Higher Socioeconomic Status Research Articles

Life-Course Socioeconomic Trajectories and Biological Aging: The Importance of Lifestyles and Physical Wellbeing

Background/Objectives: Studies investigating the associations between life-course socioeconomic status (SES) and biological aging (the difference between biological and chronological age, Δage) have mostly been focused on epigenetic clocks and on a limited number of mediators. The aim of this study was to investigate this relationship using a blood-based aging clock, as well as the potential mediation of different factors including lifestyles or their proxies and physical and mental wellbeing. Methods: A deep-learning aging clock based on 36 blood markers was deployed, in a large Italian population cohort: the Moli-sani study (N = 4772; ≥35 years; 48% men). SES was defined as an eight-level trajectory over the life course, which was tested with Δage in linear models incrementally adjusted for age, sex, and prevalent health conditions. Moreover, the proportion of associations explained by diverse potential mediators, including diet, smoking, physical activity, alcohol, body mass index (BMI), and physical and mental quality of life (QoL) was estimated. Results: Compared to participants with a stably high SES, those showing an educational and financial downward trajectory were older than their CA (β (95%CI) = 1.28 (0.73–1.83) years), as were those with a stably low SES (0.75 (0.25–01.25) years). These associations were largely explained by the tested mediators (overall proportion: 36.2% and 66.3%, respectively), prominently by physical QoL (20.7% and 41.0%), BMI (16.8% and 34.3%), lifestyle (10.6% and 24.6%), and dietary inflammatory score (5.3% and 9.2%). Conclusions: These findings indicate that life-course socioeconomic inequalities are associated with accelerated biological aging, suggesting physical wellbeing and pro-inflammatory lifestyles as potential public health targets to slow down this process in susceptible socioeconomic strata of the population.

Impact of protraction or orthognathic surgery for class III malocclusion on longitudinal quality of life in patients with cleft lip and palate.

This study assessed overall quality of life (QoL) over time in youth with cleft lip and palate (CLP) undergoing maxillary protraction treatment or orthognathic surgery for class III malocclusion to identify any differences in QoL based on treatment group and outcome success. A prospective longitudinal cohort study was conducted in two pediatric hospitals. The Short Form Health Survey (SF-12) measured physical and mental QoL prior to treatment, at maximal correction, at treatment completion, and at 1-year post treatment. Analyses included one-sample, two-sample, and paired t-tests and analyses of variance and covariance. Participants (N = 91) either completed protraction (n = 53) at age 11-14 or surgery (n = 38) at age 16-21. Participants were mostly Latinx (67%) males (55%) born with unilateral CLP (81%) and there were no demographic differences between the two groups other than age. The total sample's QoL was in the average range and significantly higher than national norms. No significant differences were found in QoL-based outcome success; however, the protraction group showed a gradual physical QoL improvement over time, while the surgery group experienced a temporary drop in physical QoL postoperatively. At treatment completion, higher physical QoL was associated with higher socioeconomic status. At a year post treatment, mental QoL was significantly higher for males. Both protraction and surgery appear to be acceptable treatment options in terms of overall QoL for youth with CLP. While treatment success did not impact QoL, there were some differences in physical QoL coinciding with the treatment phase as well as individual factors.

The influence of ICT competencies on English digital reading achievement

Due to the prevalence of information and communication technologies (ICT) among secondary school students and the increasing significance of digital reading, exploring the impact of ICT on students’ digital reading performance in English seems necessary. The current research aimed to examine the effects of ICT competencies factors on secondary school students’ English digital reading performance. Data were obtained from 7703 15-year-old students from three East Asian economies, Macau, Hong Kong, and Singapore, from the Programme for International Student Assessment (PISA) 2018 dataset. The results of hierarchical regression analysis revealed that students’ ICT literacy was negatively correlated with their English digital reading performance, while the influence of attitudes toward ICT varied across the three East Asia economies. Additionally, males had lower English digital reading achievement, while students with higher socioeconomic status (SES) had higher English digital reading performance.

Trends and inequalities in thinness and obesity among Chinese children and adolescents: evidence from seven national school surveys between 1985 and 2019.

