Greater Socioeconomic Status Research Articles

National enrollment of lung cancer clinical trials is disproportionate based on race and health care access

ObjectiveDespite declining lung cancer mortality in the United States, survival differences remain among racial and ethnic minorities in addition to those with limited health care access. Improvements in lung cancer treatment can be obtained through clinical trials, yet there are disparities in clinical trial enrollment of other cancer types. This study aims to evaluate disparities in lung cancer clinical trial enrollment to inform future enrollment initiatives. MethodsWe analyzed patients with non–small cell lung cancer from the National Cancer Database (2004-2018), categorizing them as enrolled or not enrolled in clinical trials based on “rx_summ_other” data element. Clinical, demographic, and institutional factors associated with trial enrollment were assessed using bivariate and multivariate analysis, adjusting for institutional-level clustering. ResultsA total of 1924 (0.12%) patients with lung cancer were enrolled in clinical trials. Enrolled patients were predominantly non-Hispanic White (82%), with greater socioeconomic status, treated at academic programs (67%), and had private insurance (42%) or Medicare (44%). They also traveled further for treatment compared with unenrolled patients (56 vs 27 miles, P < .001). After adjusting for demographic and clinical factors, lung cancer trial enrollment was significantly less likely among Black (odds ratio, 0.55; 95% confidence interval, 0.5-0.7, P < .001) and Hispanic (0.66; 95% confidence interval, 0.5-0.9, P = .01) patients. Patients with Medicaid or uninsured, in the lowest socioeconomic status group, and those treated at community-based cancer programs were the least likely to enroll. ConclusionsEnrollment in lung cancer trials disproportionally excludes minority patients, those in the lowest socioeconomic status, community cancer programs, and the underinsured. These disparities in demographic and access for trial participation show a need for improved enrollment strategies.

Social anxiety and celebrity worship: the mediating effects of mobile phone dependence and moderating effects of family socioeconomic status

The Absorption-addiction model suggests that people worship celebrities to compensate for some personal or social defects, so poor mental state is related to celebrity worship. The current study aimed to explore the underlying mechanisms influencing celebrity worship. A total of 1,147 participants (aged 19–26 years) completed online questionnaires to assess social anxiety, mobile phone dependence, parental income and celebrity worship. Results showed that: (1) social anxiety, socioeconomic status (SES) and celebrity worship were positively correlated; (2) Social anxiety affected celebrity worship through mobile phone dependence; (3) SES played a moderating role in the mediation model. At higher levels of SES, individuals with high social anxiety showed reduced dependence on mobile phones. These findings highlight the importance of mobile phone dependence and family SES in celebrity worship. Additionally, the findings demonstrated that females are more likely to pay attention to celebrities, but the greater SES and reduced mobile phone dependence can mitigate their celebrity addiction.

Does using the sociodental approach in oral health care influence use of dental services and oral health of adolescents living in deprived communities? a one-year follow up study

