Socioeconomic Status Groups Research Articles

Nutrient intake of young South African adults from the baseline of the African-PREDICT cohort study.

This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study according to ethnicity and socioeconomic status (SES). Cross-sectional analysis of baseline nutrient intakes in the African-PREDICT study. North West Province, South Africa. Black and white adults (n=1153), aged 20-30 years, were classified into three SES groups. Dietary data were collected using three multiple-pass 24-hour dietary recalls. Among all participants, over 70% failed to meet the Estimated Energy Requirements and the Estimated Average Requirements (EAR) for 17 of the 19 reported micronutrients. Across SES groups, more than 50% of participants consistently did not meet the EAR for calcium, magnesium, folate, pantothenic acid, and biotin, as well as vitamins A, C, D, and E. Participants' distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in magnesium, potassium, calcium, phosphorus, and fiber. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, zinc, and iron nutrient pattern. The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of cardiovascular diseases and hypertension.

Socioeconomic status and cardiovascular mortality in over 170,000 cancer survivors: a population-based cohort study

Abstract Background Cardiovascular health is acknowledged as a crucial concern among cancer survivors. Purpose We designed the current study to explore the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) outcomes in cancer survivors. Methods Using the National Health Insurance Service-National Health Examinee database, we identified cancer survivors diagnosed and surviving beyond 5 years post-diagnosis. SES was assessed based on insurance premiums and classified into 5 groups. The primary outcome was death from any CVD. Results This study analyzed 170,555 individuals (mean age 60.7 ± 11.9 years, 57.8% female). A gradual increase in risk was observed across SES groups: adjusted hazard ratios (95% confidence intervals) for overall CVD mortality were 1.20 (1.09-1.33), 1.37 (1.23-1.54), 1.38 (1.24-1.54), and 2.42 (1.48-3.96) for the second, third, and fourth quartile, and medical aid group (the lowest SES group) compared to the highest SES group, respectively. The medical aid group with hypertension exhibited a 3.4-fold higher risk of CVD mortality compared to the highest SES group without hypertension. The relative excess risk due to interaction between medical aid and hypertension was 1.30, and the synergy index was 1.62. Conclusions Low SES and hypertension are both linked to a higher risk of CVD mortality. The present study suggests that low SES, particularly the lowest SES group, synergistically interacts with hypertension, amplifying the risk of CVD mortality.

Bias analysis on socioeconomic status and lung cancer in a pooled international case-control study

Abstract Background Low socioeconomic status (SES) groups showed increased lung cancer risks even after adjustment for smoking habits and other exposures to lung carcinogens. Although several biases were often indicated and discussed, only few studies quantified the impact of potential biases. Methods We conducted a bias analysis on the association of lung cancer and SES using data from the SYNERGY project, including 12 case-control studies with 18 study centres from Europe and Canada (16,550 cases, 20,147 controls). SES in quartiles was derived from the International Socio-Economic Index of occupational status (ISEI). Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression adjusting for age, study centre, and smoking. In addition, we estimated natural direct SES effects and natural indirect smoking effects by inverse odds ratio weighting. In a multiple quantitative bias analysis, we considered impacts of misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by a protective genetic factor, and created 95% simulation intervals (SI) by bootstrap. All analyses were stratified by sex. Results Adjustment for smoking as well as natural effects estimation showed that nearly half of lung cancer risks of lower SES groups in men and up to one third in women were attributable to smoking. Consideration of all types of bias reduced lung-cancer risks in the fully adjusted logistic regression models, with the strongest impact by selection bias: For the 4th versus 1st (highest) ISEI quartile OR decreased from 1.83 (1.69-1.98 CI) to 1.50 (1.30-1.73 SI) in men, and OR 1.48 (1.27-1.72 CI) to 1.20 (0.96-1.53 SI) in women. Conclusions Smoking is the main target for prevention of lung cancer, along with occupational and environmental exposures, in particular in lower SES groups. This finding remains, though our analysis revealed reduced lung-cancer risks of lower SES groups after multiple bias adjustment. Key messages • Impact of potential biases was quantified in the association of SES and lung cancer. • Lung cancer risks were partially attributable to smoking and multiple biases.

