Socioeconomic Status Distribution Research Articles

Toxic Metal Injustice? Socioeconomic status at birth and exposure to airborne pollution

We combine administrative data on socioeconomic status (SES) with high-resolution data on residential locations, local pollution levels, industrial facilities, as well as land cover information to investigate whether exposure to airborne toxic metals (arsenic, lead, and mercury) is unequally distributed within the population of newborn children in Sweden. We find that the spatial distribution of SES among newborns weakly correlates with the distribution of toxic metals at the national level and in the largest cities, indicating negligible sorting in this dimension. If anything, high SES children are disproportionately more exposed, residing in urban areas with higher levels of traffic and industrial activities. This leads us to conclude that environmental injustice regarding airborne arsenic, lead, and mercury exposure is not a major concern in Sweden.

Influence of Socioeconomic Status on Patients' Choice of Thrombolytic Agent and its Outcome in Acute Ischemic Stroke.

Alteplase, a recombinant tissue-type plasminogen activator (rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke (AIS). Tenecteplase is a modified rtPA, which is cheaper. We aimed to study influence of socioeconomic status (SES) in patients' preference of thrombolytic agent and its outcome. This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolyzed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen, and outcomes like National Institutes of Health Stroke Scale (NIHSS) scores at 24-h and at discharge; and modified Rankin Scale (mRS) after 3 months. Thirty-nine patients received tenecteplase and 39 patients received alteplase. Seven patients belonged to upper class, all of whom (100%) chose alteplase. Thirty patients belonged to upper middle class, of whom 25 (83.3%) and five (16.7%) patients chose alteplase and tenecteplase, respectively. Twenty-five patients belonged to lower middle class in which seven (28%) and 15 (72%) chose alteplase and Tenecteplase, respectively. Twenty patients were in upper lower class, of whom 4 (20%) and 16 (80%) chose alteplase and Tenecteplase, respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant (P = 0.000). Median 3 month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups, respectively (P = 0.608). There were no significant differences in NIHSS score improvement at 24 h postthrombolysis (P = 0.537) or at discharge (P = 0.429) among different SES categories. No correlation between SES and 3 month-mRS score was found (Spearman's ρ = 0.101, P = 0.398). Majority of patients in upper and lower SES chose alteplase and Tenecteplase, respectively. However, there were no significant differences in outcomes among various SES categories.

Neighborhood racial income inequality and cognitive health.

Neighborhood socioeconomic status (SES) has been linked to dementia, but the distribution of SES within a neighborhood may also matter. Data from 460 (47% Black, 46% White) older adults from the Michigan Cognitive Aging Project were linked to census tract-level data from the National Neighborhood Data Archive (NaNDA). Neighborhood SES included two composites reflecting disadvantage and affluence. Neighborhood racial income inequality was the ratio of median incomes for White versus Black residents. Generalized estimating equations examined associations between neighborhood factors and cognitive domains. Neighborhood racial income inequality was uniquely associated with worse cognitive health, and these associations did not differ by participant race. Neighborhood disadvantage was only associated with worse cognitive health among Black participants. Both the level and racial distribution of SES within a neighborhood may be relevant for dementia risk. Racial differences in the level and impact of neighborhood SES contribute to dementia inequalities. Black participants lived in neighborhoods with lower socioeconomic status (SES) than White participants, on average. Neighborhood SES and racial income inequality were associated with worse cognition. Effects of neighborhood racial income inequality did not differ across racial groups. Effects of neighborhood SES were only evident among Black participants.

Propensity score analysis for health care disparities: a deweighting approach

BackgroundPropensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM’s definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables.MethodsThe present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions.ResultsThe procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES.ConclusionsDeweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.

