Higher Socioeconomic Status Groups Research Articles

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

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

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

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

Socioeconomic Determinants of Diet Quality on Overweight and Obesity in Adults Aged 40-59 Years in Inner Mongolia: A Cross-Sectional Study.

Objectives: This study investigated the relationship of socioeconomic status (SES), diet quality and overweight and obesity in adults aged 40–59 years in Inner Mongolia. Methods: This cross-sectional study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015. Diet quality was evaluated by the Alternate Mediterranean Diet score (aMeds). SES was measured by household annual income. Generalized estimating equations and path analysis were performed to determine the association of SES, diet quality and overweight and obesity. Results: Among participants, 63.0% had overweight and obesity. In high SES group, 66.4% had overweight and obesity. Higher SES was associated with a higher risk of overweight and obesity (OR = 1.352, 95%CI: 1.020–1.793). And higher aMeds was associated with a lower risk of overweight and obesity (OR = 0.597, 95%CI: 0.419–0.851). There was a positive correlation between SES and the intake of red and processed meat (r = 0.132, p < 0.05). Higher intake of red and processed meat was associated with lower diet quality (β = −0.34). And lower diet quality was associated with a higher risk of overweight and obesity (β = −0.10). Conclusion: In Inner Mongolia, during the period of economic transition, people aged 40–59 years in high SES had poor diet quality, which was related to a higher risk of overweight and obesity.

Trends in current alcohol use among Japanese adolescents by sociodemographic groups

Abstract Background Alcohol is the most commonly used substance among Japanese adolescents, although its use has been declining recently. However, little is known whether the declining trend in adolescent drinking can be found across all sociodemographic characteristics. This study explored time trends in alcohol use among Japanese adolescents by sociodemographic characteristics between 2008 and 2016. Methods A repeated cross-sectional study was conducted using data from three prefectural-wide surveys of public high schools in Okinawa Prefecture, Japan, in 2008, 2012, and 2016. The study participants comprised 7,807 students in grades 10 to 12 (15-18 years). Alcohol use was defined as drinking one or more alcoholic beverages on at least one day in the past month. Demographic characteristics included grade, sex, and region, and socioeconomic status (SES) was assessed by family structure, parental education, and school type. Time trends in alcohol use over time by each sociodemographic group were assessed by the Cochran-Armitage test for trend. Results The overall prevalence of adolescent alcohol use significantly reduced from 20.7% (95% CI 19.1-22.3%) in 2008 to 9.5% (95%CI 8.4-10.6%) in 2016. Similar reducing trends in adolescent alcohol use were found across all of the demographic characteristics as well as the SES groups (all P for trends &amp;lt;0.001). During the survey periods, there were no sex differences in alcohol use prevalence, while alcohol use was more prevalent among old graders. Alcohol use was also more prevalent among low SES groups than high SES groups. However, family structure in 2016 did not show significant differences in alcohol use. Conclusions Alcohol use among Japanese adolescents has been declining over time and this downward trend was similar for all demographic and socioeconomic subgroups. Further adolescent drinking prevention efforts should be implemented across all population subgroups. Moreover. monitoring of adolescent alcohol use should be continued. Key messages This study found that adolescent alcohol use in Japan has been decreasing over time across all population subgroups. The finding is a desired outcome from the viewpoint of the public health impact.

Covid-19 vaccination – Malta’s attitude

Abstract Background Covid-19 vaccines have been anticipated throughout the year 2020. These are envisaged by many as the way forward to beat the pandemic. However, vaccination hesitancy among the population is a public health concern. The aim was to explore the intend to take the Covid-19 vaccine among the adult residents of Malta. The vaccination roll-out in Malta started on 27th December 2020. Methods An anonymous survey was distributed through social media platforms during February 2021, targeting adults residing in Malta. Socio-economic data along with the intention to take the Covid-19 vaccine was gathered. Quantitative and qualitative analyses were performed. Results A total of 1,034 participants responded, with the majority showing intend to take the Covid-19 vaccine (75.44% CI95%:72.72-77.96). While 13.06% (CI95%:11.13-15.25) reported having already taken the vaccine. The majority of those not intending (n = 119) to take the vaccine were female (77.31% CI95%:68.95-83.96); between 30 to 39 years (42.02% CI95%:33.53-51.00), employed (76.47% CI95%:68.05-83.23) and with a post-graduate degree (36.97% CI95%:28.83-45.94). The commonest reasons for unintentional vaccine uptake were due to concern for its safety and long side effects as well as concerned if it is effective. Notably, 15.22% (CI95%:9.16-24.06) of the females reporting not intending to take the vaccine were concerned about the effect of the vaccine on their pregnancy or else were planning to become pregnant. Conclusions A high acceptance rate for the Covid-19 vaccine was observed among the Malta adults. However, an element of hesitancy was evident including among this study's high socioeconomic status group. The unknown future and long-term effects of the vaccine appear to be the main contributors to hesitancy. Key messages Covid-19 vaccine is well accepted in Malta, potentially reflecting the population’s desire to protect themselves and their families. Vaccine hesitancy is still evident even in the midst of the pandemic among high socio-economic group, reflecting the need for vaccine transparency.