Study on Fetal and Maternal Outcome of Postdated Pregnancy

Postdated pregnancy is not so uncommon in obstetric practice. When a pregnancy crosses the expected date of delivery (beyond 280 days) it is called postdated pregnancy. The incidence is about 7% of all pregnancies. This prospective observational study was carried out in 165 postdated pregnancies admitted in the Department of Obstetrics & Gynaecology, during a period of 3 years from January 2021 to December 2023 . Majority of the patients were below 25 years of age (47.88%) and primigravida (41.82%). Most of the patients belonged to rural areas (55.75%) and were middle socio-economic status group (45.45%). The majority of these postdated women were delivered by NVD (52.12%), followed by LSCS (32.72%) and instrumental (15.15%). Postdated pregnancy was associated with perinatal complications like meconium aspiration syndrome, oligohydramnios, fetal birth injuries, septicemia, shoulder dystocia, non-reassuring fetal heart rate status, fetal distress in labour. There was an increased risk of maternal complications like increased caesarean section rate, post-partum hemorrhage (PPH) ,cervical tear, perineal tear. Management of postdated pregnancy is challenging. Careful advice and timely interventions can reduce fetomaternal complications. EWMCJ Vol. 12, No. 1&2, January-July 2024: 94-98

Comparative Analysis of 24-h Movement Behaviours in Non-Overweight and Overweight/Obese Children: Findings from the FAMIly Physical Activity, Sedentary Behaviour, and Sleep (FAMIPASS)

Background: Childhood overweight and obesity are global health concerns associated with insufficient physical activity (PA), excessive sedentary behaviour (SB), and inadequate sleep. This study aimed to determine whether differences exist in 24 h movement behaviours between Czech non-overweight children and children with overweight/obesity aged 3–10 years, with respect to their gender, age, or family socioeconomic status (SES). Methods: A total of 381 children (49.9% girls), aged 3–10 years, participated. Their PA, SB, and sleep were continuously monitored over a regular week using wrist-worn accelerometers. Weight status was determined by BMI z-scores, according to World Health Organization standards. SES was assessed using the Family Affluence Scale. Results: Non-overweight children had averages of 414 min of PA, 472 min of SB, and 554 min of sleep per day, while children with overweight/obesity had averages of 392 min of PA, 503 min of SB, and 545 min of sleep. Non-overweight children engaged in significantly more PA (22 min per day; p = 0.014) and significantly less SB (31 min per day; p = 0.002) than children with overweight/obesity. No significant differences were found between the weight groups in gender distribution, age, family SES, or maternal and paternal obesity. Conclusions: Non-overweight children exhibited higher levels of PA and lower levels of SB compared to their counterparts with overweight/obesity, independent of gender, age, or family SES. These findings highlight an association between daily movement behaviours and weight status in young children. Further research is needed to explore the impact of modifying PA and SB on weight outcomes.

Socioeconomic status, smoking, and lung cancer: mediation and bias analysis in the SYNERGY study.

Increased lung-cancer risks for low socioeconomic status (SES) groups are only partially attributable to smoking habits. Little effort has been made to investigate the persistent risks related to low SES by quantification of potential biases. Based on 12 case-control studies, including 18 centers of the international SYNERGY project (16,550 cases, 20,147 controls), we estimated controlled direct effects (CDE) of SES on lung cancer via multiple logistic regression, adjusted for age, study center, and smoking habits, and stratified by sex. We conducted mediation analysis by inverse odds ratio weighting to estimate natural direct effects (NDE) and natural indirect effects via smoking habits. We considered misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by genetic risk, both separately as well as by multiple quantitative bias analysis, using bootstrap to create 95% simulation intervals (SI). Mediation analysis of lung-cancer risks for SES estimated mean proportions of 43% in men and 33% in women attributable to smoking. Bias analyses decreased direct effects of SES on lung cancer, with selection bias showing the strongest reduction in lung-cancer risk in the multiple bias analysis. Lung-cancer risks remained increased for lower SES groups, with higher risks in men [4th versus 1st (highest) SES quartile: CDE 1.50 (SI 1.32-1.69)] than women [CDE 1.20 (SI 1.01-1.45)]. NDE were similar to CDE, particularly in men. Bias adjustment lowered direct lung-cancer risk estimates of lower SES groups. However, risks for low SES remained elevated, likely attributable to occupational hazards or other environmental exposures.

