High nSES Research Articles

The influence of the Affordable Care Act-Dependent Care Expansion on insurance coverage among young cancer survivors in California: an updated analysis.

To assess changes in health insurance coverage for young cancer patients pre- and post- the Affordable Care Act-Dependent Care Expansion (ACA-DCE) implementation in California. Further, we examined differences in insurance coverage by socioeconomic and race/ethnicity. Data were obtained from the California Cancer Registry and Medicaid enrollment files, from 2005 to 2014. We conducted difference-in-difference analyses among 7042 cancer patients aged 22-25 years ("intervention group") and 25,269 aged 26-34 years ("control group"). We also examined the independent and combined effects of race/ethnicity and neighborhood socioeconomic status (nSES) on insurance coverage. After the ACA-DCE implementation, we observed a 52.7% reduction in the proportion of uninsured and a 35.7% increase in the proportion of privately insured patients. There was also a 17.3% reduction in Medicaid at cancer diagnosis and a 27.5% reduction in discontinuous Medicaid enrollment. However, these benefits were limited to patients of non-Hispanic White, Hispanic and Asian/Pacific Islander race/ethnicity living in higher nSES, with no differences in insurance enrollment among young adults who lived in low nSES or those of Black race/ethnicity. The ACA-DCE broadened insurance coverage for young adults with cancer in California. Yet, only certain subgroups of patients have benefited from this policy.

Abstract C063: Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women

Abstract Background: Compared to White women, African American/Black women are more likely to develop triple-negative breast cancer (TNBC), an aggressive breast cancer subtype. While many studies have examined individual-level socioeconomic status (SES) as a major social determinant of more aggressive breast tumor phenotypes, the impact of neighborhood-level SES (nSES) on breast cancer is not well understood, particularly among Blacks. Objective: To evaluate the impact of nSES on breast cancer subtypes among Black women with breast cancer. Methods: We evaluated the association of interest among 1,220 Black women with invasive breast cancer from 2006 to 2018 enrolled from 10 counties of New Jersey in the Women’s Circle of Health Study (WCHS). Residential address at diagnosis was geocoded to the census tract-level. Neighborhood SES was measured using the NCI’s census tract-level SES index, a time-dependent score constructed by a factor analysis of seven variables measuring different aspects of census tract SES (education index, percent unemployed, percent working class, median household income, percent below 150% of poverty line, median house value, and median rent). In a case-only analysis, we used multilevel multinomial logistic regressions to estimate nSES in relation to breast cancer subtype (TNBC, HER2-enriched, Luminal B vs. Luminal A). Models were adjusted for individual-level SES variables, body mass index and reproductive factors, and census tract-level percentage of Black residents. We tested whether the associations were modified by percentage of Black residents and participant’s education. Results: Higher nSES was found to predict a lower risk of TNBC. Compared to tertile 1 (lowest nSES score), the odds ratio (OR) was 0.91 (95% CI: 0.65, 1.29) for tertile 2 and 0.52 (95% CI: 0.34, 0.79) for tertile 3 (highest nSES score; p-trend: 0.001). Higher nSES was borderline significantly associated with a lower risk of Luminal B (OR: 0.61 comparing highest vs. lowest nSES tertile; 95% CI: 0.36, 1.03; p-trend: 0.055). The inverse association between nSES and TNBC was observed only among Black women living in census tracts with lower proportion of Black residents (p-for-interaction=0.08). Compared to the lowest nSES tertile, OR was 0.38 (95% CI: 0.21, 0.68) for the highest tertile (p-trend: <0.001). There was a suggestion that the inverse relationship of nSES with TNBC was also more pronounced among women who had relatively lower levels of education. Conclusion: Neighborhood socioeconomic environment may influence the development of TNBC among Black women, which might be buffered by some contextual factors in areas with more Black residents. Further investigation to elucidate these factors is needed. Citation Format: Bo Qin, Adana A.M. Llanos, Riddhi Babel, Jesse J. Plascak, Karen Pawlish, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C063.

