Composite Measure Of Socioeconomic Status Research Articles

Which adolescents are more likely to complete home-based sleep manipulation trials?

ObjectivesAttrition and nonadherence are common concerns that can distort findings in clinical trials. This study examines the potential for systematic attrition in the largest sample to date of adolescents undergoing sleep manipulation. MethodsUsing pooled data across two trials involving 242 adolescents, a cumulative logistic regression tested whether demographics and baseline sleep predicted study completion/adherence. ResultsRace, a composite measure of socioeconomic status, and its elements (e.g., income, education) individually predicted completion/adherence. When entered concurrently into a multivariate predictive model, only socioeconomic status and study (trial A vs. B) were significant. Adolescents from households with higher socioeconomic status were more likely to complete or adhere to the protocol than those from households with lower socioeconomic status, p < .001. ConclusionsSystematic attrition in sleep manipulation research could distort conclusions about under-resourced groups. Future sleep trials should intentionally measure systemic/structural factors and adopt strategies to recruit and retain participants from various backgrounds.

Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy

PurposeThe purpose of this study was to assess the association between race/ethnicity and all-cause mortality among women with advanced-stage ovarian cancer who received systemic therapy.MethodsWe analyzed data from the National Cancer Database on women diagnosed with advanced-stage ovarian cancer from 2004 to 2015 who received systemic therapy. Race/ethnicity was categorized as Non-Hispanic (NH) White, NH-Black, Hispanic, NH-Asian/Pacific Islander, and Other. Income and education were combined to form a composite measure of socioeconomic status (SES) and categorized into low-, mid-, and high-SES. Multivariable Cox proportional hazards models were used to assess whether race/ethnicity was associated with the risk of death after adjusting for sociodemographic, clinical, and treatment factors. Additionally, subgroup analyses were conducted by SES, age, and surgery receipt.ResultsThe study population comprised 53,367 women (52.4% ages ≥ 65 years, 82% NH-White, 8.7% NH-Black, 5.7% Hispanic, and 2.7% NH-Asian/Pacific Islander) in the analysis. After adjusting for covariates, the NH-Black race was associated with a higher risk of death versus NH-White race (aHR: 1.12; 95% CI: 1.07,1.18), while Hispanic ethnicity was associated with a lower risk of death compared to NH-White women (aHR: 0.87; 95% CI: 0.80, 0.95). Furthermore, NH-Black women versus NH-White women had an increased risk of mortality among those with low-SES characteristics (aHR:1.12; 95% CI:1.03–1.22) and mid-SES groups (aHR: 1.13; 95% CI:1.05–1.21).ConclusionsAmong women with advanced-stage ovarian cancer who received systemic therapy, NH-Black women experienced poorer survival compared to NH-White women. Future studies should be directed to identify drivers of ovarian cancer disparities, particularly racial differences in treatment response and surveillance.

