Highest Socioeconomic Status Category Research Articles

Socioeconomic differences in use of antiseizure medication in pregnancies with maternal epilepsy: A population-based study from Nordic universal health care systems.

Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy. We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference. Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36). Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.

Post-injury long-term sickness absence and risk of disability pension: the role of socioeconomic status

Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway. We conducted a population-based cohort study of all Norwegian residents aged 25-59 years registered with a spell of LTSA due to injury commencing in the period 2000-2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence. Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13-2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31-2.63) than for injury causes (HR = 1.73, 95 % CI 1.56-1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders. The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.

Hypertension and Socioeconomic Status in South Central Uganda: A Population-Based Cohort Study.

Background:Limited studies exploring the impact of socioeconomic status (SES) on hypertension in Africa suggest a positive association between higher SES and hypertension. The economic development in sub-Saharan African countries has led to changes in SES and associated changes in lifestyle, diet, and physical activity, which may affect the relationship between hypertension and SES differently compared with higher income countries. This cross-sectional study from a large population-based cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension prevalence, and associated risk factors in the rural Rakai Region in south-central Uganda.Methods:Adults aged 30–49 years residing in 41 RCCS fishing, trading, and agrarian communities, were surveyed with biometric data obtained between 2016 and 2018. The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored as a potential mediator.Results:Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4 %). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001). Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the multivariable model, hypertension was associated with the highest SES category (aPR 1.23; confidence interval 1.09–1.38; p = 0.001), older age, male sex, alcohol use, and living in fishing communities and inversely associated with smoking and positive HIV serostatus. When BMI was included in the model, there was no association between SES and hypertension (aPR 1.02; CI 0.90–1.15, p = 0.76).Conclusion:Hypertension is common in rural Uganda among individuals with higher SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle modification among highest-risk groups to optimize public health impact.Key Messages What is already known about this subject? Hypertension is an important modifiable risk factor for cardiovascular disease.There are few large epidemiological studies that investigate the relationship between hypertension and socioeconomic status in low-income countries. What are the new findings? Hypertension is common among adults in rural South–Central Uganda, particularly among those with higher socioeconomic status.BMI is a mediator of the relationship between hypertension and socioeconomic status. How might it impact on clinical practice in the foreseeable future? These findings suggest that public health interventions and community efforts to prevent chronic cardiovascular disease and hypertension should focus on lifestyle modification by elucidating obesity risk perception and health risk awareness, particularly among those of higher socioeconomic status.

Abstract 2628: Racial differences in the impact of socioeconomic status on cancer-specific survival in multiple myeloma

Abstract Background: Multiple myeloma (MM) incidence and outcomes differ across racial/ethnic groups in the United States. Interactions between socioeconomic status (SES) with ethnicity in MM incidence and survival outcomes are not well understood. Our objective was to evaluate disparities in cancer-specific survival of patients diagnosed with MM by race/ethnicity. Methods: We conducted a population-based retrospective cohort study of patients ages 20+ years diagnosed with MM between 2000 and 2015 using Surveillance, Epidemiology and End Results, Census Tract-level SES and Rurality Database. SES was defined using the National Cancer Institute's time-dependent composite score developed by Yost et al. (2001). Yost index quintiles were where the 1st and 5th quintiles representing the lowest and highest SES categories respectively. Cumulative incidence functions were used to analyze cancer-specific survival across strata racial/ethnic and SES and equality of functions was determined using Gray's test. Subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were calculated using the Fine and Gray regression models adjusted for age, sex, year of diagnosis, marital status, insurance status, and treatment with chemotherapy. Race-specific risk estimates were stratified by age (&amp;lt;65 and 65+ years). Results: Overall, 58,095 MM patients were included in our analysis among whom 63.0% were non-Hispanic White, 19.5% were Black, 0.3% were American Indian/Alaskan Native, 5.8% were Asian/Pacific Islander and 11.4% were Hispanic. Compared to White MM patients (median age 69 years), Black (64 years), American Indian/Alaskan Native (64 years), Asian/Pacific Islander (67 years) and Hispanic (64 years) patients were younger on average. A higher proportion of Black (42.8%) and Hispanic (27.9%) MM patients were in the lowest SES quintile compared to White (10.6%), American Indian/Alaskan Native (15.2%), and Asian/Pacific Islander (8.9%) MM patients. Cumulative incidence functions for cancer-specific survival were significantly different across SES quintiles (P &amp;lt; 0.0001) and racial/ethnic groups (P &amp;lt; 0.0001). Overall, MM patients in the lowest SES quintile had a significantly increased risk of MM-specific mortality (SHR: 1.28, 95% CI 1.21-1.36) compared to patients in the highest quintile. Risk estimates comparing the lowest to the highest quintile of SES were higher among Black (SHR 1.39, 95% CI 1.08-1.77), Hispanic (SHR: 1.78, 95% CI 1.21-2.63), and White (SHR 1.44, 95% CI 1.23-1.69) MM patients ages &amp;lt;65 years at diagnosis. Conclusion: Low SES level is independently associated with poor MM-specific survival. However, the impacts of SES on MM-specific survival differ by race/ethnicity and age with the greatest increased risk observed in younger Black, Hispanic, and White patients. Citation Format: Huiwen Deng, Ashwini Zolekar, Hsiao-Ching Huang, Mary H. Smart, Colin C. Hubbard, Brian C. Chiu, Pritesh R. Patel, Karen Sweiss, Gregory S. Calip. Racial differences in the impact of socioeconomic status on cancer-specific survival in multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2628.