Trends in socioeconomic inequality in e-cigarette use among adolescents in South Korea.

The global rise in e-cigarette use among adolescents is alarming, with associated socioeconomic inequalities posing potential public health risks. This study examined trends in the socioeconomic inequality in e-cigarette use among South Korean adolescents to inform future regulatory directions. Socioeconomic inequalities in e-cigarette use among Korean adolescents were assessed using data from the Korea Youth Risk Behavior Web-based Survey (KYRBS) from 2011 to 2023. The Concentration Index, a well-established method for measuring health inequalities, was employed. Additionally, this study investigated how the smoking behaviors of family members and friends influence socioeconomic inequality in e-cigarette use among Korean adolescents, using a decomposition analysis. The Concentration Index values showed a clear, fluctuating downward trend over 13 years, from -0.12 (95% CI: -0.13 - -0.10) in 2011 to -0.24 (95% CI: -0.26 - -0.21) in 2023. Decomposition analysis revealed that smoking among peer groups, including friends and siblings, was the primary contributor to socioeconomic inequality in e-cigarette use, followed by maternal smoking. Socioeconomic inequalities in adolescent e-cigarette use in South Korea are widening, particularly among low socioeconomic status groups. The impact of peer groups on socioeconomic inequalities in e-cigarette use among adolescents is concerning.

Patterns of change in the association between socioeconomic status and body mass index distribution in India, 1999-2021.

Body mass index (BMI) is an important indicator of human health. However, trends in socioeconomic inequalities in BMI over time throughout India are understudied. Filling this gap will elucidate which socioeconomic groups are still at risk for adverse BMI values. This repeated cross-sectional study analysed four rounds of India's National Family Health Surveys (1998-1999, 2005-2006, 2015-2016, and 2019-2021). The outcome was BMI categories, measured in kilogram per metres squared (kg/m2), defined as severely/moderately thin (<17.0 kg/m2), mildly thin (17.0-18.4 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). We examined the prevalence, standardised absolute change, and odds ratios estimated by multivariable regression models by household wealth and levels of education, two important measures of socioeconomic status (SES). The study population consisted of 1 244 149 women and 227 585 men. We found that those in the lowest SES categories were more likely to be severely/moderately thin or mildly thin. Conversely, those in the highest SES groups were more likely to be overweight or obese. The gradients were steepest for wealth, and this was substantiated by the results of regression models for every wave. There has been a decline in the difference in the prevalence of severely/moderately thin or mildly thin between SES groups when comparing the years 1999 and 2021. SES-based inequalities in BMI were smaller in 2021 compared to 1999. However, those in low SES groups were most likely to be severely/moderately thin or mildly thin while those in high SES groups were more likely to be overweight or obese. Future research should explore the pathways that link SES with BMI.

Socioeconomic disparities and cardio-cerebrovascular diseases: A nationwide cross-sectional study.

Although socioeconomic status (SES) is considered a risk factor for cardio-cerebrovascular diseases (CCVDs), few studies have examined this association. In this cross-sectional study, we aimed to assess the prevalence and trends of CCVDs across different SES groups over a 12-year period in a representative Korean population. We analysed 47 745 economically active adults aged ≥30 and <65 years from 97 622 patients in the Korean National Health and Nutrition Examination Survey (2007-18), where a new independent sample of the population was examined each year. We categorised the participants into four groups based on education level and income. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CCVD, including angina, myocardial infarction, and stroke, was analysed at four-year intervals. Average age, urban residence, white-collar occupation, and body mass index >30 increased, whereas CCVD prevalence did not change significantly (P = 0.410) over the study period. Low education (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04-1.47, P < 0.001) and low income (OR = 1.14; 95% CI = 1.02-1.28, P = 0.017) were significant determinants of CCVD in addition to existing traditional risk factors. CCVD prevalence was significantly higher in both the low-education and low-income groups compared to the high-education and high-income groups every four years, with no significant change in this gap over the study period (P = 0.239). Despite the increase in the elderly population and the prevalence of obesity, the incidence of CCVDs in Korea has remained unchanged. Individuals with low education or low income had a significantly higher prevalence of CCVD, with the lowest SES group, defined by both low education and low income, consistently having the highest prevalence of CCVDs.

