Contribution Of Socioeconomic Status Research Articles

Abstract P245: Association Between Individual Socioeconomic Status and Discharge Dispositions to Home or Rehabilitation Following Incident Stroke Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study

Background: The contribution of socioeconomic status (SES) to discharge destination in stroke survivors is not known. Hypothesis: Discharge to home, as compared to inpatient rehabilitation, will be greater among stroke survivors with low, as compared to high SES. Methods: The study population included ARIC Study participants, enrolled in fee-for-service Medicare, aged 66 years or older, with incident ischemic or hemorrhagic stroke (1992-2017). Black participants from the Minneapolis and Washington County study centers were excluded due to low numbers. Individual SES was estimated from median household income and education. Discharge disposition was ascertained from CMS Medicare inpatient records. Logistic regression models with inverse probability of treatment weighting were used to estimate the effect of exposures, accounting for age, sex, race, study center, comorbidity, and stroke severity. The Elixhauser Comorbidity Index was used to as a measure of comorbidity burden. Stroke severity was estimated from discharge diagnosis and procedure codes obtained from Medicare hospitalization records. Results: Of a total 710 ARIC stroke survivors (mean age at discharge 76 (SD: 6.2) years, 30.1% (214 of 710) Black, 57.5% (408 of 710) women), 50.7% (360 of 710) were discharged home. Compared to high income, low and moderate income was associated with lower adjusted odds of discharge to home among White participants (AOR:0.8, 95% CI: 0.68-0.93) and AOR: 0.63, 95% CI: 0.57-0.69), respectively) and higher odds discharge to home among Black participants (AOR: 1.36, 95% CI: 1.07-1.73 and AOR: 1.43, 95% CI: 1.11-1.83, respectively). Low income was also associated with higher odds of discharge home among women. Adjustment for stroke severity and comorbidity did not attenuate estimates. No significant association between education and discharge disposition was observed. Conclusions: Low and moderate median household income is statistically significantly associated with discharge home among Black and female stroke survivors.

0067 Sleep Disparities and the Academic Achievement Gap in 1.9 Million College Students

Abstract Introduction Adults from under-represented minority groups (URM) disproportionately experience sleep disturbances. Sleep disparities can be prevalent in academic settings, however, it is still unknown whether sleep disparities directly contribute to other disadvantages in URM students, such as the academic achievement gap. Using a national database of college students collected over 20 years, we investigated whether poor sleep quality mediated the relationship between race/ethnicity and grade point average (GPA). Methods We conducted secondary analyses on American College Health Association – National College Health Assessment survey data (ACHA-NCHA). The ACHA-NCHA I, II, IIb, IIc, and III surveys were conducted between 2000 and 2020, and included approximately 1,900,000 participants. We analyzed responses to questions regarding race/ethnicity, socioeconomic status, academic achievement (GPA), daytime sleepiness, and sleep health. Non-URM students were those identifying as non-Hispanic White or Asian whereas URM students included all other racial/ethnic identifications. We calculated a sleep-problems composite score by transforming each sleep item response into a z-score and averaging across all items. Results Sleep disparities were evident amongst the college students; relative to non-URM students, URM students reported fewer days per week that they felt rested (95% CIs: 3.884–3.895 vs. 4.155–4.161) and worse sleep-problem composite scores (95% CIs: .0453–.0496 vs. -.0226 – -.0199). In addition, there was significant evidence for an academic achievement gap, such that URM students reported significantly lower GPAs than non-URM students (95% CIs: 3.162–3.166 vs. 3.344–3.346). Feeling rested and sleep problem composite scores partially mediated the relationship between race/ethnicity and academic achievement (ps < .001), explaining 4.1% and 5.1% of the variance, respectively. These results were lower in magnitude than the contribution of socioeconomic status (25.3% of the mediation variance); however, sleep problems and feeling rested continued to explain significant variance even when controlling for socioeconomic status. Conclusion Sleep disparities contribute to academic achievement gaps experienced by URM students. The current findings indicate that university-wide sleep health programs may help to remove an unnecessary barrier to academic achievement, particularly if such programs incorporate behavioral change theory and address system-level financial, sociocultural, and environmental barriers to sleep quality. Support (If Any) National Science Foundation (1920730 and 1943323)