MP12-05 THE IMPACT OF SOCIOECONOMIC STATUS ON THE SURVIVAL OF MEN WITH EARLY-ONSET PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP12-05 THE IMPACT OF SOCIOECONOMIC STATUS ON THE SURVIVAL OF MEN WITH EARLY-ONSET PROSTATE CANCER Carlos Riveros, Victor Chalfant, Ahmed El-shafie, Allison H. Feibus, Mohammed Al-Toubat, Soroush Bazargani, SeyedBehzad Jazayeri, Mark Bandyk, and K.C. Balaji Carlos RiverosCarlos Riveros More articles by this author , Victor ChalfantVictor Chalfant More articles by this author , Ahmed El-shafieAhmed El-shafie More articles by this author , Allison H. FeibusAllison H. Feibus More articles by this author , Mohammed Al-ToubatMohammed Al-Toubat More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , SeyedBehzad JazayeriSeyedBehzad Jazayeri More articles by this author , Mark BandykMark Bandyk More articles by this author , and K.C. BalajiK.C. Balaji More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PC) is considered a disease of older men; about 10% of new diagnoses in the US occur in men ≤55 years old. Socioeconomic status (SES) has shown to influence survival in patients with PC; however, the impact of SES on men with early-onset PC remains undescribed. METHODS: Using the National Cancer Database, we identified men ≤55 years of age with PC between 2004-2018. Descriptive statistics were used to characterize differences among SES groups. Kaplan-Meier (KM) and Cox regression analyses were used to assess the effect of SES on overall survival (OS). To establish the impact of SES, the quartile assignments of median income and education level were combined to create a composite SES measure. Income and education level were determined by matching each patient’s zip code at the time of diagnosis with data derived from the 2016 American Community Survey on median household income and the percentage of people aged ≥25 years old who had not earned a high school diploma, respectively. The quartile assignments (Q1, Q2, Q3, Q4) of the income and education measures were added together to form 4 composite SES categories: 2-3=Low; 4-5=Mid-Low; 6-7=Mid-High; and 8=High. RESULTS: A total of 112,563 patients with early onset PC with a median follow-up of 79.0 months were included in the study cohort. Compared to high SES patients, low SES patients were more likely to be African American (42.4% vs. 8.6%; p<0.001), Hispanic (9.5% vs. 2.7%; p<0.001), and uninsured (5.2% vs. 1.1%; p<0.001); they were also more likely to live in a rural area (3.2% vs 0.1%; p<0.001) and have stage IV disease (5.5% vs. 3.1%; p<0.001). KM analysis showed that a decreasing SES was directly associated with lower rates of OS (log-rank test p<0.001). On multivariable analysis, SES was found to have a negative effect on OS (low SES vs. high SES; hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.41-1.68; p<0.001) (Figure 1). CONCLUSIONS: In patients with early-onset PC, SES was associated with overall survival. SES should be considered when implementing programs to improve the management of patients with early-onset PC Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Riveros More articles by this author Victor Chalfant More articles by this author Ahmed El-shafie More articles by this author Allison H. Feibus More articles by this author Mohammed Al-Toubat More articles by this author Soroush Bazargani More articles by this author SeyedBehzad Jazayeri More articles by this author Mark Bandyk More articles by this author K.C. Balaji More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract 11577: Disparities in One-Year Mortality Among Infants With Cyanotic Congenital Heart Disease - Insights From Contemporary National Data

Introduction: Racial inequities in congenital heart disease (CHD) are well documented. We examined the interplay between race, socioeconomic status (SES), and neonatal variables (prematurity and small for gestational age (SGA)) on 1-year mortality in infants with CHD. Hypothesis: SES and neonatal variables explain a significant part of observed racial disparities. Methods: Linked birth/death files from the Natality database for all liveborn neonates in the US were examined from 2014-2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) infants were compared to non-Hispanic White (NHW) infants. The primary outcome was 1-year mortality. A composite measure of SES was created based on maternal education and insurance with a maximal level of 4 and a minimal level of 0 (least privileged). Other mediators included prematurity and SGA. A directed acyclic graph (Figure 1) was created a priori as a conceptual model. Additive structural equation modelling with bootstrapped confidence intervals was used to calculate the contribution of each pathway in Figure 1 to the primary outcome and percent mediated by SES, prematurity and SGA. Results: We identified 7,432 NHW and 1,452 NHB infants with cyanotic CHD. NHB race was associated with increased 1-year mortality (OR 1.40, 95% CI: 1.23-1.59) compared to NHW. Figure 1 shows the contribution of each pathway to one-year mortality. The effect of SES explained 35.9% (CI 22.0-67.3) of the mortality disparity between NHB and NHW race. The effect of SGA explained 16.5% (CI 8.8-30.2) and prematurity explained 12.0% (CI 5.4-26.1). The direct effect of NHB race was not significant (35.5%, CI -4.9 - 56.7). Conclusions: Less privileged SES and greater prematurity and SGA likely explain the 1-year mortality disparity in Black infants with cyanotic CHD. These findings identify targets for social intervention to decrease racial disparities in CHD outcomes.

Social Disparities in Cardiometabolic Health in Czechia and Venezuela Using the Allostatic Load Model

