Higher Socioeconomic Status Populations Research Articles

Health equity challenges facing testing, evaluation, and implementation of multi-cancer early detection tests.

e15051 Background: The development of Multi Cancer Early Detection markers may herald a new approach to screening and detection of multiple cancers simultaneously via various biological assays. At each stage of development and evaluation of these tests, and especially at implementation, challenges to ensuring equitable access to advancements in cancer prevention, screening, diagnosis, and treatment arise. Diverse research study populations and methods are key when investigating the efficacy of screening tools in practice. Health equity encompasses all parts of research study and design, particularly increasing diversity in research study populations and methods to reflect intended populations of study and document how MCEDs may impact demographic groups differently. Methods: The MCED Consortium is a not-for-profit group of volunteers, advisors, and companies from the US and the UK spanning a wide range of expertise in biomarker evaluation and implementation, with a special focus on clinical practice, health equity, and communication ( https://www.mced.info/ ). We are developing recommendations for the evaluation of test utility, appropriate prioritized populations for screening or early detection, downstream actions in health systems, achieving health equity, and addressing the communication challenges related to this new, potentially revolutionary generation of tests. Results: The MCED consortium has made recommendations in the domains of investigator, participant level, and study design features. The Consortium also has identified key questions for MCED researchers and users regarding equitable access, acceptance, and follow-up. An emerging challenge relates to the release of these tests to selected populations via the laboratory-developed test pathway; which will almost certainly disproportionately increase access to insured and higher socioeconomic status populations. Conclusions: In this MCED Consortium presentation, we will discuss the barriers to ensuring adequate clinical trial diversity and evaluation of MCEDs and how to optimize equity during their current and near-term distribution.

Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices

BackgroundLow socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. MethodsMedline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. ResultsA total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10–1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03–1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98–1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91–0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01–1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). ConclusionLow SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. Registration and protocolThe current study was registered with PROSPERO, ID: CRD42022347987.

Race and socioeconomic status interact with HPV to influence survival disparities in oropharyngeal squamous cell carcinoma.

HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC. A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regressionand Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment. Black patients had lower overall survival than patients of other races in HPV-positive and HPV-negative OPSCC (HR 1.31, 95% CI 1.13-1.53 and HR 1.23, 95% CI 1.09-1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races. Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non-Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.

The Cost of Diversity: An Analysis of Representation and Cost Barriers in Stock Photo Libraries for Health Education Materials, 2021.

Ineffective health communication can drive health disparities and limit the effectiveness of interventions to reduce them. Stock photo libraries are a critical tool for developers of patient education, health education, and intervention materials. It is not clear how well stock photo libraries represent communities bearing disproportionate burdens of disease. We conducted a search using five popular stock image libraries (Adobe Stock Images, Canva, Getty Images, Microsoft Office Image Library, and Pixabay) in November 2021 to evaluate diversity and representation in health-related stock photos. We searched for the following five key preventive health topics: healthy eating, exercising, quitting smoking, vaccination, and pregnancy. The images (N = 495) were coded for age, gender presentation, representation of perceived minoritized racial/ethnic identity, skin color using the Massey-Martin skin color scale, markers of high socioeconomic status (SES), and access costs. Results. The representation of perceived minoritized people, darker skin color, and inclusion of markers of high SES varied greatly by the search term and library. Images predominately portrayed young adults and adults, with limited representation of other age groups. Images in libraries with any paywall were significantly more likely to depict a person of perceived minoritized racial/ethnic identity and depict darker skin colors, and were significantly less likely to contain markers of high SES identity than images in libraries that were free to use. We found that it costs more to develop culturally relevant health education materials for minoritized populations and groups that do not represent high SES populations. This may hinder the development of effective communication interventions.

