Socioeconomic Status Indicators Research Articles

Profiles of academic and cognitive abilities differ in younger and older children from diverse socioeconomic neighbourhoods

ABSTRACT Objective Research indicates that socioeconomic status (SES) influences developmental outcomes, particularly in language, executive functions, and intelligence, though findings have been mixed. This study examines the relationship between academic, cognitive and intellectual abilities in a cross-section of children at two age levels in low-SES vs. high-SES schools. Method We administered a computerised battery of tests to 46 children in Grade Two (youngest 6.9 years old) and 67 children in Grade Six (oldest 12.4 years old) across four primary schools from low-SES and high-SES neighbourhoods. The test battery comprised two academic ability tests, five cognitive ability tests, and two intelligence tests. Results In Grade Two, the low-SES group showed disadvantages on all measures except the Wisconsin Card Sorting Task and Choice Reaction Time. In Grade Six, while academic differences persisted between SES groups, cognitive differences were limited to the Wisconsin Card Sorting Task, where the high-SES group performed better than the low-SES group. Conclusions Though our results pertain to cross-sectional data using neighbourhood indices of SES, our findings contrast with previous research showing broad and pervasive disadvantages associated with lower SES. Future research should further examine the potential differences and similarities in developmental outcomes across SES groups using longitudinal methods.

Associations of Autistic Traits and Autism with Incontinence and Constipation in a UK Birth Cohort.

There is evidence that children with autism/autistic traits have higher risks of incontinence and constipation, but no studies have examined this in a large community-based cohort. Aim/Research question: are autistic traits and diagnosed autism prospectively associated with increased odds of incontinence and constipation in children and adolescents? This was a population-based cohort study based on data from the Avon Longitudinal Study of Parents and Children (n = 4233-4490 at age 9years; n = 3403-3697 at age 14). We used multivariable logistic regression to examine associations of parent-reported autistic traits (sociability, repetitive behaviours, social-communication, coherence) (at ages 3-9years) and autism with incontinence (bedwetting, daytime-wetting, soiling) and constipation (parent-reported at age 9, self-reported at age 14). We adjusted for parity, maternal age at delivery, child's sex and developmental level, maternal depression, and anxiety (antenatal and postnatal), and indicators of family socioeconomic status. Social-communication and speech coherence difficulties showed the strongest associations with incontinence, e.g., adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between social-communication difficulties and daytime-wetting was 2.21 (1.47-3.32) and for coherence was 2.34 (1.60-3.43). The odds of soiling were also higher in children with social-communication (OR: 1.88, 95% CI 1.28-2.75) and coherence difficulties (OR: 2.04, 95% CI 1.43-2.93). Diagnosed autism was only associated with an increase in the odds of daytime-wetting (OR: 3.18, 95% CI 1.44-7.02). At 14years, there was less evidence of associations between autistic traits and incontinence but there was evidence of associations between autistic traits and constipation: social-communication (OR: 1.68, 95% CI 1.13-2.49), coherence difficulties (OR: 1.64, 95% CI 1.11-2.41). Early assessment and treatment of incontinence/constipation should be considered for children with autistic traits.

Process evaluation of the digital Health4Life intervention among a sample of disadvantaged adolescents and teachers.

Disadvantaged adolescents, including those from lower socioeconomic status (SES) or geographically remote backgrounds, engage in higher rates of risk behaviours, including poor diet, alcohol and tobacco use. While digital interventions targeting lifestyle risk behaviours show potential, few studies have focused on their implementation and relevance for this population. This study conducted a process evaluation of 'Health4Life', a universal school-based digital program targeting multiple behaviours, among a sample of disadvantaged adolescents. Participants were from six schools classified as low SES (Index of Community Socio-educational Advantage percentile score ≤ 25%), and/or regional using the Australian Statistical Geography Standard. Self-reported student (n = 214) and teacher evaluations (n = 16) assessed Health4Life's acceptability, with qualitative questions capturing areas for improvement. Teacher-reported implementation data (n = 16) measured intervention fidelity and feasibility. Quantitative data were analysed using descriptive statistics and open-ended responses were thematically analysed. Compared to the entire sample, this subset of students evaluated Health4Life less favourably (66% versus 75%), with fewer enjoying the stories (63% versus 75%) and planning to use the skills and information (60% versus 70%). Teacher evaluations were mostly positive and aligned closely with the entire sample. Fidelity data also indicated comparable levels of student engagement (~92% versus ~85%). Key themes for refinement included improving content relevance and technical execution to better resonate with disadvantaged adolescents. While teacher evaluations suggest Health4Life is a valuable program in low SES or regional contexts, students' lower ratings indicate refinements are needed. Identified areas for improvement will guide co-designing the program's adaptation to improve effectiveness and relevance for disadvantaged adolescents. Trial registration: The Health4Life trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).

Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study.

Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear. This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study. A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators. Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men. There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.

Effect of socioeconomic status and women empowerment status on coverage of oral cancer screening among Indian women within reproductive age group

Oral cancer is the second most prevalent cancer in India and 5% of all cancers in women is contributed by oral cancer. In spite of being a part of national programme, the screening coverage rates remain low. Studies have indicated that the societal status of women and their empowerment plays a role in screening coverage for cancer. The objective of the current study is to estimate the coverage of oral cancer screening among Indian women within reproductive age-group across Indian states and union territories (UTs), to explore the relationship of socioeconomic status (SES) and women empower status (WES) with oral cancer screening coverage across Indian states and union territories (UT). Data from the fifth round of the nationally representative cross-sectional survey (National Family Health Survey, NFHS-2019–2021) was used in the present study with 3,48,882 individuals being included in the final analysis. We have cross-tabulated SES and WES composite scores with the Dimension Index (DI) of screening and categorised states and UTs into low, middle and high. We have represented these values over the Indian map. The interaction among these was graphically represented by a bubble plot. Further, we estimated the association of each indicator of SES and WES with screening coverage using multivariable logistic regression. The national coverage of oral cancer screening among women of reproductive age was 0.77% with Andhra Pradesh (7%) and Andaman and Nicobar Islands (10%) recording the highest screening coverage. Despite having high SES and WES scores, Madhya Pradesh and Uttar Pradesh, the screening (DI) was low. States with both high women empowerment status and high socioeconomic status showed high oral cancer screening uptake but the trend was not universal. Still, there were variations in the association among the states. The increased screening was significantly associated with higher access to improved sanitary facility (76%) and clean fuel for cooking (44%). Socio-economic status is an important precursor for better oral cancer screening coverage but women empowerment status did not always translate into good cancer screening uptake. Deep-rooted socio-cultural constructs and stigma associated with cancer and its implications may play a role. Implementation research for better uptake of oral cancer screening coverage is required.

Do Teachers have in-group Bias about Student Caste and Socioeconomic Status in India?

This article studies the extent of teacher’s in-group bias in occupational expectations and grading on the basis of a student’s caste and socioeconomic status. The article adopts an experimental approach and draws on data generated from 122 teachers from 19 schools in Delhi, India. The caste and socio-economic status of students were randomly assigned to a set of essays written by them such that the assigned characteristics were not related to essay quality. The results show that high caste teachers hold higher occupational expectations from their in-group category and are biased against the low caste category. For instance, high caste teachers assign 0.53 per cent or 0.019 points higher occupational expectations to high caste students and assign 5.6 per cent or 0.19 points lower occupational expectations to low caste students. The magnitude of coefficients is small but significant at 5 per cent level (P value<0.005). In terms of marks assigned, results show, that high caste teachers assign 2.36 points or 3.22 per cent higher marks when the assigned characteristics belong to a high caste; indicating in-group bias/favor for the same caste. The coefficient is positive and significant at 5 per cent level (P- value < 0.05). In contrast, high caste teachers are shown to be biased against low caste students as they assign 2.41 points or 3.41 per cent lower marks when the assigned characteristics is a low caste. Given the ultra-competitive nature of schooling in India and the importance of grades in determining access to higher education in India, even a point disadvantage is substantial.

Are area-level socioeconomic inequalities in obesity moderated by neighbourhood greenery?

