Higher Socioeconomic Status Groups Research Articles

Socioeconomic status and self-rated health in Iran: findings from a general population study

BackgroundThere are large gaps in health and well-being among different groups of the society. Socioeconomic factors play a significant role in determining the health status of the society. The present study was conducted to examine socioeconomic inequality in health status among the adult population of Khorramabad city, the capital of Lorestan province, wester part of Iran.MethodsA cross-sectional study was conducted on 1348 participants selected through multistage sampling. A valid and reliable questionnaire was used for data collection. The wealth index as an indicator of the socioeconomic status (SES) was used to categorize the subjects in terms of the SES. The concentration index and concentration curve was used to measure socioeconomic inequity in poor self-rated health (SRH) of population. Finally, after determine the status of inequity in poor SRH, a decomposition analysis approach was used to identify the most important determinants of this inequity.ResultsThe prevalence of poor SRH was 18.91% in all subjects, 38.52% in the lowest SES group, and 11.15% in the highest SES group. The value of the concentration index for poor SRH was − 0.3243 (95% CI − 0.3996 to − 0.2490), indicating that poor SRH was more concentrated among the poor. The results of decomposition analysis showed that SES (41.2%), higher body mass index (28.6%) and lack of physical activity (26.9%) were the most important factors associated with the concentration of poor SRH in the poor groups.ConclusionIdentification of socioeconomic factors affecting on health status is the first step for proper policymaking. Policymakers and health system managers at the national and subnational levels can use the results of this study as well as other similar domestic studies to design and implement proper interventions to promote equity and improve the health status of population.

The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population

BackgroundIn the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China.MethodsData were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed.ResultsThe preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies.ConclusionsKey policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people’s excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.

Ecological factors and childhood eating behaviours at 5 years of age: findings from the ROLO longitudinal birth cohort study

BackgroundIndividual differences in children eating behaviours have been linked with childhood overweight and obesity. The determinants of childhood eating behaviours are influenced by a complex combination of hereditary and ecological factors. This study examines if key ecological predictors of childhood overweight; maternal socio-economic status (SES), children’s screen time, and childcare arrangements, are associated with eating behaviours in children aged 5-years-old.MethodsThis is secondary, cross-sectional analysis of the ROLO (Randomized COntrol Trial of LOw glycemic diet in pregnancy) study, using data from the 5-year follow-up (n = 306). Weight, height, and body mass index (BMI) were obtained from mothers and children at the 5-year follow-up. Children’s BMI z-scores were calculated. SES was determined using maternal education level and neighborhood deprivation score. Information on children’s screen time and childcare arrangements were collected using lifestyle questionnaires. Children’s eating behaviours were measured using the Children’s Eating Behaviour Questionnaire (CEBQ). Multiple linear regression, adjusted for potential confounders, assessed associations between maternal SES, screen time and children’s eating behaviours. One-way ANOVA, independent sample t-tests and Spearman’s correlation examined childcare exposure and children’s eating behaviour.ResultsMothers in the lowest SES group had higher BMI and were younger than those in the highest SES group (p = < 0.001, p = 0.03 respectively). In adjusted analysis, the lowest SES group was associated with a 0.463-point higher mean score for ‘Desire to Drink’ (95% CI = 0.054,0.870, p = 0.027) and higher ‘Slowness to Eat’ (B = 0.388, 95% CI = 0.044,0.733, p = 0.027) when compared with the highest SES group. Screen time (hours) was associated with higher ‘Food Fussiness’ (B = 0.032, 95% CI = 0.014,0.051, p = 0.001). Those who attended childcare had higher scores for ‘Desire to Drink’(p = 0.046). No relationship was observed between longer duration (years) spent in childcare and eating behaviours.ConclusionsIn this cohort, the ecological factors examined had an influence on children’s eating behaviours aged 5-years-old. Our results illustrate the complexity of the relationship between the child’s environment, eating behaviour and children’s body composition. Being aware of the ecological factors that impact the development of eating behaviours, in the pre-school years is vital to promote optimal childhood appetitive traits, thus reducing the risk of issues with excess adiposity long-term.