Work and family characteristics as socioeconomic determinants in long sickness absence: the Japanese civil servants study.

Long sickness absence is more common among low socioeconomic status (SES) groups than high SES groups. This study aimed to evaluate whether work and family characteristics contribute to SES and sex differences in long sickness absence (7 days or more). The participants were 3080 civil servants working for a local Japanese government. In both sexes, low-grade employees were likely to take long sickness absence, with a statistically significant association for men (age-adjusted OR of lowest-grade employees for long sickness absence: 2.30 (95% Confidence Interval (CI): 1.32–4.02)). After adjusting for all variables, SES differences in long sickness absence in men decreased to OR 1.98 (CI 1.10–3.55) but remained significant; in men, being without a spouse was significantly associated with long sickness absence. Employees working long hours had lower OR for long sickness absence after adjusting for all variables in both sexes. Conversely, poor sleep quality and longstanding illness significantly increased OR for long sickness absence. In conclusion, SES differences in sickness absence were explained partly by work and family characteristics, longstanding illness, and poor sleep quality; however, other factors that were not evaluated in this study may also be associated with SES differences.

The Association Between Socioeconomic Status, Sex, Race / Ethnicity and In-Hospital Mortality Among Patients Hospitalized for Heart Failure

BackgroundThe association between socioeconomic status (SES), sex, race / ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated. Methods and ResultsWe analyzed HF hospitalizations in the United States National Inpatient Sample between 2015 and 2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race / ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (relative risk [RR] 1.02, 95% confidence interval [CI] 1.00–1.05) and male sex (RR 1.09, 95% CI 1.07–1.11) were associated with increased risk, whereas Black (RR 0.79, 95% CI 0.76–0.81) and Hispanic (RR 0.90, 95% CI 0.86–0.93) race / ethnicity were associated with a decreased risk of in-hospital mortality (5.1% of all hospitalizations). There were significant interactions between race / ethnicity and both, SES (P < .01) and sex (P = .04), such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10,940.40), female vs male patients ($9866.60 vs $10,217.10), and Black vs White patients ($9077.20 vs $10,019.80). The median costs increased with SES in all demographic groups primarily related to greater procedural utilization. ConclusionsSES, sex, and race / ethnicity were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.

The impact of the Covid-19 crisis on socioeconomic differences in physical activity behavior: Evidence from the Lifelines COVID-19 cohort study

Covid-19 and measures to contain spreading the disease have led to changed physical activity behavior. This study aims to investigate the relationship between socioeconomic status (SES) and changes in the amount of moderate to vigorous physical activity (MVPA) during the Covid-19 crisis. Using the Dutch Lifelines Covid-19 cohort study (n = 17,749), the amount of MVPA was measured at 15 time-points between March and December 2020, and compared with the amount before the Covid19 pandemic. For SES, the population was stratified in three education and income levels. Logistic regression models were used to estimate the odds ratio (OR) and confidence interval (CI) of altered MVPA for low and high SES groups, with the middle SES category as the reference group. A clear socioeconomic gradient in changes in MVPA behavior was observed. Low educated individuals had significantly higher odds (OR = 1.14; CI: 1.03–1.27) of decreasing MVPA, while the high educated had significantly lower odds of decreased MVPA (OR = 0.84, CI: 0.79–0.90). Both low education (OR = 0.87; CI: 0.77–0.98) and low income (OR = 0.85; CI 0.78–0.92) had significantly lower odds to increase MVPA, while high education (OR = 1.21, CI: 1.12–1.30) and high income (OR = 1.17; CI: 1.07–1.28) had significantly higher odds to increase MVPA. Most findings were consistent over the full research period. Socioeconomic inequalities in MVPA have increased during the Covid-19 pandemic, even when Covid-19 containment measures were relaxed. Our findings suggest that future public health policies need to increase efforts to improve physical activity behavior with an even larger focus on low SES groups.

