Highest Socioeconomic Status Quartile Research Articles

Atrial Fibrillation in young patients: Insights from the National Inpatient Sample

Abstract Background The burden of atrial fibrillation (AF) in young patients is not well characterized. We aimed to study trends in AF burden and management over time in patients aged 18-45 years. Methods We conducted a retrospective analysis of all primary AF hospitalizations in patients 18-45 years of age using the United States National Inpatient Sample (NIS) data from 01/01/2008 to 12/31/2019. We collected data on clinical and socioeconomic features including demographics, comorbidities, ZIP Code income, resource utilization, and various clinical outcomes. Quartile classification of the median household income of the zip code of the patient’s residence was used to classify socioeconomic status. Results The rate of AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p<0.001) (Figure 1). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in black patients compared to other ethnicities (20.4 for black vs. 15.6 for white vs. 8.5 Hispanic per 100,000) (Figure 2). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p<0.001), and the utilization of catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p<0.001) (Figure 1). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p <0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3%) and catheter ablation (6.1% vs. 3.3%, p <0.001) compared to black patients. Patients in the highest socioeconomic status quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p<0.001) and catheter ablation (8.0% vs. 3.7%, p<0.001) compared to patients in the lowest socioeconomic status quartile. Conclusions We found significant differences in inpatient AF burden across different patient populations. We identified differences in inpatient AF management based on sex, ethnicity, and socioeconomic status. Further research is needed to better understand these differences, their impact on clinical outcomes, and strategies to improve healthcare disparities.

The health risk of social disadvantage is transplantable into a new host

Low socioeconomic status (SES) is a risk factor for mortality and immune dysfunction across a wide range of diseases, including cancer. However, cancer is distinct in the use of allogeneic hematopoietic cell transplantation (HCT) as a treatment for hematologic malignancies to transfer healthy hematopoietic cells from one person to another. This raises the question of whether social disadvantage of an HCT cell donor, as assessed by low SES, might impact the subsequent health outcomes of the HCT recipient. To evaluate the cellular transplantability of SES-associated health risk, we analyzed the health outcomes of 2,005 HCT recipients who were transplanted for hematologic malignancy at 125 United States transplant centers and tested whether their outcomes differed as a function of their cell donor's SES (controlling for other known HCT-related risk factors). Recipients transplanted with cells from donors in the lowest quartile of SES experienced a 9.7% reduction in overall survival (P = 0.001) and 6.6% increase in treatment-related mortality within 3 y (P = 0.008) compared to those transplanted from donors in the highest SES quartile. These results are consistent with previous research linking socioeconomic disadvantage to altered immune cell function and hematopoiesis, and they reveal an unanticipated persistence of those effects after cells are transferred into a new host environment. These SES-related disparities in health outcomes underscore the need to map the biological mechanisms involved in the social determinants of health and develop interventions to block those effects and enhance the health of both HCT donors and recipients.

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

BackgroundThis study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines.MethodsA follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications.ResultsThe average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use.ConclusionsSocioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.

Socioeconomic status is associated with greater hazard of post-discharge mortality than race, gender, and ballistic injury mechanism in a young, healthy, orthopedic trauma population