Gender Disparity and the Association Between Socioeconomic Status, Mental Health, and the Need for Long-Term Services and Support Among the Older Koreans.

BackgroundPopulation aging—the inevitable increase in the percentage of older adults—is occurring all around the world as the fertility rate declines and life expectancy rises. This study examined the relationship between socioeconomic status (SES), mental health, and the need for long-term services and support (LTSS) among Korean older adults. It also aimed to provide evidence-based information for South Korea's long-term support services and programs.MethodsThis study used the data on older adults aged over 60 years from the 2018 Korean Longitudinal Study of Aging (KLoSA). Ultimately, 5,527 older adults were included in the database (42.6% men, 57.4% women). To clarify the association between SES, mental health, and the need for LTSS among older Korean men and women, chi-squared test, t-test, and structural equation modeling (SEM) were performed.ResultsThe SEM analysis showed that a significant, negative association was observed between SES and the need for LTSS among these older adults—the higher SES groups would generally have less need for LTSS. Mental health had a strong, negative impact on the need for LTSS—better mental health status of the older individuals would indicate a lower need for LTSS, and the effect was stronger among older men. Meanwhile, the positive relationship between SES and mental health was verified—the higher the SES of these older adults the better their mental health.ConclusionsGender- and social class-sensitive impacts of mental health on the need for LTSS were observed in this study. These findings could provide an evidence-based reference for interventions targeting different genders and social classes in Korea's long-term care system, such as the enhancement of social welfare and mental health status of the older adults.

Associations between Adverse Childhood Experiences and Obesity in a Developing Country: A Cross-Sectional Study among Middle-Aged and Older Chinese Adults.

Background: The association between adverse childhood experiences (ACEs) and obesity in developing countries has been underexplored and inconsistent. Methods: This cross-sectional study used data of 10,054 adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study. Information on 12 ACE indicators was collected via questionnaires. General obesity was defined as a body mass index (BMI) of ≥28 kg/m². Central obesity was defined as a waist circumference of ≥90 cm for males and ≥85 cm for females. Logistic and linear regression analyses were conducted to evaluate the association of ACEs with general obesity, central obesity, BMI, and waist circumference where appropriate. Results: Compared to the non-exposed group, the experience of ≥3 ACEs was significantly associated with decreased risks of general obesity (OR = 0.83, 95% CI: 0.69, 0.999), central obesity (OR = 0.88, 95% 0.77, 0.997), and smaller BMI (β = −0.27, 95% CI: −0.50, −0.04) and waist circumference (β = −0.89, 95% CI: −1.52, −0.26). Compared to the high socioeconomic status (SES) group, such associations were more evident in those with a low SES, except for central obesity. Conclusion: ACEs were shown to be inversely associated with later-life obesity in China, especially in socioeconomically disadvantaged populations. The context-specific impacts reflect divergent roles of socioeconomic position in the obesity epidemic between developed and developing countries. Further investigations are needed to confirm whether physical activity could shift the direction of this association.

The Moderator Role of Gender and Socioeconomic Status in the Relationship Between Metacognitive Skills and Reading Scores

The aim of this study was to examine the moderator role of gender and socioeconomic status (SES) factors in the relationship between students' metacognitive skills and reading performance. The sample of the study was 6890 students in the age group of 15 years-old who participated in the Programme for International Student Assessment (PISA) in 2018 from Turkey. 3396 of the participants (49.30%) were female and 3494 (50.70%) of them were male. Of the participants, 2273 (32.99%) were classified as low, 2273 (32.99%) as medium and 2344 (34.02%) as high socioeconomic level. Moderator effects were tested with the multi-group structural equation modelling approach. Results revealed that SES and gender moderated the relationship between metacognitive skills and reading when controlling for other variables. Female students scored lower than male students in low and medium SES group, however they scored higher in the high SES group even after controlling for metacognitive skills, liking reading, and self-concept of perception of competence and difficulty. This means gender differences in reading scores were largely driven by SES. Therefore, the effect of these two factors should be taken into consideration while working on metacognition and reading. Moreover, it was advised to integrate training of metacognitive strategies in school curriculum and encourage reading engagement in order to reduce the effect of those factors.

