High Socioeconomic Status Tertile Research Articles

Associations between variety of fruits and vegetables consumed, diet quality, and sociodemographic factors among 8th and 11th grade adolescents in Texas.

To examine demographic and dietary correlates of consumption of a variety of fruits and vegetables (FV) among Texas adolescents. Different types of FV are needed for adequate dietary intake of vitamins and phytochemicals for proper development and functioning throughout the lifespan. Cross-sectional analysis from the Texas Surveillance of Physical Activity and Nutrition (Texas SPAN) data comparing consumption of a variety of fruit and vegetables by gender, race/ethnicity, and region (Texas-Mexico border/non-border). Middle, high schools in Texas. 8th, 11th grade Texas adolescents (n=9,056 representing N=659,288) mean age 14.8 years. Within this sample, mean fruit and vegetable variety scores (0-7) ranged from 2.47-2.65. Boys consumed a significantly greater variety of fruit than girls (m=1.12 compared to 1.04). Adolescents in non-border regions consumed a greater variety of vegetables and FV compared to those in border regions. FV variety was associated with healthier eating in the full sample, particularly in the highest Socioeconomic Status (SES) tertile. Within the highest SES tertile, a one-unit increase in variety of fruit, vegetable, and FV was associated with significant increases (p<0.001) in a healthy eating measure, the SPAN Healthy Eating Index: Fruit variety (β=1.33, SE=.29), Vegetable variety (β=0.90, SE=0.28), and FV Variety (β=.81, SE=0.19). Consumption of a greater variety of FV appears to be associated with a healthier overall diet. Associations of FV variety with healthy eating were most significant in the highest SES tertile. These findings support the need to further examine consuming a variety of FV within healthy eating behavior.

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival.

ObjectiveSocioeconomic and other demographic factors are associated with outcomes in head and neck cancer. This study uses a national cancer database to explore how patient race, ethnicity, and socioeconomic status (SES) are associated with esthesioneuroblastoma outcomes, including 5-year disease-specific survival (DSS), conditional DSS, stage at diagnosis, and treatment.Study DesignRetrospective cohort analysis.SettingPatients with esthesioneuroblastomas between 1973 and 2015 from the SEER registry (Surveillance, Epidemiology, and End Results).MethodsThe National Cancer Institute Yost Index, a census tract–level composite score composed of 7 parameters, was used to categorize the SES of patients. Kaplan-Meier analysis and Cox regression were conducted to assess DSS. Conditional DSS was calculated per estimates from simplified Cox models. Logistic regression was conducted to identify risk factors for advanced cancer stage at diagnosis and the likelihood of receiving multimodal therapy.ResultsComplete data were included for 561 patients. DSS was significantly associated with SES (log-rank, P < .01) but not race. According to Cox regression, DSS was worse for the lowest SES tertile vs the highest (hazard ratio, 1.70 [95% CI, 1.05-2.75]; P = .03). Patients of the lowest SES tertile exhibited an increased risk of advanced cancer stage at diagnosis as compared with the highest SES tertile (odds ratio, 1.84 [95% CI, 1.06-3.30]; P = .035). Black patients (odds ratio, 0.44 [95% CI, 0.24-0.84]; P = .011) were less likely than other patients to receive multimodal therapy. SES alone was not associated with receiving multimodal therapy.ConclusionSES is significantly associated with DSS and conditional DSS for patients with esthesioneuroblastomas. Inequalities in access to care and treatment likely contribute to these disparities.

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

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

United States trends in active surveillance or watchful waiting across patient socioeconomic status from 2010 to 2015.