Abstract 6374: Socio-demographic predictors of recruitment in neuroblastoma therapeutic clinical trials

Abstract The generalizability of clinical trial outcomes hinges upon the equitable access and enrollment of diverse patient populations. Yet, disparities persist that may influence enrollment patterns. In neuroblastoma, the impact of ethnicity, socioeconomic status (SES), distance to care, and age at diagnosis on enrollment in therapeutic trials remains underexplored. We aimed to investigate these factors in neuroblastoma patients to identify potential disparities in clinical trial participation. We utilized the Childhood Cancer Research Network data, selecting neuroblastoma cases from 2008-2015, excluding those >21 years old or with incomplete data. We focused on factors influencing enrollment in therapeutic trials (ANBL0032, ANBL0421, ANBL0531, ANBL0532, ANBL0621, ANBL0931, ANBL1021, ANBL1221, ANBL1232). Key predictors examined were ethnicity, age at diagnosis, SES (via Yost Index), and distance to care from home to treatment hospital. We employed Poisson regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals for trial participation. Analyzing 3,148 neuroblastoma cases from the CCRN registry, the ethnic composition was as follows: 68% were non-Hispanic White, 14% Hispanic, and 10% NH Black and SES distribution was even across quintiles. Age at diagnosis was a significant factor in trial enrollment: children >2 years were 94% more likely to enroll than those under 2 years (p < 0.001). Race, ethnicity, SES, and distance to care showed no significant effect on enrollment, all with non-significant p-values. In CCRN, neuroblastoma patient's age at diagnosis was a determinant in therapeutic trial enrollment, providing insight into design strategies to encourage trial participation. While common barriers like race, ethnicity, SES, and distance to care did not impact enrollment in our cohort, the significant role of age highlights an area where focused efforts can ensure that all age groups have equitable access to the potential benefits of therapeutic trials. Category N aRR (95% CI) p-value Race and Ethnicity Non-Hispanic (NH) White 2139 ref Hispanic (All races) 436 0.93 (0.81, 1.08) 0.36 NH Black 320 1.07 (0.93, 1.23) 0.33 NH Asian/Pacific Islander 98 1.14 (0.89, 1.47) 0.30 NH American Indian/Alaska Native 17 0.95 (0.48, 1.88) 0.89 Other 138 0.94 (0.75, 1.17) 0.55 SES (Yost Index) Quintile 1 493 0.88 (0.75, 1.02) 0.09 Quintile 2 524 0.95 (0.83, 1.10) 0.53 Quintile 3 606 0.98 (0.86, 1.11) 0.71 Quintile 4 554 0.92 (0.80, 1.06) 0.24 Quintile 5 563 ref Age at Diagnosis <2 year 1790 ref >2 years 1354 1.94 (1.76, 2.12) <0.001 Distance to Care 0-25 miles 1520 ref >25-50 miles 535 1.05 (0.93, 1.18) 0.36 >50-100 miles 412 0.97 (0.85, 1.11) 0.91 >100-250 miles 239 0.99 (0.87, 1.13) 0.60 >250 miles 82 0.99 (0.77, 1.28) 0.97 Citation Format: DeVon Hunter-Schlichting, Jeannette Sample, Kate Knowles, David Van Riper, Logan Spector, Erin Marcotte. Socio-demographic predictors of recruitment in neuroblastoma therapeutic clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6374.

Associations between socioeconomic status and stroke in American adults: A population-based study

Stroke is an acute cerebrovascular disease that can lead to disability and death. This study aimed to investigate the relationship between socioeconomic status (SES) and stroke. SES was evaluated by two variables: poverty to income ratio (PIR) and education level. In this multi-subject study, we collected data from the National Health and Nutrition Examination Survey (NHANES) database between 2009 and 2018, and finally 22,792 adults (≥20 years old) were included in the study. We proceeded with weighted multivariate logistic regression analysis as well as subgroup analysis. When analyzing the effect of PIR on stroke alone, the results showed that an increase in PIR levels was associated with a decrease in stroke incidence (OR = 0.764 95% CI: (0.711, 0.820), p < 0.001). The multivariate analysis presented a decline in stroke incidence in the highest quartile PIR group compared to the lowest quartile PIR group (OR = 0.296 95% CI: (0.214, 0.409), P＜0.001). Our results indicated that PIR is a protective factor for stroke, but there are exceptions in this relationship among different people. Hence, it is imperative that policymakers, healthcare providers, and clinicians take into account the inequality distribution of SES among adults while developing and executing stroke prevention and treatment strategies.