Using aggregated mobile phone location data to compare the realised foodscapes of different socio-economic groups.

The foodscape (the built food environment) is considered one of the driving factors of the higher burden of obesity and chronic disease observed in low socio-economic status (SES) groups. Traditional data collection methods struggle to accurately capture actual access and exposure to the foodscape (realised foodscape). We assess the use of anonymised mobile phone location data (location data) in foodscape studies by applying them to a case study in Perth, Western Australia to test the hypothesis that lower SES groups have poorer realised foodscapes than high SES groups. Kernel density estimation was used to calculate realised foodscapes of different SES groups and home foodscape typologies, which were compared to home foodscapes of the different groups. The location data enabled us to measure realised foodscapes of multiple groups over an extended period and at the city scale. Low SES groups had poor availability of food outlets, including unhealthy outlets, in their home and realised foodscapes and may be more susceptible to a poor home foodscape because of low mobility.

Access to hip arthroplasty and rates of complications in different socioeconomic groups : a review of 111,000 patients in a universal healthcare system.

Total hip arthroplasty (THA) is one of the most successful surgical procedures. The objectives of this study were to define whether there is a correlation between socioeconomic status (SES) and surgical complications after elective primary unilateral THA, and investigate whether access to elective THA differs within SES groups. We conducted a retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, over a 17-year period. Patients were divided into income quintiles based on postal codes as a proxy for personal economic status. Multivariable logistic regression models were then used to primarily assess the relationship between SES and surgical complications within one year of index THA. Of 111,359 patients who underwent elective primary THA, those in the lower SES groups had statistically significantly more comorbidities and statistically significantly more postoperative complications. While there was no increase in readmission rates within 90 days, there was a statistically significant difference in the primary and secondary outcomes including all revisions due (with a subset of deep wound infection and dislocation). Results showed that those in the higher SES groups had proportionally more cases performed than those in lower groups. Compared to the highest SES quintile, the lower groups had 61% of the number of hip arthroplasties performed. Patients in lower socioeconomic groups have more comorbidities, fewer absolute number of cases performed, have their procedures performed in lower-volume centres, and ultimately have higher rates of complications. This lack of access and higher rates of complications is a "double hit" to those in lower SES groups, and indicates that we should be concentrating efforts to improve access to surgeons and hospitals where arthroplasty is routinely performed in high numbers. Even in a universal healthcare system where there are no penalties for complications such as readmission, there seems to be an inequality in the access to THA. Cite this article: Bone Joint J2022;104-B(5):589-597.

Mediating role of social capital in the association between socioeconomic status and childcare practices in rural Malawi: a cross-sectional study

ObjectivesChildcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare...

P162 Socio-economic status in patients with juvenile idiopathic arthritis in the United Kingdom