There are little recent data in China regarding contemporary nutritional inequities among children and adolescents, particularly in relation to urban-rural residence and regional socioeconomic status (SES). We aim to assess inequalities in thinness and obesity in Chinese children and adolescents. Weight and height measurements for 1 677 261 children and adolescents aged 7-18 years were obtained from seven cycles of the Chinese National Surveys on Students Constitution and Health (1985, 1995, 2000, 2005, 2010, 2014, and 2019). Sex-specific BMI-for-age Z scores were applied to define thinness (Z scores <-2SD) and obesity (Z scores >+2SD). Urban-rural classification came from the Statistical Urban and Rural Division Code, and gross domestic product (GDP) per capita in the province in which the school was situated was used as a proxy for SES. T1 represented the provinces with the most disadvantaged SES and T3 represented the provinces with the most advantaged SES. General linear regression models assessed correlations between prevalence and GDP per capita, with projections to 2030 derived from best-fitting models. The mean prevalence of obesity rose from 0·10% (95% CI 0·09 to 0·11) in 1985 to 8·25% (8·13 to 8·37) in 2019, whereas thinness prevalence decreased from 8·49% (8·41 to 8·58) to 3·37% (3·29 to 3·45). High SES provinces exhibited a significant drop in obesity prevalence from 2014 (8·42% [8·19 to 8·65]) to 2019 (7·73% [7·52 to 7·95]). Nationally, the prevalence of obesity was consistently higher in urban areas than in rural areas for both sexes from 1985 to 2019; however, a greater prevalence of obesity was observed in rural than urban girls residing in T3 regions in 2019 (urban-rural gap: -0·37% [-0·07 to -0·80]). Rural boys had a higher prevalence of thinness than their urban counterparts across all survey waves, with the exceptions of 1985 and 1995. For girls, no significant urban-rural gap in thinness was observed in the most recent survey in 2019 (-0·10% [-0·24 to 0·04]). From 1985 to 2014, boys and girls from high SES regions had a higher risk of obesity and a lower risk of thinness than those from low SES regions. However, in 2019, a nationwide shift occurred, and the T3-T1 difference in obesity approached or went below zero for boys (-0·49% [-1·02 to 0·04]) and girls (-0·68% [-1·00 to -0·35]). T3-T1 differences in thinness also approached zero for boys (-0·46% [-0·77 to -0·14]) and girls (-0·14% [-0·43 to 0·15]). The projected estimates to 2030 for urban-rural obesity gaps (boys: -1·00% [-2·65 to 0·65]; girls: -2·88% [-6·91 to 1·15]) and T3-T1 obesity differences (boys: -8·88% [-13·76 to -4·01]; girls: -8·82% [-12·78 to -4·85]) were both negative, with forecasted estimates for urban-rural gaps and T3-T1 differences in thinness prevalence in 2030 close to zero for both boys and girls. China's socioeconomic development continues to influence within-country inequities regarding the regional distribution of child and adolescent weight according to urban-rural location and regional SES. Contemporary Chinese children and adolescents in socioeconomically disadvantaged regions and rural areas constitute a vulnerable population facing nutritional risk, but from obesity rather than thinness. Disrupting projected inequities in obesity will require extensive preventive investments. National Natural Science Foundation of China, Beijing Natural Science Foundation, Peking University Talent Introduction Program Project, and Clinical Medicine Plus X-Young Scholars Project of Peking University. For the Chinese translation of the abstract see Supplementary Materials section.

The role of school safety perceptions in childhood asthma diagnosis disparities.

Childhood racial and ethnic asthma disparities in the United States are the consequence of structural inequities such as those in socioeconomic status (SES) and exposure to violence, but little research has explored the role of the school environment in perpetuating racial and ethnic disparities. This study examines associations between perceptions of unsafe school environments (USEs) and subsequent asthma diagnosis for elementary-aged children and the extent to which USE mediates relations from SES and race/ethnicity to asthma diagnosis for Black, Latinx, and non-Latinx White children. We conducted a secondary analysis of data from the Early Childhood Longitudinal Study. Structural equation modeling was used to evaluate the association between USE and subsequent asthma diagnosis, controlling for child sex, and indirect effects of SES and race/ethnicity on asthma diagnosis via USE. For 6,532 children, USE in second grade positively predicted new asthma diagnoses in third grade and mediated the association between SES and new asthma diagnosis. SES and USE serially mediated the relationship between race/ethnicity and asthma diagnosis. Identifying as non-Latinx White was associated with a lower likelihood of subsequent asthma diagnosis via higher SES and lower USE while identifying as Black or Latinx was associated with a higher likelihood of subsequent asthma diagnosis via lower SES and higher USE. USE was associated with pediatric asthma diagnosis and mediated the relationship between SES and asthma diagnosis as well as race/ethnicity and asthma diagnosis. Findings highlight the need to consider USE as a social determinant of health for pediatric asthma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhancing Patient Response to Patient-Reported Outcome Measures: Insights From a Leading Dutch University Hospital