The estimation of spatial distribution patterns of different socio-economic status (SES) groups by housing advertisement data and machine learning techniques: a case study in brooklyn, new york

Poverty eradication has long been a central issue for sustainable development goals (SDGs), which draws attention to the issue of urban inequalities that can hinder regional economic development and increase unemployment and crime rates. It is critical to understand the local socio-economic distribution pattern for better urban policies and planning strategies. Traditional SES measurements are mainly based on census data and surveys, which are slowly updated and often fail to apply in the latest analysis. The SES inference methods using other data (e.g., satellite maps, nighttime lighting data) lack a theoretical basis and are of coarse resolution. The study takes advantage of the latest data (i.e., online housing advertisement data) and point of interests (POIs) to infer fine-grained block-group-level SES in Brooklyn through machine learning techniques. In addition, natural language processing (NLP) methods are used to derive twelve housing-related SES predictors. The results show that the speculative models and predictors are feasible, and the Global decision tree (GBDT) algorithm is the most efficient of the seven algorithms. The SES distribution map demonstrates a clear socio-economic stratification in Brooklyn. The rich are mainly concentrated in the western and northern areas with a high density of facilities. Based on the analysis of the local SES, three policy recommendations are proposed. First, for the inequitable distribution of facilities, additional investment should be made in the central and eastern regions. Second, a high level of greenery should be given priority in urban planning. Third, in terms of housing, disadvantaged groups should be given attention.

Microbiome, socioeconomic status (SES), fiber intake, and response to checkpoint inhibitor therapy in patients with non-small cell lung cancer (NSCLC): A pilot study.

e14710 Background: Lung cancer affects a disproportional number of socioeconomically disadvantaged patients (pts). Responses to checkpoint inhibitor therapy (CIT) vary. Microbiome diversity may correlate with benefit from CIT. High fiber diets lead to microbiome diversity. We hypothesize that unexplained lung cancer disparities may be in part due to differences in microbiome diversity determined by unhealthy dietary patterns dictated by lower SES. Methods: Following IRB review, 25 pts with metastatic NSCLC starting CIT-based treatment were enrolled. Pre-treatment oral and fecal samples were collected. 24-hour dietary recalls were obtained. SES index was calculated based on education, employment, housing and annual income. High fiber intake was defined as &gt; 20 g/day. Best treatment response per RECIST 1.1 was assessed. Microbial 16s rRNA were sequenced with Illumina MiSeq platform. Sequence analyses utilized QIIME 2 with DADA2 plugin. Taxonomic assignments used the Greengenes database. Microbiome composition was analyzed by calculating alpha diversity (Chao1, Shannon diversity and Simpson index), beta diversity and differential abundance of microbial compositions. Hierarchical linear model was constructed for each SES variable with and without biological covariates. Results: Pts with samples &gt;1000 operational taxonomic unit (OTU) levels were included (N = 22) in the analysis. 50% were male, median age was 71, 36% (8/22) were of Black race and 23% (5/22) were of low SES. Median fiber intake was 11.9 grams. Males had higher alpha diversity than females (p=.038). Pts with high fiber intake had greater fecal Proteobacteria compared to low fiber intake pts (p&lt;0.05). Bacteroides and Firmicutes fecal levels were significantly different for all pts compared to Human Microbiome Project (HMP) reported normal levels (p&lt;0.01). Actinobacteria and Proteobacteria levels for low-fiber intake pts were also significantly elevated compared to HMP normal levels (p&lt;0.05). There were no differences observed in microbiome when comparing SES index. However, high SES index patients had elevated fecal levels of Actinobacteria, Firmicutes and Proteobacteria and lower levels of Bacteroides compared to HMP levels. There was a trend towards higher alpha diversity of oral samples in partial responders pts compared to those with stable or progression of the disease (p=0.08). Conclusions: Pts with metastatic NSCLC exhibited different microbial composition compared to HMP normal levels. Associations between SES and microbial distribution in such pts warrant further investigation. Increased sample size is needed to better determine differences in oral microbiome in responders to immunotherapy and better evaluate the role of sex in this setting.

Associations of age, sex, and socioeconomic status with adherence to guideline recommendations on protein intake and micronutrient supplementation in patients with sleeve gastrectomy or Roux-en-Y gastric bypass.