Abstract Background/Aims Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition affecting children and young people (CYP) with onset &amp;lt;16 years, and may be associated with long-term joint damage and disability if treatment is delayed. CYP with JIA from low socio-economic status (SES) have been shown to have poorer performance in school activities and self-reported functional assessments compared to those from higher SES groups, however SES association with incidence of JIA has rarely been explored. Therefore, this study aimed to investigate the association between socio-economic status and incident JIA in England. Methods CYP &amp;lt;16 years with a first JIA diagnostic code were identified in the Clinical Practice Research Datalink (CPRD) between the years 2000 and 2018, using a pre-defined codelist and were validated through linkage to Hospital Episode Statistics. Age- and gender-matched controls were identified at a ratio of 4:1. SES was defined using quintiles of indices of multiple deprivation (IMD). Descriptive analyses compared baseline characteristics (age, gender, age of first JIA code, IMD, region) in cases and controls. Logistic regression investigated the association between IMD quintiles in JIA cases compared to controls, adjusting for baseline characteristics, and linear regression analysed the association between age at first JIA code and IMD quintile. Results There were 1649 cases and 4748 controls included in this study. Most cases (1048, 64%) were female with median (interquartile range (IQR)) age at first JIA code 8.49 (4.20-12.05) years. Amongst cases, males were older at first JIA code, median (IQR) 9.80 (6.09-12.68) years, compared to females 7.55 (3.45-11.70) years. In both cases and controls, the proportion of CYP was highest in the most deprived quintile (IMD 1), 375/1649 (22.7%) and 1108/4738 (23.4%) respectively, and proportions remained similar in the remaining quintiles. There was no association identified between IMD quintile and occurrence of JIA, the multivariable odds ratio (95% CI) comparing most and least deprived groups was 0.98 (0.83-1.17). However, amongst cases there was an association between older age at diagnosis and higher SES [ß(95%CI) 0.15 years (0.01-0.29)] such that CYP in the IMD 5 quintile (highest SES) were on average 8 months older at their first JIA code compared to CYP in IMD 1. Conclusion This study found CYP from higher socio-economic groups appeared to be diagnosed at an older age than those from the least deprived backgrounds. Factors such as later presentation to healthcare after disease onset, delays in referrals to specialist care, delays in diagnosis by specialist care or differences in population demographics across IMD quantiles may all contribute to the older age of diagnosis in high SES group. Further research is required to explore these factors. Disclosure Y. Tan: None. R. Costello: None. K. Hyrich: None. J. Humphreys: None.

Health and health behaviors in China: Anomalies in the SES-health gradient?

ObjectivesFundamental Cause Theory (FCT) predicts that higher socioeconomic status (SES) leads to better health outcomes, through mechanisms including health-promoting behaviors. Most studies supporting FCT use data from Western countries. However, limited empirical studies from China, as well as theoretical considerations suggested by China's unique history and culture, raise questions about the generalizability of FCT to the Chinese context. This study explores whether the associations between SES, health behaviors, and health status in Western countries are also observed in China, and to what extent behavioral risk factors explain socioeconomic disparities in Chinese health. Data and methodUsing data on adults age 45+ from the nationally-representative 2015 China Health and Retirement Longitudinal Study (CHARLS; n = 14,420), we conduct regressions of multiple health outcomes (self-rated health, disease count, and several common chronic conditions) on demographic characteristics, SES (measured via education and wealth), and behavioral risk factors (smoking, high-frequency drinking, and overweight). To assess whether behavioral risk factors mediate the SES-health association, we use the Karlson, Holm and Breen (KHB) mediation analysis method. ResultsSupporting FCT, both education and wealth predict higher self-rated health and lower risk of arthritis. However, inconsistent with FCT, neither education nor wealth predict disease count, diabetes, or hypertension; education shows some positive association with cardiovascular disease; and higher SES is strongly associated with higher risk of dyslipidemia. Prevalence of smoking and high-frequency drinking are flat by wealth and inversely U-shaped by education, while overweight is somewhat concentrated in the highest SES groups. Results of mediation analyses show both suppression and mediation effects. ConclusionHigh prevalence of behavioral risk factors across SES groups appears to damage health in much of the Chinese population, and thus attenuates social gradients in health. A broader range of cultural, historical, and political factors should be incorporated into FCT's theoretical framework, particularly in non-Western contexts.