Abstract Background Subjects with lower socioeconomic status (SES) are exposed to higher levels of environmental stressors. The cumulative effects of chronic stressors on cardiometabolic health can be evaluated using the allostatic load (AL) score. Despite the accepted social gradient, clear relationships between social determinants and cardiometabolic health in populations with different socio-cultural contexts have been rarely explored. This study aimed to compare the relationships of social determinants with AL in different socioeconomic contexts: unstable Venezuela (VE) and stable Czechia (CZ). Methods 25-64 years old subjects from two cross-sectional population-based samples from CZ (2013-2014, n = 1579, 56% females) and VE (2014-2017, n = 1652, 70% females). The AL score (scaled 0-8) was calculated using 8 cardiometabolic biomarkers (BMI, waist circumference, systolic and diastolic blood pressure, total and HDL-cholesterol, triglycerides). Social characteristics included education in both countries, household income in CZ, and composite measure of SES based on source of income, household head's profession, motheŕs education, and housing conditions in VE. Ordinal regression was performed separately in men and women. Results In CZ, men and women with low education and women with low income were more likely to have higher score of AL compared to those with high education and income (OR 1.45, 2.29 and 1.69). In VE, women with low education and low SES were more likely to have higher AL (OR 1.47 and 1.51), while men with low education and low SES were less likely to have higher AL (OR 0.64 and 0.61), compared to those with high education and high SES. Independently of age, sex, and socioeconomic characteristics, Venezuelans were more likely to have higher AL than Czechs. Conclusions Associations of social position indices and cardiometabolic health (proxied by AL) differed between CZ and VE, most likely reflecting differences in social environment between the countries. Key messages

1016-P: Equitable Glycemic Improvement in Youth with T1D during COVID-19

Aim: Despite disruptions caused by the COVID-pandemic, prior studies suggest some improvements in glycemic control. We investigated whether this improvement was equitable and seen across socioeconomic status (SES) groups in youth with T1D. Method: Using EHR-extracted visit and CGM data, we geocoded patient addresses linked with census-tract derived education from the 20American Community Survey and a composite measure of SES, the Neighborhood Deprivation Index (NDI) . Analyses included youth ≤18 years old using CGM with T1D duration ≥6 months (age &amp;lt;6 yrs) or ≥1 yr (age ≥6 yrs) . We performed t-tests and regressions comparing SES and CGM metrics during the pandemic (4/1/20-3/15/21) with pre-pandemic (4/1/19-3/15/20) . Results: The pre-pandemic sample had 641 youth (52% female, age 12.5±3.5, T1D 6.2±3.5 yrs) and the pandemic sample had 650 youth (52% female, age 13.5±3.6, T1D 6.8±3.8 yrs) ; 86% were common to both samples. Addresses allowed for geocoding of 98%; 44% of youth lived in low education census tracts where ≥30% of adults in the census tract had no more than a high school education. Mean CGM-derived glucose management indicator (GMI) improved during the pandemic for both those living in lower (8.07±0.05% pre vs. 7.91±0.% during, p&amp;lt;0.05) and higher SES education tracts (7.82±0.% pre vs. 7.69±0.% during) . There was similar improvement in GMI in lower vs. higher SES education tracts (0.16±.vs. 0.13±.06) . Other CGM metrics similarly improved during the pandemic, mean CGM glucose decreased by 6.7 mg/dL and 5.4 mg/dL in low and high SES education tract patients respectively (both p&amp;lt;.05) . Those living in the most deprived NDI areas had the highest GMI both pre and during the pandemic (p&amp;lt;0.05) and demonstrated similar or greater improvements than those from Iess deprived areas. Conclusion: Equitable improvements in CGM metrics during the pandemic was evident in youth with T1D. Future studies can assess how changes in healthcare delivery during the pandemic can reduce disparities and sustain benefits to all patients. Disclosure S.Ojukwu: None. A.Adam: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. C.Chen: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (K12DK094721, P30DK036836)

Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: A population-based study

SummaryBackgroundThe Endocrine Society Clinical Practice Guidelines recommend the avoidance of medications that may cause weight gain (i.e., obesogenic medications) in individuals with overweight or obesity. Obesity disproportionately affects people with lower socioeconomic status (SES); however, it is unknown whether the use of obesogenic medications differs by SES.MethodsWe included adults with overweight or obesity and used prescription medications from 2009-2018 of the US National Health and Nutrition Examination Survey. We examined the associations between a composite measure of SES and use of obesogenic medications and anti-obesity medications. The composite SES included <high school education (1 point), household income below federal poverty level (1 point), no insurance (2 points), and public health insurance only (1 point). We defined 3 composite SES groups (0 [high], 1 [intermediate], and ≥2 points [low]).FindingsAmong 10,673 US adults with overweight or obesity, 20.0% had low SES. Use of obesogenic medications was common (37.7%). Low (vs. high) SES was associated with greater obesogenic medication use, independent of demographic characteristics, prescription medication burden, and comorbidities (OR 1.3 [1.2-1.5]). Among 12,133 eligible participants, utilization of anti-obesity medications was very low overall (0.5%) and within all SES groups (low 0.27%, intermediate 0.71, and high 0.65%).InterpretationOur findings highlight common and modifiable risk factors for obesity. Clinicians should screen patient medications for those that may cause weight gain and increase adoption of anti-obesity medications, especially among adults living in low SES.FundingThe National Institute of Diabetes and Digestive and Kidney Disease (R01DK115534, K24HL155861, and K01DK121825).