BackgroundOral health needs assessment is important for oral health care planning. This study compared dental treatment needs between normative and sociodental needs. We also longitudinally examined the relationships of baseline sociodental needs measures and socioeconomic status with one-year follow up measures of use of dental services, dental caries, filled teeth, and oral health-related quality of life (OHRQoL).MethodsA prospective study was conducted with 12-year-old adolescents from public schools in deprived communities in the city of Manaus, Brazil. Validated questionnaires were used to collect adolescents’ sex and socioeconomic status, OHRQoL (CPQ11 − 14) and behaviours (sugar intake, frequency of toothbrushing, regular use of fluoridated toothpaste and pattern of dental attendance). Normative need was assessed according to decayed teeth, clinical consequences of untreated dental caries, malocclusion, dental trauma, and dental calculus. The relationships between variables were tested thorough Structural equation modelling.ResultsOverall 95.5% of adolescents had normative dental treatment needs. Of these, 9.4% were classified as high level of propensity. Higher normative/impact need and greater propensity-related need directly predicted use of dental services at one-year follow up. The latter mediated the association of normative/impact need and propensity-related need with incidence of dental caries and filled teeth. Normative/impact need and use of dental services were directly associated with filled teeth at one-year follow up. Poor OHRQoL at one-year follow-up was directly predicted by higher normative/impact need at baseline and less filled teeth at one-year follow up. Greater socioeconomic status was directly associated with better propensity-related need. Socioeconomic status indirectly predicted incidence of dental caries and filled teeth via propensity-related need and use of dental services.ConclusionsSociodental needs measures were related to use of dental services, dental caries, filled teeth and OHRQoL after one year among adolescents living in deprived communities. Adolescents with dental needs treatment priorities according to the sociodental approach had more filled teeth via use of dental services. Dental services utilisation did not attenuate the impact of normative and impact-related need on dental caries incidence and poor OHRQoL after one year. Our findings suggest the importance of developing oral health promotion and enhancing access to dental care to improve oral health of adolescents living in deprived communities.

Comparison Of Mortality Rates Among Elite American Football Athletes From 1965 To 1986

Over the past decades, evidence has suggested there are increased health risks associated with playing American football. These health risks may be variable by position, due to repeated head impact exposure. PURPOSE: To analyze potential differences in life expectancy between National Football League (NFL) players named to All-Pro teams from 1965 to 1986. METHODS: Football players were identified as “elite” if they were named to an All-Pro team between 1965 and 1986. Pro-football-reference.com was used to identify these athletes and collect preliminary information. Additional information was gathered using personal interviews, news articles, blogs and forums. These data included the year that the athlete was first named to an All-Pro team, his position, team, date of birth, date of death (if applicable), the length of his NFL career, and reported height and weight. Kaplan-Meier survival analysis was used to compute the median lifespan by position and Cox regression, using forward stepwise selection, was used to determine if any of the covariates collected, including position, influenced lifespan. Special teams’ positions were excluded due to low sample size (n = 23). RESULTS: 746 elite male NFL players were identified and included. Of those, 171 were deceased as of May 1, 2020 with a median age of death of 67y. Survival analysis revealed the median life expectancy was 84y [SE = 1y; 95% confidence interval 83-86y], with offensive linemen having the shortest median lifespan (82y; 95%CI = 79-85). Cox regression revealed BMI [Exp(B) = 1.12, 95%CI = 1.06-1.19; p < 0.001] and career duration [Exp(B) = 0.943, 95%CI = 0.89-1.00; p = 0.033] significantly influenced mortality. Position was not a predictor of lifespan in the stepwise model, but was a significant predictor of lifespan if entered into the model itself (p < 0.001), with linemen having shorter lifespans than skill players. CONCLUSIONS: These findings suggest that BMI during one’s football career may be predictive of lifespan among elite NFL players. Athletes with longer NFL careers may live longer despite potentially increased exposure to repeated head impact. This paradox may be due to long careers being facilitated by the absence of major injuries and resulting in greater socioeconomic status, which may be associated with superior health post-retirement.

PCN114 Investigating Secular Trends in the Survival of Melanoma Patients in England