Guideline-adherent treatment, sociodemographic disparities, and cause-specific survival for endometrial carcinomas.

Adherence to National Comprehensive Cancer Network guidelines have been adopted as the standard of care for various cancers and have been cited to have survival benefits. Few studies have examined the association of adherent treatment and endometrial cancer survival among various racial/ethnic groups and socioeconomic statuses. Between January 1, 2006 and December 31, 2015, 83,673 women diagnosed with endometrial carcinomas were identified from the Surveillance, Epidemiology, and End Results database. Descriptive statistics of demographic and clinical characteristics were performed. Cox-proportional hazards models were used to examine the effect on cause-specific survival for adherence to guidelines across racial/ethnic and socioeconomic groups. Within our sample, 59.5% were treated according to guidelines. Nonadherence to treatment guidelines was significantly associated with decreased survival compared with adherent care (adjusted hazard ratio [HR], 1.59; 95% CI, 1.52-1.67). Being of Black (adjusted HR, 1.41; 95% CI, 1.32-1.51) or Native Hawaiian/Pacific Islander (adjusted HR, 1.44; 95% CI, 1.19-1.73) race/ethnicity compared with White women was significantly associated with worse survival. Being of Asian race/ethnicity (adjusted HR, 0.86, 95% CI, 0.78-0.94) was significantly associated with improved survival compared with White women. Lower neighborhood socioeconomic status was associated with a negative effect on survival relative to women in the highest socioeconomic status category. Findings from this study suggest treatment adherence is an independent predictor of improved survival; however, improved survival was not observed equally among all racial/ethnic and socioeconomic status groups. The National Comprehensive Cancer Network (NCCN) has developed guidelines for physicians to follow in treating various cancers. Within this study of 83,673 women with endometrial cancer, 59.5% of women were treated according to the NCCN guidelines. The findings suggest following NCCN guidelines for treatment of endometrial cancer improves survival. Black or Native Hawaiian/Pacific Islander race and lower neighborhood socioeconomic status has worse survival rates compared with other groups, indicating the importance of exploring other factors that may shape treatment across racial/ethnic and socioeconomic status groups.

Socioeconomic status and visual outcome in patients with neovascular age-related macular degeneration.