Prospective evidence supports active surveillance/watchful waiting (AS/WW) as an efficacious management option for low-risk prostate cancer that avoids potential treatment toxicity. AS/WW schedules require regular follow-up and adherence, and it is unknown to what extent patient socioeconomic status (SES) may impact management decisions for AS/WW. We sought to determine whether AS/WW use in the United States differs according to patient SES. Using the Surveillance, Epidemiology, and End Results Prostate with AS/WW Database, all adult men diagnosed with localized low-risk prostate cancer (clinical T1-T2a, Gleason 6, and prostate-specific antigen <10 ng/mL) and managed with either AS/WW, radical prostatectomy, or radiotherapy were identified between 2010 and 2015. SES tertile was measured by the validated Yost Index (low: 0-10,901; middle: 10,904-11,469; high: 11,470-11,827). AS/WW trends were defined across SES tertiles from 2010 to 2015. Logistic multivariable regression defined adjusted odds ratios (aOR) for receipt of AS/WW by SES tertile. In 50,302 men, AS/WW use was higher with increasing SES tertile (24.6, 25.3, and 30.5% for low, middle, and high SES tertiles, respectively; PTrend (SES) <0.001). From 2010 to 2015, AS/WW use in the low, middle, and high SES tertiles increased from 11.2 to 37.3%, 14.1 to 45.8%, and 17.6 to 46.4%, respectively (PTrends <0.001). By 2015, likelihood of AS/WW became comparable among the middle vs. high SES tertiles (aOR 0.96, 95% confidence interval (CI): 0.83-1.11, P = 0.55), but remained lower among the low vs. high SES tertile (aOR 0.73, 95% CI: 0.64-0.83, P < 0.001). AS/WW use for low-risk prostate cancer in the US differs by SES. Despite increases in AS/WW across SES from 2010 to 2015, patients from low SES received significantly lower rates of AS/WW compared with higher SES groups. SES may therefore influence management decisions, where factors associated with low SES might act as a barrier to AS/WW, and may need to be addressed to reduce any disproportionate risk of unnecessary treatment to lower SES patients.

Lower Socioeconomic Status Associated with Decreased Completion of Exercise Rehabilitation in Patients with Pulmonary Hypertension

Purpose Patients with pulmonary hypertension (PH) who concurrently have low socioeconomic status (SES) present with more advanced illness and have increased risk of death. Exercise rehabilitation is an underutilized therapy that improves exercise capacity and quality of life. Whether disparities in rehabilitation completion exist is unknown. Methods We performed a cross-sectional survey of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who attended the PH Association (PHA) Research Room during the biennial conference. Participants completed a survey of demographic and clinical characteristics that inquired about prior referral and completion of rehabilitation and the MacArthur Scale of Subjective Social Status (MSSS). The MSSS is a validated survey of SES that asks participants to rate where they are on a ladder ranging from 1-10 in regards to income, occupation, or education compared to other people in the US. The primary outcome was completion of rehabilitation defined as attendance at >75% of sessions. The primary predictor was SES as measured by the MSSS grouped in tertiles. Multivariable logistic regressions performed to examine association between SES and rehabilitation completion adjusted for age and WHO functional class. Using the final model, the predicted probability of completion by SES tertile was estimated. Results We enrolled 62 participants with a mean age of 51.5 (± SD; 15.1) years, of whom 87% (n =52) were female. 48.4% (n = 30) had never been referred, 4.8% (n = 3) were referred and didn't complete, and 51.6% (n = 32) had completed rehabilitation. In the multivariable analysis, participants in the lowest SES tertile had greater than 80% lower odds of being referred and completing rehabilitation than participants in the highest SES tertile (OR 0.17, 95% CI 0.04 - 0.78; p value = 0.22). Using the final model, only 25.5% (95% CI, 9.3 - 41.6) of participants in the lowest SES tertile were predicted to complete rehabilitation compared to 63.0% (38.4 - 87.6) in the highest SES tertile. Conclusion Lower SES participants with PAH and CTEPH were less likely to complete exercise rehabilitation. Decreased access to effective therapies could account for some of the excess risk seen by lower SES patients with PAH. Policies to enable equity of access to exercise rehabilitation should be explored.

Socioeconomic Predictors of Pituitary Surgery.