Socioeconomic Status as a Multidimensional Predictor of Student Achievement in 77 Societies

We reassess the relation between students’ socioeconomic status (SES) and their achievement by treating SES as multidimensional instead of unidimensional. We use data from almost 600,000 students in 77 countries participating in the 2018 PISA assessment of student achievement in math, science, and reading. The composite measure of SES that PISA uses can be broken down into six component variables that we here use as simultaneous predictors of achievement. This analysis yields several new insights. First, in the typical society, two predictors (books at home and parents’ highest occupational status) clearly outperform the rest. Second, a new composite measure based only on these two components often reveals substantially larger achievement gaps than those reported by PISA. Third, the analysis revealed remarkable differences between societies in the relation between achievement and wealth possessions. In most societies, the independent effect of wealth possessions on student achievement was zero or even slightly negative—but in the least developed societies it was strongly positive. These findings have implications for how SES achievement gaps should be measured and interpreted.

Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer

BackgroundLow socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early‐onset CRC remains undescribed.Materials and MethodsRetrospective analysis of data from the National Cancer Database (NCDB) between 2004 and 2016 was conducted. We combined income and education to form a composite measure of SES. Logistic regression and χ2 testing were used to examine early‐onset CRC according to SES group. Survival rates and Cox proportional hazards models compared stage‐specific overall survival (OS) between the SES groups.ResultsIn total, 30,903 patients with early‐onset CRC were identified, of whom 78.7% were White; 14.5% were Black. Low SES compared with high SES patients were more likely to be Black (26.3% vs. 6.1%) or Hispanic (25.3% vs. 10.5%), have T4 tumors (21.3% vs. 17.8%) and/or N2 disease (13% vs. 11.1%), and present with stage IV disease (32.8% vs. 27.7%) at diagnosis (p < .0001, all comparisons). OS gradually improved with increasing SES at all disease stages (p < .001). In stage IV, the 5‐year survival rate was 13.9% vs. 21.7% for patients with low compared with high SES. In multivariable analysis, SES (low vs. high group; adjusted hazard ratio [HRadj], 1.35; 95% confidence interval [CI], 1.26–1.46) was found to have a significant effect on survival (p < .0001) when all of the confounding variables were adjusted. Insurance (not private vs. private; HRadj, 1.38; 95% CI, 1.31–1.44) mediates 31% of the SES effect on survival.ConclusionPatients with early‐onset CRC with low SES had the worst outcomes. Our data suggest that SES should be considered when implementing programs to improve the early detection and treatment of patients with early‐onset CRC.Implications for PracticeLow socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early‐onset CRC remains undescribed. In this retrospective study of 30,903 patients with early‐onset CRC in the National Cancer Database, a steady increase in the yearly rate of stage IV diagnosis at presentation was observed. The risk of death increased as socioeconomic status decreased. Race and insurance status were independent predictors for survival. Implementation of programs to improve access to care and early diagnostic strategies among younger adults, especially those with low SES, is warranted.

Does school impact adolescents’ life satisfaction differently for students of different socio-economic status? A comparative study in 33 countries

ABSTRACT Research shows that school is one of the most important life domains shaping adolescents’ life satisfaction (LS) and this influence varies across countries and different groups of students (e.g. by gender). However, there is a lack of cross-country comparative research studying the links between school and students’ LS and how this differs across socioeconomic status (SES). This study explores this question using multilevel regression to analyse data from the 2015 Programme for International Students Assessment study on 15-year-old students in 33 countries. Two measures of SES were considered: material well-being and a composite SES measure. Results indicate that 1) in some countries, distinct school-related factors may shape students’ LS differently for students of higher and lower SES, 2) although there are some general patterns across countries for some school factors (bullying, academic competence, and parents’ support in relation to school are more strongly associated with LS among students of lower SES), for most school factors, the picture is mixed, and 3) in around half of the countries, schools seem to moderate the association between SES and students’ LS. Research and policy implications are discussed.