PurposeVisual outcome in patients with neovascular age-related macular degeneration is variable. We aimed to evaluate for association between socioeconomic status visual acuity in neovascular age-related macular degeneration.MethodsA retrospective single-center study of a consecutive group of neovascular age-related macular degeneration patients was performed. Socioeconomic status was determined for each patient based on the 2008 Israeli census. Medical information was extracted from medical records and included visual acuity and optical coherence tomography parameters. Associations between socioeconomic status and clinical outcomes were analyzed.ResultsA total of 233 patients were included in the analysis. A correlation was found between low baseline visual acuity of the first eye diagnosed with neovascular age-related macular degeneration and low socioeconomic status (r = −0.13, p = 0.049; n = 233). The difference between the visual acuity of the lowest and the highest socioeconomic status categories at baseline was approximately 3 ETDRS lines (p = 0.048). Socioeconomic status and baseline visual acuity of the second eye of the same individual with neovascular age-related macular degeneration were not correlated (r = −0.05, p = 0.95). Socioeconomic status was not associated with the number of anti-vascular endothelial growth factor injections of the first or second eye, or the visual acuity outcome of the first or second eye after 1 year of therapy (p = 0.421, p = 0.9, respectively). Central subfield thickness of the first eye at presentation as measured by spectral-domain optical coherence tomography was associated with socioeconomic status (r = −0.31 p = 0.001).ConclusionIndividuals of lower socioeconomic status presented at more advanced stage of the disease when developing neovascular age-related macular degeneration in the first eye but not in the second eye. The research underscores the importance of improving referral patterns and awareness for the lowest socioeconomic status classes.

Socio-economic differences in all-cause mortality in people with alcohol use disorder: a prospective cohort study.

While alcohol-attributable mortality rates are higher in low socio-economic status (SES) groups, less is known about SES differences in all-cause mortality in alcohol use disorder (AUD). The aim of this study was to explore whether there are SES differences in people with AUD, regarding (i) treatment admission, (ii) all-cause mortality risk and (iii) relative mortality risk. A prospective cohort study in Norway, follow-up period from 2009-10 to 2013. Data on SES and mortality were obtained through linkages to national registries, using national unique ID numbers. AUD patients (age 20+) admitted to treatment in 2009-10 (n=11 726) and age and gender frequency-matched controls from the general population (n=12 055). The SES indicator was education level (low, intermediate and high). Mortality was calculated as deaths per 1000 person-years during the 4-year observation period. Admission to AUD treatment was elevated in the low compared with the high SES categories (OR=3.31, 95% CI=3.09, 3.55). Among AUD patients, mortality risk was elevated in the low SES category (HR=1.23, 95% CI=1.04, 1.45). Relative mortality risk from AUD was significantly higher in the high SES (HR=8.65, 95% CI=6.16, 12.14) compared with the low SES categories (HR=3.29, 95% CI=2.61, 4.15). Admission to treatment for alcohol use disorders in Norway appears to decrease with increasing socio-economic status, and relative mortality risk from alcohol use disorder appears to increase with increasing socio-economic status.

Household socioeconomic status in relation to childhood general and central obesity in Farrokhshahr, Iran.

BACKGROUNDAlthough the association between socioeconomic status (SES) and general/central obesity has extensively been examined, limited data are available in this regard among children. The aim of this study was to examine the association between household SES and obesity among children.METHODSThis cross-sectional study was done in Farrokhshahr, Iran, among primary school children aged 6-12 years in 2009. SES was examined using participants’ and their parents’ oral responses to a pretested questionnaire. In the current study, participants were classified based on tertiles of SES score to low, medium, and high SES categories. General as well as central obesity was defined based on age- and sex-specific national cut-off points.RESULTSComparing individuals in the highest versus lowest tertile of SES, there was no significant difference in mean waist circumference (WC), but those in the middle tertile of SES had greater means of body mass index (BMI) than those in the lowest tertile after controlling for potential confounders (16.19 ± 0.27 vs. 15.27 ± 0.27 kg/m2, P = 0.002). We observed a greater chance of general obesity for those in the highest tertile of SES compared with those in the lowest tertile [odds ratio (OR): 4.00, 95% confidence interval (CI): 1.53-10.59, Ptrend = 0.004]. No significant association was seen between SES and central obesity, either before or after controlling for potential confounders.CONCLUSIONWe found that children in the highest SES class had a greater chance of general obesity than those in the lowest SES class. There was no significant association between SES and central obesity.

Lung cancer and socioeconomic status in a pooled analysis of case-control studies.