Leveraging social determinants of health to reduce hospital length of stay: A pilot quality improvement project to address inpatient cancer patients' barriers during the COVID 19 pandemic.

233 Background: Prior reports from our institution demonstrated high rates of racial segregation, unfavorable social determinants of health (SDoH) in Milwaukee, WI, and statewide reports of inferior outcomes for cancer patients from minority communities. At the Medical College of Wisconsin's Cancer Center (Milwaukee, WI), during the first through last quarters of 2018-2019, cancer patients from the low socioeconomic status (SES) communities who were hospitalized to inpatient oncology units had an average length of stay (LOS) of 7.2 days compared to 5.6 days for high SES group. Under the auspices of the American Society of Clinical Oncology's Quality Training Program (QTP) initiative, we aimed to reduce the hospital LOS by 10% or less by May 2021 for inpatient oncology teams. Methods: A multidisciplinary team collaboration between the inpatient and outpatient providers was developed during this QI initiative. We examined LOS index data, payer types, and other diagnostic criteria for the oncology inpatient solid tumor service and two comparator services (bone marrow transplant, BMT; internal medicine). We generated workflow, a cause-and-effect diagram, and a Pareto diagram to determine the relevant factors associated with longer hospital LOS. Institution-wide implementation of the SDH screen project was launched to evaluate and address specific barriers to SDoH to expedite a safe discharge process during the pandemic. Results: Through one test of change (Plan-Do-Study-Act cycles 1, 2 &amp;3), we identified the problem of extended LOS and patient-related barriers to discharge during this QI initiative. Compared to the baseline LOS, after the launch of the SDoH screen project, there was a 6.5% decrease in the inpatient average LOS for oncology patients (7.89 to 7.40days, p = 0.004),10.7% for BMT (15.96 days to14.26, p = 0.166), and 2.4% for Internal Medicine (4.61 to 4.50 to days, p = 0.131). There was a 10.0% decrease in LOS (8.07 to 7.26 days, p = &lt; 0.001) for the three specialties combined. With collaboration from inpatient and outpatient providers, appropriate referrals were generated to address patient-specific SDH before discharge (i.e., transportation coordination, nutritional and physical therapy referrals, social worker assistance with food, and housing insecurities). Conclusions: In this pilot project, implementing SDoH screening-based-care delivery at the time of inpatient admission demonstrated a slight improvement in LOS for solid tumor oncology patients and provided timely referrals, opportunities to engage and explore the discharge facilities early on during the COVID 19 pandemic. With this preliminary data, we plan to continue to expand our efforts through a systemwide implementation of this SDoH survey both in the inpatient and outpatient settings to address cancer inequities.

Socioeconomic disparities and risk of hypertension among older Americans: the Health and Retirement Study.

Reducing hypertension represents a critical point of intervention to lower the burden of cardiovascular disease worldwide. Although the relationship between lower socioeconomic status and higher rates of hypertension is well documented, most of the evidence comes from prevalence studies involving young adult population. To investigate the independent association of wealth, education and income with incident hypertension among older adults living in the United States. This cohort study included 16 587 individuals aged 50 years and older, free of hypertension and cardiovascular disease at baseline from the Health and Retirement Study over the period 1992-2014. We used Cox proportional hazards models to examine longitudinal associations between wealth, education, and income at baseline and self-reported diagnosis of incident hypertension. During a median follow-up of 7.8 years, 6817 participants declared an occurrence of hypertension (incidence rate: 45.3 [95% confidence interval (CI) = 44.2-46.4] per 1000 person-years). Overall, those in low as compared with high socioeconomic status groups had a higher risk of developing hypertension in late life. In particular, adjusted hazard ratios [95% CI] across decreasing wealth quartiles were 1.0 (reference), 0.97 [0.88-1.08], 1.17 [1.05-1.30], and 1.20 [1.07-1.35] in men, and 1.0 (reference), 1.28 [1.17-1.41], 1.21 [1.09-1.33], and 1.28 [1.16-1.42] in women. In multivariate analyses, wealth remained strongly associated with incident hypertension among women after accounting for other socioeconomic, behavioral and anthropometric risk factors. Socioeconomic status, especially wealth, is a strong independent predictor of incident hypertension in older adults. Our findings support population-based interventions tailored to those in disadvantaged socioeconomic groups to reduce the risk of hypertension.

