High Socioeconomic Status Areas Research Articles

Amateur Athletic Union (AAU) Accessibility: An Area Deprivation Index (ADI) Analysis of National Basketball Association (NBA) Players' Profiles

Abstract Purpose of Review Youth sports are increasingly shifting towards a “pay to play” model which has introduced financial barriers to participation. The Amateur Athletic Union (AAU) is the main organization for club basketball, serving as a platform where young athletes can compete beyond the recreational level. Outside the realm of athletes who have access to state-of-the-art facilities and top-tier coaching, the pathway to playing basketball at the next level may be predominantly available to those who can afford the considerable costs of AAU participation. The objective of this study is to determine the accessibility of AAU teams of active National Basketball Association (NBA) players through use of the Area Deprivation Index (ADI). Recent Findings We identified 114 AAU teams with physical addresses for 250 (50%) currently active domestic NBA players. The State ADI of the high schools as well as national and state ADIs of prior AAU teams of active NBA players were significantly skewed toward lower ADI rankings (higher socioeconomic status) (p < 0.05). The mean distance between high school location and AAU location was 170 miles. Summary Prior AAU teams of currently active NBA players are more frequently located in areas of higher socioeconomic status with nearly 50% being within the top 3rd lower state decile as measured by the area deprivation index. Similarly, we found the high schools these players attended, as a proxy for areas they grew up in, were also more frequently located in areas of higher socioeconomic status.

Racial and socioeconomic disparities in survival among patients with metastatic Non-Small cell lung cancer.

Immune checkpoint inhibitors (ICI) have profoundly impacted survival among patients with metastatic non-small cell lung cancer (NSCLC). However, population-based studies evaluating this impact on survival by race and socioeconomic factors are lacking. We utilized the SEER-Medicare database to identify patients with metastatic NSCLC diagnosed between 2015 and 2019. The primary study outcomes were the receipt of an ICI and overall survival (OS). Chi-square tests and logistic regression were utilized to identify demographic factors associated with receipt of ICI. The Kaplan-Meier method was used to calculate 2-year OS rates, and log-rank tests were used to compared survival by race/ethnicity. Out of 17,134 patients, approximately 39% received an ICI. Those diagnosed with cancer recently (in 2019), who are relatively younger (<85 years old), non-Hispanic white, non-Hispanic Asian, or Hispanic, living in high socioeconomic status or metropolitan areas, not Medicaid eligible, and with adenocarcinoma histology were more likely to receive ICI. The 2-year OS rate from diagnosis was 21% for the overall population. The 2-year OS rate from ICI initiation was 30%, among those who received at least one cycle and 11% among those who did not receive ICI. The 2-year OS rates were higher among non-Hispanic whites (22%) and non-Hispanic Asians (23%) compared to non-Hispanic Blacks (15%) and Hispanics (17%). There was no significant racial differences in survival for those who received ICI. ICI utilization rates and the resulting outcomes were inferior for certain vulnerable groups, mandating the need for strategies to improve access to care.

Modifying effect of urban parks on socioeconomic inequalities in diabetes prevalence: a cross-sectional population study of Madrid City, Spain

BackgroundEvidence has shown contradicting results on how the density of urban green spaces may reduce socioeconomic inequalities in type 2 diabetes (equigenic hypothesis). The aim of this study is to...

Evaluation of an early childhood caries preventive programme starting during pregnancy-Results after 3 and 6 years.