Background: There exists a lack of data on the effect of socioeconomic status (SES) on outcomes for pituitary tumors, which have been associated with significant morbidity. The goal of this population-level study is to investigate the role of SES on receiving treatment and survival in patients with pituitary tumors.Methods: The Surveillance, Epidemiology, and End Results (SEER) program database from the National Cancer Institute was used to identify patients diagnosed with pituitary tumors between 2003 and 2012. SES was determined using a validated composite index. Race was categorized as Caucasian and non-Caucasian. Treatment received included surgery, radiation, and radiation with surgery. Odds of receiving surgery and survival probability were analyzed using multivariate logistic regression and Cox proportional hazards model, respectively.Results: A total of 25,802 patients with pituitary tumors were identified for analysis. High SES tertile (odds ratio (OR) = 1.095; 95% confidence interval (CI) [1.059, 1.132]) and quintile (OR = 1.052; 95% CI [1.031, 1.072]) were associated with higher odds of receiving surgery (p<0.0001). Caucasian patients had higher odds of receiving surgery when compared to non-Caucasian patients (OR = 1.064; 95% CI [1.000, 1.133]; p<0.05). Neither SES nor race were significant predictors of survival probability.Conclusion: Socioeconomic status and race were found to be associated with higher odds of receiving surgery for pituitary tumors, and thus serve as independent predictors of surgical management. Further studies are required to investigate possible causes for these findings.

Neighbourhood socioeconomic status and cross-sectional associations with obesity and urinary biomarkers of diet among New York City adults: the heart follow-up study

ObjectiveTo determine whether neighbourhood socioeconomic status (SES) is associated with body mass index (BMI), waist circumference (WC) and biomarkers of diet (urinary sodium and potassium excretion).DesignA cross-sectional study.SettingThe data reported...

Fast-food exposure around schools in urban Adelaide.

To assess whether exposure to fast-food outlets around schools differed depending on socio-economic status (SES). Binary logistic regression was used to investigate the presence and zero-inflated Poisson regression was used for the count (due to the excess of zeroes) of fast food within 1000 m and 15000 m road network buffers around schools. The low and middle SES tertiles were combined due to a lack of significant variation as the 'disadvantaged' group and compared with the high SES tertile as the 'advantaged' group. School SES was expressed using the 2011 Australian Bureau of Statistics, socio-economic indices for areas, index of relative socio-economic disadvantage. Fast-food data included independent takeaway food outlets and major fast-food chains. Metropolitan Adelaide, South Australia. A total of 459 schools were geocoded to the street address and 1000 m and 1500 m road network distance buffers calculated. There was a 1·6 times greater risk of exposure to fast food within 1000 m (OR=1·634; 95 % 1·017, 2·625) and a 9·5 times greater risk of exposure to a fast food within 1500 m (OR=9·524; 95 % CI 3·497, 25·641) around disadvantaged schools compared with advantaged schools. Disadvantaged schools were exposed to more fast food, with more than twice the number of disadvantaged schools exposed to fast food. The higher exposure to fast food near more disadvantaged schools may reflect lower commercial land cost in low-SES areas, potentially creating more financially desirable investments for fast-food developers.

Association of socioeconomic status change between infancy and adolescence, and blood pressure, in South African young adults: Birth to Twenty Cohort

ObjectiveSocial epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between...

Life expectancy ranking of Canadians among the populations in selected OECD countries and its disparities among British Columbians.

BackgroundCanada is among the world’s leading nations with the longest life expectancy at birth (LE0), and British Columbia (BC) ranks top among Canadian provinces and territories for LE0 in both men and women. This paper examined recent data as well as projected trends in LE0 of Canadian men and women and explored the geographic and socioeconomic disparities in LE0 specific to BC.MethodsUsing retrospective data on LE0 and age-standardized mortality rates, Canada was compared to 11 other Organization for Economic Cooperation and Development (OECD) countries with the longest LE0. Projections were made using linear regression modelling to the year of 2023. The association between regional LE0 and regional socioeconomic status (SES) was examined for the province of BC using its Local Health Area (LHA) level data on SES and LE0.ResultsIn 2009, Canadian men (LE0: 78.7 years) and women (LE0: 83.3 years) ranked 7th and 8th, respectively among the 12 OECD nations under comparison. Significantly smaller annual gains in LE0 contributed to the losing of their top ranks in LE0 for Canadian men and women in recent years, which was projected to sustain. Higher mortality risks, particularly for lung cancer and external causes of mortality among women was found for Canada compared to leading countries on these measures. Geographic variations were evident in LE0 in BC, and there was a significant gap of 3.6 years in the average LE0 for BC’s LHAs in the lowest SES tertile (78.6 years, 95% CI: 78.0-79.3) compared to those in the highest SES tertile (82.2 years, 95% CI: 81.6-82.8).ConclusionsCanada continues to remain one of the OECD countries with longest living population. With the highest LE0 in the country, British Columbia has an opportunity to address socio-economic disparities in LE0.