Socioeconomic inequalities, modifiable lifestyle risk factors, and retinal vessel calibers: The African-PREDICT Study.

Lifestyle risk factors vary between socioeconomic status (SES) groups and may influence cardiovascular function differently. The retinal microvasculature allows for monitoring early changes in cardiovascular health, and therefore, we investigated whether retinal vessel calibers associate differently with modifiable risk factors in different SES groups. We included 1064 young adults (aged 20-30years) grouped by low and high SES. The central retinal artery and vein equivalents (CRAE, CRVE) were determined from fundus images captured using the Dynamic Retinal Vessel Analyzer (Imedos Systems GmbH, Jena, Germany). We collected anthropometry, self-reported alcohol consumption, and biochemical data. Retinal vessel calibers did not differ between SES groups (p ≥ .80) after adjusting for sex and ethnicity. Unique independent associations were observed in the low SES group, where CRAE (β = 0.08, p = .042) and CRVE (β = .14, p = .001) associated positively with cotinine and body mass index, respectively. In the high SES group, CRAE (β = -0.09, p = .027) associated negatively with alcohol consumption. At young ages, retinal vessel calibers associated differently with modifiable lifestyle risk factors within each SES group. Our data highlight the importance of detecting adverse lifestyle risk factors among young adults from diverse socioeconomic settings to improve prevention of cardiovascular disease.

Race, Lifetime SES, and Allostatic Load Among Older Adults.

Prior research demonstrates that Black Americans receive fewer health benefits at high levels of socioeconomic status (SES) relative to Whites. Yet, few studies have considered the role of lifetime SES (ie, changes in SES from childhood to adulthood) in shaping these patterns among older adults. This study investigates the extent to which racial disparities in allostatic load (AL), an indicator of accelerated physiological aging, vary across levels of lifetime SES among Black and White adults aged 50 and older. With data from the Nashville Stress and Health Study, modified Poisson regression models were used to assess racial differences in the odds of high AL (4+ high-risk biomarkers) among Black and White older adults (N = 518) within each level of lifetime SES (ie, stable low SES, upward mobility, downward mobility, and stable high SES). Stable high SES was associated with greater odds of high AL; there was not a significant association between other lifetime SES trajectories and AL. However, the magnitude of racial disparities varied across levels of lifetime SES, with a significant Black-White difference in AL observed only among upwardly mobile (odds ratio [OR] = 1.76, 95% confidence interval [CI] = 1.24-2.51) and high SES groups (OR = 2.22, 95% CI = 1.37-3.58). Our study demonstrates that racial disparities in AL among older adults depend on individuals' lifetime SES trajectories and that older Black Americans receive fewer health benefits for achieving higher SES. These findings underscore the need to evaluate socioeconomic resources across the life course to clarify the extent of racial disparities among aging populations.