Patients with bariatric surgery often show poor long-term compliance to recommendations for prevention of nutrient deficiency but it is unclear which factors contribute. We investigated the associations of age, sex, and socioeconomic status (SES) with adherence to guideline recommendations on protein intake and micronutrient supplementation. In a monocentric cross-sectional study we prospectively recruited patients with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) and a minimum postoperative period of 6 months. Clinical and demographic data were obtained from the patients' medical files and by questionnaire. Patients reported on supplement usage, recorded their dietary intake for seven days and underwent physical examinations including blood testing. We included 35 patients (SG: n = 25, RYGB: n = 10) with a mean (+SD) postoperative period of 20.2 (±10.4) months. Distributions of age, sex and SES were comparable between the SG and RYGB groups. Non-adherence to recommended protein intake was associated with age ≥ 50 years (p = 0.041) but not sex or SES. Protein intake inversely correlated with markers of obesity. There were no significant associations of age or sex with micronutrient supplementation. Only for vitamins A (p = 0.049) and B1 (p = 0.047) higher SES was associated with greater compliance. The only manifest deficiency associated with non-adherence to micronutrient supplementation was that for folic acid (p = 0.044). In patients after bariatric surgery, those of older age and of lower SES might have a greater risk of unfavorable outcome and may require greater attention to micronutrient and protein supplementation.

Long-run Trends in the U.S. SES—Achievement Gap

Abstract Rising inequality in the United States has raised concerns about potentially widening gaps in educational achievement by socioeconomic status (SES). Using assessments from LTT-NAEP, Main-NAEP, TIMSS, and PISA that are psychometrically linked over time, we trace trends in SES gaps in achievement for U.S. student cohorts born between 1961 and 2001. Gaps in math, reading, and science achievement between the top and bottom quartiles of the SES distribution have closed by 0.05 standard deviation per decade over this period. The findings are consistent across alternative measures of SES and subsets of available tests and hold in more recent periods. At the current pace of closure, the achievement gap would not be eliminated until the second half of the 22nd century.

Abstract 3668: Socioeconomic disparities in healthcare utilization and overall survival among patients with cancer: Application of area-level socioeconomic status in a nationwide electronic health record-derived database

Abstract Introduction: While lower socioeconomic status (SES) is associated with worse cancer outcomes, most electronic health records (EHRs) lack documentation of SES. Here we apply an area-level SES measure to an EHR-derived database to evaluate representativeness according to SES. We then examine socioeconomic disparities in the timeliness of healthcare utilization (biomarker testing and systemic treatment) and overall survival (OS) in 3 common cancers. Methods: This retrospective study uses the nationwide Flatiron Health EHR-derived de-identified database of cancer patients who have clinical activity between January 2011-August 2021. Census block group data from the American Community Survey (2015-2019) was used to measure SES per the Yost Index (incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information). SES quintiles were determined from the US population and then applied to patients based on their residential addresses. Our database included 2,067,644 cancer patients from community practices. Patients with advanced non-small-cell lung cancer (aNSCLC, n=51,596), metastatic breast cancer (mBC, n=18,268), and multiple myeloma (MM, n=8,246) were sampled and followed from advanced, metastatic, or initial diagnosis date, respectively. Differences were evaluated using Χ2 tests for categorical variables and log-rank tests for Kaplan-Meier survivor functions. Results: Compared to the US population, our database of cancer patients has a similar SES distribution (differences &amp;lt;3%), capturing cancer patients living in the most (Q1) and least affluent areas (Q5) of the country. Yet, among the 1.5% of cancer patients who participated in clinical trials, only 15.2% lived in the least affluent areas. aNSCLC and mBC patients living in the least affluent areas were less likely to receive biomarker testing within 30 days of index diagnosis than those in the most affluent areas (59.4% vs. 68.7%; 74.9% vs. 81.0%, both p&amp;lt;.01). Similar patterns were observed in receipt of systemic treatment within 60 days of index diagnosis (aNSCLC: 58.9% vs. 64.9%; mBC: 76.0% vs. 80.1%, both p&amp;lt;.01). No differences in healthcare utilization were observed among MM patients. Patients in the least affluent areas had lower median OS (months) than those in the most affluent areas (aNSCLC: 10.8 [95% CI: 10.4-11.3] vs. 12.2 [95% CI: 11.8-12.7]; mBC: 28.0 [95% CI: 26.6-29.5] vs. 34.5 [95% CI: 33.1-36.9], MM: 57.4 [95% CI: 53.5-61.5] vs. 67.5 [95% CI: 62.5-76.4]; all p&amp;lt;.01). Conclusion: Lower SES was associated with reduced clinical trial participation, less timely healthcare utilization, and worse OS. Making SES available in real-world data can support the development of inclusive clinical trials and inform interventions to reduce cancer care disparities. Citation Format: Jenny S. Guadamuz, Xiaoliang Wang, Jeremy Snider, James Walters, Rebecca A. Miksad, Gregory S. Calip. Socioeconomic disparities in healthcare utilization and overall survival among patients with cancer: Application of area-level socioeconomic status in a nationwide electronic health record-derived database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3668.