Abstract B039: The impact of social and built environments on quality of life among cancer survivors

Abstract Background: With over 16 million cancer survivors in the U.S., understanding factors that improve health-related quality of life (HRQOL) after cancer diagnosis is critical. Previous studies have identified demographic, clinical and behavioral factors that shape HRQOL among cancer patients and have observed poorer HRQOL among racial/ethnic minorities, individuals of low socioeconomic status (SES), or those with comorbidities. Few studies have considered the influence of neighborhood factors (census block group SES (nSES), census tract poverty, county segregation) on HRQOL. Thus, we proposed to assess racial/ethnic disparities in HRQOL and evaluate the extent to which these disparities are explained by neighborhood factors. Methods: We pooled data on 2,500 diverse (i.e., multiethnic, varied SES, multiple cancer sites) cancer survivors from three population-based cancer survivorship studies in California and linked them to the California Neighborhoods Data System. Separately for the two continuous HRQOL outcomes (physical and mental composite scores, PCS and MCS, from SF36), using a 3-level model with participants nested within block groups, which are nested within study/region, we calculated least squares means and parameter estimates for each racial/ethnic group, with and without adjustment for covariates. Predisposing factors included age, gender, education, employment, income, health insurance status, marital status and significant clinical and tumor characteristics. Health behaviors included physical activity and body mass index. Results: Among 2,477 cancer survivors, we observed racial/ethnic disparities in HRQOL, with African Americans reporting the lowest (worst) PCS (42.7), Latinos reporting the lowest MCS (48.4) and Asians/Pacific Islanders reporting the highest scores (PCS: 45.4; MCS: 51.1) in unadjusted models. In models adjusted for age and cancer recurrence (and stage for PCS), both PCS and MCS increased with higher nSES. Assessed separately, the following neighborhood factors were associated with decreased MCS after adjusting for nSES: higher population density, street connectivity (gamma), % renting, % non-single-family units, more parks, and restaurant index (more unhealthy). No other neighborhood factor was associated with PCS after adjusting for nSES. Compared to non-Hispanic (NH) Whites, African American disparities in PCS were fully attenuated after adjusting for nSES. Similarly adjusting for neighborhood factors fully attenuated Hispanic disparities in MCS. For PCS, adjusting for predisposing, nSES, and/or behavioral factors resulted in Hispanics having better HRQOL compared to NH Whites. Conclusions: Among a diverse cohort of cancer survivors, neighborhood attributes were associated with HRQOL. Racial/ethnic disparities in HRQOL were attenuated with inclusion of neighborhood factors in the models. Elucidating the pathways through which these neighborhood attributes impact HRQOL will be important to improving survivorship outcomes. Citation Format: Salma Shariff-Marco, Alison J. Canchola, Theresa H.M. Keegan, Alyssa Nickell, Ingrid Oakley-Girvan, Ann S. Hamilton, Scarlett L. Gomez. The impact of social and built environments on quality of life among cancer survivors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B039.

Abstract C064: Neighborhood socioeconomic status, ethnic enclave, and hepatocellular carcinoma incidence in Hispanics and Asians/Pacific Islanders living in California: An update