BackgroundReducing socioeconomic inequalities in obesity is a public health priority. Limited research exists on the role of neighbourhood environmental attributes in mitigating these inequalities. However, it has been shown that neighbourhoods with more greenery tend to have lower levels of socioeconomic inequalities in non-obesity health outcomes. We examined whether neighbourhood greenery moderates the association of area-level socioeconomic status (SES) with waist circumference.MethodsData from 3,261 middle-aged and older adults who participated in a national cohort study conducted in Australia (2011–12) were used. The outcome was objectively measured waist circumference. For area-level SES, a composite index of disadvantage based on census data was used. We used two measures of neighbourhood greenery: mean greenness and geographic size of greenspace. They were assessed using the Normalized Difference Vegetation Index (NDVI) within 0.5, 1, and 2 km radius buffers around participants’ homes. The mean NDVI value within each buffer area was used for the former, and the geographic size of the area with NDVI ≥ 0.6 (dense greenery) was used for the latter.ResultsThere was a significant negative association between area-level SES and waist circumference: one standard deviation higher score in the area-level SES indicator (less disadvantage) was associated with 1.76 cm (95% CI: -2.68, -0.83) lower waist circumference. Analyses stratified by greenery levels found similar significant associations in the areas with low and high levels of greenery but not in the areas with medium levels of greenery for both greenery measures within 1 km and 2 km buffers.ConclusionsConsistent with previous studies, our study found that participants living in disadvantaged suburbs were likely to have a larger waist circumference than those living in advantaged suburbs. However, we also found that such socioeconomic inequalities in obesity were mitigated in the areas with medium levels of greenery for this sample of Australian adults. Our findings suggest that there may be an optimum level of greenery where inequalities in obesity are alleviated. Further research is needed to understand the mechanisms underlying these findings.

Abstract 4123530: Disparities in Hypertension Treatment Intensification among Adults in a Large United States Healthcare System

Background: There are racial/ethnic and socioeconomic status (SES) disparities in hypertension control, even in populations with regular care. It is unclear if clinical inertia by clinicians contributes to these disparities. Objectives: To quantify racial/ethnic and SES disparities in treatment intensification (TI) among adults with hypertension. Methods: We performed a retrospective cohort study using electronic health records from Johns Hopkins primary care practices from January 2018 to December 2022. We included non-Hispanic Black (Black) and non-Hispanic White (White) adults with at least 2 elevated blood pressure readings (>=140/90 mm Hg) in the 12 months prior to the index primary care visit and a diagnosis of essential hypertension. We excluded patients with diagnoses of end-stage renal disease, liver disease, dementia, and metastatic solid tumor. Patients could contribute multiple index visits. We measured SES using the national Area Deprivation Index, which comprises 17 neighborhood-level SES indicators, and dichotomized the population into high and low median SES groups. We defined TI as a change in antihypertensive class or dose increase within 14 days of the index visit. We balanced covariates reflecting clinical need at the index visit (age, sex, blood pressure readings, cardiometabolic comorbidities, body mass index) and the index visit’s calendar time across racial/ethnic and SES groups using inverse probability weighting. We estimated annual race/ethnic and SES specific TI rates and risk difference measures of disparity with 95% confidence intervals (CI) using a clustered bootstrap. Results: The cohort included 25,287 patients (11,800 Black, 13,487 White) with 79,898 eligible visits. Black patients were more often younger, female, and residing in low SES areas compared to White patients. In 2018, TI rates for Black patients (37%, 95% CI: 36-38%) were slightly lower than rates for White patients (39%, 95% CI: 38-40%). In 2022, the disparity persisted, with the Black patients’ TI rate lower by 3% (95% CI: -5%, -1%). Similarly, low SES patients had lower TI rates than high SES patients by 2% to 3% over the study period. Conclusion: Black patients and those from low SES consistently had modestly lower rates of TI compared to White patients and those from high SES. It will be important to identify the drivers and clinical implications of these treatment disparities.

Independent contributions of nuclear and extended families to risk of early childhood caries among children from low socio-economic status in India.