Findings From A Scoping Review Examining Family Dog Ownership And Youth Physical Activity Levels

Higher youth physical activity (PA) is associated with favorable health outcomes. Only one in three children meet national PA guidelines, which recommend 60 minutes of daily PA. As an estimated 48% of US households own a dog, encouraging dog walking and active play with the family dog are potential high reach strategies to increase youth PA. PURPOSE: The purpose of this scoping review was to summarize the existing literature on family dog ownership and youth PA levels and identify gaps in the literature to inform future studies. METHODS: Database literature searches yielded 659, 230, and 104 results in PubMed, CINAHL, and SPORTDiscus, respectively, with the following search terms: (Kids OR children OR adolescents OR youth OR families) AND (Dog OR pet) AND (Physical activity OR walking OR steps OR exercise OR obesity). Following abstract and full-text screening, 18 articles were selected for inclusion. RESULTS: A majority of studies were cross-sectional (88.9%). Study populations were adolescents (38.9%), elementary-aged (27.8%), preschool-aged (5.5%), or combined ages (27.9%). Most studies consisted of majority White, higher socioeconomic status populations (88.9%). PA measurement tools consisted of questionnaire-only (n = 10; 55.6%), questionnaire with participant accelerometers (n = 7; 38.8%), and questionnaire with participant fitness-testing (n = 1; 5.5%). Only 1 study paired self-reported dog walking data with accelerometer data to determine whether children performed moderate-to-vigorous PA during family dog walks. Of 9 studies comparing PA levels among youth with and without dogs, 77.8% reported a positive association between dog ownership and PA. CONCLUSIONS: The majority of studies investigating dog ownership and youth PA levels are cross-sectional, and suggest dog ownership is associated with higher youth PA levels. Longitudinal studies are needed to determine whether the relationship is causal. If a causal relationship is demonstrated, initiatives that reduce family dog ownership barriers may help increase youth PA levels. Randomized trials testing interventions to increase dog-facilitated PA in youth are also needed. Finally, future studies should examine the dog ownership-PA relationship in low-income and ethnic minority youth.

Using the Tools of Today to Advance the Life Course Interventions of Tomorrow.

Using the Tools of Today to Advance the Life Course Interventions of Tomorrow.

Demystifying Psychedelic Treatments in Psychiatry: Is Ego Dissolution the Solution?

Demystifying Psychedelic Treatments in Psychiatry: Is Ego Dissolution the Solution?

Association between income and suspected nonmelanoma and melanoma skin cancers among participants of the American Academy of Dermatology's SPOT Skin Cancer screening program: A cross-sectional analysis

To the Editor: Lower income and socioeconomic status (SES) have been associated with a worse prognosis of cutaneous melanoma, partly due to poorer skin cancer awareness and screening, resulting in thicker tumors at diagnosis.1 Meanwhile, higher SES populations in selected European countries (Denmark, the Netherlands, Italy) have a greater incidence of nonmelanoma skin cancer, particularly basal cell carcinoma (BCC). However, no association between SES and survival has been found.2,3 While prior research focused on the American Academy of Dermatology's SPOT skin cancer screening program reported risk factors for suspected melanoma, BCC, and squamous cell carcinoma (SCC),4 income as a proxy for SES has not been studied as an independent predictor of skin cancer risk among this population.

The Influence of Socioeconomic Status on the Relationship of Daily Cardiovascular Mortality with Daily Ambient PM2.5 Concentrations in Phoenix, AZ

Background/Aim. Test the suggestion that people with high socioeconomic status (SES) are less susceptible to air pollution than those with low SES. Methods. Standard regression analysis using R. Results. People in different SES populations die on different lag days. By breaking the county into three SES populations, much higher associations are found in the SES populations than in the county. For example, betas for the strongest single lag day association for the low, medium, and high SES populations are 0.063, 0.061, and 0.046 but only 0.030 for the whole county. Since strong associations occur only on 4 or 5 lag days out of 12, and there are not enough deaths on other days to give meaningful associations, an unconstrained distributed lag model is used to estimate the total effect of PM2.5 on mortality. Total increase in % risk for an interquartile increase in PM2.5 (95% confidence interval) (range) is: low, 13.0% (5.1, 21.5) (16.5); middle 7.3% (0.2, 14.8) (14.6); high 11.6% (4.4, 19.3) (7.3); entire county 7.6 % (4.0, 11.3) (7.3). Conclusions. When risks from all lag days with meaningful associations are combined, people with low and high SES have approximately the same % increase in risk for a unit increase in PM2.5. However, it takes longer for the high SES people to die. If on a given lag day, only people in one SES population die due to PM2.5 exposure, the association will be high for that SES population lag day, but much lower for that lag day for the total population, since there will be the same number of deaths due to PM2.5, but within three times the total number of deaths. Thus, by breaking the county population into three SES populations, much higher associations are found in the low and high SES populations than in the county.