ObjectivesEngaging patients with patient-reported outcome measures (PROMs) is a widely recognized and pressing challenge, yet our understanding of how to achieve this is limited. This study investigated strategies implemented by a Dutch university hospital aimed at enhancing response rates among outpatients from nearly 70 subdepartments. Response rates improved, but remained below desired levels. To deepen understanding and inform future strategies, we identified patient and consultation characteristics associated with response behavior. MethodsWe investigated strategies and their underlying rationales through a document analysis of internal hospital documentation (2020-2023) using the COM-B model. We exploited electronic health record data to identify patient and consultation characteristics associated with PROMs completion, estimating a multivariate logistic regression model (n = 46 468 outpatient consultations). ResultsThirteen strategies targeted outpatients’ capability, opportunity, and motivation to complete PROMs. In 2023, PROMs were completed in more than half of the 46 468 unique consultations (56%) for which a PROM was sent. Challenges persisted in establishing effective feedback mechanisms and accommodating non-Dutch-speaking patients. The multivariate analysis showed a significantly higher response among patients of high or middle socioeconomic status and those with an in-person consultation, ie, not using telehealth. Women, patients attending a follow-up visit, or those having their consultation on a Friday were slightly less likely to complete PROMs. ConclusionsResponse rates to PROMs improved but remained below desired levels, despite multiple strategies. Hospitals may benefit from effective patient feedback on PROMs and tailoring strategies to engage specific patient groups. These approaches can enhance successful implementation and promote equity in value-based healthcare.

Area-level socioeconomic inequalities in mortality in China: a nationwide cohort study based on the ChinaHEART project

Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality. In this nationwide cohort study, residents aged 35-75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper-Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators. Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18-5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07-1·16), cardiovascular disease (1·38, 1·29-1·48), and respiratory disease (1·44, 1·22-1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution. There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity. The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China. For the Chinese translation of the abstract see Supplementary Materials section.

Uptake of and factors associated with telemedicine use for palliative care among patients diagnosed with advanced cancers during the onset of COVID-19.

53 Background: The COVID-19 pandemic propelled a rapid shift to telemedicine use, including patients with advanced cancers needing palliative care (PC). Yet, little is known about disparities in telemedicine use for PC. We leveraged population-based data to examine the trend and factors associated with telemedicine use for PC among Medicare beneficiaries diagnosed with advanced cancers during the onset of COVID-19 pandemic. Methods: We identified patients aged ≥65.5 years diagnosed with advanced-stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2015-2019 from the SEER-Medicare data. We included those with continuous fee-for-service coverage and had any PC claims from diagnosis to death, hospice admission, or by 12/31/2020 (whichever came first). Telemedicine was identified using procedure codes, modifiers, and place of service codes on PC claims. We described the percent of PC recipients using telemedicine each quarter in 2019-2020. Multivariable logistic models assessed patient and provider characteristics associated with telemedicine use among PC recipients in 2020. Results: Telemedicine use for PC was 0.24% to 0.48% across 4 quarters in 2019, which increased to 16.3% in Q1 and stabilized at about 30% in Q2-Q4 in 2020. Among 2,945 PC recipients in 2020, 22.5% used telemedicine. Older patients (75-84 years and 85+ years) were 4.4 percentage points (ppts) and 8.6 ppts (p-values&lt;0.05) less likely than patients ages 65-74 years to use telemedicine. Patients who were female (4.4 ppts), residing in higher socioeconomic status areas (Yost Quintile 5 vs 1: 7.7 ppts), treated by female providers (4.1 ppts), in hospital system (3.7 ppts vs. individual physician office) and organizations with hospice and palliative care specialists (8.9 ppts) were more likely to use telemedicine for PC (all p-values&lt;0.05). (Table). Conclusions: Telemedicine use for PC surged during the onset of the COVID-19 pandemic, with considerable disparities by patient sociodemographic and provider characteristics. These disparities suggest potential barriers related to patients’ technology literacy and internet access, provider awareness, and healthcare organization resources. Future mixed-method studies need to elucidate these barriers to design interventions at patient, provider, and system levels to ensure effective PC delivery. Selected factors associated with telemedicine use for palliative care. Absolute Probability Difference (95%CI) Age group (ref: 65-74) 75-84 -4.4 (-7.6, -1.2) 85+ -8.6 (-13.4, -3.7) Female (ref: Male) 4.4 (0.9, 7.9) Yost quintile (ref : Q1-Q2) Q3-Q4 2.2 (-1.7, 6.1) Q5 7.7 (3.3, 12.1) Hospital system (ref: Individual physician office) 3.7 (0.6, 6.7) Provider: Female (ref: Male) 4.1 (0.7, 7.5) Organization with hospice and palliative care specialists 8.9 (5.4, 12.4)