ObjectivesTo explore the utility of legacy demographic factors and ballistic injury mechanism relative to popular markers of socioeconomic status as prognostic indicators of 10-year mortality following hospital discharge in a young, healthy patient population with isolated orthopedic trauma injuries. MethodsA retrospective cohort study was performed to evaluate patients treated at an urban Level I trauma center from January 1, 2003, through December 31, 2016. Current Procedure Terminology (CPT) codes were used to identify upper and lower extremity fracture patients undergoing operative fixation. Exclusion criteria were selected to yield a patient population of isolated extremity trauma in young, otherwise healthy individuals between the ages of 18 and 65 years. Variables collected included injury mechanism, age, race, gender, behavior risk factors, Area Deprivation Index (ADI), and insurance status. The primary outcome was post-discharge mortality, occurring at any point during the study period. ResultsWe identified 2539 patients with operatively treated isolated extremity fractures. The lowest two quartiles of socioeconomic status (SES) were associated with higher hazard of mortality than the highest SES quartile in multivariable analysis (Quartile 3 HR: 2.2, 95% CI: 1.2–4.1, p = 0.01; Quartile 4 HR: 2.2, 95% CI: 1.1–4.3, p = 0.02). Not having private insurance was associated with higher mortality hazard in multivariable analysis (HR 2.0, 95% CI: 1.3–3.2, p = 0.002). The presence of any behavioral risk factor was associated with higher mortality hazard in univariable analysis (HR: 1.8, p < 0.05), but this difference did not reach statistical significance in multivariable analysis (HR: 1.4, 95%: 0.8–2.3, p = 0.20). Injury mechanism (ballistic versus blunt), gender, and race were not associated with increased hazard of mortality (p > 0.20). ConclusionLow SES is associated with a greater hazard of long-term mortality than ballistic injury mechanism, race, gender, and medically diagnosable behavioral risk factors in a young, healthy orthopedic trauma population with isolated extremity injury.

Abstract EP36: Socioeconomic Status And Spontaneous Coronary Artery Dissection Outcomes

Introduction: Spontaneous coronary artery dissection (SCAD) is an emerging cause of myocardial infarction. The epidemiology of SCAD is elucidated with recent investigations and analyses. However, the association between socioeconomic status (SES) and SCAD remains to be studied. We performed this study to identify the effects of SES on SCAD. Methods: We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. Socioeconomic status was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. Results: During the study period, total 106,970,745 patients were hospitalized of which 30.17% were from 1 st (lowest), 26.26% from 2 nd , 23.76% from 3 rd and 19.82 from 4 th (highest) quartile. 0.02 % (24,560 of 106,970,745) patients were diagnosed with spontaneous coronary artery dissection. When lowest SES was compared to the highest SES quartile, the patients from the lowest SES tended to be diabetic (34.17 % v 18.39%) and younger (48.39 ± 0.01 v 50.16 ± 0.01) and less prevalence of hyperlipidemia (2.79% v 3.86%). The prevalence of hypertension (29.78% v 28.31%) and proportion of male (43.59% v 43.33%) were similar. After adjusting for age, sex and comorbid burden, the lowest SES quartile was associated with lower risk of SCAD when it was compared to highest quartile (OR 0.70; 95% CI 0.65-0.76; p&lt;0.0001). However, the lowest SES quartile was associated with higher in-hospital mortality (OR 1.51; 95%CI 1.07-2.15; p=0.02) and 30-day readmission rate (OR 1.56; 95%CI 1.39 -1.88; p&lt;0.0001) with SCAD when it compared to the highest quartile. Discussion: In this study, the lowest SES was associated with lower risk of SCAD. Individuals with low SES carry substantial burden of cardiovascular diseases. It is possible that SCAD is underdiagnosed in low SES population due to the presence of traditional cardiovascular risk factors. The unfavorable effects of low SES on SCAD can be identified with in-hospital mortality and rate of 30-day readmission. Further research is required to better understand the impact of SES on the outcomes of SCAD.

Socioeconomic disparities in Rapid ambulance response for out-of-hospital cardiac arrest in a public emergency medical service system: A nationwide observational study

ObjectivesThis study aimed to examine whether county socioeconomic status (SES) is associated with emergency medical service (EMS) response time and dual dispatch response of out-of-hospital cardiac arrest (OHCA) patients using county property tax per capita in Korea. MethodsAll EMS-treated adults who suffered OHCAs were enrolled between 2015 and 2017, excluding cases witnessed by EMS providers. The main exposure was property tax per capita in the county where the OHCA occurred. The primary outcome was response time interval, with a secondary outcome of dual dispatch response. Negative binomial regression analysis to calculate incidence rate ratio (IRR) with a 95% confidence interval (CI) was conducted for EMS response time. A multivariable logistic regression analysis for response time interval (<8 min) and dual dispatch response was also conducted. ResultsA total of 71,326 patients in 228 counties were enrolled. Compared to the lowest SES quartile, OHCA patients in the highest SES quartile had shorter median (interquartile range [IQR]) response time intervals (9.5 [5.9] minutes vs. 7.6 [4.2] minutes, IRR [95% CI] 0.95 [0.94−0.96], respectively). The AOR (95% CI) for response time within 8 min was 1.07 (1.01−1.13) for the highest SES quartile compared to the lowest SES quartile. Those in the highest SES quartile also had higher rates of dual dispatch response compared to those in the lowest quantile (50.9% vs 26.6%; AOR [95% CI]: 2.16 [2.03−2.30]). ConclusionIn OHCA patients, those in a lower SES are associated with longer response times and lower dual dispatch response.