Desirable Dense Neighbourhoods: An Environmental Psychological Approach for Understanding Community Resistance to Densification

This article examines an environmental psychological approach to exploring the attitudes of urban residents towards what they consider to be a ‘desirable dense’ neighbourhood. Socio-cultural expectations of high-density developments are explored through an analysis of residents’ perceptions of what constitutes a desirable high-density environment. The article presents specific findings identifying influences on residents’ attitudes to urban densification derived from three case studies of designated transit-oriented development (TOD) areas located in the Perth Metropolitan Region. It was found that community resistance towards future higher-density developments is rooted in the current socio-cultural context of the area. Community resistance may be driven by the physical quality of developments (such as building heights, overshadowing), however, deeper concerns are allied to the uncertain social outcomes that are the product of new development. A dominant cultural characteristic such as a disinclination to socialise with diverse people is found to be a negative response to dense neighbourhoods in all the case studies. This characteristic is more evident in populations of high socio-economic status. These areas are usually close to the central business district (CBD) where many infill high-density developments have been proposed.

Traffic, air pollution, minority and socio-economic status: addressing inequities in exposure and risk.

Higher levels of nearby traffic increase exposure to air pollution and adversely affect health outcomes. Populations with lower socio-economic status (SES) are particularly vulnerable to stressors like air pollution. We investigated cumulative exposures and risks from traffic and from MNRiskS-modeled air pollution in multiple source categories across demographic groups. Exposures and risks, especially from on-road sources, were higher than the mean for minorities and low SES populations and lower than the mean for white and high SES populations. Owning multiple vehicles and driving alone were linked to lower household exposures and risks. Those not owning a vehicle and walking or using transit had higher household exposures and risks. These results confirm for our study location that populations on the lower end of the socio-economic spectrum and minorities are disproportionately exposed to traffic and air pollution and at higher risk for adverse health outcomes. A major source of disparities appears to be the transportation infrastructure. Those outside the urban core had lower risks but drove more, while those living nearer the urban core tended to drive less but had higher exposures and risks from on-road sources. We suggest policy considerations for addressing these inequities.

The impact of race, age, and sex in follicular lymphoma: A comprehensive SEER analysis across consecutive treatment eras

The impact of race/ethnicity and the additional factors of age, sex, and socioeconomic status (SES) on follicular lymphoma (FL) outcomes have not been comprehensively studied and are not well defined. We examined population-based FL data from >18,000 patients in SEER-13 (1992-2009) investigating race/ethnicity and the impact of relevant factors including sex, age, and SES. Further, we compared data over two consecutive periods: Era-1 (1992-2000, n = 8,355) and Era-2 (2001-2009, n = 10,475). We identified 18,830 FL patients (White: n = 15,116; Hispanic: n = 1,627; Asian/Pacific Islander (A/PI): n = 1,002; and Black: n = 846). Median ages (years) differed significantly by race/ethnicity: White: 62.1, Hispanic: 57.3, A/PI: 60.7, and Black: 56.8 (P < 0.01 each race versus White). Overall survival (OS) was superior in Era-2 versus Era-1 for all patients (5-year: 76.7% versus 67.4%, respectively, P < 0.001). Further, survival was significantly improved for all age groups <80 years, for males (P = 0.0019), and females (P < 0.001) across eras. Females had superior OS compared with males in Era-1 (P = 0.004), but not in Era-2. Additionally, all races, except A/PI, had improved 5-year OS rates from Era-1 to Era-2. Finally, OS improved across eras for lower and higher SES populations; however those with higher SES were superior to lower SES patients in both eras. In conclusion, and in the largest comprehensive evaluation of US-based FL patients to date, we show that despite improvements in OS for FL over time, critical disparities across races/ethnicities, sex, and age groups remain in the modern era and warrant further studies.

Commentary: Jumping the gun or asleep at the switch: is there a middle ground?

Commentary: Jumping the gun or asleep at the switch: is there a middle ground?

