Higher Socioeconomic Groups Research Articles

Perceived economic inequality enlarges the perceived humanity gap between low- and high-socioeconomic status groups

ABSTRACT In this paper, we analyze the influence of the perceived level of economic inequality in daily life on people’s recognition of the perceived humanity gap between low- and high-socioeconomic groups within society. To achieve this purpose, in Studies 1A–B, we analyzed the relationship between economic inequality and the humanity gap. In Studies 2A–B, we manipulated the level of inequality (low vs. high) to identify differences in the humanity gap. Results indicated that higher perceptions of economic inequality lead individuals to recognize a wider humanity gap between low- and high-socioeconomic groups in society. Implications are discussed.

Knowledge Gap Hypothesis and Pandemics: Covid-19 Knowledge, Communication Inequality, and Media Literacy in Lebanon

The study examines the knowledge gap hypothesis during the Covid-19 pandemic in a country experiencing severe social, political, and economic turmoil and inequality. The research design assesses Covid-19 knowledge through 13 variables and incorporates income, education, gender, and media literacy among the socioeconomic status variables. It also includes television exposure, social media exposure, and social media posting as media use measures. A cross-sectional survey of adults living in Lebanon was implemented between March 27 and April 23, 2020. The study aimed for a nationally representative probability sample of 1,536 participants (95% CI, ±2.5%) and received 792 valid responses (51.6% response rate). The results show a positive relationship between Covid-19 knowledge and education, media literacy, and social media exposure, but no relationship between Covid-19 knowledge and income, gender, television exposure, and social media posting behavior. The evidence shows a widening of the knowledge gap for those more likely to post on social media and a narrowing of the knowledge gap for those more exposed to social media news, but the observed narrowing of the knowledge gap for television exposure was not statistically generalizable. Finally, the evidence shows that media literacy maintains the knowledge gap by almost identically increasing the knowledge level for both low and high socioeconomic groups, although the limitations in measuring media literacy merit further exploration.

Sugar-sweetened beverage purchases in urban Peru before the implementation of taxation and warning label policies: a baseline study

BackgroundSugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru.MethodsThis study used monthly household purchase data from a panel of 5145 households from January 2016–December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume.ResultsThe trends analysis showed a decline in total beverage volume of − 52 mL/capita/month (95% CI: − 72, − 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively).ConclusionsNearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Socioeconomic inequity in coverage and quality of maternal postnatal care in Ethiopia.

High-quality postnatal care is vital for improving maternal health. This study examined the relationship between household socioeconomic status and both coverage and quality of postnatal care in Ethiopia. Cross-sectional household survey data were collected in October-November 2013 from 12 zones in 4 regions of Ethiopia. Women reporting a live birth in the 3-24 months prior to the survey were interviewed about the care they received before, during and after delivery and their demographic characteristics. Using mixed effect logistic and linear regression, the associations between household socioeconomic status and receiving postnatal care, location of postnatal care (health facility vs. non-health facility), cadre of person providing care and the number of seven key services (including physical checks and advice) provided at a postnatal visit, were estimated. A total of 16% (358/2189) of women interviewed reported receiving at least one postnatal care visit within 6 weeks of delivery. Receiving a postnatal care visit was strongly associated with socioeconomic status with women from the highest socioeconomic group having twice the odds of receiving postnatal care compared to women in the poorest quintile (OR [95% CI]: 1.98 [1.29, 3.05]). For each increasing socioeconomic status quintile there was a mean increase of 0.24 postnatal care services provided (95% CI: 0.06-0.43, p= 0.009) among women who did not give birth in a facility. There was no evidence that number of postnatal care services was associated with socioeconomic status for women who gave birth in a facility. There was no evidence that socioeconomic status was associated with the provider or location of postnatal care visits. Postnatal care in Ethiopia shows evidence of socio-economic inequity in both coverage and quality. This demonstrates the need to focus on quality improvement as well as coverage, particularly among the poorest women who did not deliver in a facility.

