Highest Socioeconomic Status Quintile Research Articles

Racial/ethnic and socioeconomic differences in breast cancer surgery performed and delayed surgical treatment: Mediating impact on mortality.

585 Background: Breast cancer is the most common malignancy affecting women of all racial and ethnic backgrounds in the United States (US). Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quantified the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. Methods: We studied 290,066 women 40+ years old diagnosed with breast cancer between 2010 and 2017 identified from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. The study subjects were de-identified, and there was no patient contact; thus, the study was exempted from an Institutional Review Board's (IRB) approval. A p-value less than 0.05 indicated significant associations for the descriptive statistics, logistic and Cox proportional hazard regressions, and mediation analysis. We used Stata 17 to perform the analyses. Results: Non-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24-1.31] were significantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites. Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-specific mortality (BCSM). Variations in treatment, SES, and clinicopathological factors significantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. Conclusions: In conclusion, health disparity continues to be a major societal concern in the US. It affects people of all ages, socioeconomic classes, and ethnic/racial backgrounds. The findings of this study showed that racial and ethnic minorities, the majority of whom have a lower socioeconomic position, are significantly disadvantaged regarding the evaluation, quality, cost, and duration of medical care. Future studies can assess the multifactorial effects of sociodemographic factors like SES, access to health care assessment, and educational background amidst other variables as a multidimensional predictor of treatment delay and overall survival of breast cancer and other health issues among minoritized populations.

Racial/ethnic and socioeconomic differences in breast cancer surgery performed and delayed treatment: mediating impact on mortality.

Although Socioeconomic status (SES), race/ethnicity, surgical type, and treatment delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and treatment delays. Also, we quantified the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. We studied 290,066 women 40 + years old diagnosed with breast cancer between 2010 and 2017 identified from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and treatment delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. Non-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI 1.24-1.31] were significantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed treatment than NH Whites. Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-specific mortality (BCSM). Variations in treatment, SES, and clinicopathological factors significantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. Bridging the gap of access to adequate healthcare services for all to diminish the disproportionate burden of breast cancer would require a multifactorial approach that addresses several biological and social factors that cause these differences.

Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer.

The purpose of this study was to assess the association of comorbidity burden with overall survival, accounting for racial/ethnic and socioeconomic differences in patients with cancer. In this retrospective cohort study, patients newly diagnosed with cancer between 2010 and 2018 were identified from a large health plan in southern California. Cancer registry data were linked with electronic health records (EHR). Comorbidity burden was defined by the Elixhauser comorbidity index (ECI). Patients were followed through December 2019 to assess all-cause mortality. Association of comorbidity burden with all-cause mortality was evaluated using Cox proportional hazards model. Crude and adjusted hazard ratio (HR, 95%CI) were determined. Of 153,270 patients included in the analysis, 29% died during the ensuing 10-year follow-up. Nearly 49% were patients of color, and 32% had an ECI > 4. After adjusting for age, sex, race/ethnicity, cancer stage, smoking status, insurance payor, medical center, year of cancer diagnosis, and cancer treatments, we observed a trend demonstrating higher mortality risk by decreasing socioeconomic status (SES) (P-trend<.05). Compared to patients in the highest SES quintile, patients in the lowest, second lowest, middle, and second highest quintiles had 25%, 21%, 18%, and 11% higher risk of mortality, respectively [(HR, 95%CI): 1.25 (1.21-1.29), 1.21 (1.18-1.25), 1.18 (1.15-1.22), and 1.11 (1.07-1.14), respectively]. When we additionally adjusted for ECI, the adjusted HRs for SES were slightly attenuated; however, the trend persisted. Patients with higher comorbidity burden had higher mortality risk compared to patients with ECI score = 0 in the adjusted model [(HR, 95%CI): 1.22 (1.17-1.28), 1.48 (1.42-1.55), 1.80 (1.72-1.89), 2.24 (2.14-2.34), and 3.39 (3.25-3.53) for ECI = 1, 2, 3, 4, and >5, respectively]. Comorbidity burden affects overall survival in cancer patients irrespective of racial/ethnic and SES differences. Reducing comorbidity burden can reduce some, but not all, of the mortality risk associated with lower SES.

Understanding the association between neighbourhood socioeconomic status and grocery store alcohol sales following market liberalization in Ontario, Canada.