Socio-economic inequalities in health-related quality of life and the contribution of cognitive impairment in Australia: A decomposition analysis

BackgroundThe distributional effects of cognitive impairment on inequalities in health-related quality of life (HRQoL) are not well studied. This relationship has not been studied in any Australian health inequality literature. Therefore, this study aims to examine how cognitive impairment affects the distribution of HRQoL across various socio-economic classes amongst older Australians. MethodsData for this study was collected from the Household, Income and Labour Dynamics in Australia (HILDA) survey. The final analysis consisted of 5,247 and 5,614 unique individuals from wave 2012 and wave 2016, respectively. An ordinary least squares (OLS) regression model was used to investigate the relationship between cognitive impairment and HRQoL. Additionally, the Wagstaff-Doorslaer-Watanabe standard concentration index was used to examine socioeconomic inequality in HRQoL. ResultsThe findings revealed pro-rich inequalities in HRQoL, as indicated by the concentration indices of 0.029 and 0.025 for wave 12 and wave 16, respectively. Additionally, the results showed that mild cognitive impairment accounted for 7.60% and 9.03%, respectively, of pro-rich socioeconomic inequality in HRQoL in 2012 and 2016. ConclusionPeople from lower socioeconomic status (SES) groups tend to have lower HRQoL compared to those from higher SES. This leads to a greater disparity in HRQoL based on SES. Cognitive impairment positively contributed to this inequality in HRQoL. Therefore, it is critical to incorporate cognitive impairment into the design of interventions to reduce socioeconomic inequality in HRQoL.

Evaluating Bias of Child Maltreatment Referrals in Encounters for Unintentional Ingestions

BackgroundUnintentional ingestions commonly result in presentation to the pediatric emergency department (PED). No standardized recommendations exist regarding when to call Child Protective Services (CPS) for unintentional ingestions, which allows for the possibility of biased decision-making. ObjectiveIdentify patient and visit level characteristics associated with CPS referral status in unintentional ingestion encounters. Participantsand Setting: Retrospective cross-sectional study of children ≤6 years old presenting with unintentional ingestion to a metropolitan PED from 2015 to 2021. MethodsICD-10-CM codes were used to identify unintentional ingestion visits in the electronic health record. CPS referral was determined by manual chart review. Bivariable and multivariable logistic regression models identified patient and visit level characteristics associated with CPS referral. Socioeconomic status (SES) was classified based on zip code, the Child Opportunity Index data, and insurance. ResultsOf 3,836 charts reviewed, 808 met inclusion criteria. CPS referrals were made in 109 (13.5%) visits. Compared to non-Hispanic white patients, non-Hispanic Black patients had 7.37 (95% CI:1.38, 39.26) higher adjusted odds of being referred to CPS after adjusting for triage level, age, and ingestion type. Patients in the Lowest SES group had a 3.01 (95% CI:1.42, 6.40) higher adjusted odds when compared to the Middle/Highest SES group. ConclusionThis study found that CPS referrals in unintentional ingestions occur more often in those identifying as non-Hispanic Black and in those in the Lowest SES group, suggesting clinician bias may impact the decision regarding referrals. To mitigate subjective decision-making, we propose creating standardized, objective CPS referral criteria for unintentional ingestions.

Clusters of parental socioeconomic status in early childhood and inherited risk for cerebrovascular disease until mid-life-Northern Finland Birth Cohort 1966.