Socioeconomic inequality in depression and anxiety and its determinants in Iranian older adults

BackgroundOlder adults with lower socioeconomic status are more vulnerable to stressful life events and at increased risk of common mental health disorders like anxiety and depression. This study investigates the socioeconomic inequality in depressive symptoms and anxiety.MethodsThe data were from 7462 participants of the Neyshabur longitudinal study of ageing registered during 2016-2018. The outcome variables were anxiety and depressive symptoms. Anxiety was defined by the “Hospital Anxiety and Depression scale Questionnaire”, and depressive symptoms was defined and measured by the “short-term form of the Epidemiological Center Questionnaire.” The socioeconomic status was defined using principal component analysis of home assets. The Concentration Index (C) was used to measure socioeconomic inequality in anxiety and depressive symptoms. Concentration index was decomposed to its determinants to determine the role of the independent variables on inequality.ResultsThe prevalence of depressive symptoms and anxiety was 12.2% (95% CI: 11.4, 12.9) and 7.0% (95% CI: 6.4, 7.5), respectively. Moreover, the C for anxiety was -0.195 (95% CI: -0.254, -0.136) and for depressive symptoms was -0.206 (95% CI: -0.252, -0.159), which indicate a considerable inequality in favor of high socioeconomic group for anxiety and depressive symptoms. Decomposition of the concentration Index showed that education, unemployment and male sex were the most important positive contributors to the observed inequality in anxiety and depressive symptoms, while age and number of grandchildren were main negative contributors of this inequality.ConclusionLow socioeconomic groups were more affected by anxiety and depressive symptoms. Any intervention for alleviation of inequality in anxiety and depression should be focus on education and employment of people, especially in younger elderly.

How theory can help to understand the potential impact of food environment policies on socioeconomic inequalities in diet: an application of Bourdieu's capital theory and the scarcity theory.

Government policies that promote healthy food environments are considered promising to reduce socioeconomic inequalities in diet. Empirical evidence of effects on these inequalities, however, is relatively scarce and, with a few exceptions, tends to be inconclusive. We use two contemporary theories that help to understand socioeconomic inequalities in health and health-related behaviours (Bourdieu's capital theory and Mullainathan and Shafir's scarcity theory) to reason how policies influencing food environments may differentially impact lower and higher socioeconomic groups. In essence, these theories enable us to understand how specific elements of broader daily living conditions (e.g. social practices that lead to habitus formation, material conditions that shape experiences of scarcity) may lead to a greater benefit of certain food environment policies for the healthfulness of diets of lower or higher socioeconomic groups. We conclude that the application of theories on the mechanisms underlying socioeconomic inequalities in health can help to guide future empirical studies in testing theory-based hypotheses on differential effects of policies, and thereby enhance the development of effective policies tackling socioeconomic inequalities in dietary intakes.

Residential parenting services: An integrative literature review of characteristics, service usage and parent and staff perspectives.

The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes. An integrative literature review. A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990-31st December 2019). Six hundred and eleven peer-reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied. Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio-economic groups, and first-time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour.

The effect of different socio-economic and working conditions on body size and proportions: A case study on adults from Samsun, Turkey.

Conditions in the early stages of life shape body size and proportions. This study includes individuals who came from different socio-economic conditions and worked in physically demanding jobs in childhood. By determining the body sizes of these individuals and evaluating the proportional relationships between several groups, the goal was to understand the effect levels of socio-economic levels and working conditions on the body. For this purpose, an anthropometric study was conducted on 623 males and females between the ages of 20 and 45 living in Samsun, Turkey. The study sample consisted of four different groups. It was divided into two main groups of high and low socio-economic level, and the low socio-economic group was divided into two subgroups of heavy-worker and nonheavy-worker. The results demonstrated that socio-economic differences in the size and proportions of the individuals were statistically significant (p<0.05). The high socio-economic group had the highest values in all measures. External factors affected the lower limbs more than the upper limbs. The measurement most affected by these factors was leg length. Longer legs characterized the high socio-economic group, while longer arms characterized both low socio-economic groups. The relative differences observed can be said to derive from the distal limbs. This finding was valid for both sexes. The average values were close to each other in the low socio-economic group, for which the aim was to comprehend the effects of heavy working conditions. However, differences in proportional relationships were more significant. In this context, it was seen that heavy labour also affected growth, in addition to the well-known factors encountered during the growth period, such as nutrition, health, and illness. The observed changes were more significant in males than in females. Thus, it can be said that males were more affected by physiological and physical conditions.