Abstract Background: Disparities in hepatocellular carcinoma (HCC) incidence exist by sex and race/ethnicity, with rates higher in men than women and higher in Asians/Pacific Islanders (API) and Hispanics than non-Hispanic Whites. We sought to update previous studies that identified disparities in HCC incidence by neighborhood contextual factors such as SES and ethnic enclave among API and Hispanic populations in California by analyzing data from the California Cancer Registry (CCR) through 2012. Methods: All primary, invasive HCC cases diagnosed from 1988 through 2012 from the CCR were identified and their addresses geocoded. Neighborhood Hispanic or API ethnic enclaves are areas marked by greater immigrant composition and linguistic isolation, applicable to Hispanic and API residents, respectively. Neighborhood SES (nSES) is an index measure comprising data on education, occupation, and housing. Age-adjusted incidence rates (IRs; per 100,000 population; standardized to the 2000 U.S. standard million population), incidence rate ratios (IRRs) (with corresponding 95% confidence intervals (CI)) were calculated for each strata of nSES and ethnic enclave by sex and race/ethnicity. Results: The final analysis included 9,636 males (4,883 Hispanics, 4,753 APIs) and 3,524 females (1,744 Hispanics, 1,780 APIs). During 1988-2012, among Hispanics, there were no clear associations between HCC incidence and nSES or ethnic enclave when considered separately. However, compared to those in high nSES/low enclave neighborhoods, Hispanic males living in low nSES/low enclave neighborhoods and Hispanic females living in low SES/high enclave neighborhoods had higher incidence of HCC (males: IRR = 1.22, CI = 1.10 - 1.36; females: IRR = 1.20, CI = 1.04 - 1.38). Among APIs, there was no association between HCC incidence and ethnic enclave but there was a strong association of increased risk for those living in the lowest vs. highest nSES neighborhoods (males: IRR = 1.69, CI = 1.53 - 1.87; females: IRR = 1.32, CI = 1.12 - 1.56). API males living in low nSES/high enclave neighborhoods had higher incidence of HCC than those living in high nSES/low enclave neighborhoods (IRR = 1.36, CI = 1.22 - 1.52). Conclusions: We found significant variation in HCC incidence by two important neighborhood factors, nSES and ethnic enclave, among Hispanics and APIs living in California, with similar findings to previous studies. Future studies with longitudinal data are needed to explore which attributes of nSES and enclaves are impacting HCC risk and for which subpopulations (such as recent immigrants). Citation Format: Meera Sangaramoorthy, Alice Guan, Juan Yang, Jennfier Jain, Mindy C. DeRouen, Scarlett Lin Gomez, Salma Shariff-Marco. Neighborhood socioeconomic status, ethnic enclave, and hepatocellular carcinoma incidence in Hispanics and Asians/Pacific Islanders living in California: An update [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C064.

Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices

Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used in advanced heart failure patients. Recent studies suggest that low socioeconomic status (SES) predicts worst survival after heart transplantation. Both individual-level and neighborhood-level SES (nSES) have been linked to cardiovascular health; however, the impact of SES in CF-LVAD patients remains unknown. We hypothesized that SES is a major determinant of CF-LVAD candidacy and postimplantation outcomes. A retrospective chart review was conducted on 362 patients between February 2009 and May 2016. Neighborhood-level SES was measured using the American Community Survey data and the Agency for Healthcare Research and Quality SES index score. Individual-level SES was self reported. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression determined survival statistics. Patients in the highest SES tertile were older (58 ± 13 vs. 53 ± 14; p < 0.001), less likely to be black or Hispanic (26% vs. 70%; p < 0.001), more likely to be married (87% vs. 65%; p < 0.001), more likely to have private insurance (50% vs. 39%; p < 0.001), and more likely to have employment (29% vs. 15%; p < 0.001) compared with patients in the lowest tertile. Low nSES was associated with a decreased risk of death (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.347-0.970; p = 0.038) in comparison to the high nSES. However, after adjusting for baseline clinical morbidities, the relationship was no longer present. When selecting patients for a LVAD, SES should not be thought of as an immutable risk factor. Carefully selected low-SES patients could be safely implanted with CF-LVAD with outcomes comparable to high-SES patients.

Nativity, ethnic enclave residence, and breast cancer survival among Latinas: Variations between California and Texas.

Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent. The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract. Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes. Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions.

Abstract TP210: Examining the Role of Context: Neighborhood Socioeconomic Status Shaping Post-Stroke Outcomes

Introduction: Neighborhoods may influence post-stroke recovery. We examined the association between neighborhood socioeconomic status (nSES) and 90-day post-stroke function, depression, cognition, and quality of life (QoL). Methods: Stroke survivors (N=782) were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. An nSES index – composite of 2010 census-tract level income, wealth, education, employment – was the exposure; higher values indicate higher nSES (median -4.56; IQR: -7.48 to -0.46). Function was measured with 22 self-reported activities of daily living/instrumental activities of daily living, depression with Patient Health Questionnaire-8, QoL with the Stroke Specific QoL Scale, and cognition with the Modified Mini Mental State Examination. Confounder-adjusted generalized estimating equations were used to estimate associations between nSES (comparing 75 th to 25 th percentile) and 90-day outcomes. We tested for effect modification by initial stroke severity (NIH Stroke Scale (NIHSS) ≤ 5 or &gt;5) by including interaction terms in adjusted models. Results: Higher nSES was associated with significantly better function, better QoL, and less depression after adjusting for person-level confounders in those with NIHSS &gt;5. Higher nSES was associated with better cognition, but this result was not significant. In those with NIHSS ≤5, higher nSES had a statistically significant (though attenuated) association with function and cognition. Conclusions: Future research should identify features of higher nSES neighborhoods that contribute to more favorable stroke outcomes. Our findings highlight the need for examining the individual and joint influence of neighborhood context and stroke severity on post-stroke recovery.