BackgroundAn association between low socioeconomic status (SES) and lung cancer has been observed in several studies, but often without adequate control for smoking behavior. We studied the association between lung cancer and occupationally derived SES, using data from the international pooled SYNERGY study.MethodsTwelve case-control studies from Europe and Canada were included in the analysis. Based on occupational histories of study participants we measured SES using the International Socio-Economic Index of Occupational Status (ISEI) and the European Socio-economic Classification (ESeC). We divided the ISEI range into categories, using various criteria. Stratifying by gender, we calculated odds ratios (OR) and 95% confidence intervals (CI) by unconditional logistic regression, adjusting for age, study, and smoking behavior. We conducted analyses by histological subtypes of lung cancer and subgroup analyses by study region, birth cohort, education and occupational exposure to known lung carcinogens.ResultsThe analysis dataset included 17,021 cases and 20,885 controls. There was a strong elevated OR between lung cancer and low SES, which was attenuated substantially after adjustment for smoking, however a social gradient persisted. SES differences in lung cancer risk were higher among men (lowest vs. highest SES category: ISEI OR 1.84 (95% CI 1.61–2.09); ESeC OR 1.53 (95% CI 1.44–1.63)), than among women (lowest vs. highest SES category: ISEI OR 1.54 (95% CI 1.20–1.98); ESeC OR 1.34 (95% CI 1.19–1.52)).ConclusionSES remained a risk factor for lung cancer after adjustment for smoking behavior.

Seasonal influenza vaccine uptake among people with disabilities: A nationwide population study of disparities by type of disability and socioeconomic status in France.

People with disabilities use various preventive health services less frequently than others, notably because of a lower socioeconomic status (SES). We examined variations of seasonal influenza vaccine uptake according to type/severity of disability and SES. We analyzed (in 2016) data from the 2008 French national cross-sectional survey on health and disability (n=12,396 adults living in the community and belonging to target groups for seasonal influenza vaccination). We defined seasonal influenza vaccine uptake during the 2007-2008 season by the self-reporting of a flu shot between September 2007 and March 2008. We built scores of mobility, cognitive, and sensory limitations, and an SES score based on education, occupation, and income. We performed bivariate analyses and then multiple log-binomial regressions. The prevalence of vaccine uptake was 23% in the 18-64 group and 63% in the ≥65 group. In bivariate analyses, it was higher among people in both age groups who had mobility and/or cognitive limitations and in the ≥65 group among those with sensory limitations. In the multiple regression analyses, only the presence of major mobility limitations in the18-64 group remained significant. The probability of vaccine uptake was higher in the highest SES category than in the lowest. Among at-risk groups, people with disabilities were more frequently vaccinated than others, mainly because of their higher levels of morbidity and healthcare use. Socioeconomic inequalities in access to vaccination persist in France. Future research is needed to monitor the trend in vaccine uptake in institutions.

Socio-economic status and fruit juice consumption in Canada.

The role of socio-economic status (SES) in fruit juice and fruit drink consumption is not well understood in a Canadian context. This study examines the relationship between SES and Canadian fruit juice and fruit drink consumption. The Canadian Community Health Survey (2011-2012), a cross-sectional survey that employs multistage cluster sampling, provided relevant data for a sample of 103125 Canadians, aged 12 and older, living in the 10 provinces. Household income level decile, ranked at the health region level, was used as a surrogate measure of SES. Fruit juice and fruit drink consumption data were collected via self-report in telephone/in-person interviews. Multivariable gamma regression was used to model the relationship between SES and frequency of fruit juice and fruit drink consumption, adjusting for age, sex, diabetes status, daily fruit and vegetable consumption, education level, racial identity and physical activity. A negative relationship was found, with a decreasing daily rate of fruit juice and fruit drink consumption associated with increasing SES. In the adjusted model, Canadians in the lowest SES category consumed fruit juice and fruit drinks at an average daily rate 1.18 times (95% CI: 1.14-1.23) that of Canadians in the highest SES category. The negative association between health region-adjusted SES and fruit juice and fruit drink consumption highlights the potentially important role of socio-economic factors at a local level. Canadian policy that aims to lower fruit juice and fruit drink consumption, and thus sugar intake, should target financial avenues (such as making fruit juice less financially attractive by lowering the cost of whole fruit and vegetables) in addition to communicating health benefits.