Childhood and adult socioeconomic status influence on late-life healthy longevity: evidence from the Chinese longitudinal healthy longevity survey.

Older people in low- and middle-income countries are more susceptible to the impact of childhood experiences. This study comprehensively examines how childhood socioeconomic status (SES) and adult SES collectively influence late-life healthy longevity from a life course perspective, providing insights for shaping health-related policies. This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (1998-2018) with 37,264 individuals aged 65 and above. Using R software, we applied continuous-time multi-state models incorporating the Rockwood frailty index with 38 indicators to assess participants' health. Childhood SES or life course SES trajectories were core explanatory variables, while age and gender were controlled. Multinomial regression estimated annual transition probabilities between different states, and the multi-state life table method calculated total and frailty-specific life expectancy (LE). (1) Social mobility among older people in China showed an upward trend from childhood to adulthood. (2) Transition probabilities for robust-frailty, robust-dead, and frailty-dead increased with age, while frailty-robust decreased. Transition probabilities and LE varied across different childhood SES (low, medium, high) or life-course SES trajectory categories (low-low, low-medium, low-high, medium-low, medium-medium, medium-high, high-low, high-medium, high-high), with probabilities of robust-frailty, robust-dead, and frailty-dead decreasing sequentially across different categories, and frailty-robust increasing sequentially across different categories. Total LE, robust LE, and robust LE proportion increased sequentially across different categories, while frailty LE decreased sequentially across different categories. (3) Women had higher total LE and frailty incidence, but lower recovery rate, mortality risk, robust LE, and robust LE proportion compared to men. Favorable childhood SES and lifelong accumulation of SES advantages protect against frailty morbidity, improve recovery rate, reduce mortality risk, and increase total LE, robust LE, and robust LE proportion. High childhood SES has a stronger protective effect than high adult SES, indicating the lasting impact of childhood conditions on healthy longevity. Systematic interventions in education, food supply, and medical accessibility for children from impoverished families are crucial.

Risk factors for SARS-CoV-2 infection in Jordan: A cross-sectional study in the prevaccination period.

This study aimed to determine the prevalence and risk factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Jordan during the prevaccination period. Between December 2020 and February 2021, nasopharyngeal and oropharyngeal swabs of 2,460 participants were tested by reverse transcription-polymerase chain reaction (RT-PCR). To assess the risk factors, a questionnaire was applied during sample collection. Of the participants, 1,463 (59.5%) individuals were found positive for SARS-CoV-2. In multivariate analysis, male gender, younger age, lower educational level, being single, middle and higher socioeconomic status, having symptoms, presence of underlying conditions and smoking were significantly associated with SARS-CoV-2 positivity. On the contrary, washing hands routinely with soap and water, and use of alcohol-based disinfectants significantly reduced possibility of SARS-CoV-2 infection. The study findings showed that determination of risk factors is of great importance to maintain disease monitoring, prevention and control, particularly in settings with high infection rates.