The incidence of cerebrovascular disease (CVD) is rising among young adults (< 55 years). The risk for CVD starts to form in early childhood and is comprised of genetic and environmental risk factors. The aim of this study is to investigate the relationship between early family socioeconomic status (SES), inherited risk, and CVD until midlife. In the Northern Finland Birth Cohort 1966 of 12,058 children, individuals were followed from gestational period up to 54 years. We used previously published early family SES clusters, based on latent class analysis of a wide set of prenatally collected variables. We investigated inherited risk with polygenic risk score (PRS) and parental CVDs during follow-up. The associations of the five distinct clusters, inherited risk, and consequent risk for various types of CVDs until middle age were analyzed with Cox regression. All analyses were conducted first in the whole sample and then stratified by sex as is recommended in cardiovascular studies. During the follow-up of 586,943 person-years, 512 CVDs occurred. No clear association between SES clusters and CVD were found. Higher PRS associated with any CVD (hazard ratio (HR) per 1 SD increase: 1.15; 95% confidence interval (CI): 1.02-1.31), and ischemic CVD (HR: 1.21; 1.05-1.40). We found no combined associations of early family SES and inherited risk for CVD. Inherited risk was associated with the risk for CVD in mid-life in Finnish population. We found no clear connection with early family SES and CVD. Being born to a specific SES group did not increase the effect of inherited risk. NFBC1966 data are available from the University of Oulu, Infrastructure for Population Studies for researchers who meet the criteria for accessing confidential data. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. Permission to use the data can be applied for research purposes from https://www.oulu.fi/nfbc.

Hidden patterns of inequality: The heterogeneity in parenting within educational groups

When sociology deals with differences within groups of similar socioeconomic status, research and theorizing tend to focus on the heterogeneity among the socioeconomically advantaged thus representing the socioeconomically disadvantaged as homogeneous. This study is a case of the opposite. For at set of high-stake cultural practices, parental strategies for social reproduction, I find most heterogeneity among socioeconomically disadvantaged mothers. Using data from the NLSY-CYA, I provide novel descriptive statistics of the variance in parenting by maternal education and analyze the determinants of these differences employing a variance function regression. I find an educational gradient in the heterogeneity of cognitively stimulating parenting: the variance is highest among mothers with no high school diploma and shrinks among mothers with more education. That is, mothers with the least amount of education show the most diversity in parenting. This educational gradient is associated with inequality in mothers’ family of origin, cognitive skills, and current economic situation. This result suggests that the systematic differences in heterogeneity stem from (1) selection into education based on family-of-origin characteristics and cognitive skills, where the non-deterministic sorting makes the least educated the most heterogeneous, and (2) the effect of education on mothers’ economic situation, where education decreases uncertainty and thereby makes the most educated the most homogeneous group. Moreover, the study calls for bringing attention to the potential larger heterogeneity in cultural practices among the socioeconomically disadvantaged and provides a theoretical framework for understanding this heterogeneity. This approach challenges stereotypes and deepens sociological understanding of inequality.

Consumer Locus of Control Scale: Validity, and Measurement Invariance Evidence in Low and High Socioeconomic Status Groups

Consumer locus of control is a key factor in purchase decisions, where consumers perceive outcomes as either dependent on or external to their own actions. These beliefs vary among individuals from different socioeconomic backgrounds, except when it comes to consumption. However, the assumption of measurement invariance across all socioeconomic groups has not been proven. To address this, a study was conducted to develop, validate, and test the invariance of the Consumer Locus of Control Scale. The first study (n = 300) involved exploratory factor analysis and reliability testing. The second study (n = 309) examined confirmatory factor analysis, convergent and discriminant validity, and measurement invariance. Results showed high explained variance and internal consistency. The five-factor structure demonstrated a good fit, supporting the scale's structural validity. Furthermore, the scale was invariant between high and low socioeconomic groups. This study provides valuable evidence for the reliability and validity of the Consumer Locus of Control Scale.

