify factors influencing postoperative functional outcomes, compared to the lower 25th percentile of normal age-matched populations, and to compare postoperative physical function with one-year mortality following hip fracture surgery. Methodology A retrospective review of 214 hip fracture patients reporting to the emergency department (ED) from July 2020 to June 2023 was conducted, with all completing a three-month postoperative Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) survey. Primary outcomes included three-month PROMIS-PF scores, with secondary outcomes focusing on one-year mortality. Factors such as demographics, comorbidities, procedures, time to surgery, length of stay, and postoperative outcomes were analyzed for correlation. Multivariate logistic regression assessed predictors of achieving a PROMIS-PF T-score of at least 32.5, representing the bottom 25th percentile for age-matched populations, and the relationship between three-month PROMIS PF T-scores and one-year mortality. Results Surgery was performed within 24 hours of ED arrival in 118 (55.1%) patients, the average length of stay was 5.2 days, and 64 (29.9%) were discharged home. Total hip arthroplasty and home discharge correlated with higher physical function scores. In contrast, older age, higher American Society of Anesthesiologists scores, certain comorbidities, specific surgical procedures, and longer hospital stays were associated with lower scores. Fewer than half (102 [47.7%]) achieved functional levels comparable to the 25th percentile of age-matched populations. Multivariate analysis indicated chronic obstructive pulmonary disease and home discharge as predictors of achieving this threshold, while higher PROMIS-PF T-scores were associated with reduced one-year mortality. Conclusions Patients undergoing hip fracture surgery are unlikely to achieve high levels of physical function within the three-month postoperative period. Fewer than half of these patients will reach functional levels, and decreased early function is associated with an increased risk of one-year mortality.

A Test of the Permanent Income Hypothesis When Households are Less Constrained

AbstractIn 2009, the Australian Government delivered approximately $8 billion in direct payments to households. These payments were randomly allocated over a 5‐week period. Panel model estimates show that for the average household, there was no significant disbursement effect on nondurable consumption. Only for relatively young and low‐income households, for example, at the bottom 10th percentile of each, was there a significant positive effect of the tax bonus payment on nondurable consumption. We argue the null findings on average could be due to macroeconomic and institutional differences leaving Australian households less constrained than their U.S. counterparts.

What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study.

The aim of this study was to identify predictors of the best 24-month improvements in patients undergoing surgery for cervical spondylotic myelopathy (CSM). For this purpose, the authors leveraged a large prospective cohort of surgically treated patients with CSM to identify factors predicting the best outcomes for disability, quality of life, and functional status following surgery. This was a retrospective analysis of prospectively collected data. The Quality Outcomes Database (QOD) CSM dataset (1141 patients) at 14 top enrolling sites was used. Baseline and surgical characteristics were compared for those reporting the top and bottom 20th percentile 24-month Neck Disability Index (NDI), EuroQol-5D (EQ-5D), and modified Japanese Orthopaedic Association (mJOA) change scores. A multivariable logistic model was constructed and included candidate variables reaching p ≤ 0.20 on univariate analyses. Least important variables were removed in a stepwise manner to determine the significant predictors of the best outcomes (top 20th percentile) for 24-month NDI, EQ-5D, and mJOA change. A total of 948 (83.1%) patients with 24-month follow-up were included in this study. For NDI, 204 (17.9%) had the best NDI outcome and 200 (17.5%) had the worst NDI outcome. Factors predicting the best NDI outcomes included symptom duration less than 12 months (OR 1.5, 95% CI 1.1-1.9; p = 0.01); procedure other than posterior fusion (OR 1.5, 95% CI 1.03-2.1; p = 0.03); higher preoperative visual analog scale neck pain score (OR 1.2, 95% CI 1.1-1.3; p < 0.001); and higher baseline NDI (OR 1.06, 95% CI 1.05-1.07; p < 0.001). For EQ-5D, 163 (14.3%) had the best EQ-5D outcome and 169 (14.8%) had the worst EQ-5D outcome. Factors predicting the best EQ-5D outcomes included arm pain-only complaints (compared to neck pain) (OR 1.9, 95% CI 1.3-2.9; p = 0.002) and lower baseline EQ-5D (OR 167.7 per unit lower, 95% CI 85.0-339.4; p < 0.001). For mJOA, 222 (19.5%) had the best mJOA outcome and 238 (20.9%) had the worst mJOA outcome. Factors predicting the best mJOA outcomes included lower BMI (OR 1.03 per unit lower, 95% CI 1.004-1.05; p = 0.02; cutoff value of ≤ 29.5 kg/m2); arm pain-only complaints (compared to neck pain) (OR 1.7, 95% CI 1.1-2.5; p = 0.02); and lower baseline mJOA (OR 1.6 per unit lower, 95% CI 1.5-1.7; p < 0.001). Compared to the worst outcomes for EQ-5D, the best outcomes were associated with patients with arm pain-only complaints. For mJOA, lower BMI and arm pain-only complaints portended the best outcomes. For NDI, those with the best outcomes had shorter symptom durations, higher preoperative neck pain scores, and less often underwent posterior spinal fusions. Given the positive impact of shorter symptom duration on outcomes, these data suggest that early surgery may be beneficial for patients with CSM.