Dementia and disadvantage in the USA and England: population-based comparative study

ObjectivesTo compare dementia prevalence and how it varies by socioeconomic status (SES) across the USA and England.DesignPopulation-based comparative study.SettingNon-Hispanic whites aged over 70 population in the USA and England.ParticipantsData from...

Exploring Diversity in Graduate and Professional School Applications

Gathering a diverse student body is important for institutions of higher education (IHEs) at the graduate/professional level. However, it is impossible to select a diverse student body from a homogenous group of candidates. Thus the aim of this study is to discover the extent to which diversity goals in admissions are precluded by the lack of diversity in the applicant pool. To explore this, the proportion of score reports sent to the 150 largest graduate/professional schools and sent for each major was compared, from each gender, race, and socioeconomic status (SES) grouping, to proportions from the overall applicant pool of graduate/professional students. Additionally, differences in the distance graduate/professional school applicants are willing to consider traveling by gender, race/ethnicity, and SES were investigated. Results show that differences exist in the gender, race, and SES distributions for score reports sent to different schools and for different majors as well as in the distance an applicant is willing to consider traveling for graduate/professional school. The patterns found for gender, racial, and socioeconomic diversity provide possibilities for researchers to work further together with graduate/professional schools to tackle the important challenge of increasing diversity in graduate/professional education.

Influence of Socio-Economic Status on Patients’ Choice of Thrombolytic Agent and It's Outcome in Acute Ischemic Stroke

Background and Purpose: Alteplase, a recombinant tissue-type plasminogen activator(rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke(AIS). Tenecteplase is a modified rtPA which is cheaper. We aimed to study role of Socio-economic status(SES) in patients’ preference of thrombolytic agent and its outcome. Methods: This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolysed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen and outcomes like NIHSS scores at 24 hours and at discharge; and modified Rankin Scale(mRS) after 3months. Results: 39 patients received tenecteplase and 39 patients received alteplase. 7 patients belonged to upper class, all of whom(100%) chose alteplase. 30 patients belonged to upper middle class, of whom 25(83.3%) and 5(16.7%) patients chose alteplase and tenecteplase respectively. 25 patients belonged to lower middle class in which 7(28%) and 15(72%) chose alteplase and tenecteplase respectively. 20 patients were in upper lower class, of whom 4(20%) and 16(80%) chose alteplase and tenecteplase respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant(p=0.000). Median 3month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups respectively(p=0.608). There were no significant differences in NIHSS score improvement at 24 hours post-thrombolysis(p=0.537) or at discharge(p=0.429) among different SES categories. No correlation between SES and 3month-mRS score was found(Spearman’s rho=0.101, p=0.398). Conclusions: Majority of patients in upper and lower SES chose alteplase and tenecteplase respectively. However, there were no significant differences in outcomes among various SES categories. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Ethical clearance was obtained from institution’s Ethics committee.

Socioeconomic status and the effectiveness of treatment for first-episode psychosis.