In 2015, Ontario partially deregulated alcohol sales by allowing grocery stores to sell alcohol. The purpose of this study was to evaluate (1) whether neighbourhood-level socioeconomic status (SES) impacted the likelihood that a grocery store began selling alcohol, and (2) whether increases in alcohol retail availability following deregulation differed between neighbourhoods based on SES. This was a repeated cross-sectional analysis of 1062 grocery stores in 17,096 neighbourhoods in urban Ontario. The association between neighbourhood-level SES and whether a grocery store began selling alcohol was modeled using mixed effect logistic regression. The annual change in drive-distance from a neighbourhood to the closest off-premise alcohol outlet between 2015 and 2020 was modeled using mixed effect linear regression. An interaction between time and SES was included to evaluate whether this change differed between neighbourhoods based on SES. Grocery stores in neighbourhoods in the lowest SES quintile were 39% less likely to start selling alcohol than grocery stores in neighbourhoods in the highest SES quintile (odds ratio (OR): 0.61, 95% confidence interval (CI): 0.39-0.94). As grocery store sales expanded, the distance to the closest off-premise alcohol outlet decreased by 51.8 m annually (95% CI: 48.8-54.9, p < 0.01). A significant interaction between year and SES was observed whereby this trend was more pronounced in high- versus low-SES neighbourhoods. The expansion of grocery store alcohol sales increased alcohol availability, but this increase was proportionately larger in high- versus low-SES neighbourhoods. This reduced historic disparities in alcohol availability between low- and high-SES neighbourhoods.

Abstract 3630: Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups

Abstract Introduction: Breast cancer survivors have an increased risk of contralateral breast cancer (CBC), among whom minority breast cancer patients are at increased risk of this adverse outcome. Studies evaluating CBC risk by race/ethnicity frequently aggregate Asian/Pacific Islanders (API) into a single group or exclude them. The purpose of this study was to determine the impact of socioeconomic status (SES) on the risk of CBC among subgroups of API breast cancer survivors. Method: We conducted a population-based retrospective cohort study of women ages 18+ years diagnosed with unilateral Stage I-III breast cancer using the Surveillance, Epidemiology and End Results Census Tract-level SES and Rurality Database (2000-2016). Women included in the study received cancer-directed surgery and the primary outcome of interest was asynchronous CBC occurring. SES was classified using the Yost index, a validated time-dependent composite score with the 1st quintile representing the lowest and 5th quintile being the highest SES. API women were categorized into Chinese, Japanese, Filipina, Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other Asian/Pacific Islanders. We determined overall associations between SES and the risk of CBC using Fine and Gray regression models accounting for competing risks comparing API women to Non-Hispanic White (NHW) women. Multivariable adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. Results: From a cohort of 44,362 API female breast cancer patients included, one quarter of the cohort were Filipina (25%), 18% were Chinese, 14% were Japanese, 8% were Indian/Pakistani, and 17% were other API. API women living in the lowest SES areas were more likely to be uninsured or have Medicaid coverage (21% vs. 6%) and have Stage lll first primary breast cancer (14% vs. 10%) compared to API women living in the highest SES areas. Overall, API breast cancer patients as an aggregate group did not have significantly increased risk of CBC compared to NHW patients. In stratified subgroups, risk estimates for CBC were higher among Chinese women (SHR 1.24, 95% CI 1.08-1.41), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Hawaiian women (SHR 1.67, 95% CI 1.37-2.08) when compared to NHW women after adjusting for demographics and baseline clinical characteristics. Lower SES was not associated with increased CBC risk among API women overall. However, the risk of CBC is significantly lower among Chinese and Vietnamese women and higher among Filipina women who lived in areas lower SES quintile compared to women who lived in area with the highest SES quintile when examining impact of SES within API subgroups. Conclusion: Chinese, Filipina, and Hawaiian women have higher risk of CBC when compared to NHW. When disaggregated API women into subgroups, the impact of SES on the risk of CBC differs significantly across API subgroups. Citation Format: Hsiao- Ching Huang, Jenny S. Guadamuz, Kent F. Hoskins, Naomi Y. Ko, Gregory S. Calip. Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3630.

The Co-occurrence of Specialty Vape Shops, Social Disadvantage, and Poor Air Quality in the United States: An Assessment of Cumulative Risks to Youth.