Intake of processed meats by Costa Rican women: effect of socioeconomic status

Intake of processed meats has been associated with serious health problems that are common among women. In 2015, the International Agency for Research on Cancer classified processed meats as human carcinogens, associated specifically with colon cancer. The increase in intake of processed meats, which are a low-cost source of dietary protein, varies by socioeconomic status (SES) and can impact chronic disease incidence. Examine the association between processed meats intake and (a) total protein intake, (b) inadequate protein intake, by SES. This study included a representative sample (N = 135) of women age 25 to 45 years, with one to four children, from three different socioeconomic groups who were residents of two counties from the Greater Metropolitan Area of San José, Costa Rica between June 2014 and March 2015. Using photographs, we examined women's perceptions of the cost and perceived desirability of 12 different foods, including processed meats. Using 24-hour dietary recalls collected on three different days, and the ValorNut food composition database, we estimated total protein intake, in grams, and determined the intake frequency (times/day) of processed meat. Each women's dietary protein requirement was estimated based on her bodyweight. Inadequate protein intake was calculated as the difference between protein requirement and actual intake. A linear regression model was used to determine the association between total protein intake in grams and intake frequency (times/day) of processed meat. A logistic regression model was used to estimate the association between low protein intake and intake frequency (times/day) of processed meat. Processed meats were perceived as the least preferred protein source but were the third most commonly consumed protein source. Consumption of processed meats differed by SES and was lower in the higher SES group (P < 0.01). The most commonly consumed processed meats by SES were "mortadella" (low-SES), sausages (middle-SES), and sliced turkey/ham (high-SES). Processed meat intake was significantly associated with an increase in protein intake. There was an inverse association between SES and inadequate protein intake. Processed meat intake is associated with SES. Women may consume processed meats because they are perceived to be a low-cost protein source. Educational strategies are needed to help women identify their protein needs and meet those needs with healthier and affordable dietary alternatives.

Influences of persistent overweight on perceptual-motor proficiency of primary school children: the North-West CHILD longitudinal study

BackgroundOverweight can be a precursor of poor motor execution, negatively impacting the overall development of school-aged children on various levels. This study determined the long-term influences of overweight on perceptual-motor proficiency (PMP) of primary school children in the North-West Province of South Africa.MethodsThe study, which included 381 participants, formed part of the NW-CHILD longitudinal study from Grade 1 (6.86 years, ± 0.39) in 2010 to Grade 7 (12.9 years, ± 0.38) in 2016. Socioeconomic categories, called quintiles, were used to compare high and low socioeconomic status groups. Overweight was identified when BMI values fell above the 85th percentile, using age- and gender-specific cut-off points. The group was categorised into 4 BMI groups (never overweight, persistent overweight, overweight-to-normal and normal-to-overweight). The Bruininks Oseretsky Test of Motor Proficiency-2 (BOT-2) Short Form and selected composites measuring strength, balance, and running speed and agility were used to assess PMP.ResultsA repeated measures ANOVA analysis indicated specific PMP differences between different BMI groups, but not total motor proficiency (BOT-2 Short Form total) differences. Practical significant group differences (Cohen’s d-values) were found in running speed and agility, strength, balance and the BOT-2 total, over seven primary school years. The persistent overweight group showed the poorest performance over time, but also showed deteriorating skills and a gradual widening in perceptual-motor skills performance, compared to the other groups. BMI-related differences in perceptual-motor coordination were also more pronounced in older age groups.ConclusionsPersistent overweight negatively impacts specific motor-proficiency components, while improving weight status can counter these effects, which highlights the importance of timeous intervention to combat obesity at a young age.

The role of sugar products and non-alcoholic beverages in the food budget: change across birth cohorts and between socio-economic groups

PurposeThis study investigates how the consumption of sugar products and non-alcoholic beverages has changed across birth cohorts. In addition, this study examines how the socio-economic gaps in the consumption of said products have evolved across birth cohorts.Design/methodology/approachThe research data are drawn from the Finnish household expenditure surveys covering the period 1985–2016 (n = 44,286). An age-period-cohort methodology is utilised through the age-period-cohort-trended lag model. The model assumes that the linear long-term component of change is caused by generations replacing one-another, and that the age effect is similar across cohorts.FindingsSugar products and non-alcoholic beverages occupied a larger portion of more recent birth cohorts' food baskets. Cohort differences were larger in beverage consumption. Lower income was associated with a higher food expenditure share of sugar products in several cohorts. A higher education level was linked to a higher food expenditure share of sugar products in more cohorts than a lower education level. In cohorts born before the 1950s, non-alcoholic beverages occupied a larger portion of the food baskets of the high socio-economic status groups. This gap reversed over time, leading to larger food expenditure shares of non-alcoholic beverages in low socio-economic status groups.Originality/valueThis study assessed how the consumption of sugar products and non-alcoholic beverages has changed across birth cohorts. In addition, this study assessed how socio-economic differences in the consumption of said products have changed. The results highlight that sugar products and non-alcoholic beverages occupy larger portions of more recent birth cohorts’ food baskets. The results also highlight a reversal of socioeconomic differences in non-alcoholic beverage consumption.

A Difference of Past Self-Evaluation Between College Students With Low and High Socioeconomic Status: Evidence From Event-Related Potentials.