STUDY OF SOCIO-ECONOMIC STATUS AND CERTAIN PERSONAL FACTORS OF B.TECH. STUDENTS

India is a secular and democratic country, which provides freedom to each and every individual to choose their own life style, type of education and vocation. Thus, our society is divided into different socio-economic groups. As per the government statistics nearly 15% of total population of our country belongs to the higher socio- economic status. It may not be considered as good sign but on the other hand about one third of total population is still deprived of even basic needs like food, clothing and shelter. In such conditions, it is extremely difficult for them to send their children for education in schools. However, the major chunk of Indian population belongs to middle class.The people of this group always try to imitate the life style of higher socio economic status group. Thus, in the hope of matching their standards with this group, they work hard and in many cases they succeed in doing so by achieving success in their respective areas.While on the other hand this competitive attitude leads them in the troubles and frustration in majority of cases. People belonging to this group don't have enough money to bear the expenditure incurred on quality school education, which is considered as the key of success for higher and professional education.This is the basic factor which creates a dilemma.Because of financial constraints,majority people of our country despite having high aspirations and the desire to receive and excel in professional and higher education are unable to fulfill their wishes.Professional courses like B.Tech., MBBS and B.D.S. are the most popular and most attractive among the Indian masses. The people who are in these professions enjoy the great respect and social approval in the society. Doctors are considered as the God on the earth. One of the most important factors, which provide these professions social approval, is that they yield high monitory returns, glamorous life style and opportunity to go abroad. Studies conducted in the related areas show that SES plays a pivotal role in the achievement of the students in the field of education. Mehrotra, S.A. (1986) found out that in both boys and girls there was a positive relationship between SES of the family of the students and academic achievement. Jain, S.P. and Shah, l. M. (1974) revealed that family background also aspires for the professional education; Mangat, D. (1988) studied the relationship between socio-economic status and academic achievement and SES and found that SES exhibited a significant relationship with academic achievement. Jayaram, N. (1976) found out that the admission to higher professional education is based on socio-economic background and ability to afford the financial constrains of social courses. Further it has also been found that those students selected in higher education were overwhelmingly a meritorious lot, and continued it in merit and latter academic performance as well. Thus, it is clear that the students belonging to higher socio-economic status tend to qualify more for B.Tech.,MBBS,and B.D.S.other professional courses.

The association between environmental greenness and the risk of food allergy: A population-based study in Melbourne, Australia.

While exposure to environmental greenness in childhood has shown mixed associations with the development of allergic disease, the relationship with food allergy has not been explored. We investigated the association between exposure to environmental greenness and challenge-confirmed food allergy in a large population-based cohort. The HealthNuts study recruited 5276 12-month-old infants in Melbourne, Australia, who underwent skin prick testing to peanut, egg, and sesame; infants with a detectable wheal underwent food challenges to determine food allergy status. Environmental greenness was estimated using the normalized difference vegetation index (NDVI) for five buffer zones around the infant's home address: at the home, 100m, 500m, 800m, and 1600m radial distances. Environmental greenness was categorized into 3 tertiles and mixed effects logistic regression models quantified the association between greenness and the risk of food allergy, adjusting for confounding and accounting for clustering at the neighborhood level. NDVI data were available for n=5097. For most buffer zones, medium and high greenness, compared to low greenness, was associated with an increased risk of peanut allergy (eg, 100m tertile 2 aOR 1.89 95% CI 1.22-2.95, tertile 3 aOR 1.78 95% CI 1.13-2.82). For egg allergy, the effect sizes were smaller (100 m tertile 2 aOR 1.52 95% CI 1.16-1.97, tertile 3 aOR 1.38 95% CI 1.05-1.82). Socioeconomic status (SES) modified the association between greenness and peanut allergy, but not egg allergy; associations were apparent in the low SES group but not in the high SES group (p for interaction 0.08 at 100m). Air pollution (PM2.5) also modified the associations between environmental greenness and food allergy, with associations present in high air pollution areas but not low (p for interaction at 100m 0.05 for peanut and 0.06 for egg allergy.) CONCLUSION: Increased exposure to environmental greenness in the first year of life was associated with an increased risk of food allergy. Increased greenness may correlate with higher pollen levels which may trigger innate immune responses skewing the immune system to the Th2-dependent allergic phenotype; additionally, some pollen and food allergens are cross-reactive. Given the mixed data on greenness and other allergies, the relationship appears complex and may also be influenced by confounding variables outside those that were measured in this study.