NEIGHBORHOOD SOCIOECONOMIC STATUS AND GRAY MATTER VOLUME IN OLDER ADULTS

Lower neighborhood socioeconomic status (nSES) is associated with poorer cognitive function; underlying neural correlates are unknown. Cross-sectional associations of nSES (six census-derived measures of income, education, and occupation) and gray matter volume (GMV) of eight memory-related regions (hippocampus, middle frontal gyrus, amygdala, insula, parahippocampal gyrus, anterior, middle, and posterior cingulum) were examined in 264 community-dwelling older adults (mean age=83, 56.82% female, 39.02% black). In linear mixed effects models adjusted for total brain atrophy and accounting for geographic clustering, higher nSES was associated with greater GMV of the left hippocampus, left posterior cingulum, and bilateral insula, middle frontal, and parahippocampal gyri. nSES remained associated with GMV of the right insula (β= -32.26, p=0.026, 95%CI: -60.66, -3.86) after adjusting for individual level age, gender, race, income, and education. The nSES and cognitive function association may not be due to gray matter volume differences; other behavioral and biological mediators should be explored.

Neighborhood Socioeconomic Status and Adverse Outcomes in Patients With Cardiovascular Disease

Neighborhood socioeconomic status (nSES) is associated with cardiovascular morbidity and mortality in the general population; however, its effect on high-risk patients with prevalent coronary artery disease (CAD) is unclear. We hypothesized "double jeopardy," whereby the association between nSES and adverse outcomes would be greater in high-risk patients with heart failure (HF) and/or previous myocardial infarction (MI) compared with those without. We followed 3,635 patients (mean age 63.2 years, 42% with HF, 25% with previous MI) with known or suspected CAD over a median of 3.3 years for all-cause death and cardiovascular death or nonfatal MI. Patients were categorized by a composite nSES score, and proportional hazards models were used to determine the association between nSES and outcomes. Cross-product interaction terms for previous MI × nSES and HF × nSES were analyzed. Compared with high nSES patients, low nSES patients had increased risk of all-cause death (hazard ratio [HR] = 1.61; 95% confidence interval [CI] = 1.20, 2.15) and cardiovascular death or MI (subdistribution HR [sHR] = 1.82; 95% CI = 1.30, 2.54). Associations were more pronounced among patients without HF or previous MI. Low nSES patients without HF had a higher risk of all-cause death (HR = 2.27; 95% CI = 1.41, 3.65) compared with those with HF (HR = 1.21; 95% CI = 0.82, 1.77, P interaction = 0.04). Similarly, low nSES patients without previous MI had a higher risk of cardiovascular death or MI (sHR = 2.72; 95% CI = 1.73, 4.28) compared with those with previous MI (sHR = 1.02; 95% CI = 0.58, 1.81, P interaction = 0.02). In conclusion, low nSES was independently associated with all-cause death and cardiovascular death or MI in patients with CAD; however, associations were greater in patients without HF or previous MI compared with those with HF or MI.

Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain): the HeartHealthyHoods study

ObjectiveTo study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain.SettingElectronic health records of the primary-care system in four...

Incidence of lung cancer histologic cell-types according to neighborhood factors: A population based study in California.