The family is a fundamental unit of society and provides care to the needs of its members. This study aims to assess the independent contributions of nuclear and extended families through direct and indirect pathways towards the risk of early childhood caries among 5-year-old children from low socio-economic status families in Central India. Cross-sectional study with two-stage sampling of 313 randomly selected school children. The American Association of Pediatric Dentistry criteria were used for diagnosing early childhood caries (ECC) and severe early childhood caries (S-ECC). It was hypothesised that the type of family would impact ECC and S-ECC by acting on individual-level variables such as frequency of cleaning teeth, dietary patterns, and utilisation of dental services. Examiner-administered interviews collected information about demographic details and oral hygiene practices. Generalized structural equation modelling (GSEM) examined the relationship between exogenous variables, including nuclear and extended families with ECC and SECC. Path coefficients and the standard error with a 95% confidence interval were reported. ECC and SECC were present among 186 (59.4%) and 47 (15%) children. Nuclear families, more frequent between meal sugar consumption and lower utilization of dental care were associated with ECC (odds ratios of 2.43, 2.78, and 8.65, respectively (p⟨ 0.001)). Nuclear families were also associated with SECC. Type of family directly (p⟨ 0.001) and indirectly (p⟨ 0.05) predicted ECC via three or more times sugar consumption and lower utilization of dental services. Nuclear families were associated with ECC and SECC among children. Health professionals need to understand the influence of the type of family and the associated pathway to tackle and reduce the burden of ECC.

Higher risk and earlier onset glaucoma in Cushing's syndrome.

Glaucoma incidence in patients with endogenous Cushing's syndrome (CS) has never been established. We aim to assess the risk for glaucoma among CS patients compared to controls and determine the age of disease onset. A nationwide retrospective matched-cohort study of patients with endogenous CS diagnosed between 2000 and 2023. Patients with CS were matched in a 1:5 ratio, with a control group individually matched for age, sex, socioeconomic status and body mass index. Main outcomes were the incidence of glaucoma and disease onset. A total of 609 patients [396 women (65%); mean age 48.1 ± 17 years] were included in the CS group and 3018 controls. Follow-up duration was 14.6 years (IQR 9.8-20.2) for the study group. The aetiology of hypercortisolism was divided into pituitary (259, 42.6%), adrenal (206, 33.8%) and unconfirmed aetiology (144, 23.6%) patients. At baseline, 44 (7.2%) CS patients had a diagnosis of glaucoma, compared with 151 (5%) controls. The overall risk for glaucoma was 74% higher in patients with CS compared with matched controls (hazard ratio = 1.74, p = 0.002). Patients with CS who developed glaucoma were younger (mean age of 62 ± 14.7 years) than controls (mean ± SD age, 62 ± 14.7 years), (p = 0.02). The overall risk for glaucoma in CS was high for both patients in remission and patients with persistent hypercortisolism (p = 0.048). Patients with active hypercortisolism experienced an earlier glaucoma onset (82.1 ± 88.0 months). Endogenous CS is associated with increased risk for glaucoma regardless of remission status and develops at a younger age compared with the general population.

Health Disparities Among Ultra-Orthodox and Non-Ultra-Orthodox Residents in Neighboring Cities in Israel: A Cross-Sectional Study.

Socioeconomic status and religion are associated with health indicators. This study compared the correlations between religious observance, socioeconomic status, and select health indicators among adults in neighboring cities in Israel based on data collected from the Maccabi Health Services database. One city is characterized by religious observance, while the other is primarily secular. Lower smoking rates and higher rates of low cholesterol, triglycerides and LDL levels were observed in the religious city. No significant differences were found for low HDL rates or diabetes. Unique characteristics of populations must be considered when planning health interventions.

Association of socioeconomic status with unintended pregnancy and induced abortion in married couples: An analysis of the 2021 national survey data in Japan

BackgroundAn association of the major indicators of socioeconomic status with unintended pregnancy and induced abortion in married couples has not been investigated in Japan, and we investigated it using recent nationwide survey data in Japan. MethodsData from the National Fertility Survey in 2021 in Japan, which evaluated the outcomes and intentions of previous pregnancies in married couples, were used. Number of unintended pregnancies, induced abortions, and unintended pregnancies ending in induced abortion were used as outcomes, and the number of unintended pregnancies ending in induced abortion was analyzed among couples who experienced an unintended pregnancy. Associations with current educational attainment, employment status, and household income were investigated using Poisson regression analysis. A complete-case analysis was conducted for dealing with missing data, as well as an analysis using multiple imputation. ResultsAverage number of unintended pregnancy and induced abortion per pregnancy of junior high school graduates was the highest among educational attainments of wives and husbands. The adjusted regression analysis showed that junior high school graduate in husbands was significantly associated with higher number of unintended pregnancies and induced abortions, regardless of the missing data analysis methods. In addition, high school or training school graduate in husbands was significantly associated with higher number of induced abortions. A significant association between socioeconomic status and the unintended pregnancy ending in induced abortion was not observed. ConclusionThis study showed that a lower educational attainment in husband was associated with higher number of unintended pregnancies and induced abortions in Japan.