The Impact of Race, Age, and Sex in Follicular Lymphoma (FL): A Comprehensive SEER Analysis in the Pre- and Post-Rituximab Eras

AbstractAbstract 1576 Background:While racial disparity has been documented in a number of cancers, the impact of race, sex, and socioeconomic status (SES) on FL outcomes is not well defined. Furthermore, the impact of modern therapeutics on these disparities has not been fully explored. Methods:We examined population-based FL overall survival (OS) data from SEER 13 (1993–2008) for race, sex, age, and socioeconomic status (SES) over two consecutive 8-year periods: Era 1 (1993–2000, n=7,409) and Era 2 (2001–2008, n=9,083). Results:We identified a total 16,492 FL patients (pts) (white (W): n=13,441 (81.5%); Hispanic (H): n=1,417 (8.5%); Asian/Pacific Islander (A/PI): n=887 (5.3%); and Black (B): n=747 (4.5%)). Median age at diagnosis differed significantly according to race: (in years, yrs) W: 62.1, H: 57.3, A/PI: 60.5, B: 56.6; P<0.01 for each race vs. W. For all pts, OS was superior in Era 2 vs. Era 1 (5-yr OS: 77% vs. 68%, respectively, P<0.0001). Further, OS was significantly improved for all age groups (<50, 50–59, 60–69, and 70–79 yrs) as well as for males (P=0.0019) and females (P<0.0001) across eras. Interestingly, females had superior OS compared with males in Era 1 (P=0.004), but not in Era 2 (P=0.83). We subsequently compared OS within and across races (see Table). All races, except A/PI, had improved 5-yr OS rates (age adjusted) from Era 1 to Era 2 (W: <0.001, H: 0.049, A/PI: 0.15, B: 0.003). Notably, A/PIs had the highest OS in Era 1, while H had the poorest OS in Era 2. These differences were more evident in males compared with females within each race. Finally, pts with higher SES had improved OS compared with low SES in both eras (P=0.02 in era 1 and <0.0001 in era 2), although OS was improved across eras within low and high SES populations (P<0.0001). Conclusions:Collectively, we identified improved OS in FL across eras, which was apparent for all ages, both sexes, and all races. However, racial disparities persist, including inferior OS for H and superior OS for A/PIs in the contemporary era. The disproportionate improvement in OS over eras and persistent inequality in outcomes based on race warrants continued examination.TableOS across eras based on race5-yr OSP valuesEra 1W vs. HW vs. A/PIW vs. BWBHA/PI68%64%68%73%0.200.850.007Era 2WBHA/PI77%75%73%79%<0.00010.0190.11 Disclosures:No relevant conflicts of interest to declare.

The impact of race, age, and sex in follicular lymphoma (FL): A comprehensive SEER analysis in the pre- and post-rituximab (R) eras.

8072 Background: While racial disparity has been well documented in a number of cancers, the impact of race in FL outcomes is not well defined. Further, the importance of gender in FL has not been fully explored. Methods: We examined population-based FL overall survival (OS) data from SEER 13 (1993-2008) regarding race, sex, age, and socioeconomic status (SES) over two consecutive 8-year (yr) periods: Era 1 (1993-2000, n=7,409) and Era 2 (2001–2008, n=9,083). Results: We identified16,492 FL patients (pts) (white (W): n=13,441; Hispanic (H): n=1,417; Asian/Pacific Islander (A/PI): n=887; and Black (B): n=747). Median ages at diagnosis differed significantly according to: (in yrs, W: 62.1, H: 57.3, A/PI: 60.5, B: 56.6; P&lt;0.01 for each race vs. W). For all pts, OS was superior in Era 2 vs. Era 1 (5-yr OS: 77% vs. 68%, respectively, P&lt;0.0001). Further, OS was significantly improved for all age groups (&lt;50, 50-59, 60-69, and 70-79 yrs) as well as for males (P=0.0019) and females (P&lt;0.0001) across eras. Interestingly, females had superior OS compared with males in Era 1 (P=0.004), but not in Era 2 (P=0.83). We subsequently compared OS within and across races (Table). All races, except A/PI, had improved 5-yr OS rates (age adjusted) from Era 1 to Era 2 (W: &lt;0.001, H: 0.049, A/PI: 0.15, B: 0.003). Notably, A/PIs had the highest OS in Era 1, while H had the poorest OS in Era 2. These differences were more evident in males compared with females within each race. Finally, pts with higher SES had better OS in both eras, although OS was improved across eras for lower and higher SES populations. Conclusions: Collectively, we identified improved OS across eras, which was apparent for all ages, both sexes, and all races. We did not find superior outcome for females in the modern era as has been recently noted. However, several racial disparities persist, including inferior OS for H and superior OS A/PIs in the contemporary era. The disproportionate improvement in outcomes for some, but not all races, warrants continued study of racial disparities in FL. [Table: see text]

Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations.