BackgroundThe relationships between neighborhood factors (i.e., neighborhood socioeconomic status (nSES) and ethnic enclave) and histologic subtypes of lung cancer for racial/ethnic groups, particularly Hispanics and Asian American/Pacific Islanders (AAPIs), are poorly understood.MethodsWe conducted a population-based study of 75,631 Californians diagnosed with lung cancer from 2008 through2012. We report incidence rate ratios (IRRs) for lung cancer histologic cell-types by nSES among racial/ethnic groups (non-Hispanic (NH) Whites, NH Blacks, Hispanics and AAPIs) and according to Hispanic or Asian neighborhood ethnic enclave status among Hispanics and AAPIs, respectively. In addition, we examined incidence jointly by nSES and ethnic enclave.ResultsPatterns of lung cancer incidence by nSES and ethnic enclave differed across race/ethnicity, sex, and histologic cell-type. For adenocarcinoma, Hispanic males and females, residing in both low nSES and high nSES neighborhoods that were low enclave, had higher incidence rates compared to those residing in low nSES, high enclave neighborhoods; males (IRR, 1.17 [95% CI, 1.04–1.32] and IRR, 1.15 [95% CI, 1.02–1.29], respectively) and females (IRR, 1.29 [95% CI, 1.15–1.44] and IRR, 1.51 [95% CI, 1.36–1.67], respectively). However, AAPI males residing in both low and high SES neighborhoods that were also low enclave had lower adenocarcinoma incidence.ConclusionsNeighborhood factors differentially influence the incidence of lung cancer histologic cell-types with heterogeneity in these associations by race/ethnicity and sex. For Hispanic males and females and AAPI males, neighborhood ethnic enclave status is strongly associated with lung adenocarcinoma incidence.

Association of Neighborhood Socioeconomic Status With Risk of Infection and Sepsis.

Prior studies suggest disparities in sepsis risk and outcomes based on place of residence. We sought to examine the association between neighborhood socioeconomic status (nSES) and hospitalization for infection and sepsis. We conducted a prospective cohort study using data from 30239 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. nSES was defined using a score derived from census data and classified into quartiles. Infection and sepsis hospitalizations were identified over the period 2003-2012. We fit Cox proportional hazards models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs) and examining mediation by participant characteristics. Over a median follow-up of 6.5 years, there were 3054 hospitalizations for serious infection. Infection incidence was lower for participants in the highest nSES quartile compared with the lowest quartile (11.7 vs 15.6 per 1000 person-years). After adjustment for demographics, comorbidities, and functional status, infection hazards were also lower for the highest quartile (HR, 0.84 [95% CI, .73-.97]), with a linear trend (P = .011). However, there was no association between nSES and sepsis at presentation among those hospitalized with infection. Physical weakness, income, and diabetes had modest mediating effects on the association of nSES with infection. Our study shows that differential infection risk may explain nSES disparities in sepsis incidence, as higher nSES is associated with lower infection hospitalization rates, but there is no association with sepsis among those hospitalized. Mediation analysis showed that nSES may influence infection hospitalization risk at least partially through physical weakness, individual income, and comorbid diabetes.

Temporal variation and scaling of parameters for a monthly hydrologic model

The temporal variation of model parameters is affected by the catchment conditions and has a significant impact on hydrological simulation. This study aims to evaluate the seasonality and downscaling of model parameter across time scales based on monthly and mean annual water balance models with a common model framework. Two parameters of the monthly model, i.e., k and m, are assumed to be time-variant at different months. Based on the hydrological data set from 121 MOPEX catchments in the United States, we firstly analyzed the correlation between parameters (k and m) and catchment properties (NDVI and frequency of rainfall events, α). The results show that parameter k is positively correlated with NDVI or α, while the correlation is opposite for parameter m, indicating that precipitation and vegetation affect monthly water balance by controlling temporal variation of parameters k and m. The multiple linear regression is then used to fit the relationship between ε and the means and coefficient of variations of parameters k and m. Based on the empirical equation and the correlations between the time-variant parameters and NDVI, the mean annual parameter ε is downscaled to monthly k and m. The results show that it has lower NSEs than these from model with time-variant k and m being calibrated through SCE-UA, while for several study catchments, it has higher NSEs than that of the model with constant parameters. The proposed method is feasible and provides a useful tool for temporal scaling of model parameter.

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis.