Socioeconomic disparities in the burden of hypertension among Indonesian adults - a multilevel analysis

ABSTRACT Background Hypertension remains a problem of public health across various socioeconomic groups, despite its high prevalence. However, few studies account for geographical variation in examining socioeconomic inequalities and hypertension in Indonesia. Objective To investigate the burden of hypertension in Indonesia based on prevalence, awareness, treatment, and control of hypertension among adults; and assess whether or not the burdens vary according to geographical variation and socioeconomic status Methods In Wave 5 of the Indonesian Family Life Survey in 2015, 32,034 individuals aged 15 and over participated in the study. Concentration Curves (CC) and Concentration Indexes (CI) were used to analyse socioeconomic inequality. We used multilevel logistic regression to assess biological, geographical variation, and socioeconomic factors associated with the burden of hypertension, adjusting for potential covariates. Results The prevalence of hypertension in Indonesia was 26.1%, and only 26.9% of those with hypertension were aware of their condition. Approximately 22.5% of hypertensive patients received treatment, but only 28.2% had controlled blood pressure and reached the therapeutic goal. Low socioeconomic groups were more prone to hypertension (CI = −0.047 in urban and CI = −0.075 in rural). In contrast, awareness, treatment, and control of hypertension were more concentrated in higher socioeconomic groups. Conclusions The high prevalence of hypertension, low awareness of the condition, poor compliance with treatment, and poor control of the condition, as well as the existing socioeconomic inequality, make this a significant determinant of public health issue in Indonesia. There is a need for effective programs for the prevention of hypertension and better management of hypertensive patients.

Measuring socioeconomic inequalities in prenatal HIV test service uptake for prevention of mother to child transmission of HIV in East Africa: A decomposition analysis.

Despite efforts made towards the elimination of mother-to-child HIV transmission, socioeconomic inequality in prenatal HIV test uptake in East Africa is not well understood. Therefore, this study aimed at measuring socioeconomic inequalities in prenatal HIV test uptake and explaining its main determinants in East Africa. We analysed a total weighted sample of 45,476 women aged 15-49 years who birthed in the two years preceding the survey. The study used the most recent DHS data from ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe). The socioeconomic inequality in prenatal HIV test uptake was measured by the concentration index and illustrated by the concentration curve. Then, regression based Erreygers decomposition method was applied to quantify the contribution of socioeconomic factors to inequalities of prenatal HIV test uptake in East Africa. The concentration index for prenatal HIV test uptake indicates that utilization of this service was concentrated in higher socio-economic groups with it being 15.94% higher among these groups in entire East Africa (p <0.001), 40.33% higher in Ethiopia (p <0.001) which was the highest and only 1.87% higher in Rwanda (p <0.01) which was the lowest. The decomposition analysis revealed that household wealth index (38.99%) followed by maternal education (13.69%), place of residence (11.78%), partner education (8.24%), watching television (7.32%), listening to the radio (7.11%) and reading newsletters (2.90%) made the largest contribution to socioeconomic inequality in prenatal HIV test in East Africa. In this study, pro-rich inequality in the utilization of prenatal HIV tests was evident. The decomposition analysis findings suggest that policymakers should focus on improving household wealth, educational attainment, and awareness of mother-to-child transmission of HIV (MTCT) through various media outlets targeting disadvantaged sub-groups.

Weight distribution and the risk of type 2 diabetes among middle- to high-income women in Saudi Arabia: A cross-sectional study

Several studies from developed countries have found a lower prevalence of diabetes and obesity among higher socioeconomic groups; however, limited studies have evaluated the risk of diabetes and prevalence of obesity among middle- to high-income populations in developing countries. Therefore, this study explored the risk of developing type 2 diabetes mellitus (T2DM) and weight status of female students in private universities in Saudi Arabia. This cross-sectional study included 121 female students aged ≤25 years. Diabetes risk was evaluated using the Finnish Diabetes Risk Score. Weight was assessed by calculating the body mass index. In total, 35.5% of students had a slightly elevated risk and 10.8% had a moderate to high risk of developing T2DM; one-third (29.7%) were overweight or obese. The risk of developing T2DM was low in most of the normal weight and underweight groups, moderate to high among 22.2% of the overweight participants, and high in over half of the participants with obesity (55.5%). large proportion of the study sample was slightly elevated to a high risk of developing T2DM, and nearly one-third of the study population had a BMI of ≥25 kg/m2. The elevated risk of T2DM among young female students is alarming and requires early identification of modifiable risk factors to minimize the risk of developing T2DM in later life. • Here, one-third of middle- to high-income female students were overweight or obese. • The risk of developing diabetes increases with body weight status. • The elevated risk of T2DM among young female is alarming and require more attention.

Sick of social status: A Bourdieusian perspective on morbidity and health inequalities.

Self‐reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with ‘identical objective health’, individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages.

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.