To assess whether patient socioeconomic status (SES) moderates the effectiveness of coordinated specialty care for first-episode psychosis and to investigate possible mechanisms. A secondary analysis of data from the RAISE-ETP Trial, which was conducted from 2010-2014. RAISE-ETP was a cluster-randomized trial comparing a coordinated specialty care (CSC) intervention called NAVIGATE with usual community care. We constructed a patient SES index based on parental education, parental occupational prestige, and race/ethnicity. After identifying correlates of SES, we used OLS regression analysis to estimate treatment effects on the major study outcomes across quartiles of the index. We also examined whether correlates of SES including the duration of untreated psychosis (DUP), and participation in NAVIGATE might account for the observed difference in effectiveness of CSC by SES. The trial sample had a similar SES distribution to the US population, and SES was positively correlated with all mental health outcomes and several potential moderators at baseline. CSC substantially improved the main trial outcomes compared to community care for patients in the highest SES quartile but had small and statistically insignificant benefits for the remaining 75% of patients. Intervention participation rates and several potential moderators did not explain this disparity. CSC may be more effective for high-SES patients with early psychosis than low-SES patients. Additional research is needed to understand why CSC is less effective for low-SES patients and to develop methods to increase effectiveness for this subgroup.

Abstract B100: Developing an integrated understanding of access to care and tumor characteristics patterns by race and age in the Carolina Breast Cancer Study Phase III, 2008 – 2013

Abstract Purpose: Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. We compared socioeconomic status (SES) and comorbidity factors from the Carolina Breast Cancer Study Phase III (CBCS3, 2008-2013) to North Carolina and examined factors related to race and age in CBCS. Methods: Distributions of SES and comorbidity factors in CBCS3 cases were compared to those of North Carolina women in the 2010 Behavioral Risk Factor Surveillance Study. Using latent class analysis of CBCS3 data, we identified covariate patterns by SES/comorbidities, barriers to care, and tumor characteristics and examined their associations with race and age using multinomial logistic regression. Results: Major SES and comorbidity patterns in CBCS3 participants were generally similar to patterns in the state. Latent classes were identified for SES/comorbidities, barriers to care, and tumor characteristics that varied by race and age. Compared to white women, black women had lower SES (odds ratio (OR)=6.3, 95% confidence interval (CI); 5.2, 7.8), more barriers to care (OR=5.6, 95% CI; 3.9, 8.1) and several aggregated tumor aggressiveness features. Compared to older women, younger women had higher SES (OR=0.5, 95% CI; 0.4, 0.6), more barriers to care (OR=2.1, 95% CI; 1.6, 2.9) and aggregated tumor aggressiveness features. Conclusions: CBCS3 is representative of North Carolina on comparable factors. Patterns of access to care and tumor characteristics are intertwined with race and age, suggesting that interventions to address disparities will need to target both access and biology. Citation Format: Marc A Emerson, Yvonne M Golightly, Xianming Tan, Allison E Aiello, Katherine E Reeder-Hayes, Andrew F Olshan, Shelley A Earp, Melissa Troester. Developing an integrated understanding of access to care and tumor characteristics patterns by race and age in the Carolina Breast Cancer Study Phase III, 2008 – 2013 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B100.

Long-Run Trends in the U.S. SES-Achievement Gap

Rising inequality in the United States has raised concerns about potentially widening gaps in educational achievement by socio-economic status (SES). Using assessments from LTT-NAEP, Main-NAEP, TIMSS, and PISA that are psychometrically linked over time, we trace trends in achievement for U.S. student cohorts born between 1954 and 2001. Achievement gaps between the top and bottom quartiles of the SES distribution have been large and remarkably constant for a near half century. These unwavering gaps have not been offset by improved achievement levels, which have risen at age 14 but have remained unchanged at age 17 for the past quarter century.

Low Socioeconomic Status Predicts Worse Outcome in Patients with Ruptured Abdominal Aortic Aneurysm