Heterogeneous Effects of a Means-Tested Benefit on Income of Older Adults: Evidence from the Basic (Old-Age) Pension in South Korea

In response to severe old-age poverty in South Korea, the Basic Pension has been operated since 2008 for 70% of low-income older adults as a means-tested benefit. It has become an important income supplement for them; however, its expenditure has sharply increased due to rapid population aging. This study analyzed the Korea Household Income and Expenditure Survey using changes-in-changes to examine heterogeneous effects at different income deciles among its development phases in 2008, 2014, 2018, and 2019–2021. First, the largest benefit increase in 2014 records greater income support effects. Second, in terms of heterogeneous effects, the bottom 10th percentile has insignificant effects in 2018 compared to 2014 because it can select another means-tested programme for general citizens, which provides more extensive benefits since 2015. The 20th–50th percentiles presented significant income increase effects. Although the benefits are distributed for the 60th–70th percentiles, who are positioned above the poverty threshold, they consistently displayed insignificant effects. Practically, obtaining a sufficient increase effect like in 2014 may be difficult considering population aging and massive budget pressure. Therefore, it is necessary to collaborate with other social service programmes and concentrate on vulnerable population to provide sustainable welfare services.

A conditional standard for the customized fetal growth trajectory in twin pregnancy

BackgroundThe difference between the birthweights of twins and singletons grows with advancing gestation. Although many fetal weight standards based on ultrasound have been created for tracking fetal growth in twin pregnancies, their applicability to other groups is limited by the fact that they are population-specific. ObjectivesTo generate conditional centiles of growth assessment in twin fetuses and compare them with other population-based growth standards for singleton and twin fetuses. Study DesignA retrospective longitudinal study of the ultrasound-based estimated fetal weight (EFW) dataset of normal twin fetuses delivered after 34 weeks of gestation was conducted. Linear mixed effects models, which adjusted for maternal characteristics, fetal gender, and chorionicity, were used to construct the relationship between EFW and gestational age. The EFW reference values were calculated using conditional centile based on the EFW at an earlier gestational age. To compare our results with previous studies, fetal growth curves were generated using a formula we created which included maternal characteristics and the EFW at 24 weeks of gestation in these studies. In a subgroup analysis of our low-risk twin babies born at full term, we calculated the number of fetuses that were reclassified as being in the bottom 10th percentile using each of the previous population-based standard. Results2644 ultrasounds with a median of 4 scans per fetus from 572 twin pregnancies were included in this analysis. Thirty six percent of the fetuses were monochorionic. Maternal age, body mass index, and the interaction between fetal gender and chorionicity were significantly associated with EFW. The predicted growth curves matched the growth standard for twins. In our low-risk group, when the singleton standard was used, the incidence of EFW 10th percentile was above 20% from gestational week 24–38, and this incidence varied when reclassified using other population-based twin standards. ConclusionsThis conditional growth chart was specifically designed to assess fetal growth in twins, but it is generalizable to other populations.