Abstract 11629: Contributions of Socio-Economic Status, Lifestyle, and Biological Risk Factors to Ethnic Differences in Type 2 Diabetes Risk in a Multi-Ethnic Asian Population

Introduction: There is no study that identified contributions of socio-economic status (SES), lifestyle, and biological risk factors to ethnic differences in T2D risk in Asia’s populous ethnic groups - Chinese, Malays and Indians. Methods: We used data of 7,427 participants from the Multiethnic Cohort, a population-based study of subjects aged ≥21 y. Information on SES and lifestyle were collected using standardized questionnaires. Biological risk factors were measured using validated methods. T2D cases were based on self-reported physician-diagnosed diabetes or a national medical registry, or fasting plasma glucose ≥7.0 mmol/L or HbA1c ≥6.5 %, after an average of 7.2 y (SD: 2.2 y). Multivariable logistic and linear regression models were used in association and mediation analyses. Results: In Model 1, Malays and Indians had a twofold higher risk of developing T2D compared with Chinese ( Table 2 ). In Model 2, only the association between Indians and Chinese remained. The higher T2D risk in Malays and Indians was largely mediated by BMI and HDL cholesterol ( Table 3 ). Adjusting for adiponectin concentrations widened the differences in T2D risk. We observed a larger mediation effect by HOMA-IR for Indians than Malays. Conclusion: The excess risk in Malays was completely explained by higher BMI. In contrast, neither adiposity nor SES and lifestyle could fully explain the higher T2D risk in Indians.

Abstract 61: Community Factors Associated With Persistently High 1-Year Recurrent Stroke Rates in the United States

Background: There is known geographic variation in recurrent stroke rates in the US; however, the contributions of socioeconomic status (SES), healthcare access/utilization, and community resources to these disparities are uncertain. We assessed community characteristics in counties having persistently higher recurrent stroke rates over a 16-year period. Methods: We included 3,485,618 fee-for-service Medicare beneficiaries aged ≥65y discharged with ischemic stroke from 2001-2016, grouped into four 4-year periods. We categorized 3221 US counties or equivalents into 6 groups based on the % of stroke patients with a recurrent stroke within 1 year. Persistently high-recurrence counties were those in the highest sextile for each 4-year period. We integrated county-specific demographic, geographic, SES, general health, care availability, health behavior, and environmental data from the US Census Bureau, USDA Economic Research Service, and Dartmouth Atlas. We calculated mean standardized differences in county characteristics between high-recurrence and other counties and used logistic regression to model high-recurrence counties as a function of 12 potentially modifiable county characteristics. Results: There were 133 persistently high-recurrence counties that were concentrated in the South Central US and included 140,144 stroke patients during the study (A; mean age 78.3y, 57% women, 82% White, 11.5% stroke recurrence vs 79.0 y, 55% women, 86% White, 10.5% stroke recurrence in other counties). Compared with the rest of the US, these counties had populations with lower SES, poorer health, more limited access to care providers and recreation/fitness, and reduced rates of preventive testing (B). The model including 12 potentially actionable characteristics had a c statistic of 0.84. Conclusions: Our findings highlight the value of identifying potentially modifiable community characteristics that, if improved, might reduce recurrent stroke rates.

Social Vulnerability Is Associated with Emergency Department Dependency in Pediatric Sickle Cell Disease Patients