Although treatment for new back pain is heavily guideline driven, deviations occur frequently. Neighborhood socioeconomic status (nSES) may contribute to these deviations. Determine whether nSES is associated with type of treatment provided for patients seeking treatment for new back pain in primary care clinics. This retrospective cohort was conducted in academic internal and family medicine practices. Data were examined from the Primary Care Patient Data Registry. Eligibility criteria included age ≥18 years, free of HIV and cancer, and presenting to primary care with a new diagnosis of back pain, resulting in1646 patients included. Patients' nSES was determined using ZIP code and calculating a validated index of 7 census-tract variables. Multinomial logistic regression was used to measure the association between nSES and 3 treatment outcomes compared with no pharmacologic management. Outcomes included opioid prescription, nonsteroidal anti-inflammatory (NSAID)/muscle relaxant prescription, or combined opioid/nonopioid treatment within 90 days of initial presentation. Covariates included age, sex, race, high clinic utilization (HCU), depression, anxiety, substance use, obesity, comorbidities, smoking, number of pain conditions, and physical therapy (PT) referral. The cohort was 67.9% female with an average age of 55.72 years (Standard Error [SE] = 0.387). Compared with no pharmacologic treatment, individuals in the low nSES group had 63% higher odds of receiving an opioid only compared with the high nSES group (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.01 to 2.62). There was no significant association between nSES and odds of nonopioid or combined treatment compared with no pharmacotherapy (OR, 1.17; 95% CI, 0.97 to 1.50), (OR, 1.09; 95% CI, 0.67 to 1.78), respectively. Covariates associated with increased odds of opioid only included HCU, ever smoker, and increasing comorbidity index. PT referral was associated with NSAID/muscle relaxant only, and increasing age and comorbidity index were inversely associated with odds of NSAID/muscle relaxant only. Finally, covariates associated with increased odds of receiving both therapies included high clinic utilizusation, ever smoking, and PT referral. These data characterize a possible association between low nSES and increased risk of receiving an opioid only when being treated for new back pain. This may be evidence that patients of low nSES are at increased risk of receiving guideline-noncompliant treatment for new back pain.

Lung cancer incidence trends in California by race/ethnicity, histology, sex, and neighborhood socioeconomic status: An analysis spanning 28 years

ObjectivesLung cancer incidence trends by histology, sex, race/ethnicity, and neighborhood socioeconomic status (nSES) have not been previously reported. We conducted a population-based study of lung cancer incidence over three peri-censal periods: 1988–1992, 1998–2002, and 2008–2012. Materials and methodsWe abstracted lung cancer cases from the California Cancer Registry and used US Census and American Community Survey data to develop multidimensional nSES indices for each census period. We calculated nSES tertile-specific incidence rates and rate ratios for each peri-censal period and used incidence rate ratios (IRR) to assess changes in rates from 1988 to 1992 to 1998–2002 and 2008–2012. ResultsThere were a total of 231,205 lung cancer cases. Males: Among males, incidence rates of lung cancer decreased over time, all race/ethnicities, and all nSES tertiles, with larger declines among males in higher nSES areas. Rates either declined or were stable for adenocarcinoma, with larger declines for other histologic subtypes. Females: Among females, declines in incidence rates of lung cancer were more pronounced for females in higher nSES areas, but diverged more so than for males, with variations by histology and race/ethnicity. Incidence rates of adenocarcinoma increased over time among all females, with greater increase among females in low nSES areas. ConclusionsOur findings demonstrate differences in incidence trends over three decades by histology, gender, race/ethnicity, and nSES. While incidence rates consistently declined over time for males, there were greater declines in incidence for high nSES populations. In contrast, among females, there was evidence of increases in lung cancer incidence among low SES API females, and for adenocarcinoma.

Effects of marital status and economic resources on survival after cancer: A population-based study.

Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26-1.29) than among females (HR, 1.19; 95% CI, 1.18-1.20; Pinteraction < .001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10(-9) among males and 8.2 × 10(-8) among females). The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources. Cancer 2016;122:1618-25. © 2016 American Cancer Society.

Geographic variations in sleep duration: a multilevel analysis from the Boston Area Community Health (BACH) Survey

BackgroundSleep plays an important role in health and varies by social determinants. Little is known, however, about geographic variations in sleep and the role of individual-level and neighbourhood-level factors.MethodsWe used...

Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study.

Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups. We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), ages 18 to 79 years and diagnosed 1995 to 2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups. In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (P trend = 0.03), Hispanics (P trend = 0.01), and Asian-Americans (P trend = 0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (P trend = 0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7 times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9 times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education. Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity. A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions toward reducing long-standing disparities in breast cancer survival.

Abstract P308: Lower Neighborhood Socioeconomic Status is Associated with Higher BNP and Prolonged QTc Intervals among Heart Failure Patients with Preserved Ejection Fraction

Background: Prior studies have shown that high B-type natriuretic peptide (BNP) levels and prolonged QTc intervals are associated with increased mortality, particularly sudden cardiac death, among heart failure (HF) patients. Whether neighborhood socioeconomic status (nSES) impacts BNP or QTc remains unknown. Methods: This study included consecutive patients enrolled from the outpatient clinic of the Northwestern Heart Failure with Preserved Ejection Fraction (HFpEF) Program from June 2007 to November 2010 after hospitalization for HF and followed through May 2011. Patients’ residential addresses were geocoded to identify their census tract of residence. Census 2000 data were used to create a single, summary score of nSES based on residential income, education and employment for each census tract and was divided into tertiles. Outcomes included post-discharge BNP and QTc, obtained within 1 month after HF hospitalization during the outpatient HFpEF clinic visit GEE models were used to examine the association between nSES and BNP and QTc adjusting for age, race, gender, NYHA class, blood pressure, obesity, smoking, glucose, eGFR, and comorbidities. Results: Among the 368 HFpEF patients, 37.0% were female, 50.5% White, avg. age was 64.8 yrs and 45.9% had NYHA class 3+. Higher nSES was significantly associated with lower BNP levels and shorter QTc intervals (Table). The adjusted BNP levels per nSES tertile were 718 pg/mL (±101.4) for the lowest nSES tertile, 508 pg/mL (± 75.3) for the intermediate nSES tertile and 454.2 pg/mL for the highest nSES tertile. Simlarly, QTc interval decreased with increasing tertile of nSES from 464.1 ms (± 5.7) in the lowest nSES tertile to 457.2 ms (± 5.8) and 448.9 ms (± 5.4) for the intermediate and highest tertiles, respectively. Conclusion: Low nSES is associated with increased BNP levels and a longer QTc interval in HFpEF patients. These findings may explain the association of nSES with higher rates of sudden cardiac death and worse outcomes among HF patients in disadvantaged neighborhoods.

Incidence of Non–Small-Cell Lung Cancer among California Hispanics According to Neighborhood Socioeconomic Status

Lung cancer incidence is associated with markers of lower socioeconomic status (SES) in whites, blacks, and Asians but with markers of higher SES in Hispanics. The magnitude and etiology of this positive gradient in Hispanics remain undefined. We examined non-small-cell lung cancer (NSCLC) incidence and ever-smoking rates among California Hispanics according to measures of SES. We computed neighborhood (n)SES-specific incidence rates by sex and race or ethnicity for 74,179 NSCLC cases in the California Cancer Registry, 1998-2002. Associations between nSES and NSCLC incidence were examined, using incidence rate ratios and linear trend tests, and stratified by age, stage, and histology. Ever-smoking rates among Hispanics were obtained from California Health Interview Survey 2001 data, and odds ratios for ever-smoking were calculated for measures of SES and acculturation. Compared with the lowest nSES quintile, the NSCLC incidence in the highest quintile was 1.86 and 1.18 times higher for Hispanic women and men, respectively. The positive nSES gradients remained significant for all ages, stages, and nonsquamous histologies in women, and only for older age, local or regional stages, and adenocarcinoma histology in men. Ever-smoking rates were associated with English-speaking households and U.S.-born status for Hispanic women and low education and U.S.-born status for Hispanic men. For California Hispanics, higher nSES was strongly associated with increased NSCLC incidence in women, but weakly associated in men, and ever-smoking rates were strongly correlated with increased acculturation. This finding may portend an increasing burden of NSCLC in Hispanic women, given future trends in acculturation and SES.