Early childhood caries (ECC) has been found to be up to five times more common among children living in areas of low socio-economic status (SES) than among children in areas of higher SES. To evaluate an ECC prevention programme from pregnancy to 3 and 6 years of age. A prospective, controlled, intervention cohort study was initiated in 2013 in a low-SES area in Sweden. The intervention group received an individual interdisciplinary ECC prevention programme starting pre-birth, consisting of supportive oral health-promoting talks using motivational interviewing techniques and individual ECC preventive actions. A control group, consisting of pregnant women living in a comparable area, received ordinary routines. Of the 336 pregnant women, 64 mothers (with 64 children) completed the programme, and 394 children were born in the control group. At the sixth year examination, the proportion of children with no caries was similar between the groups (53% resp. 52%, p = .976), whereas the proportion with decayed, missed, filled primary teeth (dmft = 1-5) was slightly lower (23% resp. 36%, p = .063), and the proportion with severe caries disease (dmft > 5) was higher (p = .013) in the intervention group (25%) than in the control group (12%). No preventive effect regarding caries can be demonstrated at sixth year of age. Maternal behavioural change in dental care was not sufficient to even out inequalities in oral health in children, eventually due to difficulties in reaching the target group and the lack of effects among the families reached.

Environmental Inequalities in Ecosystem Services Benefits of Green Infrastructure: A Case Study from China

Rapid urbanization is widespread globally, particularly impacting developing countries. In the face of climate challenges and shrinking public spaces resulting from urbanization, the significance of green infrastructure (GI) for human well-being and sustainability has increasingly taken center stage. This study employs an array of social-environmental benefits to evaluate GI’s contributions to human well-being, including mitigation of the urban heat island (UHI) effect, recreational functions, enhanced landscape connectivity, and efficient stormwater management. By mapping GI’s advantages, we scrutinized tradeoffs and ‘hot spots’ linked to these benefits within a metropolitan region. Moreover, we correlated GI’s advantages with the well-being of different socio-economic status (SES) groups by global and local regression. The study reveals environmental inequality, with higher SES areas—such as affluent and well-educated neighborhoods—providing superior and multifaceted GI benefits. The income coefficient is significantly positively correlated with the recreation function at the 1% significance level, while the coefficient for education is significant at the 10% level. Moreover, the income coefficient (0.349) surpasses the education coefficient (0.012). Our research also highlights that accessibility to GI’s recreational services may be an essential and overlooked indicator of environmental justice, especially for communities with a high proportion of elderly and low-income individuals.

School-Level Socioeconomic Status and Nutrient Content of Outdoor Food/Beverage Advertisements.

We examined if areas around schools with more students of lower socioeconomic status (SES) have more total food/beverage advertisements and/or more advertisements with poorer nutritional content as compared to areas around schools with fewer students with lower SES. All outdoor food/beverage advertisements within a half-mile radius of 47 middle and high schools in the United States were objectively documented in 2012 and coded for nutritional content. The total number of advertisements and the macronutrient and micronutrient contents (total calories, fat (g), protein (g), carbohydrate (g), sugar (g), and sodium (mg)) of food and beverage items depicted in the advertisements were calculated. In total, 9132 unique advertisements were recorded, with 3153 ads displaying food and beverages that could be coded for nutrient content. Schools located in areas of lower SES (≥60% students receiving free/reduced-price lunch) had significantly more advertisements displaying food and beverages that could be coded for nutrient content (z = 2.01, p = 0.04), as well as advertisements that contained more sodium (z = 2.20, p = 0.03), as compared to schools located in areas of higher SES. There were no differences in calorie, fat, protein, carbohydrate, or sugar content. Policies to reduce the prevalence of outdoor food and beverage advertising are warranted.

Area-level socioeconomic inequalities in overweight and obesity: Systematic review on moderation by built-environment attributes.

Residents of lower socioeconomic status (SES) areas are at a higher risk of overweight/obesity than those from higher SES areas. Built environment attributes may mitigate such inequalities. This systematic review synthesised findings of studies examining built environment attributes as potential moderators of the associations between area-level SES and overweight/obesity in adults. From five databases, nine eligible studies were identified. The SES-overweight/obesity relationship was stronger in inner areas and suburbs of large cities, while it was weaker in more rural areas. Two studies examined walkability and reported contrasting findings: no moderation in one and marginally significant moderation (less inequality in higher walkability areas) in the other. No evidence of moderation was found for street connectivity, population density, the food environment, access to physical activity facilities and several perceived environmental attributes. Further research is needed on other built environment attributes (e.g., access to, quantity and quality of green spaces, active transport features), and ideally using prospective study designs and objective makers of adiposity.