Introduction: We conducted a cumulative environmental health risk assessment of whether specialty vape shops and poor air quality are more likely to co-occur in socially disadvantaged neighborhoods where racial/ethnic minority youth live.Methods: We examined the population-adjusted incidence of specialty vape shops in relation to youth race/ethnicity, neighborhood socioeconomic status (SES), and air quality (nitrogen dioxide [NO2]) at the census tract level across the conterminous United States for 2018.Results: We did not find disparity in vape shop incidence related to minority youth race/ethnicity. Vape shop incidence was significantly negatively associated with all the youth race/ethnicities examined. The two lowest SES quintiles had nearly double the rate of specialty vape shop incidence compared with the highest SES quintile. Specialty vape shop incidence increased with NO2 concentration, with more vape shops in poor air quality neighborhoods.Conclusions: Specialty vape shops are disproportionately present in neighborhoods with poor air quality and where socially disadvantaged youth live. The increased incidence of vape shops in poor air quality neighborhoods, particularly in an urban context with increased traffic emissions, further points to potentially disproportionate impacts on disadvantaged populations due to cumulative social and environmental risks. This raises environmental justice and health equity concerns. Retailer-focused strategies aimed at limiting youth exposure to electronic cigarettes' labeling and advertising, preventing sales to minors, and limiting the number of retailers in low-SES neighborhoods may reduce initiation and help prevent tobacco-related health disparities among youth.

Socioeconomic Disparities in Functional Status in a National Sample of Patients With Rheumatoid Arthritis

Little is known about the association of poverty with functional status (FS) in patients with rheumatoid arthritis (RA) who use rheumatology care. To examine the association between socioeconomic status (SES) and FS among patients with RA and to evaluate the association between SES and functional declines over time in patients who received at least some rheumatology care. This cohort study used data from the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) registry between January 1, 2016, and December 31, 2018. Analyses included all adult patients with a confirmed RA diagnosis (ie, had ≥2 encounters associated with RA International Classification of Diseases codes ≥30 days apart) and at least 1 FS score documented between 2016 and 2018 seen at participating rheumatology practices. Data analysis was conducted from April to December 2020. The Area Deprivation Index (ADI), a zip code-based indicator of neighborhood poverty, was used as a proxy for SES. ADI scores were categorized into quintiles. FS measures included Multidimensional Health Assessment Questionnaire (MDHAQ), Health Assessment Questionnaire Disability index, and Health Assessment Questionnaire-II. Cross-sectionally, mean FS scores were compared across ADI quintiles. Longitudinally, among patients with at least 2 FS scores, multilevel multivariate regression computed the probability of functional decline, defined as a change greater than the minimum clinically important difference, across ADI quintiles. In a subgroup analysis, whether disease activity mediated the association between SES and functional decline was examined. Of the 83 965 patients included in the study, 66 649 (77%) were women, and 60 037 (72%) were non-Hispanic White. Mean (SD) age was 63.4 (13.7) years. MDHAQ was the most reported FS measure (56 928 patients [67.8%]). For all measures, mean (SD) FS score was worse at lower SES levels (eg, for MDHAQ quintile 1: 1.79 [1.87]; quintile 5: 2.43 [2.17]). In longitudinal analyses, the probability of functional decline was 14.1% (95% CI, 12.5%-15.7%) in the highest SES quintile and 18.9% (95% CI, 17.1%-20.7%) in the lowest SES quintile. The association between SES and functional decline was partially mediated (7%; 95% CI, 4%-22%) by disease activity. In this cohort study of patients with RA, worse FS and faster declines in functioning over time were observed in patients with lower SES. These findings provide a framework for monitoring disparities in RA and for generating evidence to spur action toward achieving health equity.