Lower social vulnerability is associated with a higher prevalence of social media-involved violent crimes in Prince George’s County, Maryland, 2018–2023

BackgroundSocial vulnerability may play a role in social media-involved crime, but few studies have investigated this issue. We investigated associations between social vulnerability and social media-involved violent crimes.MethodsWe analyzed 22,801 violent crimes occurring between 2018 and 2023 in Prince George’s County, Maryland. Social media involvement was obtained from crime reports at the Prince George’s County Police Department. Social media application types included social networking, advertising/selling, ridesharing, dating, image/video hosting, mobile payment, instant messaging/Voice over Internet Protocol, and other. We used the Centers for Disease Control and Prevention’s Social Vulnerability Index to assess socioeconomic status (SES), household characteristics, racial and ethnic minority status, housing type and transportation, and overall vulnerability. Modified Poisson models estimated adjusted prevalence ratios (aPRs) among the overall sample and stratified by crime type (assault and homicide, robbery, and sexual offense). Covariates included year and crime type.ResultsRelative to high tertile areas, we observed a higher prevalence of social media-involved violent crimes in areas with low SES vulnerability (aPR: 1.82, 95% CI: 1.37-2.43), low housing type and transportation vulnerability (aPR: 1.53, 95% CI: 1.17-2.02), and low overall vulnerability (aPR: 1.63, 95% CI: 1.23-2.17). Low SES vulnerability areas were significantly associated with higher prevalences of social media-involved assaults and homicides (aPR: 1.64, 95% CI: 1.02-2.62), robberies (aPR: 2.00, 95% CI: 1.28-3.12), and sexual offenses (aPR: 2.07, 95% CI: 1.02-4.19) compared to high SES vulnerability areas. Low housing type and transportation vulnerability (vs. high) was significantly associated with a higher prevalence of social media-involved robberies (aPR: 1.54, 95% CI:1.01-2.37). Modified Poisson models also indicated that low overall vulnerability areas had higher prevalences of social media-involved robberies (aPR: 1.71, 95% CI: 1.10-2.67) and sexual offenses (aPR: 2.14, 95% CI: 1.05-4.39) than high overall vulnerability areas.ConclusionsWe quantified the prevalence of social media-involved violent crimes across social vulnerability levels. These insights underscore the need for collecting incident-based social media involvement in crime reports among law enforcement agencies across the United States and internationally. Comprehensive data collection at the national and international levels provides the capacity to elucidate the relationships between neighborhoods, social media, and population health.

Assessing the Impact of Smartphone Addiction among medical and health faculty students at university of Kirkuk

Background: Modern smartphones have become an integral part of daily life, particularly among medical students who experience significant academic pressure and stress This study aimed to assess the extent of students' impact from smartphone addiction and investigate its association with their demographic characteristics, socio-economic status, and associated risk factors. Methods: A descriptive cross-sectional study design was used in this study. 772 students from all stages of study in the medical faculties of Kirkuk University. using Smartphone Addiction Scale (SAS), Nordic questionnaires for the analysis of musculoskeletal symptoms, and the severity of digital vision syndrome (DES) was measured using 12 items, The Data was analyzed through Statistical Package for Social Sciences (SPSS) 22. Results: The result of the current study shows that 55.1% were female and the male were 347 (44.9%). the average age of the students was 21.09 ± 1.75. 46.80% of the sample were overweight and obese. around 343(44.4%) sampled are assigned intermittent sleep. while significant relationships are obtained with each of Socio-Economic Status, specialization, using Smartphone in 24hrs, sleeping hours during a day in at least at P&lt;0.05. an overall through global mean of score for the studied domains was assessed in compact form a moderate level, with percentile ranged responses from 5.65 to 80.61 for the studied sample. Conclusion: Our study substantiated that health and medical students are progressing into a state of addiction. no significant difference between males and females when considering of smartphone addiction. The age group most affected was individuals aged 22-23. while the Individuals with moderate to high SES are more susceptibility to addiction. Smartphone use should be limited. To increase awareness and knowledge about the detrimental impacts of smartphone addiction, workshops, courses, and conferences should be held.