Background: Sickle cell disease (SCD) is a complex genetic disorder characterized by significant, largely unpredictable heterogeneity in disease severity and healthcare utilization. The contribution of socioeconomic status (SES) and other environmental factors to this heterogeneity is poorly understood. In other disorders, SES is a major influence on healthcare quality and access, which can be affected by financial status, social stability, transportation, household overcrowding, and other variables. The multiplicative nature of these factors limits the ability to incorporate them in a single measure. The Social Vulnerability Index (SVI) was created by CDC to assist disaster management officials in identifying the locations of their most socially vulnerable populations (https://svi.cdc.gov/). SVI combines many of the SES factors that may contribute to disease severity and healthcare utilization. SVI has previously been validated for use assessing chronic conditions such as asthma, youth inactivity, and BMI. Thus, we hypothesized that SVI is associated with SCD-related severity and utilization. This analysis explores the relationship between census tract level social vulnerability and healthcare utilization in pediatric SCD patients. Methods: The Children's Healthcare of Atlanta's (CHOA) SCD Clinical Database houses a large, population-based cohort of pediatric sickle cell patients. It includes laboratory-confirmed SCD genotype, treatment history, and healthcare utilization for over 3,500 patients from 2010-2018. The database was queried for patients who had ≥1 SCD-related healthcare encounter from 2016-2018 and whose most recent address was in a metro Atlanta county. Addresses were geocoded and matched to CDC's SVI at the census tract level. The SVI combines 15 measures from the US Census and groups them into four related themes - SES, Household Composition & Disability, Minority Status & Language, and Housing & Transportation , which are combined into a percentile ranking of overall social vulnerability ranging from 0 (lowest) to 1 (highest). Patients were categorized by sickle cell anemia (SCA) genotypes (SS or Sβ0 Thalassemia) vs. other. Healthcare utilization was used to calculate the emergency department dependency ratio (EDR, ratio of ED visits to sum of ED and SCD clinic visits) and total inpatient days for acute illness as a measure of disease severity. As reported in previous studies, EDR was classified as high (>=0.33) or low (<0.33). SVI, age, and annual inpatient days were included as continuous variables. A logistic regression model was used to assess the relationship between SVI and EDR. SCA vs. other SCD genotypes, age, and total inpatient days were included as covariates and a backwards selection was used to find the best model. Results: Of the 2,578 active patients from 2016 to 2018, 1,328 met inclusion criteria. Mean age at the end of each measurement year was 10.0 years (SD=5.6), 47.7% were female, and 62.0% had SCA genotypes. Average inpatient days was 3.2 (SD=8.3). Average SVI was 0.50 (SD=0.28) and average EDR was 0.29 (SD=0.29); 44.8% of which were classified as high. All covariates were significant in the multivariate model. In the crude model, SVI was significantly associated with high EDR (OR=2.08, 95% CI: 1.62, 2.66). After controlling for inpatient length of stay, age, and genotype, SVI remained positively associated with high EDR (OR=1.85, 95% CI: 1.41, 2.44). Of the covariates, total hospital days (OR=1.28, 95% CI: 1.25, 1.32) was associated with a higher EDR. Older age (OR=0.97, 95% CI (0.96, 0.99) and SCA genotype (OR=0.41, 95% CI: 0.35-0.48), were negatively associated with high EDR. After controlling for SCA genotype, age, and length of stay, a 1 unit increase in SVI was associated with 85% greater odds of having a high EDR. Conclusions: The analysis demonstrates a significant relationship between SVI and EDR. Further analyses will assess the effect of distance to emergency department, treatment with hydroxyurea or chronic transfusions, and individual themes within SVI to further elucidate this relationship. A limitation of this analysis is that encounters were limited to those occurring at a CHOA facility. Overall, the results support our hypothesis that high social vulnerability is associated with increased reliance on the emergency department for care and that SVI may be a predictor of disease severity and increased healthcare utilization. Disclosures Lane: NHLBI: Research Funding; CDC: Research Funding; GA Dept: Other: Contract for newborn screeninjg follow-up services services; Bio Products Laboratory: Other: Sickle Cell Advisory Board; FORMA Therapeutics: Other: Clinical Advisory Board.