Abstract 776: Differences in impact of socioeconomic status on cancer: Specific survival in metastatic breast cancer by race/ethnicity

Abstract Introduction: Disparities in breast cancer (BC) incidence and outcomes exist across racial/ethnic groups in the U.S. and by socioeconomic status (SES). The extent to which lower SES independently impacts breast cancer outcomes in different racial/ethnic groups is not fully described. Our purpose was to determine the impact of SES on cancer-specific mortality among women with metastatic breast cancer. Method: We conducted a large, population-based retrospective cohort study of women ages 18+ years diagnosed with de novo metastatic breast cancer using the Surveillance, Epidemiology and End Results Census Tract-level SES and Rurality Database (2000-2015). SES was described using the Yost index, a validated time-dependent composite score that reflects SES based on several components including education and income, with the 1st quintile representing the lowest and 5th quintile being the highest SES. Information on demographic and clinical characteristics, including hormone receptor (HR) status, cancer treatment, survival and cause of death were collected from cancer registry data. We determined associations between SES and BC-specific mortality in Fine and Gray regression models. Multivariable adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were calculated accounting for competing risks of death. We determined associations between SES and BC mortality overall and calculated stratum specific SHR estimates by racial/ethnic groups and HR status. Results: In an overall cohort of 33,976 women with de novo metastatic BC, the majority were non-Hispanic white (67%), 17% were Black, 0.4% were American Indian/Alaskan Native, 6% were Asian/Pacific Islander and 10% were Hispanic. Compared to women in the highest SES quintile, women in the lowest SES were more likely to be uninsured or on Medicaid (25% vs. 7%) and have HR-negative disease (24% vs. 18%) but were similar with respect to treatment with surgery, radiation and chemotherapy. Overall, metastatic BC patients in the lowest SES quintile had a significantly increased risk of BC mortality compared to the highest SES quintile (adjusted SHR 1.27, 95% CI 1.22-1.32); however, these impacts of SES differed across racial/ethnic groups and by HR status. Risk estimates for the association between low SES (1st quintile) and BC mortality were lower among HR-positive white women (SHR 1.19, 95% CI 1.12-1.26) and minimal among Asian/Pacific Islander women (SHR 1.05, 95% CI 0.88-1.25). The greatest increased risk was observed among HR-negative Black women (SHR 1.38, 95% CI 1.00-1.90) with metastatic BC. Conclusion: Independent of race/ethnicity, lower SES is significantly associated with BC-specific mortality among women with de novo metastatic disease. However, when stratifying these effects by racial/ethnic groups and HR status, the impact of SES appears to be greater among Black women with HR-negative metastatic BC. Citation Format: Hsiao- Ching Huang, Mary H. Smart, Huiwen Deng, Ashwini Zolekar, Colin C. Hubbard, Kent F. Hoskins, Naomi Y. Ko, Gregory S. Calip. Differences in impact of socioeconomic status on cancer: Specific survival in metastatic breast cancer by race/ethnicity [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 776.

Socioeconomic Disparities in All-Cause and Cause-Specific Mortality Rates among Municipalities in Japan, 1999-2019.

Differences in all-cause and cause-specific mortality rates depending on municipal socioeconomic status (SES) in Japan have not been revealed over the last 20 years. This study exposes the difference in 1999 and 2019 using the Vital Statistics. All of the municipalities were grouped into five quintiles based on their SES, and standardized mortality ratio (SMR) of each municipal quintile compared with all of Japan was calculated for all-cause mortality and representative cause of deaths. As a result, although SMR for all-cause mortality for women tended to be lower in low SES quintiles in 1999, the reverse phenomenon was observed in 2019. Additionally, although SMR for all-cause of mortality for men was the lowest in the highest SES quintiles already in 1999, the difference in the SMR for all-cause mortality rates between the lowest and highest SES quintiles increased in 2019. The improvement of the SMR in the highest SES quintile and the deterioration in the lowest was also observed in representative types of cancer, heart disease, stroke, pneumonia, liver disease, and renal failure for men and women. Therefore, this study indicates a disparity in mortality depending on municipal SES enlarged in the last 20 years.

Education and Socioeconomic Level of Mothers Are Negatively Associated with the Diet Quality of Their Offspring– Evidence from the 2015 Colombian Nutrition Survey