Socio-Economic Status and Life Expectancy in the United States, 1990-2010: Are We Reaching the Limits of Human Longevity?

The relationship between socio-economic status (SES) and life expectancy for 1970 and 1990 is examined in eight states randomly selected from each of eight of the nine census divisions in the United States. High SES populations in seven of the eight states gained additional life expectancy over low SES populations between 1970 and 1990. In the remaining state, the gap between high and low SES populations found in 1970 narrowed by 1990, but did not disappear. The findings have implications for the study of social inequality and its relationship to health outcomes. They also suggest that the United States is unlikely to meet one of two key national health policy goals, the elimination of health disparities by 2010.

Geographic and ethnic variations in the incidence of childhood cancer.

The total incidence of childhood cancer varies rather little between different regions of the world, with cumulative risk to age 15 nearly always in the range 1.0-2.5 per thousand. Acute lymphoblastic leukaemia, especially in early childhood, is most common in populations of high socio-economic status and is the most frequent childhood cancer in all industrialised countries. The risk of Burkitt's lymphoma is highest in tropical Africa and Papua New Guinea; it is strongly associated with Epstein-Barr virus infection and intense immune stimulation by malaria. Other lymphomas are also relatively common in developing countries. Non-heritable retinoblastoma has a higher incidence among less affluent populations, suggesting an association with poor living conditions and maybe an infectious aetiology. In contrast, the incidence of Wilms' tumour and Ewing's sarcoma varies largely on ethnic lines, indicating a strong role for genetic predisposition. Much of the variation in recorded incidence of brain tumours and neuroblastoma may be due to varying levels of case ascertainment. Recently the incidence of childhood Kaposi's sarcoma has risen substantially in parts of Africa severely affected by the AIDS epidemic.

Cancer in the european population of harare, Zimbabwe, 1990–1992

The data presented from the population-based cancer registry in Harare, Zimbabwe, represent the first information on the incidence of cancer in a population of European origin living in Southern Africa for over 30 years. Their cancer pattern is more or less typical of white populations of high socio-economic status living in Europe or North America, with elevated incidence rates of breast cancer, large-bowel cancer and, in women, lung cancer. However, there are also several unusual features, with extremely high incidence rates of skin cancers, including melanomas, and higher rates of liver and bladder cancer than normally seen in white populations.

Physical Activity Behaviors in Lower and Higher Socioeconomic Status Populations

Few data on physical activity habits among populations of low socioeconomic status have been published. The authors studied physical activity habits--leisure-time physical activity, job-related physical activity, household physical activity, and walking--among 172 lower socioeconomic status women and 84 lower socioeconomic status men and compared their habits with those of 208 higher socioeconomic status women and 95 higher socioeconomic status men. All subjects resided in the greater Pittsburgh, Pennsylvania, area. Data collection occurred throughout 1986. Lower socioeconomic status women, the least active group, averaged 1,536 +/- 1,701 minutes/week (+/- standard deviation) of total physical activity, whereas higher socioeconomic status women, the most active group, averaged 2,079 +/- 1,807 minutes/week (p less than 0.0001). Higher socioeconomic status men averaged 1,952 +/- 1,799 minutes/week, and lower socioeconomic status men averaged 1,948 +/- 1,916 minutes/week. Higher socioeconomic status women spent significantly more time each week in leisure-time physical activity, job-related physical activity, and household physical activity than did lower socioeconomic status women. Lower socioeconomic status men spent significantly more time each week walking and doing household chores, whereas higher socioeconomic status men tended to be more active in leisure-time physical activity. These data suggest important quantitative and qualitative differences in physical activity among population subgroups. In view of the important role of physical activity in promoting physical and mental health, reasons for the differences among groups of varying socioeconomic status must be examined and elucidated.