Cancer inequalities in incidence and mortality in the State of São Paulo, Brazil 2001-17.

Cancer disparities exist between and within countries; we sought to compare cancer-specific incidence and mortality according to area-level socioeconomic status (SES) in the State of São Paulo, Brazil. Cancer cases diagnosed 2003-2017 in the Barretos region and 2001-2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age-standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES-cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.

Exploration of the food environment in different socioeconomic areas in Hong Kong and Singapore: a cross-sectional case study

This study explored the local food environment of Hong Kong and Singapore using a qualitative case study approach to inform future upstream public health nutrition policies. Food outlets that provide food to be eaten in the home were mapped in selected areas of high and low socioeconomic status (SES) of Hong Kong and Singapore. Food outlet density relative to land area was determined. In both countries, lower SES areas surveyed were shown to have higher food outlet density while higher SES areas had fewer but larger food outlets. In Hong Kong, both SES areas reported similar proportions of healthy and unhealthy food outlets.This study highlights the accessibility of food outlet types through their geographical location and density. Future research assessing the differences in eating culture between these two countries should be considered alongside this study’s findings, to investigate strategies influencing the food environment in order to promote healthier eating habits.

Associations of neighborhood-level socioeconomic status, accessibility, and quality of green spaces in Finnish urban regions

Ensuring fair access to urban green spaces is a constant challenge for planning in densifying cities. Moreover, the quality of green spaces that determines their usability is often insufficiently considered in accessibility research. We examined residents’ accessibility to different types of green spaces also by neighborhood-level socioeconomic status (SES) in the seven largest urban regions in Finland. We identified eight different green space types, and high and low SES neighborhoods using income, education, and unemployment rate. We calculated network-based accessibility to the different types of green spaces and compared areas with a high and low SES using ANOVA. 90% of the urban residents lived within 300 meters of any green space. However, inclusion of the quality factors decreased accessibility of the green spaces from 34% to 75%. Residents living in high and low SES areas had different quality features in their nearest green spaces. Recreation facilities and routes were closer to low SES areas, whereas areas of high SES were associated with better accessibility to large green areas, and forests. This pattern recurred in most individual cities with varying distance differences. Our results emphasize the importance of considering the quality of green spaces in urban planning.

Social vulnerability and prevalence of Autism Spectrum Disorder, Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP)

The Metropolitan Atlanta Developmental Disabilities Surveillance Program tracks autism spectrum disorder (ASD) in selected counties within Georgia as part of the Autism and Developmental Disabilities Monitoring (ADDM)Network. ADDM Network analyses have historically found a higher prevalence of ASD in areas of higher socioeconomic status. We linked 2018 data from Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to two Metropolitan Atlanta Developmental Disabilities Surveillance Program counties by census tract, grouped census tracts into tertiles representing low, medium, and high social vulnerability, and calculated ASD prevalence for each tertile, overall and by each of four SVI themes. We found that overall prevalence was higher in areas of low compared to high vulnerability for the socioeconomic status and transportation themes, and in areas of medium compared to high vulnerability for all themes. This pattern was consistent among males but varied for females and by race or ethnicity. Linking ASD prevalence to SVI metrics can improve the understanding of inequities among children with ASD in racial and ethnic minority groups or those living in low-resource settings. These methods can be applied to other ADDM Network surveillance sites and public health surveillance programs.

Early impacts of the 'National Suicide Prevention Trial' on trends in suicide and hospital admissions for self-harm in Australia.