Socioeconomic Status and Physical Fitness Levels among University Students

This study examines the correlation between socioeconomic status (SES) and physical fitness levels among university students in Henan, China. The research considers various SES indicators, including parental education, household income, and access to healthcare, in relation to students' self-assessed physical fitness and activity levels across multiple domains, such as vigorous physical activity, organized sports, and recreational activities. Findings reveal that students from lower SES backgrounds often face barriers, such as limited access to safe recreational spaces and organized sports, which may hinder their ability to participate in physical activities, thereby impacting their fitness levels. In contrast, students from higher SES backgrounds have greater access to fitness resources, leading to more favorable physical fitness outcomes. The study underscores the need for policy interventions and school programs that prioritize equitable access to physical activity opportunities for students of all socioeconomic backgrounds.

Effects of Social Determinants of Health and Social Support on Surgical Outcomes Among Patients Undergoing Hysterectomy.

To describe composite 30-day postoperative complication rates among patients undergoing hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic and to determine baseline and postoperative mental health symptoms, levels of social support, and socioeconomic status and their association with hysterectomy outcomes. This multicenter prospective cohort study at eight centers across the United States enrolled patients who underwent minimally invasive hysterectomy for benign indications during the COVID-19 pandemic. Patients completed preoperative and postoperative surveys assessing mental health (PHQ-9 [Patient Health Questionnaire]), social support (MOS-SS [Medical Outcomes Study Social Support Survey]), and socioeconomic status (Hollingshead Index [Hollingshead Four Factor Index of Socioeconomic Status]). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and 30-day composite complication rates were measured and categorized by Clavien-Dindo Grade. Bivariate associations of survey data on complications were assessed. Logistic regression analyses were used to identify independent predictors of 30-day complications and complication severity. Postoperative complications within 30 days occurred in 67 of 273 (24.5%) patients. Most (88.1%) complications were mild, but eight (11.9%) experienced severe complications. Only three patients (1.1%) tested positive for SARS-CoV-2 infection. There were no differences in complication rates when comparing race and ethnicity, age, or socioeconomic status. Survey responses that indicated more depression and worse support from preoperative to postoperative were seen in patients with severe complications (P=.008 and P=.09, respectively). Multivariate analysis demonstrated that an increase in support scores was protective against severe complications (P=.02). Worsening depression scores were associated with more severe complications (P=.03). This study showed a high rate of complications (24.5%) among patients who underwent hysterectomy during the COVID-19 pandemic. Lower social support and worse mental health status are associated with worse postoperative outcomes after hysterectomy.

Narrowing socioeconomic inequalities in coronary heart disease: insight from Mendelian randomization

Abstract Background Socioeconomic inequalities in coronary heart disease (CHD) represent a pressing global public health concern. However, which dimensions of socioeconomic status (SES) affect CHD and the potential modifiable mediators remain elusive. Methods We performed two-sample Mendelian randomization (MR) analyses based on summary data from large-scale genome-wide association studies in populations of European ancestry. Specifically, by applying bidirectional univariable MR (UVMR) and multivariable MR (MVMR), we investigated the causal relationships of education, occupation, income, Townsend deprivation index (TDI) with CHD and the independent effects of these SES indicators. We further employed a two-step MR to comprehensively profile the mediating effects of 23 behavioral, 3 psychological and 5 biological factors in the relationships. Results An independent causal association was observed between genetically predicated education and CHD, with a 30% lower risk of CHD (OR: 0.70; 95% CI: 0.53-0.93) for each 4.2-year of schooling. Each one-s.d. higher household income was causally, but not independently, associated with a 39% lower risk of CHD (OR: 0.61; 95% CI: 0.49-0.77). No significant causal association was suggested for occupation and TDI with CHD, and no reverse causal effect was observed for CHD on the SES indicators. Of 31 candidate mediators, nine factors mediated the effect of education on CHD significantly, with an individual mediation proportion of 33.5% for smoking, 29.2% for sedentary behaviour, 14.4% for blood lipids, 13.4% for BMI, 11.7% for systolic blood pressure, 9.5% for diastolic blood pressure, 7.8% for well-being spectrum, 6.4% for depression and 2.8% for blood glucose. Conclusions This study highlights that education was the primary SES indicator affecting CHD with considerable mediation by a number of modifiable risk factors. These findings inform policies to mitigate disparities of CHD risk attributable to socioeconomic inequalities. Key messages • Education can be prioritized over other common SES indicators as an essential strategy to reduce the burden of CHD. • Interventions for narrowing socioeconomic inequalities in CHD could focus on more easily modifiable mediating factors.