Mexican Children under 2 Years of Age Consume Food Groups High in Energy and Low in Micronutrients

Background: Mexico faces malnutrition problems in the child population. Analysis of food consumption in small children allows us to identify and propose strategies focused on feeding to improve their nutritional status.Objective: We described the consumption of beverages and food groups in Mexican children <24 mo of age.Methods: A cross-sectional study was carried out in 926 children aged <24 mo participating in the 2012 ENSANUT (National Health and Nutrition Study). Dietary information was obtained through 24-h recalls. The foods and beverages consumed were divided into 17 groups. Consumption was estimated in grams or milliliters, kilocalories per day, and percentage of energy (PE) per day. The percentage of consumers was calculated for each food group and stratified by age (<6, 6–11, and 12–23 mo) and by breastfeeding status (breastfed or not breastfed). Differences in the consumption of food groups were analyzed by breastfeeding status, area of residence (urban or rural), and socioeconomic status (SES) by using linear regression adjusted for age, breastfeeding status, and survey design.Results: Only 35% of the children consumed breast milk. Infant formula was consumed by 48% in children aged <6 mo and by 33% in children 6–11 mo old. More than 35% of the children aged 6–11 and 12–23 mo and 12% of children <6 mo old consumed nondairy sugar-sweetened beverages. Legumes and seeds and maize-based preparations contributed a higher PE in rural areas (3.4% and 1.9%, respectively) than in urban areas (11.1% and 6.4%, respectively) (P < 0.05). Children from the lowest SES category consumed less PE from cereals other than maize (2.4%) and more from maize-based preparations (10.2%) than did the middle (4.9% from other cereals and 8.0% from maize) and high (6.0% from other cereals and 4.5% from maize) SES categories (P < 0.05).Conclusion: Mexican children <24 mo of age do not consume a diet that meets recommendations, which is consistent with the high prevalence of malnutrition in Mexico.

Are there disparities in the presentation, treatment and outcomes of patients diagnosed with medullary thyroid cancer?-An analysis of 634 patients from the California Cancer Registry.

Race, gender and socioeconomic disparities have been suggested to adversely influence stage at presentation, treatment options and outcomes in patients with cancer. Underserved minorities and those with a low socioeconomic status (SES) present with more advanced disease and have worse outcomes for differentiated thyroid cancer, but this relationship has never been evaluated for medullary thyroid cancer (MTC). We used the California Cancer Registry (CCR) to evaluate disparities in the presentation, treatment and outcomes of patients diagnosed with MTC. We identified 634 patients with MTC diagnosed between 1988 and 2011. Almost everyone (85%) underwent thyroidectomy with 50% having a central lymph node dissection (CLND). There were no statistically significant differences by age, race or SES in mean tumor size or the proportion of patients diagnosed with localized disease, but men were diagnosed with larger tumors than women and were less likely to be diagnosed at a localized stage. Younger patients and women were more likely to be treated with a thyroidectomy. There were no statistically significant differences in surgical treatment by race or SES. Patients in the highest SES category had a better overall survival, but not disease specific survival, than those in the lowest SES (HR =0.3, CI =0.1-0.7). Patients treated with thyroidectomy had a better overall and cause specific survival, but the effect of CLND was not statistically significant after adjustment for other factors. In MTC, we did not find that race, gender or SES influenced the presentation, treatment or outcomes of patients with MTC. Men with MTC present with larger tumors and are less likely to have localized disease. Half of the MTC patients in California do not undergo a CLND at the time of thyroidectomy, which may suggest a lack appropriate care across a range of healthcare systems.

Factors associated with contralateral preventive mastectomy.

IntroductionContralateral prophylactic mastectomy (CPM) is an option for women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure.MethodsThe population-based Florida cancer registry, Florida’s Agency for Health Care Administration data, and US census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status and insurance status.ResultsOur population was 91.1% White and 7.5% Black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 patients with a single unilateral invasive breast cancer lesion, 837 (3.9%) underwent CPM. Significantly more White than Black (3.9% vs 2.8%; P<0.001) and more Hispanic than non-Hispanic (4.5% vs 3.8%; P=0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3% vs 2.9%; P<0.001). In multivariate analyses, Blacks compared to Whites (OR =0.59, 95% CI =0.42–0.83, P=0.002) and uninsured patients compared to privately insured (OR =0.60, 95% CI =0.36–0.98, P=0.043) had significantly less CPM.ConclusionCPM rates were significantly different among patients of different race, socio-economic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of these disparities in health care choice and delivery is critically needed.

Factors associated with increasing rates of contralateral prophylactic mastectomy.