Social disparities in the first wave of COVID-19 incidence rates in Germany: a county-scale explainable machine learning approach

ObjectivesKnowledge about the socioeconomic spread of the first wave of COVID-19 infections in Germany is scattered across different studies. We explored whether COVID-19 incidence rates differed between counties according to...

The Family Is My Priority: How Motherhood Frames Participation in Physical Activity in a Group of Mothers Living in a Low Socioeconomic Status Area.

Socioeconomic status (SES) is known to influence strongly both life expectancy and healthy life expectancy. Whilst there are multiple factors with complex interactions that provide the explanation for this observation, differences in the uptake of physical activity between high and low SES groups play a role. This in-depth qualitative study set out to understand the response of a group of mothers with young children living in a low SES area of a London (UK) borough to the current physical activity guidance and to investigate whether existing and established interventions based on behavior change are appropriate for this group. A series of three in depth interviews was carried out with the mothers (n = 20) over a period of 16 months, and the data collected were analyzed thematically. Four main themes were identified: (1) mothering comes before exercise; (2) mothers are a special case; (3) alone or together; and (4) facilities fail mothers. The mothers were unsure about the benefits of exercise, whether it was relevant for them and how to accommodate exercise alongside their mothering responsibilities. Family and peer group could be both a barrier and a facilitator to participation in physical activity. Without an in depth understanding of the role of physical activity in the lives of mothers of young children, behavior change-based public interventions are likely to fail to meet the needs of this group. A reduction in the current health inequities will only be possible when the needs of the mothers are acknowledged and used as the basis of appropriate public health guidance.

Literature Review Reveals a Global Access Inequity to Urban Green Spaces

Differences in the accessibility to urban resources between different racial and socioeconomic groups have exerted pressure on effective planning and management for sustainable city development. However, few studies have examined the multiple factors that may influence the mitigation of urban green spaces (UGS) inequity. This study reports the results of a systematic mapping of access inequity research through correspondence analysis (CA) to reveal critical trends, knowledge gaps, and clusters based on a sample of 49 empirical studies screened from 563 selected papers. Our findings suggest that although the scale of cities with UGS access inequity varies between countries, large cities (more than 1,000,000 population), especially in low- and middle-income countries (LMICs), are particularly affected. Moreover, the number of cities in which high socioeconomic status (high-SES) groups (e.g., young, rich, or employed) are at an advantage concerning access to UGS is substantially higher than the number of cities showing better accessibility for low-SES groups. Across the reviewed papers, analyses on mitigating interventions are sparse, and among the few studies that touch upon this, we found different central issues in local mitigating strategies between high-income countries (HICs) and LMICs. An explanatory framework is offered, explaining the interaction between UGS access inequity and local mitigating measures.

Diversity of protein food sources, protein adequacy and amino acid profiles in Indonesia diets: Socio-Cultural Research in Protein Transition (SCRiPT).