Patients with geographic barriers to health care access are prescribed a higher proportion of drugs with pharmacogenetic testing guidelines

Pharmacogenetic (PGx) testing may be particularly beneficial in medically underserved populations by reducing the number of appointments required to optimize drug therapy and increasing the effectiveness of less expensive off‐patent drugs. The objective of this study was to identify patient populations with poor health care access and assess prescribing trends for drugs with published PGx testing guidelines. We used electronic health record data from 67,753 University of Florida Health patients, geographic access scores calculated via the 2‐step floating catchment area method, and a composite measure of socioeconomic status. Comparing the poorest (Q4) and greatest (Q1) access score quartiles, poor geographic access was significantly associated with fewer prescriber encounters (incidence rate ratio [IRR] 0.88, 95% confidence interval [CI] 0.86–0.91), fewer total unique drugs (IRR 0.92, 95% CI 0.9–0.95), and fewer PGx guideline drugs (IRR 0.94, 95% CI 0.9–0.99). After correcting for number of unique drugs, patients in low‐access areas were prescribed a greater proportion of PGx guideline drugs (IRR 1.08, 95% CI 1.04–1.13). We detected significant interactions between Black race and access score. Compared to Q1, Black patients with Q4 access scores were disproportionately affected and had fewer encounters (IRR 0.76, 95% CI 0.7–0.82) and a higher proportion of PGx drugs (IRR 1.26, 95% CI 1.13–1.41), creating further disparity. Overall, these results suggest that improved geographic access to PGx testing may allow prescribers to make more efficient use of limited opportunities to optimize therapy for drugs with PGx testing guidelines.

Racial Discrimination and Telomere Length in Midlife African American Women: Interactions of Educational Attainment and Employment Status.

Over the life course, African American (AA) women have faster telomere attrition, a biological indicator of accelerated aging, than White women. Race, sex, age, and composite socioeconomic status (SES) modify associations of institutional racial discrimination and telomere length. However, interactions with everyday racial discrimination have not been detected in AA women, nor have interactions with individual socioeconomic predictors. We estimated statistical interaction of institutional and everyday racial discrimination with age, education, employment, poverty, and composite SES on telomere length among midlife AA women. Data are from a cross-section of 140 AA women aged 30-50 years residing in the San Francisco Bay Area. Participants completed questionnaires, computer-assisted self-interviews, physical examinations, and blood draws. Adjusted linear regression estimated bootstrapped racial discrimination-relative telomere length associations with interaction terms. Racial discrimination did not interact with age, poverty, or composite SES measures to modify associations with telomere length. Interactions between independent SES variables were nonsignificant for everyday discrimination whereas institutional discrimination interacted with educational attainment and employment status to modify telomere length. After adjusting for covariates, we found that higher institutional discrimination was associated with shorter telomeres among employed women with lower education (β = -0.020; 95% confidence interval = -0.036, -0.003). Among unemployed women with higher education, higher institutional discrimination was associated with longer telomeres (β = 0.017; 95% confidence interval = 0.003, 0.032). Factors related to having a post-high school education may be protective against the negative effects of institutional racism on cellular aging for AA women.

Distinct influence of parental occupation on cortical thickness and surface area in children and adolescents: Relation to self-esteem.

Studies of socioeconomic disparities have largely focused on correlating brain measures with either composite measure of socioeconomic status (SES), or its components—family income or parental education, giving little attention to the component of parental occupation. Emerging evidence suggests that parental occupation may be an important and neglected indicator of childhood and adolescent SES compared to absolute measures of material resources or academic attainment because, while related, it may more precisely capture position in social hierarchy and related health outcomes. On the other hand, although cortical thickness and surface area are brain measures with distinct genetic and developmental origins, large‐scale neuroimaging studies investigating regional differences in interaction of the composite measure of SES or its components with cortical thickness and surface area are missing. We set out to fill this gap, focusing specifically on the role of parental occupation on cortical thickness and surface area by analyzing magnetic resonance imaging scans from 704 healthy individuals (age = 3–21 years). We observed spatially distributed patterns of (parental occupation × age2) interaction with cortical thickness (localized at the left caudal middle frontal, the left inferior parietal and the right superior parietal) and surface area (localized at the left orbitofrontal cortex), indicating independent sources of variability. Further, with decreased cortical thickness, children from families with lower parental occupation exhibited lower self‐esteem. Our findings demonstrate distinct influence of parental occupation on cortical thickness and surface area in children and adolescents, potentially reflecting different neurobiological mechanisms by which parental occupation may impact brain development.