The role of family health, socio-economic status, and heritability of neurodevelopmental disorders in the severity of cognitive dysfunctions in school-age children with ADHD

Introduction and objective: Little is known about the association between socioeconomic status, alcohol and tobacco use, and specific cognitive functions, like attention, working memory or executive functions in attention-deficit/hyperactivity disorder. We aimed to determine if socioeconomic adversity and unhealthy family behaviours are predictors of cognitive functions in children with attention-deficit/hyperactivity disorder. Materials and methods: We tested 176 Polish children with attention-deficit/hyperactivity disorder aged 10–13 using the PU1 Battery of Cognitive Functions, while the children’s parents completed a questionnaire on socioeconomic status and alcohol and tobacco use at home during their child’s life stages. We applied cluster analysis of family types and moderation analysis that tested the heritability of neurodevelopmental disorders in family interactions. Results: We identified three family types that raise children with attention-deficit/hyperactivity disorder: 1) families with higher socioeconomic status, lower level of unhealthy family behaviours, and average levels of children’s cognitive functioning, 2) families with low socioeconomic status, high level of unhealthy family behaviours, and average levels of children’s cognitive functioning, and 3) families with average socioeconomic status, low level of unhealthy family behaviours and low level of children’s cognitive functioning. We found no statistically significant associations between family predictors, the moderator variable, and cognitive functions in children with attention-deficit/hyperactivity disorder. Conclusions: The results of our study contrast with the large amount of evidence that shows a link between cognitive dysfunctions in children with attention-deficit/hyperactivity disorder and socioeconomic status and alcohol and tobacco use.

A preliminary study of educational experiences that promote perceptions of college readiness in individuals from lower socioeconomic backgrounds interested in pursuing a career in science, technology, engineering, math, or medicine (STEMM)

IntroductionCollege readiness encompasses many different domains, including content knowledge, metacognitive skills, communication skills, learning strategies, and transitional knowledge. College readiness impacts academic achievement; moreover, student perceptions regarding college readiness impact their behavior and decision to attend college. High-achieving students from lower socioeconomic status (SES) areas possess grit and intelligence, but systemic barriers and inequities can interfere with the achievement of academic success in part due to reduced college readiness.MethodsIn this study, we explore if educational opportunities, such as outreach and pathway programs (OPP), Advanced Placement and International Baccalaureate, and college dual enrollment, impact perceptions of college readiness in a nationwide sample of 339 matriculating college students who wish to enter into Science, Technology, Engineering, Mathematics, and Medicine (STEMM) related fields.ResultsOPPs (p = 0.005) and dual enrollment (p = 0.002) are predictive of higher perceptions of college readiness. When individuals are partitioned into low and high SES by a median-split, OPPs (p = 0.015) and dual enrollment (p &amp;lt; 0.001) are predictive for students from low SES areas only.ConclusionThis work indicates the importance of educational opportunities in improving perceptions of college readiness for students from low SES areas and potentially how resources may be better allocated in the future.

Inequities in sleep duration and quality among adolescents in Canada

BackgroundSeveral recent global events may have impacted adolescent sleep and exacerbated pre-existing disparities by social positions (i.e., social roles, identity or sociodemographic factors, and/or group memberships that are associated with power and oppression due to the structures and processes in a given society at given time). Current understanding of sleep among adolescents is critical to inform interventions for a more equitable future, given the short and long-term consequences of inadequate sleep on health and well-being. This study aimed to provide contemporary evidence on sleep disparities by key social positions among adolescents in Canada.MethodsCross-sectional analyses were conducted using self-reported data collected during 2020–2021 (the first full school year after the COVID-19 pandemic onset) from 52,138 students (mean [SD] age = 14.9 [1.5]) attending 133 Canadian secondary schools. Multiple regression models were used to test whether sleep quality (how well students slept during past week), duration (weekday, weekend, weighted daily average), and guideline adherence (8–10 h/day) differed by sex and gender, race and ethnicity, and socioeconomic status (SES).ResultsFemales reported a mean [95% CI] difference of -1.7 [-3.7, 0.4] min/day less sleep on weekdays than males, but 7.1 [4.5, 9.6] min/day more sleep on weekends, resulting in no difference in average daily sleep between males and females. Females were less likely to report good quality sleep compared to males (AOR = 0.57 [0.54, 0.60]). SES followed a generally monotonic trend where higher scores were associated with more sleep on weekdays (Δhighest: lowest = -28.6 [-39.5, -17.6]) and weekends (Δhighest: lowest = -17.5 [-3.8, -31.2]) and greater likelihood of higher sleep quality (AORhighest: lowest = 3.04 [2.35, 3.92]). Relative to White adolescents, weekday and average daily sleep duration were lower among all other racial identities; mean differences ranged from ∼ 5–15 min/day, with Black students reporting the least sleep.ConclusionsDifferences in sleep duration and quality were most profound among adolescents from the lowest and highest SES. Racial disparities were more evident on weekdays. Compensatory weekend sleep appears more pronounced in females than males. Addressing sleep inequities is critical, as a robust predictor of multiple health outcomes.