Abstract C127: Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California

Abstract Purpose. Several factors including, socioeconomic status (SES), access to screening and healthcare coverage, tumor biology, differences in disease management and care delivery in various healthcare settings, and implicit bias among healthcare providers contribute to mortality disparities in individuals with cancer. Further, health insurance is strongly associated with better survival. Previous studies that examined disparities in cancer mortality included patients with and without healthcare coverage, making it difficult to disentangle the effects of health insurance coverage from other SES factors. Thus, we evaluated the influence of race/ethnicity and geocoded SES on all-cause mortality in cancer patients with health insurance. Methods. We identified adults with health insurance coverage diagnosed with eight common cancers from 2009 to 2014 from the California Cancer Registry (stages I-IV) and followed them through 2017 (8 years maximum). Specifically, we identified those who lived in southern California counties. Patients had managed care, preferred provider organization, Medicare, Medicaid, dual Medicare and Medicaid, and other private insurance. We calculated person-year mortality rates by race/ethnicity and geocoded SES quintiles. Adjusted hazard ratios for the association between overall mortality and race/ethnicity and SES were estimated using Cox proportional hazards models accounting for other demographics, stage at diagnosis, and cancer treatments. Results. 164,197 adults were diagnosed with cancer originating from breast, prostate, lung, colon, skin melanoma, uterus, kidney, and bladder. For all racial/ethnic groups combined, the mortality rates from lowest to highest SES groups were 112.1/1000 PY (lowest); 100.2/1000 PY (lower-middle); 91.2/1000 PY (middle); 79.1/1000 PY (upper-middle); and 63.5/1000 PY (upper). These rates suggest that people with the lowest SES have a markedly increased mortality risk after cancer diagnosis even if they have health insurance. In multivariable analyses, those in the lowest SES group had a 40–78% increased risk of all-cause mortality compared to those in the upper SES group across all races/ethnicities. For example, within African Americans, the adjusted mortality risk was up to 61% higher (HR 1.61, 95% CI 1.41–1.83) in the lowest SES group compared to the highest SES group. Conclusion. This study suggests disparities in overall mortality risk after cancer diagnoses persist even in a cohort with health insurance, and that SES is an important driver of this disparity. Issues related to travel distance, access to transportation to cancer care facilities, and access to telemedicine may be magnified among those with lower SES during cancer care where optimal management becomes more complex. To potentially mitigate the effects of these social determinants, healthcare systems must either implement programs to support patients, or have partnerships with local community organizations to do so. All of this requires systems level support through social work, patient navigation, and cancer case management. Citation Format: Reina Haque, Amrita Mukherjee, Robert M. Cooper. Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C127.

Abstract C126: Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system

Abstract Purpose. After a cancer diagnosis, delays in initiating treatment may impact treatment response, disease progression, adverse health events, and overall survival. Race and socioeconomic status (SES) may be factors in initiating cancer treatment. Complicating this issue is the lack of insurance or underinsurance. Thus, the purpose of this study was to assess the influence of race/ethnicity and SES on time to treatments for insured patients diagnosed with cancer in a vertically integrated healthcare system. Methods. We conducted a cross-sectional nested study within a cohort of patients diagnosed with cancer between 2010 and 2018 from Kaiser Permanente Southern California (KPSC), a vertically integrated healthcare system. Patients of all ages and all cancer anatomical sites were included. Patients with in-situ cancers were excluded, with no other exclusion criteria. The main independent variables are race/ethnicity and SES, and the dependent variable is time to initial treatment. All information was pulled from the KPSC Cancer Registry, including race/ethnicity, and treatments (surgical; radiation; chemotherapy; immunotherapy; hormonal). SES was categorized into quintiles based on geocoded expected income using home addresses from census tract data. For each patient, we calculated days from diagnosis to first treatment. Results. We identified 153,270 patients of all ages with cancers of all anatomical sites diagnosed between 2010 and 2018, of which 125,943 received treatment. When examining racial groups, the mean time to treatment for White, Black, Hispanic, Asian/PI, and other patients was 42.5, 52.6, 44.3, 44.1, and 41.2 days, respectively. For White patients, mean time to treatment was 42.4 days in the lower 20% income quintile and 42.7 days in the top 20% income quintile. For Black patients, mean time to treat was 53.9 days in the lower 20% income quintile and 52.8 days in the top 20% income quintile. For Hispanic patients, mean time to treat was 45.8 days in the lower 20% income quintile and 42.1 days in the top 20% income quintile. For Asian/PI patients, mean time to treat was 44.1 days in the lower 20% income quintile and 43.5 days in the top 20% income quintile. For other patients, mean time to treat was 51.4 days in the lower 20% income quintile and 39.2 days in the top 20% income quintile. Within each SES quintile, Black patients consistently started cancer treatment later than other racial/ethnic groups. Conclusion. We found minimal disparities in time to initial treatment based on SES in this vertically integrated system of care. Within each of the White, Black, and Asian racial groups, the difference in time to treatment between the highest and lowest SES groups was less than 2%. This difference was closer to 7% in Hispanic patients. Additional work is necessary to elucidate reasons why Black patients initiate cancer treatments later than other racial groups and if this affects recurrence or survival. Citation Format: Robert Cooper, Reina Haque, Andrea Young, Zimin Zhuang. Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C126.