Understanding survival through use of population level cancer registry data can help to describe standards of care, identify unmet need and understand changes in the therapeutic landscape. We assessed the availability of such data from Public Health England (PHE) to study malignant melanoma survival in England. De-identified cancer registry data were obtained from PHE after NHS ethics committee approval. Survival was estimated in a cohort of patients diagnosed with malignant melanoma in England from 1995 to 2016. The data included numerous clinical characteristics (e.g. tumour site, cancer morphology, behaviour, T,N,M and pathological stage) and an indicator of socioeconomic status (SES). Primary endpoints measured from time of diagnosis, were one-year overall survival (OS) and one-year relative survival (RS) relative to the total population of England (1995 to 2016). One-year OS by disease stage and SES was also investigated. Data were available for 184,864 melanoma patients. Disease stage was missing in 57% of patients (79% between 1995 and 2011, and 13% between 2012 and 2016). No information was available on relevant behaviours such as smoking. In the overall population, average one-year OS and RS were high (94% and 97% respectively). Between 1995 and 2016, one-year OS and RS increased from 92% to 95%, and from 95% to 99% respectively. The average OS for Stage I, II, III and IV melanoma was 99%, 94%, 90% and 48% respectively. Probability of survival was also higher with greater SES (95% versus 92% for the highest and lowest quintile). England’s PHE data provides a useful resource to study trends in melanoma survival over time, with rich clinical detail. While it is limited by high levels of missing data on disease stage in earlier years, it nevertheless provides a robust source of data to understand population level disease epidemiology.

Regional and network neural activity reflect men\u2019s preference for greater socioeconomic status during impression formation

Evidence from social psychology suggests that men compared to women more readily display and pursue control over human resources or capital. However, studying how status and gender shape deliberate impression formation is difficult due to social desirability concerns. Using univariate and multivariate fMRI analyses (n = 65), we examined how gender and socioeconomic status (SES) may influence brain responses during deliberate but private impression formation. Men more than women showed greater activity in the VMPFC and NAcc when forming impressions of high-SES (vs. low-SES) targets. Seed partial least squares (PLS) analysis showed that this SES-based increase in VMPFC activity was associated with greater co-activation across an evaluative network for the high-SES versus low-SES univariate comparison. A data-driven task PLS analysis also showed greater co-activation in an extended network consisting of regions involved in salience detection, attention, and task engagement as a function of increasing target SES. This co-activating network was most pronounced for men. These findings provide evidence that high-SES targets elicit neural responses indicative of positivity, reward, and salience during impression formation among men. Contributions to a network neuroscience understanding of status perception and implications for gender- and status-based impression formation are discussed.

Associations between area socioeconomic status, individual mental health, physical activity, diet and change in cardiometabolic risk amongst a cohort of Australian adults: A longitudinal path analysis.

Presumed pathways from environments to cardiometabolic risk largely implicate health behaviour although mental health may play a role. Few studies assess relationships between these factors. This study estimated associations between area socioeconomic status (SES), mental health, diet, physical activity, and 10-year change in glycosylated haemoglobin (HbA1c), comparing two proposed path structures: 1) mental health and behaviour functioning as parallel mediators between area SES and HbA1c; and 2) a sequential structure where mental health influences behaviour and consequently HbA1c. Three waves (10 years) of population-based biomedical cohort data were spatially linked to census data based on participant residential address. Area SES was expressed at baseline using an established index (SEIFA-IEO). Individual behavioural and mental health information (Wave 2) included diet (fruit and vegetable servings per day), physical activity (meets/does not meet recommendations), and the mental health component score of the 36-item Short Form Health Survey. HbA1c was measured at each wave. Latent variable growth models with a structural equation modelling approach estimated associations within both parallel and sequential path structures. Models were adjusted for age, sex, employment status, marital status, education, and smoking. The sequential path model best fit the data. HbA1c worsened over time. Greater area SES was statistically significantly associated with greater fruit intake, meeting physical activity recommendations, and had a protective effect against increasing HbA1c directly and indirectly through physical activity behaviour. Positive mental health was statistically significantly associated with greater fruit and vegetable intakes and was indirectly protective against increasing HbA1c through physical activity. Greater SES was protective against increasing HbA1c. This relationship was partially mediated by physical activity but not diet. A protective effect of mental health was exerted through physical activity. Public health interventions should ensure individuals residing in low SES areas, and those with poorer mental health are supported in meeting physical activity recommendations.