Socioeconomic status and depression in later life: longitudinal mediation effects of activities of daily living

BackgroundSocioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults.MethodsData from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling.ResultsThe average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (βiADL=-0.100[-0.143, -0.057]), IADL (βiIADL=-0.140[-0.185, -0.095]), and depression (βiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (βiDEP = 0.566[0.503, 0.629]) and IADL (βiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept.ConclusionsHigher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES.

Childhood Socioeconomic Status Affects Dental Pain in Later Life.

Lower socioeconomic status (SES) is associated with increased dental pain among children. Lower SES in childhood may also contribute to the experience of dental pain among older adults, regardless of the SES in later life. However, this association is still unclear. We used cross-sectional data from the 2019 Japan Gerontological Evaluation Study using self-administrated questionnaires to investigate the causal mediating pathways between childhood SES and dental pain in later life using several SES variables collected at older age as potential mediators. A total of 21,212 physically and cognitively independent participants aged 65 y or older were included in the analysis. The dependent variable was experiencing dental pain during the past 6 mo. The independent variable was the SES at the age of 15 y (low/middle/high). Ten covariates were selected covering demographics and other domains. Education, subjective current income, objective current income, objective current property ownership, and the number of remaining teeth were used as mediators. Prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for dental pain by childhood SES were calculated using a modified Poisson regression model. The mean age of the study participants was 74.5 ± 6.2 y, and 47.5% were men. Of these, 6,222 participants (29.3%) experienced dental pain during the past 6 mo, and 8,537 participants (40.2%) were of low childhood SES. Adjusted for covariates and mediators, the participants with middle and high childhood SES had a lower PR of dental pain (PR = 0.93 [95%, CI 0.89-0.98], PR = 0.79 [95% CI, 0.73-0.85], respectively). Almost 40% of the association between childhood SES and dental pain at older age was mediated via SES in later life and the number of teeth. This study reemphasizes the importance of support for early-life SES to maintain favorable oral health outcomes at an older age. The results of this study can be used by policymakers to promote policies based on a life-course approach that supports children living in communities with low SES and helps them maintain favorable oral health outcomes into their older age.

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 B138: The association of neighborhood-level socioeconomic status and treatment outcomes in dermatofibrosarcoma protuberans: A United States cohort analysis

Abstract Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue sarcoma predominantly affecting the dermis and subcutaneous fat. There has been a lack of research on the intersection of socioeconomic status (SES) and DFSP. Therefore, this study aims to investigate the impact of SES on DFSP outcomes, specifically with differing treatments, an area previously underexplored due to the disease’s rarity. Cases of malignant DFSP from 2006-2018 in the Surveillance, Epidemiology, and End Results Census Tract-level SES and Rurality Database were identified to conduct a retrospective cohort analysis. SES was categorized into 5 groups using the Yost Index, a composite census-tract level measure of SES which incorporates factors like household income, educational level, and home value. Multivariable Cox-proportional hazards regression was conducted to assess relationships of reported characteristics with overall survival. Multivariable logistic regression was used to assess for independent predictors of receipt of Mohs surgery. The associations were also stratified by race/ethnicity. Among the 4995 DFSP cases identified, patients were mostly female (53%), white (52%), and of highest SES (Yost Index Group 5, 29%). Most patients received surgical excision, including Mohs surgery, (93%; Mohs: 9.1%). Higher SES was associated with better overall survival compared to lower SES patients (highest vs lowest SES: hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.26-0.58). Mohs surgery was also the only surgical intervention associated with better survival, compared to no surgery (HR, 0.40; 95% CI, 0.16-0.95). When stratified by race/ethnicity, the association of higher SES with better survival was present in both white (highest vs lowest SES: HR, 0.47; 95% CI, 0.24-0.90) and non-white patients (highest vs lowest SES: HR, 0.34; 95% CI, 0.20-0.58). Higher SES was associated with an increased likelihood of receiving Mohs (highest vs lowest SES: odds ratio [OR], 2.77; 95% CI, 1.80-4.25), and Black patients (23%) were less likely than white patients to receive Mohs (OR, 0.49; 95% CI, 0.33-0.72). When stratified by race/ethnicity, the association of higher SES with receipt of Mohs was present in white patients (highest vs lowest SES: OR, 5.44; 95% CI, 2.88-10.3), though it was not significant in non-white patients. This study demonstrates that higher SES and Mohs were associated with better overall survival for patients with DFSP. Higher SES also increased the likelihood of receiving Mohs, an optimal DFSP treatment. Our study emphasizes that patients with lower SES may have reduced access to more effective treatments like Mohs for DFSP, which may lead to poorer survival. This indicates a need for healthcare policies that address these disparities to improve treatment for patients of all socioeconomic statuses, including racial/ethnic minorities. *Both authors contributed equally Citation Format: Fatima N. Mirza, Megan Hoang, Hayley S Goldbach, Oliver J. Wisco, Tiffany J. Libby, Martin A. Weinstock, Abrar A. Qureshi, Eunyoung Cho. The association of neighborhood-level socioeconomic status and treatment outcomes in dermatofibrosarcoma protuberans: A United States cohort analysis [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 B138.