Impact of socioeconomic status on cardiac arrest outcomes during COVID-19 pandemic

IntroductionThe coronavirus disease 19 (COVID-19) pandemic has affected healthcare services, potentially leading to inequitable outcomes based on patients’ socioeconomic status (SES). This study aimed to evaluate the impact of COVID-19 on out-of-hospital cardiac arrest (OHCA) outcomes by examining disparities across SES levels. MethodsThe study analyzed non-traumatic OHCA cases registered in the Korean Out-of-Hospital Cardiac Arrest Registry from 2010 to 2021, encompassing 238,668 patients aged 18 years and older. SES was assessed at both the individual (Medicaid vs non-Medicaid) and area levels using a deprivation index. Outcomes included any return of spontaneous circulation, survival to admission, survival to discharge, and favorable neurological recovery. Logistic regression and generalized additive models (GAMs) were used for analysis. ResultsOHCA outcomes—including survival to admission, survival to discharge, and favorable neurological recovery—improved over the years, peaking in 2019 before subsequently declining. Logistic regression showed that the lowest SES area was associated with lower rates of ROSC (adjusted odds rations [aOR] 0.82, 95 % confidence interval [CI] 0.75–0.88) and survival to admission (aOR 0.56, 95%CI 0.49–0.64) and discharge (aOR 0.78, 95%CI 0.61–0.98) during the pandemic. GAM analysis revealed that lower SES groups (deprivation index levels 4 and 5) experienced higher-than-expected survival to admission and discharge rates, as well as favorable neurological recovery. Although outcomes in the deprivation index level 1 group (5.5 % in 2021) remained superior, indicating poor outcomes for the lowest SES area group (3.43 % in 2021), the disparity decreased following the pandemic. ConclusionLower levels of SES are a significant risk factor for unfavorable neurological recovery in OHCA, independent of the COVID-19 pandemic. However, SES-related disparities in the outcomes decreased post-pandemic. Despite the overall negative impact of COVID-19, certain lower SES groups showed improved survival rates, likely due to differences in the EMS response and healthcare burden across regions.

Segregated by whom? Examining triple neighbourhood disadvantages and activity spaces in Seoul, South Korea

This study explores the potential mechanisms by which neighbourhood isolation is created and reinforced in non-home activity locations. The existing discussion on neighbourhood isolation, its consequences, and the subsequent reproduction of interactions between individuals and their environment has focused on their residential locations. However, the vitality of a neighbourhood depends not only on its own socioeconomic conditions but also on the conditions of the other neighbourhoods its residents visit and are visited by. Residential locations are only one of the many spaces in which individuals engage in their activities; therefore, to fully comprehend people’s everyday experiences of integration and isolation, it is imperative to look at interactions within both home and non-home activity spaces. Building on this extended perspective, we examine: (1) whether residential neighbourhood isolation is intensified by socioeconomic conditions individuals’ encounter in consumption and commuting activity spaces; and (2) which socioeconomic group drives the association between residential neighbourhood isolation and activity spaces—whether both disadvantaged and privileged groups contribute to isolation through the differential use of urban space or either group predominantly leads this association. We use Seoul as a case study, characterised as a city that is highly populated, contains multiple economic centres, functions with a highly affordable and efficient public transportation system, and suffers from increasing socioeconomic segregation. The results suggest that mobility patterns in activity spaces tend to reinforce neighbourhood isolation through potential forces driven by neighbourhood homophily. Isolation in the use of urban spaces appears to be driven mainly by the self-seclusion of the most advantaged neighbourhood group, while neighbourhoods in the lower socioeconomic status groups indicate broader cross-interactions across status groups, probably because of Seoul’s transit-friendly environment. Our study contributes to enhancing the understanding of spatial-societal inequalities in Korea and beyond and could assist in formulating policies for a more balanced provision of diverse urban social services and infrastructure.