Professional Networks Within U.S. Higher Education: Avenues to Foster Career and Institutional Success

Within the United States, higher education is a ladder up to greater socioeconomic status. In spite of this fact, today’s students need to focus on more than just completing their education. This scholarly essay focuses on the value of professional networks, in conjunction with institutions of higher learning, in career advancement and upward movement in socioeconomic levels. This essay emphasizes the role that professional networks play in enhancing the value of a bachelor’s degree and provides evidence that students and institutions benefit from the development of professional networks both in support of the advancement of students’ careers and in the engagement of alumni. The essay also demonstrates the benefits to academic institutions themselves when alumni engagement is fostered to a greater degree.

Genetic Fortune: Winning or Losing Education, Income, and Health

We develop a polygenic index for individual income and examine random differences in this index with lifetime outcomes in a sample of ~35,000 biological siblings. We find that genetic fortune for higher income causes greater socio-economic status and better health, partly via intervenable environmental pathways such as education. The positive returns to schooling remain substantial even after controlling for now observable genetic confounds. Our findings illustrate that inequalities in education, income, and health are partly due the outcomes of a genetic lottery. However, the consequences of different genetic endowments are malleable, for example via policies that target education.

Impact of Socioeconomic Status on Outcomes of Patients with Kawasaki Disease

To evaluate the association of neighborhood socioeconomic status (SES) with time to intravenous immunoglobulin treatment, length of stay (LOS), and coronary artery aneurysms (CAAs) in patients with Kawasaki disease. We examined the relationship of SES in 915 patients treated at a large academic center between 2000 and 2017. Neighborhood SES was measured using a US census-based score derived from 6 measures related to income, education, and occupation. Linear and logistic regression were used to examine the association of SES with number of days of fever at time of treatment, LOS, and CAA. Patients in the lowest SES quartile were treated later than patients with greater SES (7 [IQR 5, 9] vs 6 [IQR 5, 8] days, P=.01). Patients in the lowest SES quartile were more likely to be treated after 10days of illness, with an OR 1.9 (95% CI 1.3-2.8). In multivariable analysis, SES remained an independent predictor of the number of days of fever at time of treatment (P=.01). Patients in the lowest SES quartile had longer LOS than patients with greater SES (3 [IQR 2, 5] vs 3 [IQR 2, 4], P=.007). In subgroup analysis of white children, those in the lowest SES quartile vs quartiles 2-4 were more likely to develop large/giant CAA 17 (12%) vs 30 (6%), P=.03. Lower SES is associated with delayed treatment, prolonged LOS, and increased risk of large/giant CAA. Novel approaches to diagnosis and education are needed for children living in low-SES neighborhoods.

Lower socioeconomic status predicts lower pneumococcal antibody titers among young adults with asthma

Despite the significantly increased risk of invasive pneumococcal disease among patients with asthma, the association of socio-economic status (SES) with antibody titers is not known. We conducted a prospective study to assess the association of pneumococcal titers and immune response to PPSV23 to SES. We prospectively enrolled 50 asthmatics between 19-21 years old that did not have a history of PPSV23 from Mayo Clinic primary care practice. One person in 50 had PCV-7 while none had PCV-13 immunization in childhood. Pneumococcal titers for 23 serotypes were measured at baseline and 6 weeks post vaccination. SES was measured by HOUSES, a validated individual-level housing-based SES index (the higher HOUSES, the greater SES). The study approval and oversight was by the Mayo Clinic IRB. Asthma control test (ACT) scores at baseline did not differ by SES measured by HOUSES among subjects. A majority of baseline titers of PPSV23 showed positive association with HOUSES (P<0.05 for 7 titers: 1, 10A, 12F, 15B, 18C, 19F, 22F, 5, 7F, 8 and p: 0.05-0.1 for 4 titers: 23F, 3, 9N and 9V). Fold change of 20 out of 23 titers showed no association with HOUSES. Lower SES is associated with lower baseline PPSV23 titers and SES may be an unrecognized determinant of vaccine responses. PPSV23 vaccination may reduce health disparities by SES in risk of pneumococcal pneumonia in asthmatics. While the mechanisms underlying this observation are studied, whether this observation is true for other vaccine titers need to be elucidated.