A Review of the Public Health Literature Examining the Roles of Socioeconomic Status and Race/Ethnicity on Health Outcomes in the United States.

This review of reviews examines the role of socioeconomic status (SES) indicators on health inequities among different racial and ethnic groups in the United States (US) between 2019 and 2023. Of the 419 articles, 27 reviews met the inclusion criteria and were aggregated into seven categories: COVID-19 and respiratory pandemic disparities; neighborhoods, gentrification, and food environment; surgical treatments; mental, psychological, and behavioral health; insurance, access to care, and policy impact; cancers; and other topics. The findings revealed a documented impact of SES indicators on racial/ethnic health inequities, with racial/ethnic minority communities, especially Black Americans, consistently showing poor health outcomes associated with lower SES, regardless of the outcome or indicator examined. These findings call attention to the importance of policies and practices that address socioeconomic factors and systemic racial/ethnic inequities affecting the social determinants of health affecting racial/ethnic inequities to improve health outcomes in the US population.

Race/Ethnicity, Education, and All-Cause Mortality in US Adults: Mediation by Telomere Length

Abstract Background Racial/ethnic inequities in mortality risk are pervasive in the United States even after controlling for socioeconomic status indicators such as educational attainment. Although the mechanisms underlying these inequities remain unclear, telomere length (TL) has emerged as a potential mediator. We aimed to investigate the joint association of race/ethnicity and education with all-cause mortality risk, and the contribution of TL to this relationship. Methods We used data from the U.S. National Health and Nutrition Examination Survey, 1999 to 2002, and 2019 Linked Mortality File (n = 6,526 non-institutionalized adults aged 25 years or older, including 2,166 deaths), a retrospective cohort study with a follow-up period to December 31, 2019. Cox proportional hazards regression and causal mediation analysis were used to address these aims. We reported hazard ratios (HR) and 95 % confidence intervals (CI). Furthermore, for the mediation analysis, we reported the total, direct, and indirect effects measured as HR and 95 % CI. Results After adjusting for age and sex, among White individuals, those with less than a high school education had a 2.26 times higher (95% CI: 1.93, 2.65) rate of all-cause mortality compared to those with some college or higher education. When compared with White adults with at least a college degree, Black adults with at least a college degree had a 1.38 higher rate of dying (95% CI: 1.04, 1.84). There was no significant joint association of race/ethnicity and education on all-cause mortality in Mexican Americans. In the mediation analysis, TL did not significantly contribute to the joint association of race/ethnicity and education with all-cause mortality risk. Discussion These findings underscore the need for a better understanding of the joint relationship of race/ethnicity and education on mortality risk inequities and their potential mechanisms to improve population health ultimately. Key messages • Lower educational attainment was associated with higher mortality rates among White individuals, disparities persisted among the Black population, despite higher education levels. • Our analysis did not find a significant mediation effect of telomere length on the joint effect of race/ethnicity and education-mortality relationship.