Abstract 11954: Predictors of Adverse Outcome in STEMI Patients Post-PCI With Cardiogenic Shock Requiring Intra-Aortic Balloon Pump Support

Introduction: Cardiogenic shock is a serious complication of ST-segment elevation myocardial infarction (STEMI), however clinical and demographic factors may further impact outcomes. This study investigated how age, gender, income, comorbidities, and arrhythmias affect mortality of STEMI patients receiving intra-aortic balloon pumps (IABP) for management of cardiogenic shock. Methods: This retrospective study used the National Inpatient Sample (NIS) database from 2016 to 2020. We identified STEMI admissions as the principal diagnosis and cardiogenic shock as the secondary diagnosis. Patients who received IABP support were included using the ICD-10 Procedure Coding System (PCS) code 5A02210. Logistic linear regression was used to analyze the data while adjusting for confounding variables such as age, sex, and comorbidities. Results: Of the 24,915 admissions with STEMI requiring IABP post PCI, the average age was 65, 29.5% were female, 28.8% died and 51.7% patients had congestive heart failure. The highest mortality rate was associated with liver disease, followed by left bundle branch block, age over 65, ventricular fibrillation, renal failure, female gender, peripheral vascular disease (PVD), and ventricular tachycardia (table 1). Income in the bottom 25 th percentile also had increased mortality. Conclusion: This study identified several predictors of adverse outcomes in post-PCI STEMI patients with cardiogenic shock requiring IABP support, including ventricular fibrillation, ventricular tachycardia, left bundle branch block, peripheral vascular disease, renal failure, liver disease, age 65 or older, female, and low income. These findings may aid in the management of STEMI patients with cardiogenic shock by allowing healthcare providers to identify patients at high risk for adverse outcomes and tailor their treatment accordingly.

Population pharmacokinetic-pharmacodynamic modeling of clopidogrel for dose regimen optimization based on CYP2C19 phenotypes: A proof of concept study.

Clopidogrel is an antiplatelet drug used to reduce the risk of acute coronary syndrome and stroke. It is converted by CYP2C19 to its active metabolite; therefore, poor metabolizers (PMs) of CYP2C19 exhibit diminished antiplatelet effects. Herein, we conducted a proof-of-concept study for using population pharmacokinetic-pharmacodynamic (PK-PD) modeling to recommend a personalized clopidogrel dosing regimen for individuals with varying CYP2C19 phenotypes and baseline P2Y12 reaction unit (PRU) levels. Data from a prospective phase I clinical trial involving 36 healthy male participants were used to develop the population PK-PD model predicting the concentrations of clopidogrel, clopidogrel H4, and clopidogrel carboxylic acid, and linking clopidogrel H4 concentrations to changes in PRU levels. A two-compartment model effectively described the PKs of both clopidogrel and clopidogrel carboxylic acid, and a one-compartment model of those of clopidogrel H4. The CYP2C19 phenotype was identified as a significant covariate influencing the metabolic conversion of the parent drug to its metabolites. A PD submodel of clopidogrel H4 that stimulated the fractional turnover rate of PRU levels showed the best performance. Monte Carlo simulations suggested that PMs require three to four times higher doses than extensive metabolizers to reach the target PRU level. Individuals within the top 20th percentile of baseline PRU levels were shown to require 2.5-3 times higher doses than those in the bottom 20th percentile. We successfully developed a population PK-PD model for clopidogrel considering the impact of CYP2C19 phenotypes and baseline PRU levels. Further studies are necessary to confirm actual dosing recommendations for clopidogrel.

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries.

The purpose of this study was to understand the role of social determinants of health assessed by the Area Deprivation Index (ADI) on hospital length of stay and discharge destination following surgical fixation of pelvic ring fractures. A retrospective chart analysis was performed for all patients who presented to our level-I trauma center with pelvic ring injuries that were treated with surgical fixation. Social determinants of health were determined via use of the ADI, a comprehensive metric of socioeconomic status, education, income, employment, and housing quality. ADI values range from 0 to 100 and are normalized to a U.S. mean of 50, with higher scores representing greater social deprivation. We stratified our cohort into 4 ADI quartiles. Statistical analysis was performed on the bottom (25th percentile and below, least deprived) and top (75th percentile and above, most deprived) ADI quartiles. Significance was set at p < 0.05. There were 134 patients who met the inclusion criteria. Patients in the most deprived group were significantly more likely to have a history of smoking, to self-identify as Black, and to have a lower mean household income (p = 0.001). The most deprived ADI quartile had a significantly longer mean length of stay (and standard deviation) (19.2 ± 19 days) compared with the least deprived ADI quartile (14.7 ± 11 days) (p = 0.04). The least deprived quartile had a significantly higher percentage of patients who were discharged to a resource-intensive skilled nursing facility or inpatient rehabilitation facility compared with those in the most deprived quartile (p = 0.04). Race, insurance, and income were not significant predictors of discharge destination or hospital length of stay. Patients facing greater social determinants of health had longer hospital stays and were less likely to be discharged to resource-intensive facilities when compared with patients of lesser social deprivation. This may be due to socioeconomic barriers that limit access to such facilities. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Technical change, task reallocation, and wage inequality