The ongoing nutrition transition in lower- and middle-income countries (LMIC) in South East Asia may have a positive impact on protein nutrition. This study assessed the diversity of plant and animal protein food sources in relation to essential amino acid (EAA) adequacy in a population-based sample (N 1665) in Indonesia. Dietary intakes from in-person 24 h recalls provided data on energy and protein intakes (in g/d) from plants (grains, legumes), meat, poultry and fish, and eggs and dairy. Protein diversity scores were based on the number of protein food sources over 24 h. EAA scores were the ratio of amino acid intakes to recommended values. Protein diversity and EAA scores were then compared across multiple socio-demographic indices. Analysis of variance and χ 2 tests were used to test for differences among groups. Energy intakes were 1678 kcal/d for men and 1435 kcal/d for women. Average protein intakes (and prevalence of inadequacy) were 59⋅4 g/d (41⋅7%) for men and 51⋅5 g/d (51⋅1%) for women. In regression analyses, higher protein diversity scores were associated with higher protein intakes, more animal protein and less plant protein and with higher EAA scores. Lower protein diversity scores were associated with lower intakes of lysine, leucine and valine relative to requirements, as well as with lower EAA, rural settings, less wealth and less modernisation. Greater diversity of animal protein food sources, observed among groups of higher socio-economic status, was linked to better amino acid adequacy and protein nutrition.

Abstract PO-210: Healthcare disparities in melanoma overall survival evaluated by race/ethnicity and socioeconomic status and the impact of integrated healthcare on an insured population

Abstract Background: The objective of this study was to quantify the influence of race/ethnicity and socioeconomic status (SES) on overall mortality within an insured population of patients diagnosed with melanoma in Southern California. Specifically, we compared outcomes between insured patients within the largest vertically integrated health care system in Southern California, Kaiser Permanente Southern California (KPSC), with insured patients diagnosed elsewhere. Methods: We identified adults (≥20 years old) diagnosed with Stage 0-IV melanoma from 1 January 2009 through 31 December 2014, followed through the end of 2017, from the California Cancer Registry. We compared overall mortality in those diagnosed within KPSC versus those with other private insurance (OPI). Main variables included race/ethnicity and SES based on 2010 Census data. Person-year (PY) mortality rates and 95% confidence intervals (CI) were calculated by race/ethnicity and SES. Multivariable-adjusted hazard ratios (HR) for the association between all-cause mortality and race/ethnicity and SES were estimated using Cox proportional hazards models. Results: A total of 14,614 adults were diagnosed with melanoma in our cohort (KPSC: n=4,701; OPI: n=9,913). The total of number of all-cause deaths was 2,456 (KPSC: n=729; OPI: n=1,727). Mortality rates by race/ethnicity within KPSC and OPI did not reveal significant disparities. The poorest patients in KPSC (lowest, lower-middle, and middle SES groups) had statistically significant decreased mortality rates compared to those in OPI. For example, in the lowest SES, those in OPI had 38.7 additional deaths per 1000 PY compared to KPSC (KPSC Rate per 1000 PY: 57.7, 95% CI: 44.9-73.1; OPI Rate per 1000 PY: 96.4, 95% CI 80.9-113.9). Multivariable models demonstrated statistically significant increased mortality risk among the lowest (HR 1.70, 95% CI 1.43-2.02), lower-middle (HR 1.47, 9% CI 1.29-1.68), middle (HR 1.36, 95% CI 1.21-1.53), and upper-middle (HR 1.19, 95% CI 1.07-1.33) SES groups when compared to the highest SES group. This increased mortality risk among lower SES groups persisted when stratifying by KPSC and OPI. Although KPSC patients had a lower mortality risk across all SES groups compared to OPI, the difference was not statistically significant. For example, among the lowest SES, those in the OPI group had an overall mortality risk 80% greater than those of the highest SES (HR 1.80; 95% CI 1.47-2.22), while those in KPSC held risk only 47% greater (HR 1.47, 95% CI 1.09-2.00). Conclusions: While the existence of disparities in cancer survival are well established, our present study examined survival with respect to SES among two distinct populations of melanoma patients: insured patients within an integrated healthcare system and insured patients within a traditional model of healthcare. While racial/ethnic disparities are not observed in integrated healthcare systems such as KPSC, our findings underscore the persistence of socioeconomic disparities within an insured population, despite having access to care. Citation Format: Amanda H. Rosenthal, Shivani Reddy, Christina N. Kim, Robert M. Cooper, Reina Haque. Healthcare disparities in melanoma overall survival evaluated by race/ethnicity and socioeconomic status and the impact of integrated healthcare on an insured population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-210.