Abstract Objectives To analyze the association between maternal education level and socio-economic status (SES), and diet quality of Colombian children. Methods The National Nutrition Survey (ENSIN) 2015 was a cross-sectional survey examining general health and dietary intake in a representative sample of Colombian children and adults. The Alternative Healthy Eating Index (AHEI), an indicator of adherence to diet quality, was calculated using a single 24 h recall questionnaire administered to 11,641 children aged 6–17y (5470 females, 6171 males). Diet quality was considered low, intermediate or high if the median AHEI score ranged between 17.0–44.0; 44.5–54.0; or 54.5–74.0, respectively. Maternal education was categorized as having: incomplete elementary school or less, complete primary or incomplete high school, complete high school or incomplete university, or professional degree or higher. A validated wealth index (quintiles) was used to define SES. These two risk factors were fitted in an adjusted linear regression model to investigate their association with children's diet quality. Results The median AHEI score was 43.7 (IQR: 35.7–51.5) A fifth of the mothers had the lowest educational level, whilst 5.7% reported having a professional degree or higher education. Increasing maternal education level was negatively associated with diet quality (p-trend &amp;lt; 0.001). Children of women with the highest educational level had, on average, 2.7 lower units of AHEI compared to those of mothers with the lowest education level (P &amp;lt; 0.001). Similarly, SES was negatively associated with diet quality (p-trend &amp;lt; 0.001). Children in the highest SES quintile had a mean 4.7 lower units of AHEI compared those in the lowest SES (P &amp;lt; 0.001). Conclusions Higher maternal education and SES were associated with lower diet quality in Colombian children. The findings suggest that Colombia is experiencing a pattern 4 of the Nutrition Transition (‘Western’ style diet), which is a known risk factor for non-communicable diseases. Funding Sources GMG was supported by the Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS) (Fondo para Investigación en Salud-FIS-). MRD was funded by COLCIENCIAS (Convocatoria 647). FDCM was funded by the Fulbright Commission and the Fundação para a Ciência e Tecnologia (SFRH/BD/144,563/2019).

Socioeconomic status, race, and mortality disparities in insured patients in southern California.

e19060 Background: One known factor related to increased mortality is lack of health insurance coverage. To eliminate this variable we evaluated overall mortality by socioeconomic status (SES) in an insured southern California population diagnosed with cancer accounting for confounding factors including race/ethnicity. Methods: We identified adults diagnosed with eight common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and race/ethnicity. Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder; total of numbers of deaths was N=41,727. Compared to subjects in the highest SES quintile, we found an increased overall mortality risk in each of the lower SES quintiles. In multivariable models, mortality risk was 16% to 37% greater in the lower SES groups versus the highest SES group. Conclusions: After multivariable adjustment that accounted for race/ethnicity, cancer treatments and tumor factors, insured individuals in lower SES groups had a significantly higher overall mortality risk compared those in the highest SES group. [Table: see text]

A comparison of sociodemographic and psychological characteristics among intended parents, surrogates, and partners involved in Australian altruistic surrogacy arrangements

To characterize the sociodemographic and psychological profiles of participant groups involved in altruistic surrogacy in Australia. Cross-sectional study. Single psychological practice in Sydney, Australia. Six hundred and two individuals involved in 160 altruistic surrogacy arrangements: 143 intended mothers, 175 intended fathers (including 17 same-sex intended father couples), 160 surrogates, and 124 surrogate partners. None. Responses to a presurrogacy sociodemographic assessment counseling protocol and the Personality Assessment Inventory (PAI). The surrogates were primarily sisters, sisters-in-law, mothers (48.6%), or other extended family or friends (46.3%) of the intended parents. Most participants resided in residential postcode areas within the highest socioeconomic status quintile; however, intended mothers were more likely than surrogates to live in the most advantaged residential areas, to be younger and be more educated, and to be employed in professional occupations. Most participant psychological profiles were normal. A statistically significantly elevated PAI Somatic Complaints-Health Concerns subscale for intended mothers was observed compared with other participant groups. The higher PAI Warmth scale scores of intended mothers and surrogates were statistically significantly different from their respective partners, although not different from each other. Sociodemographic and some psychological differences between participant groups were observed that warrant exploration in pretreatment surrogacy counseling. Importantly, the higher scores on the PAI Warmth scale exhibited by intended mothers and surrogates in the context of close family and friendship relationships are likely to serve as protective mechanisms for the altruistic surrogacy outcome.

Contribution of Geographic Location to Disparities in Ovarian Cancer Treatment.