Socioeconomic status and the effectiveness of treatment for first-episode psychosis.

To assess whether patient socioeconomic status (SES) moderates the effectiveness of coordinated specialty care for first-episode psychosis and to investigate possible mechanisms. A secondary analysis of data from the RAISE-ETP Trial, which was conducted from 2010-2014. RAISE-ETP was a cluster-randomized trial comparing a coordinated specialty care (CSC) intervention called NAVIGATE with usual community care. We constructed a patient SES index based on parental education, parental occupational prestige, and race/ethnicity. After identifying correlates of SES, we used OLS regression analysis to estimate treatment effects on the major study outcomes across quartiles of the index. We also examined whether correlates of SES including the duration of untreated psychosis (DUP), and participation in NAVIGATE might account for the observed difference in effectiveness of CSC by SES. The trial sample had a similar SES distribution to the US population, and SES was positively correlated with all mental health outcomes and several potential moderators at baseline. CSC substantially improved the main trial outcomes compared to community care for patients in the highest SES quartile but had small and statistically insignificant benefits for the remaining 75% of patients. Intervention participation rates and several potential moderators did not explain this disparity. CSC may be more effective for high-SES patients with early psychosis than low-SES patients. Additional research is needed to understand why CSC is less effective for low-SES patients and to develop methods to increase effectiveness for this subgroup.

Effectiveness of Gas and Chimney Biomass Stoves for Reducing Household Air Pollution Pregnancy Exposure in Guatemala: Sociodemographic Effect Modifiers.

Household air pollution (HAP) due to solid fuel use during pregnancy is associated with adverse birth outcomes. The real-life effectiveness of clean cooking interventions has been disappointing overall yet variable, but the sociodemographic determinants are not well described. We measured personal 24-h PM2.5 (particulate matter <2.5 µm in aerodynamic diameter) thrice in pregnant women (n = 218) gravimetrically with Teflon filter, impactor, and personal pump setups. To estimate the effectiveness of owning chimney and liquefied petroleum gas (LPG) stoves (i.e., proportion of PM2.5 exposure that would be prevented) and to predict subject-specific typical exposures, we used linear mixed-effects models with log (PM2.5) as dependent variable and random intercept for subject. Median (IQR) personal PM2.5 in µg/m3 was 148 (90–249) for open fire, 78 (51–125) for chimney stove, and 55 (34–79) for LPG stoves. Adjusted effectiveness of LPG stoves was greater in women with ≥6 years of education (49% (95% CI: 34, 60)) versus <6 years (26% (95% CI: 5, 42)). In contrast, chimney stove adjusted effectiveness was greater in women with <6 years of education (50% (95% CI: 38, 60)), rural residence (46% (95% CI: 34, 55)) and lowest SES (socio-economic status) quartile (59% (95% CI: 45, 70)) than ≥6 years education (16% (95% CI: 22, 43)), urban (23% (95% CI: −164, 42)) and highest SES quartile (−44% (95% CI: −183, 27)), respectively. A minority of LPG stove owners (12%) and no chimney owner had typical exposure below World Health Organization Air Quality guidelines (35 μg/m3). Although having a cleaner stove alone typically does not lower exposure enough to protect health, understanding sociodemographic determinants of effectiveness may lead to better targeting, implementation, and adoption of interventions.