Abstract B148: Prevalence of Multimorbidity Among Patients with Newly Diagnosed Cancer at a Safety-Net Health System

Abstract Background: Multimorbidity (MM) presents challenges for cancer care and may require coordination between oncologists and primary or specialty care providers. Nevertheless, U.S.-based studies of MM among cancer patients have mostly been conducted in non-Hispanic White and insured populations, which limits understanding of strategic care planning and resource allocation among more diverse populations. Therefore, we aimed to assess the prevalence of MM among adults with newly diagnosed cancer at a large, racial/ethnically diverse safety-net health system. Methods: We used electronic health record and cancer registry data from JPS Health Network, an urban safety-net health system in North Texas. Our eligible population included patients ≥18 years of age diagnosed with first primary cancer in 2016 – 2020 (excluding in situ cases), whose diagnosis or first-course cancer treatment was received at JPS. Our outcomes of interest were MM (≥2 chronic conditions) and severe MM (≥3 chronic conditions) based on 30 chronic conditions defined by the Centers for Medicare &amp; Medicaid Services with up to a 2-year lookback period before cancer diagnosis. We assessed overall and sub-group specific (age group, sex, and race/ethnicity) prevalence of MM and severe MM. We estimated prevalence differences (PD) and 95% confidence intervals between groups using pairwise comparisons with Bonferroni correction. Results: Our study population comprised 5,019 newly diagnosed adult cancer patients. The median age was 58 years and the majority were females (51%), racial/ethnic minorities (59%), uninsured (51%), and overweight or obese (69%). The most common cancer types were breast (13%), lung (12%), and colorectal (11%). Nearly half (45%) were diagnosed with advanced stage cancer. A high proportion of cancer patients had MM (79%) and severe MM (62%). The most common conditions were hypertension (55%), anemia (36%), hyperlipidemia (31%), diabetes (27%), and depressive mood disorders (22%). MM increased by age: 56% among patients aged 18 – 39 years, 78% among patients aged 40 – 64 years, and 91% among patients aged ≥65 years. A higher proportion of males had MM (PD: 6.0% [95% CI: 3.8%, 8.3%]) and severe MM (PD: 7.5% [95% CI: 4.9%, 10%]) compared with females. By race/ethnicity, Non-Hispanic Black patients had the highest prevalence of MM (PD: 8.1% [95% CI: 4.3%, 12%]) and severe MM (PD: 11% [95% CI: 6.7%, 16%]) compared with the lowest prevalences among Hispanic patients. Conclusions: We observed a high prevalence of MM and severe MM among adult cancer patients, particularly among patients aged ≥45 years and non-Hispanic Black patients. Our estimates were &amp;gt;15% higher than prior studies that included mostly non-Hispanic White adult cancer survivors with higher socioeconomic status. Our findings provide insight about the burden of MM among racially diverse cancer patients with low socioeconomic status, which may inform resource allocation and care coordination initiatives to manage MM. Citation Format: Anand B. Singh, Yan Lu, Aaron W Gehr, Kalyani Narra, Bhavna Tanna, Jolonda Bullock, Rachel J. Meadows. Prevalence of Multimorbidity Among Patients with Newly Diagnosed Cancer at a Safety-Net Health 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 B148.