Physical inactivity prevalence and trends among Mexican adults: results from the National Health and Nutrition Survey (ENSANUT) 2006 and 2012

BackgroundLifestyles such as unhealthy diets and the lack of physical activity have been contributed to the increased prevalence of obesity. In 2012, the world health organization published the first global recommendation for physical activity and health. People who do not meet at least 150 minutes of moderate-to-vigorous physical activity are considered to be physically inactive. The prevalence of physical inactivity worldwide is 31%, however there is insufficient data from prevalence and trends of physical inactivity in Mexican population. The purposes of this study are to describe the physical inactivity prevalence and recent trends in Mexican adults and to examine the association between physical inactivity with biologic and sociodemographic characteristics.MethodsRepresentative samples of 17,183 and 10,729 adults (aged 20 to 69 years) who participated in the National Health and Nutrition Survey (ENSANUT) in 2006 and 2012, respectively. Moderate-to-vigorous physical activity (MVPA) was assessed using the short form version of the International Physical Activity Questionnaire (IPAQ), which was administered in face-to-face interviews. Self-reported IPAQ MVPA levels were adjusted using an equation derived from a previous validation study. Participants were considered inactive if they engaged in <150-minutes/week of moderate physical activity or <75 minutes/week of vigorous physical activity according to WHO classification criteria.ResultsThe prevalence of physical inactivity was significantly higher in 2012 (19.4%, 95% CI: 18.1, 20.7) than in 2006 (13.4%, 95% CI: 12.5, 14.5). Adults in the obese category, 60–69 age group, and those in the highest socioeconomic status tertile were more likely to be physically inactive.ConclusionsThe proportion of the Mexican adult population who do not meet the minimum WHO physical activity criteria has increased by 6% points between 2006 and 2012. Given the increasing prevalence of obesity, the aging of the population, and the shift in socioeconomic status in Mexico, physical inactivity could continue to increase in the coming years unless effective public health interventions are implemented.

Socio-economic status and body composition outcomes in urban South African children

Objective: To determine which aspects of socio-economic status (SES) measured at birth and at ages 9 or 10 years, are associated with body composition at ages 9 or 10 years....

Socio-economic status in relation to risk factors associated with cardiovascular disease, in healthy individuals from the ATTICA study

Social status has been related with the prevalence and incidence of cardiovascular disease. The aim of this study is to investigate the relationships between socio-economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease-free men and women. Cross-sectional survey. During 2001-2002, 1514 men (20-87 years old) and 1528 women (20-89 years old) from the Attica region (Greece) were randomly enrolled into the study. Trends in established and emerging cardiovascular risk factors were examined across the participants' socio-economic status. A special index was developed (years of school by annual income) and three socio-economic classes were created. An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index. An inverse association was observed between body mass index, waist-to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile, individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumour necrosis factor-alpha, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders. Finally, a considerable proportion of men and women reported lack of health knowledge and education. An inverse association between SES and factors related to cardiovascular risk exists, but the causal pathway itself requires more detailed explanation before the social status can have explanatory power.

Socio-Economic Status in Relation to Risk Factors Associated with Cardiovascular Disease, in Healthy Individuals from the ATTICA Study

Background Social status has been related with the prevalence and incidence of cardiovascular disease. The aim of this study is to investigate the relationships between socio-economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease-free men and women. Design Cross-sectional survey. Methods During 2001-2002, 1514 men (20-87 years old) and 1528 women (20-89 years old) from the Attica region (Greece) were randomly enrolled into the study. Trends in established and emerging cardiovascular risk factors were examined across the participants' socio-economic status. A special index was developed (years of school by annual income) and three socio-economic classes were created. Results An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index. An inverse association was observed between body mass index, waist-to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile, individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumour necrosis factor-α, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders. Finally, a considerable proportion of men and women reported lack of health knowledge and education. Conclusions An inverse association between SES and factors related to cardiovascular risk exists, but the causal pathway itself requires more detailed explanation before the social status can have explanatory power.