The Association Between Socioeconomic Status, Renal Cancer Presentation, and Survival in the United States: A Survival, Epidemiology, and End Results Analysis

To determine whether socioeconomic status (SES) predicts the size and local extent of tumors at presentation, and if this association leads to differences in survival. The National Cancer Institute's Survival, Epidemiology, and End Results registry was queried for patients diagnosed with renal cancers between 2004 and 2010. Demographic, tumor, survival, and socioeconomic data were obtained. Cancers with T0 classification, nonrenal cell histology, or missing clinical or pathologic data were excluded. An SES measure was created from available metrics. Outcomes analyzed were tumor size, TNM classifications at diagnosis, tumor grade and histology subtype, and survival duration. A total of 40,212 cases were identified. On regression modeling, lower SES was an independent risk factor for tumor size ≥ 4 cm (P = .003) and for T classification ≥ T2 (P = .040) at presentation, but did not predict histology subtype, positive lymph nodes, or metastasis. Lower SES predicted high-grade disease on univariate analysis (P = .012) but lost significance in the multivariate model. Lower SES was also independently predictive of shortened cancer-specific survival on multivariate analysis after adjusting for available cofactors (lowest vs highest SES quartile; P = .001). This study suggests that low SES is correlated with poorer survival outcomes in renal cancer, and this may be related to a tendency toward larger and more locally advanced tumors at diagnosis. Additional investigation is needed to ascertain whether these effects could be mediated by relatively lower rates of incidental detection via abdominal imaging in disadvantaged populations.

Association of race and socioeconomic status with the use of endovascular repair to treat thoracic aortic diseases

Descending thoracic aortic diseases may be treated with either open thoracic aortic repair or thoracic endovascular aortic repair (TEVAR). Previous studies have demonstrated that race and socioeconomic status (SES) affect access to care and treatment allocation in vascular surgery. We hypothesized that racial minorities and lower SES patients have decreased propensity to have their thoracic aortic disease treated with TEVAR. Weighted discharge records for patients who underwent either open thoracic aortic repair or TEVAR between 2005 and 2008 were evaluated using the Nationwide Inpatient Sample. Patient records were stratified by therapeutic intervention (open repair vs TEVAR). Differences in baseline comorbidities, race, and SES were compared. To account for the effects of comorbidities and other factors, hierarchical logistic regression modeling was used to determine the likelihood for TEVAR performance based on differences in patients' race and SES. A total of 60,784 thoracic repairs were analyzed, the majority (79.4%) of which were open repairs. The most common race was white (78.2%), followed by black (9.1%), Hispanic (5.7%), Asian or Pacific Islander (2.9%), and Native American (0.7%). Patients were divided into quartiles according to SES with 20.6% of patients in the lowest SES quartile, 24.3% in the second quartile, 26.4% in the third quartile, and 28.8% in the highest SES quartile. Indications for treatment were similar for both treatment groups. After adjusting for multiple patient and hospital factors, race and SES were significantly associated with treatment modality for thoracic aortic disease. Black, Hispanic, and Native American populations had increased adjusted odds ratios of TEVAR performance compared with white patients. Similarly, lower SES correlated with increased use of TEVAR. Contrary to our initial hypothesis, racial minorities (Black, Hispanic, and Native American) and patients with lower median household incomes have a greater association with the performance for TEVAR after accounting for patient comorbid disease, indication for treatment, payer status, and hospital volume. These results indicate that traditional racial disparities do not persist in TEVAR allocation.

Following the Organ Supply

Disparity in access to liver transplantation (LT) in the United States persists despite directives from the federal government to reduce geographic variation. We assessed the impact of socioeconomic status (SES) and traveling to alternative donation service areas (DSAs) on patient survival. A prospective cohort study integrating transplant registry and U.S. Census data was analyzed using multivariate linear Cox proportional hazards models. A separate matched-pairs analysis was used to assess the benefit of traveling on patient survival and transplantation rate. High SES is associated with increased access to LT (adjusted hazard ratio [aHR], 1.05; 95% confidence interval [95% CI], 1.01-1.08) and reduced mortality after waitlisting (aHR [95% CI], 0.88 [0.85-0.93]). Increased access is mediated, in part, through inter-DSA travel. Travel was associated with high SES, white race, blood group O, private insurance, and residence in regions 1, 5, and 11. Transplant candidates in the highest SES quartile were approximately 70% more likely to travel (aHR [95% CI], 1.67 [1.43-1.97]) than those in the lowest SES quartile. Compared with matched control patients, travelers were 74% more likely to be transplanted (aHR [95% CI], 1.74 [1.56-1.94]) and 20% less likely to die after listing (aHR [95% CI], 0.79 [0.69-0.92]). High SES and inter-DSA travel are strongly associated with increased LT access and reduced mortality. Travelers are more likely to be sociodemographically advantaged and privately insured and to live in regions with reduced access to deceased-donor organs.