The National Suicide Prevention Trial was announced by the Australian Government in 2016 and aimed to prevent suicidal behaviour in 12 trial sites (representing a population of ~8 million). This study investigated the early population-level impact of the National Suicide Prevention Trial activity on rates of suicide and hospital admissions for self-harm in comparison to control areas. Relative and absolute differences in monthly rates of suicide and hospital admissions for self-harm were compared in the period after the National Suicide Prevention Trial implementation (July 2017-November 2020) to the period prior to implementation (January 2010-June 2017) in (1) 'National Suicide Prevention Trial areas' and (2) 'Control areas', using a difference-in-difference method in a series of negative binomial models. Analyses also investigated whether associations for suicide and self-harm rates differed by key socio-demographic factors, namely sex, age group, area socio-economic status and urban-rural residence. There were no substantial differences between 'National Suicide Prevention Trial areas' and 'Control areas' in rates of suicide (2% relative decrease, relative risk = 0.98, 95% confidence interval = [0.91, 1.06]) or self-harm (1% relative decrease, relative risk = 0.99, 95% confidence interval = [0.96, 1.02]), adjusting for sex, age group and socio-economic status. Stronger relative decreases in self-harm only were evident for those aged 50-64 years, high socio-economic status areas, metropolitan and remote geographic areas. There was limited evidence that the National Suicide Prevention Trial resulted in reductions in suicide or hospital admissions for self-harm during the first 4 years of implementation. Continued monitoring of trends with timely data is imperative over the next 2-3 years to ascertain whether there are any subsequent impacts of National Suicide Prevention Trial activities.

The production of within-family inequality: Insights and implications of integrating genetic data.

The integration of genetic data within large-scale social and health surveys provides new opportunities to test long-standing theories of parental investments in children and within-family inequality. Genetic predictors, called polygenic scores, allow novel assessments of young children's abilities that are uncontaminated by parental investments, and family-based samples allow indirect tests of whether children's abilities are reinforced or compensated. We use over 16,000 sibling pairs from the UK Biobank to test whether the relative ranking of siblings' polygenic scores for educational attainment is consequential for actual attainments. We find evidence consistent with compensatory processes, on average, where the association between genotype and phenotype of educational attainment is reduced by over 20% for the higher-ranked sibling compared to the lower-ranked sibling. These effects are most pronounced in high socioeconomic status areas. We find no evidence that similar processes hold in the case of height or for relatives who are not full biological siblings (e.g. cousins). Our results provide a new use of polygenic scores to understand processes that generate within-family inequalities and also suggest important caveats to causal interpretations the effects of polygenic scores using sibling difference designs. Future work should seek to replicate these findings in other data and contexts.

The Australian Child Maltreatment Study (ACMS), a national survey of the prevalence of child maltreatment and its correlates: methodology.

To describe the aims, design, methodology, and respondent sample representativeness of the Australian Child Maltreatment Study (ACMS). Cross-sectional, retrospective survey; computer-assisted mobile telephone interviewing using random digit dialling (computer-generated), Australia, 9 April - 11 October 2021. People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from five further age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). Primary outcomes: Emotional abuse, neglect, physical abuse, sexual abuse, exposure to domestic violence during childhood, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). selected mental disorder diagnoses (Mini International Neuropsychiatric Interview, MINI), selected physical health conditions, health risk behaviours, health service use. The demographic characteristics of the ACMS sample were similar to those of the Australian population in 2016 with respect to gender, Indigenous status, region and remoteness category of residence, and marital status, but larger proportions of participants were born in Australia, lived in areas of higher socio-economic status, had tertiary qualifications, and had income greater than $1250 per week. Population weights were derived to adjust for these differences. Associations between the number of calls required to recruit participants and maltreatment rates and health outcomes were not statistically significant. The ACMS provides the first reliable estimates of the prevalence of each type of child maltreatment in Australia. These estimates, and those of associated mental health and health risk behaviours reported in this supplement can inform policy and practice initiatives for reducing the prevalence of child maltreatment and its consequences. Our benchmark study also provides baseline data for repeated waves of the ACMS that will assess the effectiveness of these initiatives.