Association of neighborhood level socioeconomic status and patient reported clinical improvement following total shoulder arthroplasty

BackgroundPrior studies have demonstrated higher preoperative pain and decreased patient reported outcomes (PROs) following total shoulder arthroplasty (TSA) in individuals with lower socioeconomic status (SES). The goal of this study was to investigate the rate of clinical improvement following TSA in individuals with differing SES. MethodsIndividuals included in this study underwent anatomic (a)TSA or reverse (r)TSA by two surgeons between May 2018 and January 2021. Patients were split into three SES groups (low, moderate, and high) based on neighborhood SES level as determined by Area Deprivation Index (ADI). PROs were collected preoperatively and at 9 weeks, 26 weeks, 1 year, and 2 years postoperatively. Shoulder specific PROs included the American Shoulder and Elbows Surgeon’s shoulder score (ASES), 10-point visual analog scale (VAS) for pain, single assessment numeric evaluation (SANE), and Western Ontario Osteoarthritis of the Shoulder Index (WOOS). The Veterans Rand 12 item health survey (VR-12) was utilized to measure overall well-being. We utilized a mixed design analysis of variance (ANOVA) to determine the interaction of time and improvement in PROs following surgery followed by one-way ANOVA with post-hoc analysis. Results/Discussion170 individuals (low SES n=34, moderate n=90, high n=46) met inclusion criteria and were included in this study. There were no significant differences between groups for BMI or age at time of surgery. All groups significantly improved from baseline scores on all PROs (p<.001) with the majority of improvement being achieved within the first year after surgery. There were no significant differences in rate of clinical improvement on PROs among the groups when compared to their respective preoperative scores. Significant differences were discovered when comparing groups independent of time with the low and moderate SES groups scoring significantly lower on ASES when compared to the high SES group (p<.01) and the low SES group reporting significantly higher VAS pain when compared to the high SES group (p=.034). ConclusionIndividuals with lower SES at the neighborhood level report higher pain and decreased shoulder function both preoperatively and postoperatively following TSA; however, the rate of clinical improvement following surgery in this group is comparable to individuals with higher SES when compared to baseline scores. All groups demonstrated significant improvement following surgery, suggesting TSA remains a successful operation regardless of SES.

Trends in COPD severe exacerbations, and all-cause and respiratory mortality, before and after implementation of newer long-acting bronchodilators in a large population-based cohort

BackgroundLittle is known about the trends in morbidity and mortality at the population level that followed the introduction of newer once-daily long-acting bronchodilators for COPD. The purpose of the study was to evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across sex and socioeconomic status classes.MethodsWe used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e., trend effect) in monthly severe exacerbation and mortality rates after 03/2013 and 02/2015 compared to the tiotropium period (04/2007 to 02/2013). Cohorts of individuals > 65 years with COPD were created from the nationally representative database of the Quebec Integrated Chronic Disease Surveillance System in the province of Quebec, Canada. Whether these trends were similar for men and women and across different socioeconomic status classes was also assessed.ResultsThere were 130,750 hospitalizations for severe exacerbation and 104,460 deaths, including 24,457 (23.4%) respiratory-related deaths, over the study period (928,934 person-years). Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.14%/month;95%CI -1.90% to -0.38%), which further decreased after 02/2015 (-1.78%/month;95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%/month;95%CI -4.38% to -0.47%) and severe exacerbation (-1,90%/month;95%CI -3.04% to -0.75%) rates were only observed after 02/2015. These observations tended to be more pronounced in women than in men and in higher socioeconomic status groups (less deprived) than in lower socioeconomic status groups (more deprived).ConclusionsThe arrival of newer bronchodilators was chronologically associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD > 65 years. Our findings document population benefits on key patient-relevant outcomes in the years following the introduction of newer once-daily long-acting bronchodilators and their combinations, which were likely multifactorial. Public health efforts should focus on closing the gap between lower and higher socioeconomic status groups.