Beyond Science: Effect of Marital Status and Socioeconomic Index on Outcomes of Spinal Cord Tumors: Analysis From a National Cancer Registry

The effect of marital status and living arrangements on health through modified health behaviors and social networks has been well-established in reported studies, with many experts claiming a "protective" effect from married life for individuals. We sought to study the effect of marital and socioeconomic status (SES) on the outcomes of patients with spinal cord tumors. The Surveillance, Epidemiology, and End Results program was queried for patients with spinal cord tumors from 2004 to 2014. Patients were separated into 4 groups according to their marital status: single/never married, married/living together, divorced/separated, and widowed. SES was calculated using a validated method. Kaplan-Meier curves and multivariable logistic and Cox regression analyses were used to investigate the relationship between marital status and SES and the mortality rate of patients with available follow-up information. Of the 1188 patients identified (683 women [57.5%] and 505 men [42.5%]), 241 (20.3%) were in the single group, 732 (61.6%) in the married/living together, 109 (9.2%) in the divorced/separated, and 106 (8.9%) in the widowed group. Compared with married patients, divorced/separated and widowed patients had a greater mortality rate (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.1-2.9; P=0.02; HR, 2.01; 95% CI, 1.3-3.1; P= 0.001, respectively). Male sex compared with female was associated with lower survival (HR, 1.42; 95% CI, 1.03-1.9; P= 0.03). Patients with greater SES had a lower mortality rate (HR, 0.77; 95% CI, 0.55-1.08; P= 0.143). Unmarried and widowed status, lower SES, and male sex resulted in a greater risk of mortality. These factors should be considered when tailoring the treatment plan for such patients.

Association Between Primary Payer Status and Survival in Patients With Stage III Colon Cancer: An National Cancer Database Analysis

BackgroundColon cancer is the third most frequent cancer diagnosis, and primary payer status has been shown to be associated with treatment modalities and survival in cancer patients. The goal of our study was to determine the between-insurance differences in survival in patients with clinical stage III colon cancer using data from the National Cancer Database (NCDB). Materials and MethodsWe identified 130,998 patients with clinical stage III colon cancer in the NCDB diagnosed from 2004 to 2012. Kaplan-Meier curves and multivariable Cox regression models were used to determine the association between insurance status and survival. ResultsPatients with private insurance plans were 28%, 30%, and 16% less likely to die than were uninsured patients, Medicaid recipients, and Medicare beneficiaries, respectively. Medicare patients were 14% were less likely to die compared with uninsured patients. Patients receiving chemotherapy were, on average, 65% less likely to die compared with the patients not receiving chemotherapy. ConclusionPrivate insurance and a greater socioeconomic status were associated with increased patient survival compared with other insurance plans or the lack of insurance. Future research should continue to unravel how socioeconomic status and insurance status contribute to the quality of care and survival of oncologic patients.

Implicit Physician Biases in Periviability Counseling

To assess whether neonatologists show implicit racial and/or socioeconomic biases and whether these are predictive of recommendations at extreme periviability. A nationwide survey using a clinical vignette of a woman in labor at 232/7 weeks of gestation asked physicians how likely they were to recommend intensive vs comfort care. Participants were randomized to 1 of 4 versions of the vignette in which racial and socioeconomic stimuli were varied, followed by 2 implicit association tests (IATs). IATs revealed implicit preferences favoring white (mean IAT score = 0.48, P < .001) and greater socioeconomic status (mean IAT score = 0.73, P < .001). Multivariable linear regression analysis showed that physicians with implicit bias toward greater socioeconomic status were more likely than those without bias to recommend comfort care when presented with a patient of high socioeconomic status (P = .037). No significant effect was seen for implicit racial bias. Building on previous demonstrations of unconscious racial and socioeconomic biases among physicians and their predictive validity, our results suggest that unconscious socioeconomic bias influences recommendations when counseling at the limits of viability. Physicians who display a negative socioeconomic bias are less likely to recommend resuscitation when counseling women of high socioeconomic status. The influence of implicit socioeconomic bias on recommendations at periviability may influence neonatal healthcare disparities and should be explored in future studies.