Global burden of ischemic stroke attributable to high body mass index in 204 countries and territories, 1990–2021

BackgroundA high body mass index (hBMI) is one of the major risk factors for ischemic stroke (IS), although independent estimates of the global burden and trend of IS attributable to hBMI are unclear.MethodsStudy data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study and analysed by age, sex, year, and geographical location. The sociodemographic index (SDI) and the human development index (HDI) were used as indicators of national socioeconomic status. Geographic distributions and trends were assessed by calculating the estimated annual percentage change (EAPC). Associations between the age-standardized death rate (ASMR) or disability-adjusted life year rate (DALY) and socioeconomic status were analysed.ResultsDeaths and DALYs increased worldwide from 1990–2021, with increases of 95.74% for the former and 133.00% for the latter; the ASMR and ASDR decreased, with an ASMR and ASDR-related EAPCs of -1.10 (95% CI: -1.24–-0.96) and 0.04 (95% CI:-0.47–0.55), respectively; women had greater numbers of deaths and DALYs, and the majority of deaths and DALYs were shared by those aged ≥ 70. The highest burden rates were shared by Eastern Europe, North Africa, the Middle East, and Central Asia. The ASMR-related EAPCs were associated with the ASMR in 1990 (R = -0.35, P < 0.001) and the SDI in 2021 in different countries (R = -0.66, P < 0.001); these patterns were similar to those of the ASDR; the HDI in 2021 was associated with the ASMR-related EAPC (R = -0.71, P < 0.001) and the ASDR-related EAPC in different countries (R = -0.71, P < 0.001).ConclusionsThe number of deaths and DALYs from ischemic stroke attributable to hBMI worldwide increased substantially from 1990–2021. Successful population-wide initiatives targeting hBMI may mitigate a wide range of burdens on this disease. Taking into account variations in the SDI burden, future prevention and control strategies must be developed and implemented according to country-specific development status.

Socioeconomic status, linguistic skills and language background differentially relate to preschoolers' emotional and behavioural profile.

Proximal and distal factors interact to shape children's development and well-being. The present study aimed to examine socioeconomic status (SES), linguistic skills, and language background as concurrent predictors of socio-emotional and behavioural outcomes in heritage bilingual and monolingual children attending preschool. Parents of 1810 children (mean age = 63.42 months ± 7.36), attending preschool in Italy, completed the Four Factor Index of SES and the Strengths and Difficulties Questionnaire (SDQ). Teachers (n = 99) completed a questionnaire on children's linguistic skills and emotional and behavioural profiles. A subsample of 995 children was administered an expressive vocabulary task in Italian. Regression analyses showed that linguistic skills were the only concurrent predictor of conduct problems, as well as the dominant predictor of hyperactivity/impulsivity, peer problems, and better prosocial behaviour. SES was negatively related to ADHD traits, peer problems, and prosocial behaviour. Finally, heritage bilingualism background was associated, although not as a primary predictor, with increased emotional problems, peer relationship problems, and lower teacher-rated emotional and behavioural skills. However, it was the main factor positively associated with prosocial behaviour. The implications of these findings for research in this area and for educational policy are discussed, highlighting the need for a multidimensional perspective that includes linguistic skills and SES in the assessment of children's emotional and behavioural outcomes.

Relationship Between Socioeconomic Status and Basic Auditory Processing in Young Adults.

The current study aimed at investigating the relationship between socioeconomic status (SES) and basic auditory processing in young adults with normal hearing. Specifically, we sought to determine whether SES metrics, including parental education, parental occupation, and individual education attainment, influenced performance on tasks of basic auditory processing. Secondarily, we also aimed at understanding the interactive effects of SES and working memory on basic auditory processing. A total of 38 young adults were included in the study. Self-reported SES measures were recorded through Likert scales, and auditory processing measures included tests for temporal fine structure (TFS) and spectrotemporal sensitivity (STS). Pearson correlation analyses were conducted to probe the relationships between SES indicators and auditory processing performance. Multiple linear regressions were conducted to understand the interactive effects of SES and working memory on auditory processing performance. The analysis revealed no significant correlation between SES measures and basic auditory processing performance across TFS and STS tasks. Furthermore, analysis investigating the interaction between SES and working memory also yielded nonsignificant results. These findings indicate that, within this specific age cohort, SES information may not be indispensable for assessing basic auditory processing. Our study suggests that SES may not significantly influence basic auditory processing in young adults with normal hearing. However, further research with larger sample sizes and longitudinal designs is warranted to confirm these findings and explore potential age-related differences in the impact of SES on auditory processing across the lifespan.