RACIAL DIFFERENCES IN CONTEMPLATIVE PRACTICES IN LATER LIFE: EXAMINING THE ROLE OF SES AND HEALTH DISADVANTAGE

Substantial scholarly attention has been placed on prayer as a buffer of life events’ adverse influences on well-being in later life. The disproportionate distribution of adverse life events among Black adults has also attracted scholarly interest in racial differences in contemplative practices. Black adults have been found to more likely engage in private prayer than White adults, whereas studies have observed an opposite pattern for meditation. The contribution of stratification in socioeconomic status and health to racial differences in contemplative practices, especially in meditation has received relatively less attention. Drawing from a subsample from Health and Retirement Survey (N = 1102), this study takes a next necessary step to assess the contribution of socioeconomic status, multimorbidity, and depressive symptoms to racial differences in both prayer and meditation use in later life. Consistent with prior studies, the odds of engaging in private prayer (OR=2.78, p<0.01) was higher among Blacks than White older adults. Our findings of higher odds (OR=2.92, p<0.001) of meditation among Black older adults than White older adults, however, do not align with previous studies. The disadvantage in socioeconomic status, health, and psychological well-being completely explain racial differences in prayer, but this difference in meditation persist even after adjusting for those factors. Our findings call for further research on contextually influenced underlying individual motivations that drive older adults of different racial and social economic groups to engage in various contemplative practices. Further research is also warranted on how older adults, particularly Blacks differentiate between private prayer and meditation.

The contributions of socioeconomic status, perceived stress, and depression to disability in adults with systemic lupus erythematosus

Purpose: Psychological and sociodemographic factors contribute to disability in systemic lupus erythematosus. Yet the pathways by which these factors influence disability remain unclear. The objective of this study was to evaluate a model examining socioeconomic status (SES), perceived stress, and depressive symptoms as determinants of lupus-related disability.Methods: The sample included 134 patients receiving treatment at an academic hospital. Structural equation modeling examined the direct and indirect effects of SES (income, education, and subjective social status), perceived stress (Perceived Stress Scale), and depressive symptoms (Hospital Depression Anxiety Scale depression subscale) on disability (Lupus Patient-Reported Outcome measure Physical Health and Pain-Vitality subscales).Results: Structural equation modeling confirmed that the model fit the data well. The SES exerted a direct negative effect on perceived stress (β = −0.40, p < 0.001). In turn, perceived stress predicted higher levels of depression (β = 0.72, p < 0.001), which ultimately contributed to greater disability (β = 0.53, p < 0.001). The influence of SES on disability was indirect (mediated by perceived stress and depression).Conclusions: Findings support the socioeconomic gradient in disability as mediated by perceived stress and depression, such that lower SES contributed to lupus-related disability via perceived stress and depressive symptoms.Implications for RehabilitationLow socioeconomic status, perceived stress, and depression are prognostic factors for the disability in systemic lupus erythematosus.Study findings indicate that perceived stress and depression fully mediate (account for) the negative impact of low socioeconomic status on lupus-related disability.Screening for and addressing psychological distress may enhance management of disability in lupus patients.This research demonstrates the value of a conceptual framework for identifying potentially modifiable risk factors for disability in lupus and other chronic disabling diseases.

Contribution of Socioeconomic Status at 3 Life-Course Periods to Late-Life Memory Function and Decline: Early and Late Predictors of Dementia Risk.

Both early life and adult socioeconomic status (SES) predict late-life level of memory; however, evidence is mixed on the relationship between SES and rate of memory decline. Further, the relative importance of different life-course periods for rate of late-life memory decline has not been evaluated. We examined associations between life-course SES and late-life memory function and decline. Health and Retirement Study participants (n = 10,781) were interviewed biennially from 1998-2012 (United States). SES measurements for childhood (composite score including parents' educational attainment), early adulthood (high-school or college completion), and older adulthood (income, mean age 66 years) were all dichotomized. Word-list memory was modeled via inverse-probability weighted longitudinal models accounting for differential attrition, survival, and time-varying confounding, with nonrespondents retained via proxy assessments. Compared to low SES at all 3 points (referent), stable, high SES predicted the best memory function and slowest decline. High-school completion had the largest estimated effect on memory (β = 0.19; 95% confidence interval: 0.15, 0.22), but high late-life income had the largest estimated benefit for slowing declines (for 10-year memory change, β = 0.35; 95% confidence interval: 0.24, 0.46). Both early and late-life interventions are potentially relevant for reducing dementia risk by improving memory function or slowing decline.