MP21-15 PRIVATE EQUITY FAVORS UROLOGY PRACTICES IN AFFLUENT AND LESS DIVERSE NEIGHBORHOODS

You have accessJournal of UrologyCME1 Apr 2023MP21-15 PRIVATE EQUITY FAVORS UROLOGY PRACTICES IN AFFLUENT AND LESS DIVERSE NEIGHBORHOODS Stephen Kisty, Michael Stencel, Alex Watts, Bruce Jacobs, and Benjamin Davies Stephen KistyStephen Kisty More articles by this author , Michael StencelMichael Stencel More articles by this author , Alex WattsAlex Watts More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Private equity involvement in healthcare has increased rapidly over the past 20 years, but the first urology practice was not acquired until 2016. After acquisition of a medical practice, private equity firms commonly deploy a “buy and build” model where they increase revenue and decrease costs to grow practice valuation before selling the practice within 5-7 years to a larger private equity firm. This study aimed to describe the private equity-ownership in urology practices and identify key characteristics of the populations these clinics serve. METHODS: We identified private equity-owned urology practices from February 25, 2022 through May 31, 2022. Practice acquisition was confirmed by cross referencing news releases, platform websites, and Pitchbook (a comprehensive market data warehouse). Population-level data was obtained from the U.S. Census website for each zip code tabulation area (ZCTA) within each county that had at least 1 private equity-owned urology clinic. Zip codes were converted to ZCTAs for analysis using a crosswalk. Zip codes containing private equity-backed urology clinics were compared to zip codes that did not contain a private equity-backed urology clinic but were in the same county. Data was analyzed using one-way ANOVA, and Chi-squared tests of significance. RESULTS: As of June 2022, 7 private equity platforms operate 387 urology clinics in 18 states, across 100 unique counties and employ 731 urologists. Zip codes that contained private equity-backed urology clinics (n=316) had higher rates of residents with a bachelor’s degree or higher, higher median family incomes, more white and less African American and Hispanic residents, and a greater proportion of privately insured residents than zip codes that did not contain a private equity-owned urology clinic (n=3,145, Table 1). These differences were universally amplified in zip codes that had higher concentration of PE-owned clinics (2 ≤ private equity-owned urology clinics). CONCLUSIONS: Private equity ownership in urology has grown significantly since the first acquisition and is concentrated in areas of higher socio-economic status and less racial diversity. If there are quality benchmarks that are improved by private equity acquisition, those benefits are being disproportionally directed at wealthy and largely white communities thus far. Source of Funding: NIH/NIDDK University of Pittsburgh O'Brien Cooperative Research Center Program (U54 DK112079) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e291 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Kisty More articles by this author Michael Stencel More articles by this author Alex Watts More articles by this author Bruce Jacobs More articles by this author Benjamin Davies More articles by this author Expand All Advertisement PDF downloadLoading ...

Relationship between selection criteria and trainee performance in medical specialty training: A retrospective longitudinal study