Socioeconomic status (SES) refers to the social position or class according to their material and non-material social resources. We conducted a study with 60 college students to explore whether SES affects past self-evaluation and used event-related potentials (ERPs) in a self-reference task that required participants to judge whether the trait adjectives (positive or negative) describing themselves 5 years ago were appropriate for them. Behavioral data showed that individuals’ positive past self-evaluations were significantly higher than individuals’ negative past self-evaluations, regardless of high or low SES. Individuals with high SES had significantly higher positive past self-evaluations than those with low SES. ERP data showed that in the low SES group, negative adjectives elicited a marginally greater N400 amplitude than positive adjectives; in the high SES group, negative adjectives elicited a greater late positive potential (LPP) amplitude than positive adjectives. N400 is an index of the accessibility of semantic processing, and a larger N400 amplitude reflects less fluent semantic processing. LPP is an index of continuous attention during late processing; the larger LPP amplitude is elicited, the more attention resources are invested. Our results indicated that compared with college students with low SES, the past self-evaluations of college students with high SES were more positive; college students with high SES paid more attention to negative adjectives. However, college students with low SES were marginally less fluent in processing negative adjectives.

HIV care coverage among HIV-positive adolescent girls and young women in South Africa: Results from the HERStory Study.

Health service coverage cascades measure the proportion of a population in need of a service that experienced a positive health outcome from the service, and enable tracking of progress in achieving universal health coverage and inequities in care coverage. To investigate HIV care coverage among HIV-positive adolescent girls and young women (AGYW) living in six South African districts, compare coverage by age and socioeconomic status (SES), and investigate other associated factors including participation in a combination HIV prevention intervention. The HERStory Study was an evaluation of the combination intervention, comprising a representative household survey of AGYW aged 15 - 24 years living in six intervention districts. From September 2017 to November 2018, biological, sociodemographic and behavioural data were collected. HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression were determined through laboratory tests (enzyme-linked immunosorbent assay for HIV antibodies, antiretroviral (ARV) metabolites and viral load (VL) testing). Viral suppression was defined as a VL &lt;1 000 copies/mL. Knowledge of HIV-positive status was self-reported, and participants testing positive for ARV metabolites were assumed to have known their HIV-positive status. Unconditional HIV care cascades were created, stratified by age and SES. We used Pearson's χ2 tests corrected for survey-based analysis to describe factors associated with knowledge of HIV status, and being on ART. Of the 4 399 participants, 568 were HIV-positive (12.4%), of whom 60.8% (95% confidence interval (CI) 57.1 - 64.5) knew their status, 50.6% (95% CI 46.6 - 54.0) were on ART, and 62.1% (95% CI 58.4 - 65.9) were virally suppressed. Most participants (84.9%) were in the lower SES group, and they had better coverage than the higher SES group: 61.9% (95% CI 58.3 - 65.4) knew their status, 52.1% (95% CI 48.4 - 55.9) were on ART, and 64.9% (95% CI 61.3 - 68.4) were virally suppressed, compared with 55.0% (95% CI 42.1 - 68.0), 40.0% (95% CI 29.2 - 50.8), and 46.6% (95% CI 34.5 - 58.7), respectively. Participants aged 15 - 19 years had slightly inferior coverage to the 20 - 24-year-old group: 57.5% knew their status, 46.1% were on ART and 59.5% were virally suppressed, compared with 62.3%, 52.2% and 63.3%. These findings emphasise the need to close the gaps in HIV care coverage among AGYW, of whom only 61% knew their HIV-positive status and only 62% were virally suppressed. There is pro-poor inequality in HIV care coverage, with those in lower socioeconomic groups more likely to be virally suppressed.

Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients

BackgroundWhile ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates. MethodsRetrospective cohort study using a 20% representative sample of Medicare beneficiaries >65 years old with diverticulitis who received ostomies between January 1, 2010, to December 31, 2017. We evaluated the effect of neighborhood socioeconomic status, measured by the Social Deprivation Index, on ostomy reversal within 1 year. Secondary outcomes were complications and mortality. ResultsOf 10,572 patients, ostomy reversals ranged from 21.2% (low socioeconomic status) to 29.8% (highest socioeconomic status), with a shorter time to reversal among higher socioeconomic status groups. Patients with low socioeconomic status were less likely to have their ostomies reversed, compared with the highest socioeconomic status group (hazard ratio 0.83, 95% confidence interval 0.74–0.93) and were more likely to die (hazard ratio 1.21, 95% confidence interval 1.10–1.33). When stratified by race/ethnicity and socioeconomic status, non-Hispanic White patients at every socioeconomic status had a higher reversal rate than non-Hispanic Black patients (White patients 32.0%–24.8% vs Black patients 19.6%–14.7%). Socioeconomic status appeared to have a higher relative impact among non-Hispanic Black patients. ConclusionAmong Medicare diverticulitis patients, ostomy reversal rates are low. Patients with lower socioeconomic status are less likely to undergo stoma reversal and are more likely to die; Black patients are least likely to have an ostomy reversal.

Association Between Diet Quality and Cardiometabolic Risk Factor Clustering Stratified by Socioeconomic Status Among Chinese Children

BackgroundFew studies have evaluated the long-term relationship between diet quality and cardiometabolic risk factor clustering among children. The moderating effect of socio-economic status (SES) is of interest. ObjectiveTo investigate the association between diet quality with cardiometabolic risk among Chinese children and to explore the moderating effect of SES. DesignIn this cohort study, 5 waves (1997-2009) of the China Health and Nutrition Survey were used. Diet quality was measured by a modified version of the Chinese Children Dietary Index (mCCDI) based on Dietary Guidelines for Chinese. ParticipantsChildren between the ages of 7 and 17 (n = 2903) who completed at least 2 surveys were included. Those who missed measures or had hypertension or diabetes at baseline were excluded. Main outcome measuresThe fasting blood samples were collected in 2009. Waist circumference (WC) and blood pressure (BP) were measured in each survey. Statistical analysis performedA continuous cardiometabolic risk score (MetScore) was derived by a confirmatory factor analysis of 5 components: WC, BP, glucose, triglycerides, and high-density lipoprotein cholesterol. Considering the latency period of the effect of behaviors, the mCCDI was lagged by the period between surveys. Linear regression was used to analyze the association of mCCDI with MetScore and its components. Mixed effect linear regression and lagged mCCDI were used for WC and BP models. ResultsHigher mCCDI was independently associated with a lower MetScore at follow-up (β: −.11; 95% CI: −.18 to −.04). Higher lagged mCCDI over time was associated with a lower WC z score overall (β: −.05; 95% CI: −.08 to −.01) and among children in the low SES group (β: −.09; 95% CI: −.14 to −.04) but not those in the high SES group. When examining the 15 mCDDI components separately, scores for 5 components: more grains, vegetables, soybeans and its products; less sugar-sweetened beverages; and more diet variety were significantly associated with a lower MetScore. ConclusionsAmong Chinese children, higher diet quality measured by mCCDI was independently associated with a lower MetScore at follow-up.

The Association Between Obesity, Being Overweight and Socio-economic Status Among School-Age Children Living in Big Cities

Introduction: Obesity has become a serious health concern worldwide. Risk factors of obesity are different in urban and rural areas. The aim of this study was to determine the risk factors related to obesity and being overweight among children in low and high socio-economic groups in a big metropolitan city, Istanbul. Materials and Methods: A cross-sectional study was carried out on 490 schoolage children between 5 and 15 years. Low and high socio-economic groups were determined according to socio-economic status (SES). Socio-demographic characteristics of children were collected from the parents. Results: The effect of having frequent snacks rich in carbonhydrates (p=0,001) and sedentary lifestyles (p=0,001) on BMI was significant in both SES groups. In high SES group, BMI of the <10 years boys was significantly higher than that of the <10 years girls; Boys also had higher BMI at both age groups of either younger or older than 10 years. In low SES group, girls were significantly more overweight than boys. High family income, high paternal BMI and consuming energy rich products increased the obesity risk in children 1,560 times (OR: 1,560, %95 CI: 1,046-2,326), 2,015 times (OR: 2,015, %95 CI: 1,092-3,720), and 4,33 times (OR: 4,330, %95 CI: 2,897-6,472), respectively. Conclusions: As conclusion, high family income, high paternal BMI and consuming energy rich products incre-ased the obesity risk. We suggest that every community has own characteristics but boys tend to have high BMIs in families with high SES.