Lower Socioeconomic Status is Associated With Adverse Urinary Markers and Surgical Complexity in Kidney Stone Patients

To determine if socioeconomic status (SES) correlates with severity of kidney stone disease and 24-hour urine parameters. An IRB approved prospectively maintained database for nephrolithiasis was retrospectively analyzed for both 24-hour urine results and surgical procedures performed from 2009 to 2019. Severely distressed communities (SDC) were categorized as those with a Distressed Communities Index (DCI), a composite measure of SES, score in the top quartile (lowest for SES). Univariate and multivariate analyses were performed to evaluate the strength of the association of DCI on: stone size at presentation, need for and type of surgical procedure, need for staged surgery and specific stone risk factors in 24-hour urine collections. Surgical procedures were performed on 3939 patients (1978 women) who were not from SDC and 200 (97 women) from SDC. Patients from SDC were older (57.1 years vs 54.2 years; P=.009). Patients from SDC were more likely to undergo proportionally more invasive procedures (17.5% vs 11.6%; P=.011) and require staged surgery at a higher rate (13.0% vs 8.5%; P=.028). Men from SDC had larger stones (12.5 mm vs 9.7 mm; P=.001). Among 24-hour urine results from 2454 patients (1187 women), DCI was not correlated with sodium, calcium, magnesium, volume, oxalate, phosphate, and pH levels. Higher DCI (lower SES) correlated with lower urine citrate (P=.001) and lower urine potassium (P=.002). SES correlates with larger stone burden at the time of urologic intervention, requires proportionally more invasive procedures and more staged procedures. Lower SES correlated with lower urine citrate and potassium.

Which measure of socioeconomic status best predicts bilingual lexical abilities and how? A focus on four-year-olds exposed to two majority languages.

This study evaluates the ability of different measures of socioeconomic status (SES) to predict lexical outcomes for preschoolers raised in a context of nationwide bilingualism. The participants were 58 children aged 3;11-4;3 from Maltese-dominant homes who attended state preschools. Receptive picture name judgement and picture naming, in Maltese and English, were employed to measure receptive and expressive lexical abilities, respectively. Lexical outcomes for four individual SES variables and a single composite SES measure were similar but not directly interchangeable. The composite SES variable emerged as most strongly predictive of children's lexical performance. Receptive judgement of phonological accuracy improved similarly in both languages with higher composite SES. Naming skills increased significantly in English but not in Maltese, suggesting differences in English input related to parental SES. A focus on SES in relation to lexical skills in two majority languages is novel and adds to current understanding of normative bilingual acquisition.

Screen-time, Physical Activity And Bmi

PURPOSE: Observational studies often adjust for confounding by socioeconomic status (SES) but rarely report the magnitude of confounding bias. Also, different indicators of SES may not meet the definition of a confounder for some associations. This study will determine whether different measures of SES have different confounding effects on the associations of screen time with BMI and of moderate/vigorous physical activity (MVPA) with BMI. METHODS: In a 15 year prospective cohort study, 1830 young adults (age 25 - 36) reported height and weight (used to calculate BMI in kg/m2), hours/day of screen time, hours/week of MVPA and nine measures of SES in 2015. SES at baseline (2000) was based on parent education and employment. BMI, screen time and MVPA were regressed with linear regression on each SES measure and a composite measure that combined young adults’ income and education. Crude associations of screen time with BMI and of MVPA with BMI were assessed with linear regression. The SES measures were added individually to these models to determine the percent change in the associations (percent confounding). RESULTS: Seven measures of SES were associated with BMI; eight with screen time; and four with MVPA. Education, income, financial strain and living with parents all confounded the association of screen time with BMI by more than 10%. No measure confounded the relationship of MVPA with BMI by more than 10%. The composite measure was significantly associated with screen time (β = -0.39, 95% CI [-0.47 to -0.31]) and BMI (β = -1.29, 95% CI [-1.58 to -0.99]), but not with MVPA. This composite substantially confounded the association of screen time with BMI (29%) but not of MVPA with BMI (3%). CONCLUSIONS: The composite SES measure had similar properties to individual SES measures: it was associated with screen time and BMI but not with MVPA and it had substantial confounding bias effect on the association of screen time with BMI, but not on the association of MVPA with BMI. Knowing the magnitude of confounding can help assess results from other studies that do not adjust for SES. A composite measure may be useful for the varied analyses done with data from large cohort studies. However, because of the potential for over fitting models, associations with measures of SES should be carefully considered before using them to adjust for confounding.

Risk Factors for Malnutrition Among Children With Cerebral Palsy in Botswana

BackgroundChildren with cerebral palsy in low-resource settings are at high risk of malnutrition, which further increases their risk of poor health outcomes. However, there are few available data on specific risk factors for malnutrition among children with cerebral palsy in the developing world. MethodsWe performed a case-control study among children with cerebral palsy receiving care at a tertiary care hospital in Gaborone, Botswana. Children with cerebral palsy and malnutrition were identified according to World Health Organization growth curves and compared with subjects with cerebral palsy without malnutrition. Risk factors for malnutrition were identified using multivariable logistic regression models. These risk factors were then used to generate a Malnutrition Risk Score, and Receiver Operating Characteristic curves were used to identify optimal cutoffs to identify subjects at high risk of malnutrition. ResultsWe identified 61 children with cerebral palsy, 26 of whom (43%) met criteria for malnutrition. Nonambulatory status (odds ratio 13.8, 95% confidence interval [CI] 3.8-50.1, P < 0.001) and a composite measure of socioeconomic status (odds ratio 1.6, 95% CI 1.0-2.5, P = 0.03) were the strongest risk factors for malnutrition. A Malnutrition Risk Score was constructed based on these risk factors, and receiver operating characteristic curve analysis demonstrated excellent performance characteristics of this score (area under the curve 0.92, 95% CI 0.89-0.94). ConclusionsMalnutrition is common among children with cerebral palsy in Botswana, and a simple risk score may help identify children with the highest risk. Further studies are needed to validate this screening tool and to determine optimal nutritional interventions in this population.

Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England

BackgroundThe Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age.MethodData were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage.ResultsWe observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups.ConclusionDifferent SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.

Socio-economic status and overweight or obesity among school-age children in sub-Saharan Africa - a systematic review.

Childhood overweight and obesity have emerged as a public health concern in sub-Saharan Africa. We conducted a systematic review with the aim to examine the association between socio-economic status (SES) and overweight or obesity among school-age children in sub-Saharan Africa. In March 2014 we searched five electronic databases for reports which presented cross-sectional data on prevalence levels of overweight or obesity stratified by SES groups among school-age children in sub-Saharan Africa. We used a random-effect model to pool the relative indexes of inequality of the association from the individual studies. In total, 20 reports satisfied the inclusion criteria providing results of 21 datasets. The risk of overweight or obesity in children from highest SES households was 5.28 times as high as that of children from lowest SES households (95% confidence interval [CI] 2.62 to 10.66). On subgroup analysis, this association was statistically significant for household income and composite SES measures but not for parental educational attainment and occupation type. Similarly, the risk of overweight or obesity in children attending affluent (private) schools was 15.94 times as high as that of children going to either urban or rural public schools (95% CI 5.82 to 43.68). The magnitude of the association tended to be stronger for area or school-type compared with composite measures. In summary, children from higher SES households and those attending private schools tended to be overweight and obese.

Convergent Validity Assessment of a Brief Screen for Poverty with South African Adolescents

We explored the convergent validity of a brief screen for poverty with a convenience sample of 462 South African school-aged adolescents. Participants completed the poverty screen of the Developmental Trauma Inventory as well as the Household Economic and Social Status Index, which is a composite measure of socioeconomic status that was developed and validated using South African samples. Results indicated that scores on the poverty screen were significantly negatively correlated for financial/social capital, material consumption, and socioeconomic status subscales, as well as the total scale. These findings provide support for the convergent construct validity of the Developmental Trauma Inventory poverty screen.