More than 14,000 women in the United States die of ovarian cancer (OC) every year. Disparities in survival have been observed by race and socioeconomic status (SES), and vary spatially even after adjusting for treatment received. This study aimed to determine the impact of geographic location on receiving treatment adherent to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for OC, independent of other predictors. Women diagnosed with all stages of epithelial OC (1996-2014) were identified through the California Cancer Registry. Generalized additive models, smoothing for residential location, were used to calculate adjusted odds ratios (ORs) and 95% CIs for receiving nonadherent care throughout California. We assessed the impact of distance traveled for care, distance to closest high-quality hospital, race/ethnicity, and SES on receipt of quality care, adjusting for demographic and cancer characteristics and stratifying by disease stage. Of 29,844 patients with OC, 11,419 (38.3%) received guideline-adherent care. ORs for nonadherent care were lower in northern California and higher in Kern and Los Angeles counties. Magnitudes of associations with location varied by stage (OR range, 0.45-2.19). Living farther from a high-quality hospital increased the odds of receiving nonadherent care (OR, 1.18; 95% CI, 1.07-1.29), but travel >32 km to receive care was associated with decreased odds (OR, 0.76; 95% CI, 0.70-0.84). American Indian/other women were more likely to travel greater distances to receive care. Women in the highest SES quintile, those with Medicare insurance, and women of non-Hispanic black race were less likely to travel far. Patients who were Asian/Pacific Islander lived the closest to a high-quality hospital. Among California women diagnosed with OC, living closer to a high-quality center was associated with receiving adherent care. Non-Hispanic black women were less likely to receive adherent care, and women with lower SES lived farthest from high-quality hospitals. Geographic location in California is an independent predictor of adherence to NCCN Guidelines for OC.

Who Enrolls in High School Music? A National Profile of U.S. Students, 2009–2013

The purpose of this study is to construct a complete demographic profile of high school music ensemble students using nationally representative data for the U.S. graduating high school class of 2013. We make use of restricted-use data from the National Center for Education Statistics High School Longitudinal Study of 2009 (HSLS). Results showed that 24% of the class of 2013 enrolled in at least one year of a course in band, choir, or orchestra at some point during high school. Music students were 60% female and 40% male, and the racial/ethnic composition of music ensemble students was 58% White, 13% Black or African American, 17% Hispanic or Latino, 4% Asian or Pacific Islander, 8% two or more races, and under 1% American Indian or Alaska Native. Students from the highest socioeconomic status quintiles were overrepresented among music students. Fully 61% of music ensemble students participated in some form of arts activity outside of school, and 71% of music students attended a play, concert, or live show with their parents as ninth graders. Complete results presented in the article include disaggregated profiles by type of ensemble and a multivariate logistic regression analysis.

Maternal socioeconomic status and infant mortality with low birth weight as a mediator: an inter-country comparison between Scotland and Denmark using administrative data

ABSTRACT&#x0D; ObjectivesHigher rates of infant mortality in the UK than in the Nordic countries are partly explained by wider socio-economic disparities in the UK. We examined the extent to which low birth weight mediates the association between socioeconomic status (SES) and infant mortality using causal mediation analysis. We used cohorts of live births identified in administrative hospital data for the whole of Scotland and Denmark to explore the contribution of prenatal factors, represented by low birth weight, to differences in infant mortality between the two countries.&#x0D; ApproachWe included live-born children born in Denmark (n=1,432,205) and Scotland (n=1,427,163) from 1981-2004. Follow up was to 12 months of age. Information on deaths in first year of life was obtained through linkage with cause of death registers. We determined the effect of socioeconomic status on all cause infant mortality by comparing the highest and lowest quintiles of area-based deprivation (based on Carstairs score in Scotland) or level of maternal education in Denmark. Causal mediation analysis was used for survival outcomes with adjustment for maternal age at birth, sex, birth year of the child, and records indicating congenital malformation.&#x0D; ResultsDuring the follow-up, there were 8,158(0.57%) deaths in Denmark and 8,271(0.58%) deaths in Scotland. Comparing with the very high SES group, the overall hazard ratios of death for each SES quintile (starting with the lowest) compared with the highest SES quintile were 1.58(95% Confidence interval: 1.47-1.71), 1.40(1.32-1.49),1.25(1.20-1.30), 1.11(1.09-1.14) in Denmark, and 1.50(1.36-1.65),1.35(1.25-1.45),1.22(1.16-1.28),1.10(1.08-1.13) in Scotland. The proportions of excess infant deaths mediated through low birth weight (starting with the lowest) compared with the highest SES quintile were 54.7%, 52.1%, 49.5%, 46.9% in Denmark, and 26.0%, 23.9%, 22.0%, 20.1% in Scotland.&#x0D; ConclusionOur result suggests that SES has similar effects on infant mortality in Denmark and Scotland but more of the effect of SES on infant mortality is mediated through low birth weight in Denmark. Public health preventive strategies for infant mortality in both countries need to address prenatal risk factors for low birth weight. The substantial direct effects of SES on infant mortality seen in Scotland, which were not mediated through low birth weight, may be explained by other birth characteristics or could reflect persisting SES disparities in the care of infants after birth.