Psychological factors moderate the link between SES and inflammatory markers in pregnant women

Elevated pro-inflammatory cytokines and decreased anti-inflammatory cytokines are linked with adverse perinatal health outcomes. One key contributor to inflammation is socioeconomic status (SES). Data examining psychological factors that modify the relationship between SES and inflammation in pregnancy are lacking. This study examined the roles of repetitive negative thinking (RNT) and presence of meaning in life on the SES-inflammation link among 67 pregnant women. A cumulative SES index defined as income, education, perceived social class, and receipt of governmental support was calculated. Measures included the Perseverative Thinking Questionnaire, Meaning in Life Questionnaire, IL-6, and IL-4. Relationships between SES with IL-6 (p = 0.08) and IL-4 (p = 0.47) were not significant. Using PROCESS, moderation analyses showed significant interactions between SES and psychological factors on inflammation. Greater SES was associated with (a) lower IL-6 levels among women reporting low RNT (p = 0.03) and (b) higher IL-4 levels among women reporting high presence of meaning in life (p = 0.02). These effects only emerged in women with high SES. Findings remained after adjustment for race, pre-pregnancy body mass index, exercise, gestational age at visit, and medical conditions. In sum, in pregnant women, greater SES was beneficial for inflammatory markers among women exhibiting enhanced psychological functioning. Future examinations should identify targets of psychological intervention that mitigate the effects of financial stress on inflammation in women with low SES.

Comparing the validity of the payment card and structured haggling willingness to pay methods: The case of a diabetes prevention program in rural Kenya

BackgroundThe objective of this study was to compare the theoretical validity of two willingness-to-pay (WTP) methods, the commonly used payment card (PC) and the recently developed structured haggling (SH), for estimating the potential benefits of a diabetes prevention program in rural Kenya. MethodsA convenience sample of adult residents from a rural county in Kenya (Kiambu), with no history of diabetes, was randomly assigned to one of two WTP methods, PC or SH, using structured face-to-face interviews from December 2011 to February 2012. ResultsA total of 376 respondents completed the interviews using PC (n = 185) or SH (n = 191). More than 95% of respondents were willing to pay something for program access. The study showed that both methods were feasible in rural Kenya. SH resulted in a higher annual mean WTP than PC, Ksh504.05 (US$7.25) versus Ksh619.95 (US$5.90), respectively (p < 0.01). Based on theory, it was hypothesized that certain predisposing factors would result in greater WTP. Greater socio-economic status (measured using income proxies) resulted in greater unconditional WTP for both the PC and SH groups (t-tests and bivariate correlations) and conditional WTP (GLM models). GLM for PC showed being male, employed and having distant relatives with diabetes were significant predictors for WTP, while for SH being educated, employed and owning a vehicle were significant predictors. ConclusionBoth PC and SH showed theoretical validity in rural Kenya. However, the use of SH over PC in rural Kenya may be the better choice given that SH more closely mirrors marketplace transactions in this setting and the use of SH resulted in more significant variables in the GLM models.

Is socioeconomic incorporation associated with a healthier diet? Dietary patterns among Mexican-origin children in the United States

With each successive generation in the United States, Mexican-origin families lose their initial dietary advantages. Focusing on children's diets, we ask whether greater socioeconomic status (SES) can help buffer Mexican-origin children in immigrant families from negative dietary acculturation or whether it exacerbates these dietary risks. Pooling data from the 1999 to 2009 waves of the continuous National Health and Nutrition Examination Survey, we test whether the association between generational status and Mexican-origin children's nutrition varies by the family's SES. When predicting children's overall dietary quality using the Healthy Eating Index (2010) and predicting unhealthy dietary patterns, we find stronger evidence of segmented assimilation, whereby greater family average SES is associated with better diets across generations of Mexican-origin children. High-status Mexican-origin parents appear able to buffer their children against generational dietary declines documented in the acculturation literature.

Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans.

Hearing impairment is highly prevalent, but little is known about hearing health care among older minority adults. We analyzed nationally representative, cross-sectional data from 1,544 older adults ≥ 70 years with audiometry and hearing care data from the 2005-2006 and 2009-2010 National Health and Nutritional Examination Surveys. After adjusting for age and speech frequency pure tone average, Blacks (odds ratio [OR] = 1.68, vs. Whites) and those with greater education (OR = 1.63, ≥ college vs. < high school) were more likely to report recent hearing testing, while White older adults and those with greater socioeconomic status were more likely to report regular hearing aid use (all ps < .05). Based on a multivariate analysis, Blacks were not more likely than Whites to use hearing aids despite being more likely to have had recent hearing testing. Racial/ethnic and socioeconomic disparities exist in hearing health care and represent critical areas for research and intervention.

ED-25 * SOCIOECONOMIC STATUS MODIFIES THE IMPACT OF RACE/ETHNICITY ON GLIOBLASTOMA PROGNOSIS

BACKGROUND: Demographic factors, most prominently age but also race and marital status, are associated with glioblastoma prognosis. Likewise, treatment-related factors, such as surgery type and radiation therapy, significantly impact survival. Socioeconomic status (SES) is associated both with demographic factors and access to health care in the USA. Analyses of glioblastoma patient survival which include SES will provide new insight into the relationship between demographics, treatment received, and ultimately survival. METHODS: The Surveillance, Epidemiology, and End Results (SEER) program tracks cancer incidence and survival in the United States. We obtained a custom SEER data set containing demographic and treatment information regarding patients with GBM diagnosed from 2000 to 2010, including information on SES based on the census tract. Predictors of GBM treatment and survival were evaluated via Kaplan-Meier analyses as well as Cox proportional hazards regression models. RESULTS: A total of 26,481 patients with glioblastoma were evaluated. In the final model, age, marital status, race/ethnicity, SES quintile, radiation use, and surgery type were all associated with survival. Notably, race/ethnicity was not a predictor of survival in models controlling for age alone, but in multivariable models including SES, White Non-Hispanic patients (ref) had poorer survival than White Hispanics [RR 0.90 (95% CI 0.86-0.95)], Blacks [RR 0.87 (95% CI 0.81-0.92)], and All Others [RR 0.85 (95% CI 0.80-0.91)]. With regard to treatment, greater SES was associated with higher gross total resection rate and higher utilization of radiation (p < 0.001 for each comparison). CONCLUSION: Higher SES is associated with both more aggressive treatment of glioblastoma and longer survival. Previously known demographic prognostic factors, including age and marital status, remain significant when SES is also considered. White Non-Hispanic individuals had poorer survival than other racial/ethnic groups when controlling for demographic and treatment factors, a finding that stands in contrast to previous analyses and warrants further evaluation.

Determinants of book reading and library attendance in Colombia. A microeconometric approach

The article explores the determinants of the decision to read books and visit libraries in a developing country, Colombia, based on data from the Encuesta de Consumo Cultural 2008 [Cultural Consumption Survey] (ECC2008). For this purpose, multilevel logistic regressions are estimated, results showing that a high level of education and a greater socioeconomic status have a positive and significant effect on the decision to read, whereas socioeconomic status does not prove significant vis-à-vis library visits. Moreover, the VPC (Variance Partition Coefficient), 5.33% (6.58%) of the residual variation in the propensity to read at least one book (visit a library), can be attributed to unobserved features of the neighbourhood