Investigation of tools used for candidate selection as predictors of future performance in medical education has been primarily undertaken within the undergraduate setting, but little is known about the selection to medical specialist programs. This retrospective longitudinal study aims to explore correlations between selection tools and the performance of trainees enrolled in the Australasian College of Dermatologists (ACD), the accredited specialist medical college for training in dermatology in Australia. Data were collected from consecutive cohorts of ACD trainees commencing from 2007 to 2015. Predictive variables were trainee demographics and selection tools (prior academic qualification; research experience; clinical experience; curriculum vitae [CV] rating; interview scores). The outcome variables were exam performance. First Year ([Pharmacology and Clinical Sciences] and Fellowship Exam [Written, Clinical, and Overall Score]). Statistical analyses included: descriptive statistics summaries; bivariate correlation of selection criteria and demographic data with exam performance; and linear regression analysis to identify predictors of exam performance. Demographic analysis (N= 172) showed that 64% of trainees were female, the average age was 30.5 years (± 3.47) and trainees living in high socioeconomic status (SES) areas were over-represented. Using Pearson correlation analysis, interview scores were significantly positively correlated with First Year Pharmacology results (p= 0.018), Fellowship Written results (p= 0.002), and Fellowship Overall Scores (p= 0.006). First Year Pharmacology Exam performance was most highly correlated with Fellowship Exam performance (p= 0.000). No association was identified between exam performance and gender, SES, prior academic qualification, research experience or CV rating. Linear regression analysis showed that interview score (p= 0.012), entry age (p= 0.026) and First Year Pharmacology score (p= 0.002) were predictors of Fellowship exam performance. These results suggest that the comprehensive selection tools used by ACD are effective, with interviews being a highly valid tool linked to exam performance. These findings have important practical implications for assessing the selection process in specialist dermatology training.

Would you like fries with that? Investigating fast-food outlet availability near schools in Perth, Western Australia.

Locating fast-food outlets near schools is a potential public health risk to schoolchildren, given the easy access and repeated exposure to energy-dense, nutrient-poor foods they provide. Fast-food outlet availability near schools has not been previously investigated in Perth, Western Australia. This study aimed to quantify fast-food outlet availability near Perth schools and determine whether differences in area-level disadvantage and school type exist. Fast-food outlet locations were sourced from Perth Local Governments in 2018/2019. All Perth Primary (n=454), Secondary (n=107) and K-12 (n=94) schools were assigned an area-level disadvantage decile ranking based on the Australian Bureau of Statistics Socio-Economic Index for Areas (SEIFA). Regression models assessed whether fast-food outlet availability within 400 m, 800 m and 1km of schools differed by school type (ie, Primary/Secondary/K-12) or SEIFA. Secondary schools were significantly more likely than Primary and K-12 schools to have a higher presence and density of fast-food outlets and the "Top 4" fast-food outlet chains (McDonalds, Hungry Jacks, KFC and Red Rooster) nearby. Schools located in low socio-economic status (SES) areas had a significantly higher density of fast-food outlets within 400 m, and "Top 4" fast-food outlet chains within 400 m and 1km, than schools located in high SES area. Perth schools are surrounded by fast-food outlets with densities significantly higher around secondary schools and schools located in lower SES areas. SO WHAT?: Policies and regulations aimed at reducing fast-food outlets near schools is an essential strategy to improve dietary intakes and reduce obesity in schoolchildren.

Inequalities in Access to Mental Health Treatment by Australian Youths During the COVID-19 Pandemic.

The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas. Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates. Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status. During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.

Association of Area-Based Socioeconomic Measures with Tuberculosis Incidence in California

We assessed the association of area-based socio-economic status (SES) measures with tuberculosis (TB) incidence in California. We used TB disease data for 2012–2016 (n = 9901), population estimates, and SES measures to calculate incidence rates, rate ratios, and 95% confidence intervals (95% CI) by SES and birth country. SES was measured by census tract and was categorized by quartiles for education, crowding, and the California Healthy Places Index (HPI)and by specific cutoffs for poverty. The lowest SES areas defined by education, crowding, poverty, and HPI had 39%, 40%, 41%, and 33% of TB cases respectively. SES level was inversely associated with TB incidence across all SES measures and birth countries. TB rates were 3.2 (95% CI 3.0–3.4), 2.1 (95% CI 1.9–2.2), 3.6 (95% CI 3.3–3.8), and 2.0 (95% CI 1.9–2.1) times higher in lowest SES areas vs. highest SES areas as defined by education, crowding, poverty and HPI respectively. Area-based SES measures are associated with TB incidence in California. This information could inform TB prevention efforts in terms of materials, partnerships, and prioritization.