Abstract A78: Atlas of disparities in cancer survival in California: An intersectional approach

Abstract The burden of cancer on the diverse U.S. population is not equal. Enduring disparities in survival persist by social determinants of health (SDOH) including race/ethnicity, nativity, individual and contextual socioeconomic status (SES), and marital status. To accurately target cancer control initiatives to patients with the greatest need, it is vital to know where disparities in survival occur. The cancer survival atlas aims to systematically identify disparities in cancer survival in the state of California, applying an intersectional approach to examine disparities jointly by sex and SDOH factors including race/ethnicity, nativity, health insurance, marital status, and neighborhood SES. The atlas will provide the necessary epidemiological underpinning for future initiatives focused on improving outcomes in disadvantaged and under-served populations. Statewide population-based cancer registry data, enhanced with complete nativity and neighborhood characteristics, was used to produce cancer-specific survival at 1-, 3-, 5- and 10-years for all patients diagnosed between the year 2000 and 2013 with one of the five most common cancers in the state (breast, prostate, lung, colorectal and melanoma). Population groups were defined by sex, age, marital status, race/ethnicity (non-Hispanic White, Hispanic, Black, and Asian American &amp; Pacific Islander (AAPI) ethnic groups), nativity, health insurance, and neighborhood SES. Neighborhood SES was assigned to cases based on residential block group, based on principal components analyses derived indices from 2000 Census or 2007-2011 American Community Survey data, and categorized according to statewide quintiles. Age and stage-adjusted survival probabilities were estimated, then multivariable Cox Proportional Hazard models were used to investigate the relative contribution of factors associated with survival and to adjust for confounders. We found considerable socioeconomic and racial/ethnic disparities in survival for all five cancer sites examined, with the largest disparities seen for cancers with a good prognosis (breast, prostate, melanoma), and by health insurance status of all of the SDOH factors. For breast cancer, women residing in neighborhoods with the lowest SES quintile had significantly poorer cancer-specific survival than women in the highest SES quintile (hazard ratio (HR) = 1.53 (95% CI 1.47-1.61), adjusting for stage, health insurance, race/ethnicity). The largest racial/ethnic disparities were also seen in breast cancer. Non-Hispanic Black women had the lowest survival (HR = 1.50 (95% CI 1.44-1.56)), and AAPI women the highest (HR = 0.85 (95% CI 0.81-0.89)) compared to Non-Hispanic White women. Differences in survival by health insurance status were also evident for all five cancers. For melanoma, survival was substantially lower among men with no health insurance (HR = 1.89 (95% CI 1.57-2.26)) and among men with public, military or Medicaid insurance (HR = 1.40 (95% CI 1.29-1.52)) compared to men with private insurance. Disparities in survival by health insurance status were present across all socioeconomic and racial/ethnic groups. Disparities in survival among groups defined by SDOH factors in California are substantial. These results will serve as a resource for the targeting and development of interventions, such as early diagnosis initiatives, to address the needs of specific population groups in California. Citation Format: Elizabeth Ellis, Scarlett L. Gomez. Atlas of disparities in cancer survival in California: An intersectional approach. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A78.

Socioeconomic status and glioblastoma risk: a population-based analysis

Socioeconomic status (SES) is associated with risk of various cancer types because of correlation between SES and causal factors or increased case ascertainment, or both. Studies evaluating the association between glioblastoma and occupational or SES factors have yielded inconsistent results. We evaluated the association between SES and glioblastoma risk using a large, population-based cancer registry dataset. Data of the Surveillance, Epidemiology, and End Results Program were used to evaluate the impact of SES on glioblastoma risk. SES was divided into quintiles on the basis of census tract of residence. Census tracts are small, geographically defined areas with relatively homogeneous population characteristics. Higher SES was strongly associated with increased risk of glioblastoma (p<.001). Relative to persons living in census tracts of the lowest SES quintile, the highest SES quintile had a rate ratio of 1.45 (95% CI 1.39-1.51) (p<.001). Similar associations were seen in population subgroups defined by age, sex, and race. The strong association between higher SES and greater glioblastoma risk is unlikely to represent an ascertainment effect because glioblastoma is rapidly progressive and ultimately fatal. A number of previously proposed glioma risk factors may be correlated with SES, including atopy and allergy rates, cellular telephone use, and body morphometric measures. Further research is needed to define the mechanism of this association.