Abstract PO-222: Reduced socioeconomic status disparity in colon cancer mortality in an insured population treated in an integrated healthcare system

Abstract Objectives: Lower socioeconomic status (SES), among other factors, presents a barrier to healthcare delivery and is associated with worse health outcomes. Integrated healthcare systems (IHS) in which barriers to care are minimized would be ideal settings to identify factors associated with mortality disparities. The aim of this study was to compare outcomes of colon cancer cases diagnosed at one of the largest IHS in California, Kaiser Permanente Southern California (KPSC), to other private insurance (OPI) to determine how SES influence differences in mortality. Methods: This retrospective cohort study included all insured adults in Southern California diagnosed with colon cancer between 2009 and 2014 using data from the California Cancer Registry (CCR). The main outcome was all-cause (overall) mortality, and subjects were followed through December 31, 2017. Person-year mortality rates were calculated for the two groups, KPSC and OPI. Multivariate adjusted hazard ratios were calculated for the association between SES and overall mortality within each group. Results: A total of 16,646 patients were diagnosed with colon cancer in Southern California, 4552 patients (27.3 %) within KPSC and 12,094 patients (72.3%) in OPI. 5937 deaths occurred during the follow-up period; 1428 (24.1%) deaths within KPSC, 4509 (75.9%) deaths in non-KPSC. Mortality rates per 1000 year follow-up with 95% confidence interval revealed a lower overall rate of 103.8 (98.5 – 109.3) in KPSC compared to 139.3 (135.2 – 143.4.) in OPI. Compared to the highest SES group, lower SES was not significantly associated with mortality in the KPSC population, even after adjusting for race/ethnicity and other factors (lowest SES HR 1.13 95% CI 0.93-1.38). However, in OPI patients, lower SES was significantly associated with higher HR with the greatest disparity in the lower-middle (HR 1.27 95% CI 1.15-1.40) and lowest (HR 1.26 95% CI 1.13-1.40) SES groups. Conclusions: Comparing mortality rates in an integrated health system such as KPSC to OPI hospitals revealed that lower SES was associated with worse outcomes within the OPI group. However, within KPSC no association was found between SES and overall mortality in patients with colon cancers. Systems that optimize care coordination for all patients may reduce disparities for the most at risk patients. Citation Format: Vikram Attaluri, Robert M. Cooper, Reina Haque, Jay Patel, Joan J. Ryoo, David P. Wu, Joanie WL Chung. Reduced socioeconomic status disparity in colon cancer mortality in an insured population treated in an integrated healthcare system [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-222.

Promoting Resilient and Healthy Cities for Everyone in an Urban Planning Context by Assessing Green Area Accessibility

Rapid economic development and population growth has led to urban densification and massive land use changes, putting pressure on both ecosystems, and people. In this context, public health issues have become crucial for cities to address to ensure they remain livable and healthy for everyone. Since the health challenges of cities tend to manifest themselves differently among different population groups—e.g., groups of higher socioeconomic status tend to be correlated with better health than groups of low socioeconomic status—closing the health gap has become a priority for creating healthy cities for everyone. More greenness close to where people live and better accessibility to green areas has been shown to be useful for improving human health and for tackling health inequalities. This paper aims at developing a method for supporting urban planners and policymakers on where to geographically prioritize investments in green infrastructure to contribute to closing the health gap and promote community resilience through improving public health. Using the City of Stockholm as a pilot, we apply a GIS analysis to identify vulnerable population groups in relation to geotagged empirical human health- and socio-economic data. By then assessing vulnerable populations in relation to population numbers and accessibility to urban green areas, an Urban Green Opportunity Map (UGOM) was created, identifying focus areas where investment in green infrastructure will contribute most to closing the health gap and building community resilience.