513 THE RATES OF METASTATIC RENAL CELL CARCINOMA ARE DECREASING OVER TIME: A POPULATION-BASED ANALYSIS

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging I1 Apr 2010513 THE RATES OF METASTATIC RENAL CELL CARCINOMA ARE DECREASING OVER TIME: A POPULATION-BASED ANALYSIS Giovanni Lughezzani, Claudio Jeldres, Lars Budaus, Shahrokh F. Shariat, Rodolphe Thuret, Daniel Liberman, Philippe Arjane, Hugues Widmer, Paul Perrotte, Jean-Jacques Patard, Francesco Montorsi, and Pierre I. Karakiewicz Giovanni LughezzaniGiovanni Lughezzani Milano, Italy More articles by this author , Claudio JeldresClaudio Jeldres Montreal, Canada More articles by this author , Lars BudausLars Budaus Hamburg, Germany More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat Montreal, Canada More articles by this author , Rodolphe ThuretRodolphe Thuret Montpellier, France More articles by this author , Daniel LibermanDaniel Liberman Montreal, Canada More articles by this author , Philippe ArjanePhilippe Arjane Montreal, Canada More articles by this author , Hugues WidmerHugues Widmer Montreal, Canada More articles by this author , Paul PerrottePaul Perrotte Montreal, Canada More articles by this author , Jean-Jacques PatardJean-Jacques Patard Rennes, France More articles by this author , Francesco MontorsiFrancesco Montorsi Milano, Italy More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We assessed the rate of metastatic renal cell carcinoma (mRCC) at diagnosis in a large population-based tumor registry. METHODS Between 1988 and 2006 87842 patients were identified within 17 Surveillance, Epidemiology and End Results (SEER) registries with tissue-proven diagnosis of RCC of all stages. We examined the rates of mRCC at diagnosis throughout the study period. Multivariable logistic regression models examined the impact of year of diagnosis quartiles (1988-1992 vs. 1993-1997 vs. 1998-2002 vs. 2003-2006) on mRCC rates after adjusting for patient age, gender, race and socioeconomic status. RESULTS The overall rate of mRCC was 19.1% and it decreased from 23.8% in the first year quartile to 16.5% over the study period (chi-square trend: p<0.001). The decrease in mRCC rates was more pronounced in females (-8.6%) than in males (-6.9%), in older individuals (-12.3% in ≥80 years) than in younger patients (-7.0% in <50 years), in African-American (-9.7%) than in Caucasian patients (-7.3%), and in patients within the highest socioeconomic status quartile (-8.9%) relative to individuals within the lowest socioeconomic status quartile (-7.3%). In multivariable logistic regression models more advanced age (p<0.001), male gender (p<0.001), race other than Caucasian and African-American (p=0.02) and lower socioeconomic status (p<0.001) represented independent predictors of mRCC diagnosis. Finally, more contemporary year of diagnosis remained the foremost predictor of lower rate of mRCC at initial diagnosis (p<0.001). CONCLUSIONS Our findings are highly encouraging and suggest that a larger proportion of patients will harbor curable or highly treatable stages of RCC. Conversely, an increasingly smaller proportion of mRCC will hopefully contribute to the overall RCC patient population. The increased use of imaging studies may represent an explanation for the observed results. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e203 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Lughezzani Milano, Italy More articles by this author Claudio Jeldres Montreal, Canada More articles by this author Lars Budaus Hamburg, Germany More articles by this author Shahrokh F. Shariat Montreal, Canada More articles by this author Rodolphe Thuret Montpellier, France More articles by this author Daniel Liberman Montreal, Canada More articles by this author Philippe Arjane Montreal, Canada More articles by this author Hugues Widmer Montreal, Canada More articles by this author Paul Perrotte Montreal, Canada More articles by this author Jean-Jacques Patard Rennes, France More articles by this author Francesco Montorsi Milano, Italy More articles by this author Pierre I. Karakiewicz Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Associations between children's socioeconomic status, weight status, and sex, with screen-based sedentary behaviours and sport participation