Socioeconomic status and the use of computed tomography in the emergency department.

Low socioeconomic status (SES) is associated with adverse health outcomes. Possible explanations include differences in health status, access to health care, and care provided by clinicians. We sought to determine whether SES is associated with computed tomography (CT) use in the emergency department (ED). A retrospective cohort study of all Ontario ED patients (April 1, 2009, to March 31, 2010) using administrative databases was conducted, and patients were stratified into SES quintiles based on median neighbourhood income. Using multivariate logistical regression, CT scan use within SES quintiles was compared for all patients and subgroups based on chief complaints: headache, abdominal pain, and complex abdominal pain (age ≥ 65 years, high acuity, and admittance to hospital). We analyzed 4,551,101 patient visits, of which 52% were female. Overall, 8.2% underwent CT scanning. In adjusted analyses, the lowest SES patients were less likely to undergo CT scanning overall and in all clinical subgroups, except for complex abdominal pain. Compared to the lowest SES quintile, the adjusted odds ratios of CT scanning in the highest SES quintile were 1.08 (95% CI 1.07-1.09), 1.28 (95% CI 1.22-1.34), and 1.24 (95% CI 1.21-1.27) for all patients, headache pain patients, and abdominal pain patients, respectively. For patients presenting with complex abdominal pain, no significant difference in CT use was observed. Lowest SES ED patients were less likely to receive CT scans overall and in headache and abdominal pain subgroups. No difference was seen among complex abdominal pain patients, suggesting that as clinical indications for the test become more clearcut, use across SES quintiles differs less.

Impact of socio‐economic status on breast cancer screening in women with diabetes: a population‐based study

There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes. A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday, or 2 years after diabetes diagnosis--whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables. Of 504,288 women studied (188,759 with diabetes, 315,529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio 0.79, 95% CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio 0.79, 95% CI 0.75-0.83). The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider, and health system factors are needed to improve cancer screening in this population.

A California population-based study on long-term survivors of hepatocellular carcinoma.

195 Background: Hepatocellular carcinoma (HCC) is becoming increasingly common in the United States and long-term survival remains dismal, with only 15% of patients surviving more than 5 years. Little is known about the demographic and clinical characteristics of patients who survive. Methods: Using data from the California Cancer Registry, a member of the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program, we identified all patients diagnosed with hepatocellular carcinoma between 1988 and 2007. Patients were included if they had pathological, clinical, laboratory or radiological confirmation of diagnosis. Patient’s demographic information including socio-economic status, summary stage, tumor characteristics and treatment details were included in the analysis. Hazard ratios (HR) for survival were calculated using Cox proportional hazards regression modeling. Results: We identified 19,855 patients with a median age of diagnosis of 63. Patients were predominantly male (74.4%). The majority of patients were Non-Hispanic Whites (38.1%) followed by Asian and Pacific Islander (API) (30.4%) and Hispanics (23.2%). Of the entire cohort, 3546 (17.9%) survived at least 3 years. Amongst long-term survivors, when classified by summary stage, 2552 (72%) were localized, 556 (15.7%) regional, 217 (6.1%) remote and 221 (6.2%) unknown. In a multivariate model, variables associated with survival were resection or transplant (HR 0.31), liver-directed therapies (0.53), chemotherapy (0.64), academic status of treating hospital (0.74), API race (0.832), highest socio-economic status quintile (0.88), female gender (0.93) and Hispanic race (0.94). When stratified by summary stage, API race, receipt of surgery, receipt of liver-directed therapies and treatment in an academic hospital remained significantly associated with long-term survival across all stages. Conclusions: Patients who survive for 3 years after a diagnosis of HCC have distinct demographic and clinical characteristics from patients who do not survive.