Psychosocial Keys to African American Achievement? Examining the Relationship Between Achievement and Psychosocial Variables in High Achieving African Americans

Grit, growth mindset, ethnic identity, and other group orientation are four psychosocial variables that have been associated with academic achievement in adolescent populations. In a sample of 105 high achieving African American high school students (cumulative grade point average [GPA] &gt; 3.0), we examined whether these four psychosocial variables contributed to the achievement of high achieving African Americans beyond the contribution of socioeconomic status (SES) and other demographic variables. Results indicated that the psychosocial variables were not significant predictors of academic achievement for the high achieving African American students in this sample. However, SES was a significant predictor of the academic achievement with a medium effect size. These findings suggest that interventions focused on grit, growth mindset, ethnic identity, and other group orientation may not be as effective as hypothesized.

Socioeconomic status and intelligence quotient as predictors of psychiatric disorders in children and adolescents with high-functioning autism spectrum disorder and in their siblings.

Previous studies have shown high rates of comorbid disorders in children and adolescents with autism spectrum disorder, but failed to compare them with general population and few of them have identified predictors of comorbidity. This study compared the rates of psychiatric disorders in 50 children and adolescents with autism spectrum disorder, 24 of their siblings, 32 controls from general population and 22 of their siblings. Children and adolescent with autism spectrum disorder and their siblings had higher rates of attention deficit and hyperactivity disorder compared to controls. Lower socioeconomic status and intelligence quotient were the main risk factors. The contribution of socioeconomic status and intelligence quotient to increase the risk of developing comorbidity in autism spectrum disorder and psychopathology in their siblings deserves further study.

Ethnic differences in self-reported sleep duration in the Netherlands – the HELIUS study

BackgroundWe investigated ethnic differences in sleep duration, and the contribution of socio-economic status (SES) to the observed differences in Amsterdam, the Netherlands. Methods6959 participants (aged 18–71 years) from the multi-ethnic HELIUS cohort were studied. Outcome variables were short sleep (<7 h/night) and long sleep (≥9 h/night). Comparisons among groups were made using Prevalence Ratios (PRs). ResultsEthnic minority groups were more likely than ethnic-Dutch to report short sleep, with prevalence ranging from 15.1% to 49.7% in men and 16.3% to 41.4% in women. Among men, the age-adjusted PRs ranged from 2.15 (95% CI 1.72–2.69) in Turkish to 3.31 (2.75–3.99) in Ghanaians; and among women, from 1.62 (1.30–2.01) in Turkish to 2.52 (2.15–2.95) in African-Surinamese, respectively. The prevalence of long sleep was significantly higher only in Moroccan men and all the ethnic minority women than in ethnic-Dutch women except for African-Surinamese. Adjustment for SES explains the ethnic difference in long sleep, but not for short sleep. ConclusionEthnic minority groups reported more short sleep than ethnic-Dutch, while there were no ethnic differences in long sleep. Further study is needed to investigate how this finding on short sleep may contribute to ethnic differences in health outcomes.

Contribution of socio-economic status on the prevalence of cerebral palsy: a systematic search and review.

The association between socio-economic status (SES) and cerebral palsy (CP) remains controversial. Preterm birth, low birthweight, and postnatal injuries are accepted mediating risk factors for CP, but the question remains whether SES confers additional risk. The aim of this study was to analyse existing knowledge on the relationship between SES and the risk of CP. We conducted a systematic search and review of potentially relevant research relating to SES and CP published from 1980 to 2012. Heterogeneity between studies did not allow for data aggregation or meta-analysis; therefore, a narrative review was used to summarize the findings. Twelve studies were included in the systematic review. Of these, eight found low SES to be a risk factor for increased CP prevalence. Three studies detected statistically significant associations even after controlling for birthweight and gestational age as variables. Two of these studies also accounted for additional confounding variables (multiple births and timing of CP acquisition) and continued to detect contributory effects of SES. Linear negative correlations between CP prevalence and SES were shown by three studies. Evidence suggests that the effect of SES on CP prevalence goes beyond that of the mediating factors preterm birth, low birthweight, and postnatal trauma. These associations were seen in area-based and, to a lesser extent, individual measures of SES. A better understanding of mediating factors is imperative in developing targeted public health intervention programmes to reduce the prevalence of CP.