Abstract This paper empirically investigates wage inequality within the group of skilled workers in the recent four decades in the USA using CPS data and finds evidence that the trend of wage growth of the top and bottom 10th percentile of skilled workers significantly diverged starting from 2000. Using a task-based framework of occupation, I find that the changing trend of wage inequality was entirely driven by one category of occupation, namely the nonroutine analytic occupation. Then, I consider in a model task reallocation between two broad task categories, namely the routine and abstract task, induced by an ongoing investment-specific technical change. In my model, the labor in the routine task is replaced by cheaper machines due to investment-specific technical change, then workers that are less productive in the abstract task enter abstract occupations. As a result, the wage inequality in the abstract task widens because of the reallocation of less productive workers from the routine task to the abstract task, that is, the “composition effect.” In addition, since economic agents tend to postpone the investment in machines after the ongoing investment-specific technical change takes place for a while, the expansion path of wage inequality is not linear but features an acceleration of wage dispersion in the middle of the technical change. The quantitative results suggest that the model is able to provide a well-matched timing and magnitude of the nonlinear expansion path in wage inequality that is observed in the data.

Demographic and Regional Trends of Cardiovascular Diseases and Diabetes Mellitus-Related Mortality in the United States From 1999 to 2019

ObjectiveThe purpose of this research was to study the contemporary trends in cardiovascular disease (CVD) and diabetes mellitus (DM)-related mortality. MethodsWe used the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to identify adults ≥25 years old where both CVD and DM were listed as an underlying or contributing cause of death between 1999 and 2019. Crude and age-adjusted mortality rates per 100,000 population were determined. ResultsThe overall age-adjusted mortality rate was 99.18 in 1999 and 91.43 in 2019, with a recent increase from 2014-2019 (annual percent change 1.0; 95% confidence interval [CI], 0.3-1.6). Age-adjusted mortality rate was higher for males compared with females, with increasing mortality in males between 2014 and 2019 (annual percent change 1.5; 95% CI, 0.9-2.0). Age-adjusted mortality rate was highest for non-Hispanic Black adults and was ∼2-fold higher compared with non-Hispanic White adults. Young and middle-aged adults (25-69 years) had increasing age-adjusted mortality rates in recent years. There were significant urban-rural disparities, and age-adjusted mortality rates in rural counties increased from 2014 to 2019 (annual percent change 2.2; 95% CI, 1.5-2.9); states in the 90th percentile of mortality had age-adjusted mortality rates that were ∼2-fold higher than those in the bottom 10th percentile of mortality. ConclusionAfter an initial decrease in DM + CVD-related mortality for a decade, this trend has reversed, with increasing mortality from 2014 to 2019. Significant geographic and demographic disparities persist, requiring targeted health policy interventions to prevent the loss of years of progress.

Body composition and lung cancer-associated cachexia in TRACERx.

Cancer-associated cachexia (CAC) is a major contributor to morbidity and mortality in individuals with non-small cell lung cancer. Key features of CAC include alterations in body composition and body weight. Here, we explore the association between body composition and body weight with survival and delineate potential biological processes and mediators that contribute to the development of CAC. Computed tomography-based body composition analysis of 651 individuals in the TRACERx (TRAcking non-small cell lung Cancer Evolution through therapy (Rx)) study suggested that individuals in the bottom 20th percentile of the distribution of skeletal muscle or adipose tissue area at the time of lung cancer diagnosis, had significantly shorter lung cancer-specific survival and overall survival. This finding was validated in 420 individuals in the independent Boston Lung Cancer Study. Individuals classified as having developed CAC according to one or more features at relapse encompassing loss of adipose or muscle tissue, or body mass index-adjusted weight loss were found to have distinct tumor genomic and transcriptomic profiles compared with individuals who did not develop such features. Primary non-small cell lung cancers from individuals who developed CAC were characterized by enrichment of inflammatory signaling and epithelial-mesenchymal transitional pathways, and differentially expressed genes upregulated in these tumors included cancer-testis antigen MAGEA6 and matrix metalloproteinases, such as ADAMTS3. In an exploratory proteomic analysis of circulating putative mediators of cachexia performed in a subset of 110 individuals from TRACERx, a significant association between circulating GDF15 and loss of body weight, skeletal muscle and adipose tissue was identified at relapse, supporting the potential therapeutic relevance of targeting GDF15 in the management of CAC.