57 Background: Contralateral prophylactic mastectomy (CPM) is an option increasingly used by women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods: The population-based Florida cancer registry, Florida’s Agency for Health Care Administration (AHCA) data, and U.S. census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM in those with a single unilateral cancer diagnosis. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status, and insurance status. Results: The rates of CPM rose from 2% in 1996 to 4.8% in 2006 up to 8% in 2009. The population studied was 91.1% white and 7.5% black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 included patients, 837 (3.9%) underwent CPM. Significantly more white than black (3.9 versus 2.8%; p &lt; 0.001) and more Hispanic than non-Hispanic (4.5 versus 3.8%; p = 0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3 versus 2.9%; p &lt; 0.001). In multivariate analyses, Blacks and uninsured patients had significantly less CPM compared to whites and private patients (OR = 0.59, 95% CI 0.42- 0.83, p = 0.002) and (OR = 0.60, 95% CI 0.36- 0.98, p = 0.043), respectively. Conclusions: CPM rates are significantly increasing; these rates were significantly different among patients of different race, socioeconomic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of this increase and the disparities in healthcare delivery is critically needed.

Socioeconomic development and girl child survival in rural North India: solution or problem?

BackgroundSocioeconomic development has been considered as a solution to the problem of sex differentials at birth and under-five mortality. This paper analyses longitudinal data from the Ballabgarh Health and Demographic...

Going against the tide: increasing incidence of colorectal cancer among Koreans, Filipinos, and South Asians in California, 1988–2007

Colorectal cancer has declined markedly in California for all major racial/ethnic groups, including Asian/Pacific Islanders as a whole. Analyzing cancer data for Asian/Pacific Islanders collectively masks important differences that exist between individual Asian subgroups. This study examines secular, sex-, age-, and socioeconomic-specific trends in colorectal cancer incidence among six Asian subgroups-Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian-to determine whether these groups experienced a decline in colorectal cancer incidence and to assess possible differences in colorectal cancer incidence trends among these groups. Cases of invasive colorectal cancer diagnosed among Japanese, Chinese, Filipinos, Koreans, Vietnamese, and South Asians between 1988 and 2007 were identified using the California Cancer Registry database. Secular, sex-, age-, and socioeconomic-specific trends in the age-adjusted colorectal cancer incidence rates for each Asian subgroup were examined using joinpoint analysis to estimate the annual percent change (APC). Among males, Koreans (APC, 3.6%) were the only group that experienced a significant increase in colorectal cancer incidence. Among females, Koreans (APC, 2.7%), South Asians (APC, 2.8%), and Filipinos (APC, 1.6%) experienced significant increases. Stratification by age at diagnosis revealed that Korean males (APC, 3.4%) and females (APC, 2.9%) as well as Filipino females (APC, 1.8%) aged 50years and older experienced a significant increase in colorectal cancer incidence. Korean males aged less than 50years (APC, 3.4%) also experienced a significant increase. Japanese (APC, -1.2%) and Chinese (APC, -1.6%) males aged 50years and older experienced a significant decrease in colorectal cancer incidence. Stratification by socioeconomic status (SES) revealed that Korean males (APC, 2.5%) and females (APC, 2.9%) as well as Filipino females (APC, 2.1%) in the lowest SES category experienced a significant increase in colorectal cancer incidence. Korean males (APC, 5.2%) and females (APC, 3.1%) as well as Filipino males (APC, 1.5%) in the highest SES category also experienced a significant increase. Japanese males (APC, -2.5%) and females (APC, -2.0%) as well as Chinese males (APC, -2.8%) and females (APC, -2.9%) in the lowest SES category experienced a significant decrease. Chinese males in the middle (APC, -3.4%) and highest (APC, -3.5%) SES categories also experienced significant decreases in colorectal cancer incidence. In contrast to the decreasing trends in colorectal cancer incidence reported among all major racial/ethnic groups including Asian/Pacific Islanders, colorectal cancer is actually increasing among some Asian subgroups in California including Korean males and females, as well as South Asian and Filipino females. Furthermore, the colorectal cancer incidence trends for these Asian subgroups differ with respect to age at diagnosis and socioeconomic status. These findings suggest that more efforts need to be made to target these populations with culturally sensitive cancer prevention and screening programs. More research is needed to examine the differences in the colorectal cancer burden among these populations.