Assessing the social equity of urban parks: An improved index integrating multiple quality dimensions and service accessibility

Urban parks are important social resources that can promote the physical and mental health of visitors. Concerns over adverse effects brought by the inequitable distribution of park resources are increasing worldwide. Many studies have used park accessibility to address this environmental inequity issue by focusing on populations with varying socioeconomic statuses and racial/ethnic compositions across regions. However, the inequities caused by differences in park quality are under-represented in these studies, especially for minority groups such as elderly individuals, children and unemployed individuals. Thus, this study proposes an improved environmental equity assessment that integrates park accessibility and multidimensional park quality, which includes aesthetic features (AFs), facilities for recreation (FRs), facilities for convenience (FCs), and a total score (TS). The results indicate that FCs related to people's basic needs are the most accessible service in Shanghai's urban parks, followed by AFs and FRs. According to the improved index, as with high socio-economic groups, areas with more elderly and unemployed people have easier access to better-quality urban parks; unfortunately, the opposite is true for children. Our findings also suggest that the priority of urban park planning and management is supply and demand balance, followed by improvements and adjustments of park quality. The proposed index could be used as a useful tool to facilitate the enhancement of social equity in urban park planning and management.

Abstract 3673: Socioeconomic disparities and the genomic landscape of gastric cancer

Abstract Background: Gastric cancer is a malignancy of diverse etiology and exposition to risk factors may vary in distinct socioeconomic (SE) groups. Our aim was to compare the landscape of genomic alterations in malignant gastric tumors between different socioeconomic groups in Peru. Methods: We conducted a preliminary prospective study in one private clinic and two public hospitals in Lima and Ica (Peru). We evaluated 20 patients with gastric carcinomas, 10 of which were classified as low SE status (LSE) and 10 as medium/high SE status (MHSE), according to the Peruvian Association of Market Intelligence Companies (APEIM) classification system. We conducted a comprehensive genomic profiling of gastric tumors with the FoundationOne CDx platform. We compared rates of alterations in single nucleotide variants, copy number variations, tumor mutation burden, microsatellite instability, and pathways altered. Results: In our cohort, the mean age at diagnosis was 67.5 yo vs 61 yo, while 40% vs 55.6% were male patients, for LSE vs MHSE, respectively. We found alterations in driver genes in 19 patients (10 LSE and 9 MHSE). Histological analysis of the tumor samples revealed a higher proportion of intestinal histology in the LSE group (80%) compared to MHSE (55.6%). On the other hand, the diffuse subtype pattern was more prevalent in the MHSE group (33%) compared to LSE (20%). One case of mixed histology was observed in the high SE group. Both LSE and HMSE showed a similar distribution of Bormann Classification/type, where most of the samples were of class III/IV (75%) followed by class I/II (25%). Furthermore, genomic profiling analysis showed 45 driver alterations in LSE, while only 25 alterations were detected in MHSE. the most frequently altered genes were TP53 and KRAS in both SE groups, but with a higher incidence in LSE (60% and 20%, respectively). Components of the MAPK pathway were altered in 50% vs 33.3%, while the DNA repair pathway was altered in 20% vs 11%, in LSE vs MHSE, respectively. The PI3K/Akt pathway was altered in only one case of LSE. Median of tumor mutation burden was 6.1Mut/Mb in LSE vs 5.3Mut/Mb MHSE. Only one case with microsatellite instability was found in LSE. Conclusions: Despite the limitations of this preliminary study, we observed some differences in the genomic background between patients from different socioeconomic groups. Therefore, the need of a thorough diagnosis approach that leads to the use of a comprehensive treatment that includes targeted therapy and immunotherapy could be different based on the SE status of the patient. Further research on this topic will be necessary. Citation Format: Daniel Zanabria, Marco Galvez-Nino, Cristina Eunbee Cho, Williams Fajardo, Luis Saravia, Jhajaira Araujo, Alejandro Alfaro, Lidia Quispe, Melanie Cornejo, Paula Medina, Junior Carbajal, Paola Montenegro, Alejandra Zevallos, Alfredo Aguilar, Joseph A. Pinto. Socioeconomic disparities and the genomic landscape of gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3673.