Contribution of socioeconomic status, stature and birth weight to obesity in Sub-Saharan Africa: cross-sectional data from primary school-age children in Cameroon

BackgroundThe pattern of obesity in relation to socioeconomic status is of public health concern. This study investigates whether the association between height and obesity in children is affected by their socioeconomic background. It also explores the relationship between high birth weight and obesity.MethodsSchool children, (N = 557; 5 to 12 years old) were recruited from randomly selected primary schools in a cross-sectional study including 173 rural and 384 urban children in the North West Region of Cameroon. Socioeconomic status (SES) and birth weight were obtained using a self administered questionnaire. Anthropometric measures included height, weight, BMI, waist circumference and percentage body fat. These measures were transformed into age and sex-standardized variables. Then participants were divided according to quartiles of height SDS.ResultsThe highest frequencies of overweight/obesity (18.8%), abdominal overweight/obesity (10.9%) and high body fat/obesity (12.3%) were observed among the tallest children from a high socioeconomic background. Univariate analyses indicate that children of high SES (39.9%), fourth height quartile (33.1%) and of high birth weight (54.8%) were significantly (p < 0.001) more likely to be overweight/obese. Multivariate analyses showed high SES (OR 8.3, 95% CI 3.9 – 15.4), fourth height quartile (OR 9.1, 95% CI 3.4 – 16.7) and high birth weight (OR 0.1, 95% CI 0.06 – 0.2) as independent predictors of overweight/obesity.ConclusionsThis study confirms that children coming from a high socioeconomic background and being tall are at particular risk of becoming obese.

Socioeconomic Status, Comorbidity, Activity Limitation, and Healthy Life Expectancy in Older Men and Women

This study aimed to explore the structural contributions of socioeconomic status (SES), comorbidity, and activity limitation to the healthy life expectancy (HALE) of Japanese suburban elderly. A questionnaire survey was distributed to all residents aged 65 years and older in Tama City, Tokyo, in 2001; a follow-up study was conducted in 2004; and individual vital status data from the municipal residents' registry were tracked until 2007. In all, 7,905 respondents were included for analysis. Data analysis was performed by structural equation modeling (SEM). The data were well fit by the models, and HALE was found to be well explained by SES, comorbidity, and activity limitation (R (2) = .59 for men and R (2) = .71 for women). In conclusion, elderly people with higher SES were more likely to live longer with good self-rated health, via living with less chronic diseases and better performance in daily living activities, especially for elderly women.

Sleep patterns and sleep problems in a multi-ethnic population in Amsterdam, The Netherlands

Background Evidence indicates that insufficient sleep or poor sleep quality is a risk factor for several health outcomes. However, very little is known about ethnic differences in sleep patterns, especially in Europe. Objectives This study sought to investigate ethnic differences in sleep duration and sleep problems in a multi-ethnic population in Amsterdam, The Netherlands. We also assessed the contribution of socio-economic status (SES) to …

Mastery in Middle Adolescence: The Contributions of Socioeconomic Status, Maternal Mastery and Supportive-Involved Mothering

Mastery, or the feeling of power or control over one's life, is a vital yet understudied covariate of wellbeing in adolescence and adulthood. The goal of the current study was to explore the effects of demographic characteristics (i.e., sex, age, race/ethnicity, and socioeconomic status (SES)), maternal mastery, and supportive-involved mothering on children's mastery at ages 16-17 years. 855 teens (47.6% female) and their mothers provided study data as part of the 1992 and 1998 waves of National Longitudinal Survey of Youth-1979 (NLSY-79; 24.1% Hispanic, 36.6% Black). Hybrid path models indicated that only maternal parenting during middle childhood was linked directly to levels of children's mastery in middle adolescence; a small portion of the association between parenting and adolescent mastery was attributable to SES. The discussion centers on significance of these findings for future research and theory development.