Exploring Links to Unorganized and Organized Physical Activity During Adolescence

There is limited research on participation context in studies of physical activity correlates during adolescence. Using an ecological approach, this study explored the association of gender, socioeconomic status (SES), weight status, and physical education enjoyment with participation in organized and unorganized physical activity contexts in a representative sample of Canadian adolescents. Drawing on data from the National Longitudinal Survey of Children and Youth (Cycle 3), we conducted multiple logistic regression analyses to model the associations among the variables of interest. Girls participated less frequently in unorganized physical activities than boys (adjusted odds ratios [AORs] ranging from 0.57 to 0.65, 95% confidence intervals [CIs] range: 0.46–0.72 to 0.52–0.81). Adolescents in the middle and high SES categories participated more in organized physical activity than their peers in the low SES category (AOR = 1.40–1.87, CI = 1.06–1.84 to 1.41–2.47). Obese adolescents were generally less active than their overweight and normal weight counterparts, particularly in unorganized physical activity contexts (AOR = 0.63–0.66, CI = 0.43–0.92 to 0.44–0.99). Physical education enjoyment was consistently correlated with participation in organized and unorganized physical activity when all variables were considered (AOR = 1.58–3.98, CI = 1.22–2.05 to 3.14–5.03).

Increase in basal cell carcinoma incidence steepest in individuals with high socioeconomic status: results of a cancer registry study in the Netherlands

Development of both basal cell carcinoma (BCC) and cutaneous malignant melanoma (MM) is associated with acute and intermittent sun exposure. In contrast to MM, the association between socioeconomic status (SES) and BCC is not well documented. To investigate the incidence of BCC according to SES, stratifying by age and tumour localization in a large population-based cohort. To assess changes over time in the distribution of the patients with BCC across the SES categories. All patients with a histologically confirmed first primary BCC (n = 27,027) diagnosed between 1988 and 2005 in the Southeast of The Netherlands were stratified by sex, age (25-44, 45-64 and > or = 65 years), period of diagnosis, SES category (based on income and value of housing) and localization of the BCC. Age-standardized BCC incidence rates were calculated for the year 2004 by SES category and localization. Ordinal regression was used to assess changes over time in the proportion of patients with BCC by sex, age and SES. For men in all age groups higher BCC incidence in the highest SES category was observed, which remained significant after stratification for tumour localization. For women a consistent relationship was found only in younger women (< 65 years) for truncal BCCs, which occurred more frequently in high SES groups. Between 1990 and 2004, the proportion of BCC patients with high SES increased (+6%) and the proportion with low SES decreased (-7%). High SES is associated with increased incidence of BCC among men. Our data suggest that BCC is changing from a disease of the poor to a disease of the rich.

Socio-economic status and the risk of liver cancer mortality: A prospective study in Korean men

To examine the association between socio-economic status (SES) and liver cancer mortality among Korean men. Prospective cohort study Data were acquired from a large, prospective cohort study that included 548,530 civil service workers aged 30-59 years who had undergone health examination in 1998 provided by the Korean National Health Insurance System. Information on lifestyle and demographic characteristics was acquired through self-administered questionnaires. The main outcome event was mortality from liver cancer. Cox proportional hazards model was used to estimate relative risks (RRs) and 95% confidence intervals (95% CIs) after adjusting for age, body mass index, fasting serum glucose, alcohol consumption, smoking and hepatitis B surface antigen (HBsAg) status. Liver cancer mortality differentials relating to SES were statistically significant and consistent in the fully adjusted model. Compared with the highest SES category, excess risk associated with liver cancer mortality was observed with decreasing SES levels: the RRs in the upper middle, lower middle and low SES categories were 1.35 (95% CI 1.13-1.61), 1.54 (95% CI 1.28-1.86) and 1.72 (95% CI 1.45-2.04), respectively. There was no effect modification by HBsAg status on the association between SES and liver cancer mortality. This study demonstrated an inverse association between SES and liver cancer mortality, suggesting that SES is an independent predictor of liver cancer mortality. The policies and interventions regarding prevention of liver cancer need to focus on disadvantaged groups in order to reduce health disparities related to liver cancer.