The Psychological Impact of COVID-19 Pandemic on Suicidal Thoughts in the United Kingdom

AimsBackground: The impact of the pandemic and resultant restrictions on suicidal thoughts may vary across populations, geographical areas, between high and low socio-economic groups and vulnerable populations. Aim: To investigate the psychological impact of COVID-19 and resultant restrictions on suicidal thoughts in the United Kingdom.MethodsThe study group conducted a cross sectional survey using a questionnaire based on published approaches (Generalised Anxiety Disorder 7, Patient Health Questionnaire 9, Impact of Events Scale-Revised) to understand the psychological impact of COVID-19 and the resultant restrictions on suicidal thoughts. The study was conducted in 3 phases to capture the different phases of the pandemic restrictions: Phase 1: 1st May 2020 to 31st July 2020Phase 2: 12th November 2020 to 12th February 2021Phase 3: 1st July 2021 to 30th September 2021Inclusion: All individuals above 16 years of age who wanted to participate were eligible.Analysis strategy: Descriptive analysis and logistic regression is applied in this study.ResultsThe study recruited 29133 participants in phase 1; 83851 participants in phase 2 and 75204 participants in phase 3. The largest age group of participants was 45–64 years. About two thirds of respondents were female. Majority of participants were of White British ethnicity. 31% participants in phase 1, 30% in phase 2 and 19% in phase 3 reported suicidal thoughts.The preliminary regression analysis indicates that younger and male participants reported more suicidal thoughts among other findings which will be reported in the presentation.Limitations: The non-probability sample design and time limited surveys meant that longitudinal changes were not possible to elicit.ConclusionThere is mixed evidence on whether rates of suicidal thoughts increased during the pandemic. The results of this study will add to the evidence base and influence future pandemic planning and efforts to developing resilience and good mental health in society.

Assessing baseline cancer demographics versus those that participate in cancer clinical trials over one year in Louisiana.

e18546 Background: To determine which barriers exist for cancer clinical trial participation in Louisiana and define areas for improvement, we report cancer demographics of all new cancer diagnoses in Louisiana in 2019 and compare those to the baseline demographics of cancer patients that enrolled on a cancer treatment trial. Methods: A retrospective study evaluating baseline cancer demographics over 2019 was performed. Our baseline population included all new cancer diagnoses in patients 18+ registered with the Louisiana Tumor Registry (LTR) between January-December 2019. Baseline demographics were compared between all patients enrolled in a cancer treatment clinical trial in 2019 through the Gulf South Clinical Trials Network (GSCTN) versus those who were not. Summary statistics were performed with regards to basic cancer and patient demographics. Results: Although patients of the highest socioeconomic group made up, n = 5,444, (21.9%) of total cancers, a larger proportion, n = 35 (32.4%), p = 0.01 ultimately enrolled in a trial. Similarly, of those living in an urban area, n = 22,258 (84.5%), a larger proportion, n = 103 (92.8%), enrolled in a trial when compared to those that were not, p = 0.02. There was a significant positive correlation (p = 0.01) between clinical trial enrollment and residency in geographic areas with higher rate of high-school graduation. Our data also demonstrated that a smaller proportion, n = 7 (6.3%), of clinical trial participants died compared to those who did not participate, n = 5176 (19.6%), p &lt; 0.01. Urologic cancer, including both prostate and bladder cancer, was the second most-diagnosed cancer primary site in Louisiana in 2019 with, n = 5481, patients diagnosed. Although black men made up, n = 1767 (32.2%) of diagnosed urologic cancer, only, n = 9 (14.1%), were accrued to participate in a urologic cancer clinical trial, p &lt; 0.01. White men, who made up, n = 3661 (66.8%), of diagnosed urologic cancer, had a larger proportion, n = 55 (85%), of trial participation, p &lt; 0.01. Conclusions: Overall, lack of geographic access proves to be a barrier for recruitment in clinical cancer trials. Patients of higher SES that live in urban areas make up a larger proportion of clinical trial participants and have better survival rates than those who do not participate. For specific cancers such as urologic cancer, further investigation on the cancer-specific inclusion and exclusion criteria must be investigated to determine the effect on equitable trial entry for populations in need. In conclusion, Louisiana offers a diverse cancer population, however, further efforts must be made to improve clinical trial access to our diverse and underserved populations.

Prevalence and factors associated with caesarean section in Rwanda: a trend analysis of Rwanda demographic and health survey 2000 to 2019–20

BackgroundCaesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades.MethodsWe used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019–20. All births in the preceding 3 years to the survey were assessed for the mode of delivery. The participants’ characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys.ResultsThe population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8–2.6) in 2000 to 15.6% (95% CI 13.9–16.5) in 2019–20. Despite increasing in all health facilities over time, the rate of CS was about four times higher in private (60.6%) compared to public health facilities (15.4%) in 2019–20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies.ConclusionOver the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.

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.

The need for improved Australian data on social determinants of health inequities

The need for improved Australian data on social determinants of health inequities