Self-Rated Stress Is Noncontributory to Coronary Artery Disease in Higher Socioeconomic Strata

Stress and its attendant psychosocial and lifestyle variables have been associated with coronary artery disease (CAD), yet the contribution of socioeconomic status (SES) has not been addressed. The aim of this study is to determine if stress assessment is associated with CAD independent of SES, and is incremental to the Framingham Score. The study group consisted of 325 executive patients undergoing comprehensive health assessment. Stress was assessed utilizing the validated "Self-Rated Stress" (SRS) instrument. Coronary artery calcification (CAC) served to assess the degree of atherosclerosis, a CAD equivalent and risk assessment tool. The relationship between SRS and CAC was assessed, with adjustment by potential confounders. CAC was modeled by a variety of cut points (>0, ≥5, ≥100, ≥200) for the test of trend across stress levels per Mantel-Haenszel chi-square (1 df) with nonsignificant P values of 0.9960, 0.5242, 0.1692, 0.3233, respectively. A logistic regression model with SRS as a categorically ranked and continuous variable to predict binary outcome of calcification yielded P values of 0.2366 and 0.9644; this relationship, further adjusted by age, fruit and vegetable consumption, exercise, and education, yielded no statistically significant association. No improvement of fit was observed for the established Framingham Score to CAC relation utilizing SRS. The study concluded that SRS did not play a role in early CAD when focusing on a population in higher socioeconomic strata, and SRS did not add predictive value beyond patient age or calculated Framingham risk. Future studies should focus on additional validated instruments of stress to differentiate between subtypes of stress for varying SES strata.

Association of the common FTO-rs9939609 polymorphism with type 2 diabetes, independent of obesity-related traits in a Vietnamese population

Type 2 diabetes (T2D) is a complex disorder resulting from both genetic and environmental factors in its pathogenesis. A case−control study was designed with subjects recruited from a general population to investigate whether the association between T2D and the common T>A polymorphism (rs9939609) in fat mass and obesity associated (FTO) gene is mediated by obesity-related measurements, considering the contribution of socio-economic status and lifestyle factors. The significant association between the FTO rs9939609 polymorphism and T2D was first observed in the model unadjusted (OR per A allele=1.61, 95% CI=1.06–2.44, P=0.024). It remained consistently replicated in the final model after adjustments for sex, age, systolic blood pressure, socio-economic status, lifestyle factors, and obesity-related measurements (body mass index, waist–hip ratio, body fat percentage, and body adiposity index), showing an increased T2D risk with an additive effect of the alleles (ORs per A allele=1.80–1.92, 95% CI=1.09–3.19, P<0.05). The FTO-rs9939609 polymorphism, systolic blood pressure, and waist–hip ratio were the most significant independent predictors for T2D, in which the power of the adjusted prediction model was 0.769. In conclusion, the study suggested that the FTO-rs9939609 polymorphism was significantly associated with the increased risk of T2D, independent of obesity-related measurements in a Vietnamese population.

ARE RACE/ETHNIC DISPARITIES IN THE PREVALENCE OF NOCTURIA DUE TO SOCIOECONOMIC STATUS? RESULTS FROM THE BOSTON AREA COMMUNITY HEALTH (BACH) SURVEY

Purpose Race/ethnic disparities in prevalence of nocturia have been reported previously. The objective of this analysis is to estimate prevalence rates of nocturia by race/ethnicity and determine the contribution of socioeconomic status (SES) to potential differences by race/ethnicity.

The burden of disease associated with being African-American in the United States and the contribution of socio-economic status

The burden of disease associated with being African-American in the US, and the contribution of socio-economic status (SES) to that burden have not been quantified. We derived burden of disease estimates for African-Americans and whites by age group, with and without adjustment for SES (income and education). We used (1) EQ-5D Index scores from the 2000 US Medical Expenditure Panel Survey to derive quality-adjusted life year (QALY) compatible estimates of health-related quality of life (HRQL); (2) 1990–1992 US National Health Interview Survey data linked to National Death Index data through 1995 to derive mortality risks; and (3) 2000 US mortality data from the National Center for Health Statistics to derive current mortality estimates for the US population. We found that relative to whites, African-Americans suffer 67,000 more deaths annually, resulting in 2.2 million years of life lost, and 1.1 million years after SES adjustment. Total QALYs lost (HRQL and mortality) dropped from 2.3 million to 902,000 after SES adjustment. SES differences between African-Americans and whites appear to explain all the HRQL disparity but only half the mortality disparity. Better understanding of the disparate effects of SES may inform interventions to address health disparities adversely affecting African-Americans.