Introduction - Low socioeconomic status (SES) has been reported to negatively influence cardiovascular morbidity and mortality. The prognostic implication of SES on the outcome of abdominal aortic aneurysm (AAA) has never been investigated in a large population-based study. The aim of this study was to compare the SES distribution in patients with intact (iAAA) and ruptured AAA (rAAA), with the particular aim to elucidate the influence of SES on intervention rate and outcome for rAAA patients. Methods - Nationwide, population-based study on all individuals diagnosed with iAAA or rAAA during the period 2001-2015. All cases were retrieved from the National Patient Register and the Cause of Death Register. Individual-level data on indicators of SES, including annual disposable household income (in quintiles) and educational level (low = ≤9 school years, middle = 10-12 school years, high = university or higher) were obtained from Statistics Sweden. The proportion of iAAA vs rAAA at initial diagnosis in relation to SES was analysed by calculating odds ratios (OR) with 95% confidence intervals (CI) using logistic regression models, as were the treatment frequencies and 90-day mortality outcome after treatment. Results - The total number of individuals with an AAA (iAAA or rAAA) was 42,997, of whom 34,335 (79.9%) with iAAA and 8,662 (20.1%) with rAAA. The overall proportion of women was 21.6%, but was higher in the rAAA group (29.9%) than in the iAAA group (21.2%). In age- and sex-adjusted analysis, individuals with low disposable household income as well as those with low educational level were found to have a higher risk of presenting with a rAAA at the time of the first diagnosis (OR 1.61, 95% CI 1.48-1.74, p<0.001 and OR 1.36, 95% CI 1.24-1.49, p<0.001 respectively). More than one third (38.6 %) of the rAAA patients underwent repair. Low disposable household income was associated with a lower treatment frequency (OR 0.71, 95% CI 0.61-0.82, p<0.001) and was also significantly associated with increased 90-day mortality after treatment (OR 1.78 95% CI 1.39-2.27, p<0.001). Corresponding analyses of low educational level showed less clear associations (OR 0.85 95% CI 0.72-1.01, p=0.051 and OR 1.27 95% CI 0.97-1.68, p=0.091). Conclusion - Low SES is an indicator of poorer outcome and higher disease severity at initial presentation in patients with AAA. These results confirm that social inequalities can also be found in patients treated for aortic disease. In a western, modernized country where health care is regulated to be equally distributed and offered to its inhabitants, we still find discrepancies in how care is distributed through different socioeconomic strata. This should implicate the need for the development of strategic and logistical efforts to prevent rupture among individuals with low SES. Increased attention should be shown towards groups with obviously higher risks for complications postoperatively.

Potential for non-combustible nicotine products to reduce socioeconomic inequalities in smoking: a systematic review and synthesis of best available evidence

BackgroundWhile some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic.MethodsTen electronic databases were searched in February 2017 using terms relating to e-cigarettes, smokeless tobacco and nicotine replacement therapy (NRT); and SES. We included studies published since 1980 that were available in English and examined product use by SES indicators such as income and education. Data synthesis was based on those studies judged to be of medium- to high-quality using guidelines adapted from the Critical Appraisal Skills Programme.ResultsWe identified 54 studies describing NCNP use by SES across 12 countries, of which 27 were judged of sufficient quality to include in data synthesis. We found mixed patterns of e-cigarette current use by SES, with evidence of higher use among low-income adults but unclear or mixed findings by education and occupation. In contrast, smokeless tobacco current use was consistently higher among low SES adults. There was very limited evidence on the SES distribution of NRT in adults and of all NCNPs in young people.ConclusionsThe only NCNP for which there are clear patterns of use by SES is smokeless tobacco, where prevalence is higher among low SES groups. While this suggests a potentially positive impact on inequalities in smoking (if NCNP use displaces smoked tobacco use), this has not been seen in practice. These findings do not support the suggestion that e-cigarettes have the potential to reduce social inequalities in smoking, since i) current evidence does not show a clear trend of higher e-cigarette use in population groups with higher tobacco consumption, and ii) the experience of smokeless tobacco suggests that – even where NCNP use is higher among low SES groups – this does not necessarily replace smoked tobacco use in these groups.

The Unwavering SES Achievement Gap: Trends in U.S. Student Performance

Concerns about the breadth of the U.S. income distribution and limited intergenerational mobility have led to a focus on educational achievement gaps by socio-economic status (SES). Using intertemporally linked assessments from NAEP, TIMSS, and PISA, we trace the achievement of U.S. student cohorts born between 1954 and 2001. Achievement gaps between the top and bottom deciles and the top and bottom quartiles of the SES distribution have been large and remarkably constant for a near half century. These unwavering gaps have not been offset by overall improvements in achievement levels, which have risen at age 14 but remained unchanged at age 17 for the most recent quarter century. The long-term failure of major educational policies to alter SES gaps suggests a need to reconsider standard approaches to mitigating disparities.