Multiple Myeloma Transplant: Examining the Intersection of Access, Age and Race

Introduction: Autologous Stem Cell Transplant (ASCT) is standard frontline therapy for patients newly diagnosed with Multiple myeloma (MM). Receipt of ASCT is influenced by factors such as race, age, socioeconomic status (SES), and geographic location. The degree to which these factors collectively influence MM transplant access and jointly impact overall survival is not well established. Our study aimed to assess the impact of age, race, rurality, and area-level SES on ASCT transplant receipt and overall survival following MM diagnosis. Methods: An IRB approved retrospective analysis was conducted of adult MM patients diagnosed in 1992-2020 from The Ohio State University Comprehensive Cancer Center (OSUCCC). Patients included were previously consented to the Buckeye Surveillance, Contact, and Research for Multiple Myeloma and Amyloidosis Protocol (NCT01408225); a registry database for patients with suspected plasma cell dyscrasia pursuing care at OSUCCC; and the Bone Marrow Transplant (BMT) registry, an internal database compiled of demographic and transplant-specific data. Area-level SES was measured by census tract-level (2008-2017) Yost indices (a composite of education-, income-, and occupation-related variables.)1, 2 Rural-urban status was measured by census tract-level 2010 Rural-Urban Commuting Area (RUCA) codes.3 Yost were categorized into quartiles where higher quartiles represented higher SES, and RUCA codes were grouped by metropolitan (Primary RUCA 1-3) v. non-metropolitan (Primary RUCA 4-10). Poisson regression models with robust variance were used to evaluate the associations between patient characteristics and receipt of transplant. Overall survival (OS) from diagnosis was analyzed and median OS was estimated using the Kaplan-Meier method. Cox proportional hazard models were used to estimate the hazard ratios of risk of death. Results: In the combined MM registries, a total of 1,799 MM patients were included in this analysis, 1,169 (65%) received a transplant. MM patients median age at diagnosis was 61 (17-87), race was self-identified as White (85.6%), Black (13.1%) other (1.3%). In multivariable analysis, patients who were 65 years or older were less likely to undergo a transplant (age 65-70: IRR=0.80, 95% CI: 0.72-0.89, p<0.001; age > 70: IRR 0.23, 95% CI: 0.18-0.30, p<0.001). When assessed by race, relative to White patients, Black patients were less likely to receive a MM transplant (IRR=0.85, 95% CI: 0.74-0.97, p=0.018). RUCA code showed no significant difference in receiving a transplant between the non-metropolitan v. metropolitan groupings (IRR 1.06, 95% CI: 0.97-1.16, p=0.186). Residence in higher SES areas (quartiles 2-4) was associated with higher rate of ASCT receipt compared to those in quartile 1 (IRR 1.16, 95% CI: 1.05-1.29, p=0.038). Among all MM patients median OS for age <65 was 9.0 years (95%CI 8.4-9.7); age 65-70, 7.0 years (95%CI 6.3-7.9); age>70, 4.7 years (95%CI 4.0-5.3). In multivariable analysis, hazard of death was lower for those who received a transplant (vs. no transplant, HR= 0.63, 95%CI 0.53-0.74, p<0.001), patients identified as Black (vs. White, HR=0.66, 95%CI 0.51-0.85, p=0.001), and those residing in higher SES areas (quartile 2-4 vs. quartile 1, HR=0.69, 95%CI 0.58-0.83, p<0.001). Advancing age was associated with higher hazard of death, age 65-70 HR=1.45 (95%CI 1.18-1.78, p<0.001); age >70 HR=2.03 (95%CI 1.65-2.49, p<0.001). Rurality was not associated with OS (HR 1.14, 95% CI 0.96-1.35, p=0.134). Conclusions: In a large MM population, age, race, and area-level socioeconomic status impact both the receipt of transplant and overall survival following MM diagnosis. Area-level SES could be an important driver of MM survival independent of transplant access.