The objective was to study associations between socioeconomic status (SES), weight status, and sex, with children's participation in sedentary behaviours and sport. Children (aged 9-10 years; n = 6,337) completed a questionnaire to establish how long they spent in sedentary behaviours and sport participation during week days and weekend days. Height and weight were measured to calculate body mass index. Associations between dependent and independent variables were investigated using hierarchical loglinear analysis. A significantly greater proportion of boys than girls spent > or = 1 h per weekday and weekend day watching television (TV) (p < 0.001), playing video games (p < 0.001), and participating in sport (p < 0.001). TV viewing and video gaming for > or = 1 h per day were inversely associated with SES (p = 0.001), whilst the greatest proportion of children participating in sport for > or = 1 h were in the highest SES quartile (p < 0.001). Overweight girls were more likely than normal weight girls to use the internet for > or = 1 h per weekend day (p < 0.001). Relatively more lower SES children spent time in sedentary behaviours than sport participation. Weight status was not consistently associated with sedentary behaviours. Proportionately more boys than girls watched TV, played video games, and participated in sport, suggesting that boys find time for sedentary behaviours and physical activity. Efforts should be made to address inequalities in the prevalence of sedentary behaviours and sport participation for all children regardless of SES, weight status, or sex.

Socioeconomic Status and the Incidence of ESRD

Persons of low socioeconomic status (SES) may be at increased risk of end-stage renal disease (ESRD). This study examines the association between SES and incidence of ESRD caused by all primary renal diseases and caused by 3 diseases that differ in the availability of effective treatment: diabetes mellitus, lupus nephritis, and autosomal dominant polycystic kidney disease (ADPKD). Retrospective cohort study. Adults with incident ESRD in the United States from January 1, 1996, to June 30, 2004 (N = 747,556). SES, based on characteristics of the patient's ZIP code of residence. Incidence of ESRD. In all sex-race groups, the incidence of ESRD caused by all primary renal diseases was greatest in those in the lowest SES score quartile and decreased progressively with higher SES. For example, for white women, the incidence of ESRD was 388.9 per million in the lowest quartile of SES and 200.8 per million in the highest quartile of SES (relative risk, 1.92; 95% confidence interval, 1.89 to 1.95). However, this association differed among patients with primary renal diseases. There were strong associations between SES and ESRD caused by diabetes mellitus, weaker associations for ESRD caused by lupus nephritis, and generally no associations for ESRD caused by ADPKD. For example, for white women, relative risks of ESRD in the lowest compared with the highest SES quartile were 2.84 for ESRD caused by diabetes mellitus, 1.63 for ESRD caused by lupus nephritis, and 1.27 for ESRD caused by ADPKD. Use of an area-based measure of SES. The strength of the association between SES and ESRD differs among patients with diabetes mellitus, lupus nephritis, and ADPKD, suggesting that socioeconomic factors act differently in the progression of chronic kidney disease in these conditions.