Small area variations in four measures of poverty among Indian households: Econometric analysis of National Family Health Survey 2019–2021

India has seen enormous reductions in poverty in the past few decades. However, much of this progress has been unequal throughout the country. This paper examined the 2019–2021 National Family Health Survey to examine small area variations in four measures of household poverty. Overall, the results show that clusters and states were the largest sources of variation for the four measures of poverty. These findings also show persistent within-district inequality when examining the bottom 10th wealth percentile, bottom 20th wealth percentile, and multidimensional poverty. Thus, these findings pinpoint the precise districts where between-cluster inequality in poverty is most prevalent. This can help guide policy makers in terms of targeting policies aimed at reducing poverty.

S-28-4: ASSOCIATION BETWEEN INCOME AND PROGRESSION OF CHRONIC KIDNEY DISEASE IN JAPAN: A NATIONWIDE COHORT STUDY

Introduction: Chronic kidney disease (CKD) is one of the major public health issues, causing 1.4 million death in 2019 worldwide. While previous studies have shown the relationship between socioeconomic status and CKD, little is known about whether its relationship exists even in a country where insurance is comprehensively covered. Thus, we conducted a nationwide study to examine the association between individual income levels and the progression of CKD in Japan, a country with universal health coverage. Methods: We used the national database from the Japan Health Insurance Association (kyokai-kempo) between April 2015 and March 2021. We included 6,318,952 adults who undertook health check-ups in 2015 and had estimated Glomerular Filtration Rate (eGFR) measured at least twice during the study period. A multivariable linear regression model was used to investigate the association between income deciles and the average change in eGFR per year. A multivariable Cox proportional hazard regression model was used to estimate the hazard ratio [HR] for kidney replacement therapy (dialysis or kidney transplantation) according to deciles of individual income. We conducted the subgroup analysis by gender and prefectures. Results: The mean age was 48.8 years and 33.5 % were women. After adjusting for potential confounders, the lowest income group (bottom 10th percentile) showed a 0.08 [95%CI, 0.06–0.09] ml/min/1.73 m2/year larger decrease in eGFR than the highest income group (top 10th percentile). In our time-to-event analysis, we found an increased risk of kidney replacement therapy among the lowest income groups (HR [95%CI], 2.22 [1.99–2.48]) than among the highest income group. We found a similar pattern across gender and prefectures. Conclusion: Individual income levels were associated with the progression of CKD, particularly for the initiation of kidney replacement therapy in Japan. Our findings highlight the importance of considering socioeconomic status in CKD prevention and management even when insurance is covered.

Moderation of teacher–student relationships in the link between motivation and English performance of struggling learners in China

ABSTRACT This study examined the motivation level of struggling English learners in China and explored the link between motivation and their English achievement. Furthermore, this research dug into the moderation effect of teacher–student relationships on this link based on attachment theory and self-dertemination theory. Struggling students (n = 14,531) were chosen according to the bottom 25th percentile cutoff on English achievement from a large-scale survey in China. The standardised English performance test and students’ self-reported motivation and teacher–student relationships were adopted to collect data. Descriptive statistics showed that struggling English learners had medium intrinsic and utility value and low self-efficacy. Correlation analysis revealed that intrinsic value and utility value were positively correlated with their English performance, while self-efficacy was not. The moderation analysis further demonstrated that supportive teacher–student relationships had a buffering effect on the low or medium motivation of struggling English learners. These findings suggest that harmonious teacher–student relationships are important for improving the English performance of struggling students.

A Comprehensive Assessment of Qualitative and Quantitative Prodromal Parkinsonian Features in Carriers of Gaucher Disease-Identifying Those at the Greatest Risk.

Carriers of GBA1 gene variants have a significant risk of developing Parkinson’s disease (PD). A cohort study of GBA carriers between 40–75 years of age was initiated to study the presence of prodromal PD features. Participants underwent non-invasive tests to assess different domains of PD. Ninety-eight unrelated GBA carriers were enrolled (43 males) at a median age (range) of 51 (40–74) years; 71 carried the N370S variant (c.1226A > G) and 25 had a positive family history of PD. The Montreal Cognitive Assessment (MoCA) was the most frequently abnormal (23.7%, 95% CI 15.7–33.4%), followed by the ultrasound hyperechogenicity (22%, 95% CI 14–32%), Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) (17.2%, 95% CI 10.2–26.4%), smell assessment (12.4%, 95% CI 6.6–20.6%) and abnormalities in sleep questionnaires (11%, 95% CI 5.7–19.4%). Significant correlations were found between tests from different domains. To define the risk for PD, we assessed the bottom 10th percentile of each prodromal test, defining this level as “abnormal”. Then we calculated the percentage of “abnormal” tests for each subject; the median (range) was 4.55 (0–43.5%). Twenty-two subjects had more than 15% “abnormal” tests. The limitations of the study included ascertainment bias of individuals with GBA-related PD in relatives, some incomplete data due to technical issues, and a lack of well-characterized normal value ranges in some tests. We plan to enroll additional participants and conduct longitudinal follow-up assessments to build a model for identifying individuals at risk for PD and investigate interventions aiming to delay the onset or perhaps to prevent full-blown PD.

Associations between the built environment and emotional, social and physical indicators of early child development across high and low socioeconomic neighbourhoods

Emerging evidence indicates that the built environment influences early child development. Access to, and the quality of, built environment features vary with the socioeconomic status (SES) of neighbourhoods. It has not yet been established whether the association between built environment features and early child development varies by neighbourhood SES. We sought to identify built environment features associated with neighbourhood-level variations in the early child development domains of physical health and wellbeing, social competence, and emotional maturity, and how these associations differ among high and low SES neighbourhoods where child development patterns follow expected outcomes ("on-diagonal" neighbourhoods) and where child development patterns differ from expected outcomes ("off-diagonal" neighbourhoods). This cross-sectional study analysed data from the Australian Early Development Census (AEDC) for children residing in 3839 neighbourhoods in the Perth and Peel metropolitan areas of Western Australia. Children's AEDC scores were aggregated at the area-level and merged with Geographic Information Systems derived measures of neighbourhood residential density, parks, walkability, community facilities and public transport. Multivariate logistic regressions modelled the odds of low and high SES neighbourhoods having a higher proportion of children developmentally "on-track" (scores in the 26th to 100th percentile of the AEDC) or "not on-track" (scores in the bottom 25th percentile of the AEDC) for each built environment feature. In high SES neighbourhoods, better development across all three domains was associated with greater residential density and improved access to parks, public transport, learning, childcare and health services. Conversely, in low SES neighbourhoods, greater residential density was associated with better physical, but poorer social and emotional development; increased traffic and street connectivity were associated with poorer physical and emotional development; shorter distances to parks, learning, childcare and health services were associated with poorer physical and emotional development; and more services and public transport stops were associated with poorer emotional development. The mixed findings in low SES neighbourhoods suggest that positive associations with built environment features seen in one domain of early child development may be negative in other domains. The reasons for the mixed findings in low SES neighbourhoods are likely multifactorial and may include parental neighbourhood perceptions, as well as quality and usage of built environment features. These findings can be used to inform state and local governments to establish child-friendly town planning and urban design features. Further research is needed to confirm the interplay between SES, early child development, the built environment and other unmeasured factors to better inform public health policy.

Racial disparities in the pattern of intergenerational neighbourhood mobility.

Neighbourhood context is known to shape one's life chances, but much of neighbourhood disadvantage is passed down from parents to children. The gap in social and economic achievements between Black and White families in the United States may partially be explained by differences in the intergenerational transmission of neighbourhood context. Using census tract socio-economic data, we created a national ranking of US census tracts. We then examined intergenerational neighbourhood mobility using 2828 parent-child pairs from a longitudinal household survey. We found that White children, compared with Black children, were more likely to inherit higher neighbourhood ranks from their parents. Income and education had smaller negative effects on neighbourhood rank for White children than Black children, all other things equal. Black children whose parents were in the bottom 25th percentile neighbourhood rank tended to move up in neighbourhood rank. But by much smaller magnitudes than their White counterparts. Our findings indicate that different patterns of intergenerational neighbourhood mobility between White and Black families may be an important factor for persisting racial disparities in the neighbourhood context.