Transfer Access from Community Colleges and the Distribution of Elite Higher Education

admissions practices of the most highly selective colleges and universities of the United States are under scrutiny for their failure to enroll poor and working-class students (Douthat, 2005; Karabel, 2005; Klein, 2005). This negative attention has been spearheaded by findings reported in two important books examining the shortage of low-income students at the pinnacle of American higher education, Equity and Excellence in Higher Education by William Bowen, Martin Kurzweil, and Eugene Tobin (2005) and America's Untapped Resource: Low-Income Students in Higher Education, edited by Richard Kahlenberg (2004), as well as by research articles (e.g. Winston & Hill, 2005). In a chapter in the Kahlenberg text, for example, Carnevale andRose reported that only 3% of freshmen entering 146 highly selective institutions in 1992 came from the lowest quartile of a socioeconomic status (SES) index and about 10% came from the entire bottom half of the SES distribution (2004, p. 106). Demonstrating a highly skewed distribution of access, nearly three fourths (74%) of students enrolled at these institutions come from the highest SES quartile. Contributing further attention to the lack of socioeconomic diversity at elites, Thomas Mortenson of the Pell Institute for the Study of Opportunity in Higher Education began ranking prestigious schools according to their success or failure in enrolling financially needy students, as indicated by the proportion of the student body receiving federal Pell grants (Fischer, 2006a). findings of these studies have been widely reported (see, for example, Fischer, 2006a; Gose, 2005; Hong, 2005; Selingo & Brainard, 2006), inspiring headlines such as The chorus grows louder for class-based affirmative action (Gose, 2005). controversy raises substantial questions about the way in which valuable educational resources are distributed and the definitions of merit that prevail when elite institutions choose among numerous qualified candidates. Family affluence clearly affects what type of college a student attends or whether they go to college at all. This is shown, for example, by differences in college participation by high-and low-income students with medium-high preparedness--in other words, those who are not at the top of their class but are well qualified for college. Only 3% of wellqualified students from high-income families did not attend college, in comparison to 13% of those from low-income families. Well-qualified students from high-income families were also much more likely to attend a high-priced college than were their low-income peers (52% vs. 20%) (Hoxby, 2000, cited in Bowen et al., 2005, p. 87). Socioeconomic inequalities in college enrollments raise troubling issues for education in a democratic society. Providing students with the opportunity to enroll at a college appropriate for their level of academic ability, regardless of family circumstances, is a cornerstone of higher education policy (Bowen et al., 2005; Kahlenberg, 2004; St. John, 2003). Maintaining this commitment has become more challenging as per capita government funding for college operating subsidies and low-income student aid has declined (Archibald & Feldman, 2006; Trends in Student Aid, 2006; Weerts & Ronca, 2006). As the returns to a college degree have increased, so has demand (Education Pays, 2006), particularly for spots at highly selective colleges, whose graduates enjoy an even higher earnings premium than others (Eide, Brewer, & Ehrenberg, 1998). Students at elite colleges enjoy additional benefits as well, including a greater likelihood of degree completion and greater access tograduate and professional study (Carnevale & Rose, 2004). These benefits have spawned intense competition for enrollment at highly selective colleges, and the recent increases in socioeconomic inequities in access (Astin & Oseguera, 2004) suggest that upper-income students have successfully utilized their numerous advantages to win this competition. …

The relationship between socio-economic status and physical activity patterns in South African children.

To examine: (1) the associations between socio-economic status, physical activity, anthropometric and body composition variables in South African children; (2) the influence maternal characteristics have on children's physical activity levels; and (3) associations between television watching, activity level and body composition. In 381 South African children, physical activity and socio-economic status were assessed via structured retrospective interview using validated questionnaires. An asset indicator score was calculated as a proxy measure of socio-economic status and used to divide children into quartiles. Children falling into the highest socio-economic status quartile had mothers with the highest educational levels, generally came from dual parent homes, were highly physically active, watched less television, weighed more and had greater lean tissue than children in lower quartiles. A greater percentage of children living in dual parent homes and with mothers of a higher educational status were highly active compared with children living in single parent homes and with mothers of a lower educational status. We found greater levels of lean mass with increased activity level after controlling for television watching time and fat mass. There were high levels of low activity and high television watching time among lower socio-economic status groups. There were significant racial differences in patterns of activity. White children were found to be more active than black children, more likely to participate in physical education classes at school and watched less television than black children. Physical activity levels and socio-economic variables are closely related in this population of South African children.

Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria

Objectives: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers’ view and inequities in willingness to pay (WTP) for CT. Methods: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine–pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem R were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates. Results: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem R in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group. Conclusion: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria.