Social Class Index Research Articles

Clinico-demographic features and the benign diseases requiring hysterectomy; A Cross Sectional Study.

Objective: To evaluate the relationship between the clinic-demographic features and the benign diseases requiring hysterectomy. Study Design: Cross sectional study. Setting: Department of Obstetrics & Gynecology, Peshawar Medical College and its Affiliate Tertiary Care Hospitals. Period: 03 Oct, 2020 to 03 Oct, 2021. Methods: It was a part of the dissertation mandated by the college of physician and surgeons as part of the FCPS program. Using WHO sample size calculator a sample size of 104 patients was obtained and consecutive sampling was done. Logistic regression was used to co-relate clinic-demographic features with different diseases with 5% level of significance. Results: Mean of age of the patients was 48.55 years (±10.5years SD), mean height was 5.508 feet (±1.1feet SD), mean weight was 73.20 kg (±15.4kg SD) and the mean BMI was 26.58 (±4.5 SD). Diabetes mellitus was significantly more common in patients with leiomyoma and abnormal uterine bleeding, whereas, the social class and body mass index did not have an impact on the benign gynecological condition (p>0.05). Conclusion: Patients with symptomatic fibroid uterus and abnormal uterine bleeding are more likely to be hypertensive and diabetic, whereas, BMI, social class and residence area does not significantly differ among patients.

Influence of health literacy on health-related quality of life after total hip arthroplasty

IntroductionPersonal knowledge about the own disease, a key component of health literacy (HL), may have a considerable impact on treatment outcomes. The purpose of this study was to investigate whether the patients’ knowledge about the surgical procedure, risks, and aftercare, as well as the satisfaction with the preoperative level of information, has an influence on the health-related quality of life (HRQoL) after primary total hip arthroplasty (THA).Materials and methodsA total of 176 patients (68.3 ± 10.3 years, 60.8% female) were evaluated. HRQoL was assessed prior to surgery as well as one and twelve months after THA using the 12-item Short Form Questionnaire. Following standardized surgical informed consent, HL was assessed preoperatively using a self-constructed quiz score, while information satisfaction was measured with a single-item rating scale. Sociodemographic and clinical characteristics, including pain (VAS), functionality (WOMAC), and psychological distress (PHQ-4), were also assessed at baseline. Multiple linear regression analyses were performed to examine whether HL, satisfaction with information, age, social class, WOMAC, VAS, and PHQ-4 predict HRQoL at one and twelve months post-surgery.ResultsThe average HL quiz score was 23 ± 5.1 out of a possible 33 points. Social class index significantly influenced HL (p < 0.001). A weak correlation between HL and age (r = 0.23, p = 0.01) and no correlation between HL and psychological distress (p = 0.868) were observed. One month after THA, physical HRQoL was significantly predicted by the WOMAC index (p = 0.031) and subjective satisfaction with information (p = 0.022), but not by HL. After twelve months, only the WOMAC was a significant predictor (p < 0.001) of physical HRQoL.ConclusionAlthough subjective satisfaction with the patient’s preoperative level of information had a significant effect on the physical HRQoL at one month after THA, the influence of osteoarthritis severity outweighed this effect after twelve months. HL had no direct influence on HRQoL. These results suggest that patient satisfaction, rather than knowledge, predicts HRQoL.

Social Class and Socialization Values in the United States and China

The psychological correlate of social class across cultures is a topic of debate. Some have argued cross-cultural similarities, while others have maintained culturally divergent manifestations of social class. Using the data from the World Value Survey 2017 to 2020 (Wave 7), the current study examined the associations between social class and socialization values among parents in the United States ( n = 1,615) and China ( n = 2,524). Results indicated that all social class indices (i.e., education level, income, subjective social status, and composite social class) were positively associated with self-oriented socialization values in the United States, whereas such associations were absent in China, except for education level. In addition, higher social class, in terms of higher income, higher subjective social status, and higher composite social class, was associated with greater other-oriented socialization values in China. However, such associations were absent (for income, education level, and composite social class) or even reversed (for subjective social status) in the United States. These findings extend the literature on social class variations in parenting and highlight cultural specificity in the psychological manifestations of social class.

Associations between socioeconomic status and physical activity among older adults: cross-sectional results from the OUTDOOR ACTIVE study.

BackgroundRegular physical activity (PA) is an important strategy for healthy ageing. Socioeconomic status was found to be a key determinant of PA, however, evidence on associations between socioeconomic status and PA among older adults is limited. The aim of this study was to contribute to research on the associations of socioeconomic status and PA among older adults by including self-reported and objectively measured PA data. Furthermore, we examined the self-reported PA data more closely by looking at the activities separately.MethodsCross-sectional data of 1507 participants (52.5% female) of the OUTDOOR ACTIVE study between 65 and 75 years, residing in Bremen, Germany, were included in the analyses. Self-reported PA was assessed via questionnaire and comprised all organised and non-organised activities. For analyses, mean hours per week of total and moderate to vigorous PA, and mean metabolic equivalents per week were used. Objectively measured PA was assessed using accelerometers over seven consecutive days. Socioeconomic status was included as an additive social class index containing education, income, and occupation. To test for associations between PA and socioeconomic status, linear regressions were carried out.ResultsSelf-reported PA showed significant negative associations with socioeconomic status for both men and women. Objectively measured PA was positively associated with socioeconomic status, which was significant in men but not in women. When examining physical activities separately, time spent on housework, gardening, biking, and walking decreased with increasing socioeconomic status. Women in the second SES quintile and men in the third quintile reported the most, and women in the first quintile and men in the fifth quintile the least hours per week spent on exercise.ConclusionsThe results of this study contributed to the existing research gap on the associations of socioeconomic status and PA among older adults. Moreover, we provided information on both self-reported and objectively measured PA, and showed the discrepancies in the two methods’ results. These findings can help to develop PA promotion interventions targeting specific socioeconomic status groups and to develop accurate, valid, and reliable self-reported and objective measurements of PA for older adults.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-022-03075-7.

Childhood inflammatory markers and risks for psychosis and depression at age 24: Examination of temporality and specificity of association in a population-based prospective birth cohort

BackgroundCross-sectional studies have reported elevated concentrations of inflammatory markers in psychosis and depression. However, questions regarding temporality and specificity of association, crucial for understanding the potential role of inflammation, remain. MethodsBased on 2224 ALSPAC birth cohort participants, we used regression analyses to test associations of interleukin-6 (IL-6) and C-reactive protein (CRP) levels at age 9 with risks for psychosis (psychotic experiences; negative symptoms; psychotic disorder), and depression (depressive episode; symptom score) at age 24. Regression models were adjusted for sex, ethnicity, social class and body mass index. We tested for linearity (using quadratic terms) and specificity (using bi-variate probit regression) of association, and used multiple imputation to explore the impact of missing data. ResultsAfter adjustments, higher IL-6 levels at age 9 were associated with increased risk of psychotic disorder (OR = 1.56; 95% C.I., 1.09–2.21 per SD increase in IL-6; OR=2.60; 95% C.I., 1.04-6.53 for the top compared with bottom third of IL-6) and depressive episode (OR = 1.14; 95% C.I., 0.99–1.32 per SD increase in IL-6; OR = 1.49; 95% C.I., 1.02–2.18 for the top compared with bottom third of IL-6). IL-6 was associated with negative symptoms after adjusting for depression (β = 0.09; 95% C.I., 0.01–0.22). There was no evidence for outcome-specific associations of IL-6. Childhood CRP was not associated with adult psychosis or depression. ConclusionsEvidence for similar, longitudinal, dose-response associations suggest that elevated childhood IL-6 could be a shared risk factor for adult psychosis and depression. The IL-6 pathway may represent a novel target for treatment and prevention of these disorders.

Factors related to the psychological impact of malocclusion in adolescents

To study the association between orthodontic treatment need and the psychosocial impact of dental aesthetics in a sample of adolescents, as well as other associated factors. A transversal study was conducted on 1,158 adolescents (12–16 years old) examined at the schools selected for the 2018 epidemiological study on oral health in the Comunidad Valenciana (Spain). The need for orthodontic treatment was determined by DAI and IOTN. The psychosocial impact was established by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Other variables considered were sex, social class, DMFT index and Body-Mass Index, and having previously worn or presently wearing an orthodontic device. A lineal regression statistical technique was applied to study the significant associations with the scoring obtained in PIDAQ. The PIDAQ scores revealed a significant and positive lineal relationship with regard to need for orthodontic treatment: DAI (ẞ = 0.20) and IOTN-DHC (ẞ = 4.87), in women (ẞ = 2.66) and a negative one for having previously worn an orthodontic device (ẞ = − 5.74). The rest of the variables had no statistical significance (p > 0.05). The psychosocial impact of dental aesthetics in adolescents is associated with the presence of malocclusion and the female sex, while the condition of having previously worn an orthodontic device reduces the psychosocial impact.

Usual physical activity and subsequent hospital usage over 20\u2009years in a general population: the EPIC-Norfolk cohort

BackgroundWhile physical activity interventions have been reported to reduce hospital stays, it is not clear if, in the general population, usual physical activity patterns may be associated with subsequent hospital use independently of other lifestyle factors.ObjectiveWe examined the relationship between reported usual physical activity and subsequent admissions to hospital and time spent in hospital for 11,228 men and 13,786 women aged 40–79 years in the general population.MethodsParticipants from a British prospective population-based cohort study were followed for 20 years (1999–2019) using record linkage to document hospital usage. Total physical activity was estimated by combining workplace and leisure time activity reported in a baseline lifestyle questionnaire and repeated in a subset at a second time point approximately 12 years later.ResultsCompared to those reporting no physical activity, participants who were the most active had a lower likelihood of spending more than 20 days in hospital odds ratio (OR) 0.88 (95% confidence interval (CI) 0.81–0.96) over the next 20 years after multivariable adjustment for age, sex, smoking status, education, social class and body mass index. Participants reporting any activity had a mean of 0.42 fewer hospital days per year between 1999 and 2009 compared to inactive participants, an estimated potential saving to the National Health Service (NHS) of £247 per person per year, or approximately 7% of UK health expenditure. Participants who remained physically active or became active 12 years later had lower risk of subsequent hospital usage than those who remained inactive or became inactive, p-trend < 0.001.ConclusionUsual physical activity in this middle-aged and older population predicts lower future hospitalisations - time spent in hospital and number of admissions independently of behavioural and sociodemographic factors. Small feasible differences in usual physical activity in the general population may potentially have a substantial impact on hospital usage and costs.

Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort

ObjectivesTo investigate whether residential area deprivation index predicts subsequent admissions to hospital and time spent in hospital independently of individual social class and lifestyle factors.DesignProspective population-based study.SettingThe European Prospective Investigation...

Elaborating the Connection between Social Class and Classism in College.

Scholarship has documented the challenges that face college students of marginalized economic backgrounds, an issue that is relevant for Community Psychology because of the field's commitment to social justice. Community psychologists are concerned with facilitating access to social resources such as education across the full range of social identities. The current study builds on recent research that has identified the key role of classism in students' struggles. We developed a new measure of college student financial stress in order to investigate the relationship between indices of social class (financial stress, subjective social status, and parental education) and indices of classism (institutional, interpersonal, and citational). We also explored whether race or immigration status moderated these relationships in a sample of diverse students (N=278). Findings show that students' current financial stress has the strongest relationship with classism, and immigration status moderates the exposure to citational classism. Specifically, we found evidence for perpetuation of classism among U.S. born students higher on the social class ladder. Implications for future research include the importance of considering multiple domains of social class, studying social class in a context-specific way, and differentiating dimensions of classism. Findings also suggest that financial stress is an important focus in the work to support marginalized students, and that classist narratives need to be addressed among students of higher social class.

Gait in children and adolescents with idiopathic musculoskeletal pain

IntroductionMusculoskeletal pain is a constant complaint in pediatric practice. The pain may be related to a number of organic diseases and / or be part of the amplified musculoskeletal pain syndromes. Idiopathic musculoskeletal pain (IMSP) is defined as the presence of intermittent pain in three or more body regions for at least three months, excluding organic diseases that could explain the symptoms.ObjectiveTo study the gait of children and adolescents with IMSP by dynamic baropodometry.MethodologyThirty-two patients with IMSP and 32 healthy controls, matched by age, sex, social class, and body mass index (BMI) were enrolled. All were evaluated for pain intensity through the visual analogue scale (VAS) and gait evaluation using dynamic baropodometry.ResultsThe mean age of the IMSP group was 13.6 years (SD = 2.1, range 9.8–16.9) and of the control group was 13.5 years (SD = 2.0, range 9.6–16.5). The mean pain scale was 5.4 cm in the IMSP group and 0 cm in the control group (p < 0.001). In gait, the mean right foot velocity of the IMSP group was significantly lower (p = 0.034), the time of the step of the IMSP group was significantly higher (p = 0.003) and the pace of the IMSP group was significantly lower (p = 0.001).ConclusionIn our study we observed differences between the gait of children with IMSP and healthy controls according to the dynamic baropodometry. This finding indicates the need for individualized attention to the gait of children with musculoskeletal pain.

The association of neighborhood-level social class and tobacco consumption with adverse lung cancer characteristics in Maryland.

INTRODUCTIONAlthough both active tobacco use and passive tobacco exposure are well-established as being risk factors for lung cancer, it is challenging to measure tobacco-related exposures at the population level, while considering other factors (gender, race, socioeconomic status) that may modify the relationship between tobacco and lung cancer. Moreover, research to date has focused primarily on relationships between tobacco and endpoints of lung cancer incidence or mortality. Tobacco’s role in disease progression, through association with important disease characteristics such as tumor histological type and grade, and stage of disease at diagnosis, has been less well examined.METHODSThis research examines associations between area-level tobacco use and social class, as well as individual gender, race and age, and three adverse disease characteristics (tumor type, grade and stage) among incident cases of lung cancer reported to the Maryland Cancer Registry in 2000. Cases were geocoded by residential address. Multi-level logistic regression models included Census block group-level estimates of per capita tobacco spending, from Consumer Expenditure Survey data, and a 4-item social class index, from Census estimates of rates of high school graduation, employment, white collar occupation, and per capita income.RESULTSAnalyses of 3223 cases found no significant differences by race, however, results differed by gender. Lower block-group social class and higher tobacco spending were associated with squamous and small cell histological types and poorly differentiated or undifferentiated tumor grade. However, for later stage at diagnosis (SEER stages 2–7), both higher social class and greater tobacco spending were protective, especially for women, suggesting women in high tobacco use communities may benefit from early detection.CONCLUSIONSResults support using area-level behavioral data as tools for identifying high risk communities suitable for more resource-intensive research or interventions. Findings also suggest that area-level social resources are consistent drivers of lung cancer disparities, and merit continued research attention.

Obesity, depression and hip pain.

Up to 64% of the general population reports experiencing chronic pain, with the hip being one of the most frequent sites. An association has been shown between chronic back pain, obesity and depression. To date, a similar association has not been investigated with chronic hip pain. A total of 2,515 subjects were chosen as a representative cross-section of the German population. Each was provided with a questionnaire that included the Regional Pain Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Beck Depression Inventory-Primary Care and Winkler social class index. Participant height and weight values were obtained from self-reports. Using logistic regression methodology, we analysed the association between hip pain, obesity and increased depression scores. A total of 124 (4.9%) subjects reported chronic hip pain and an additional 39 (1.5%) reported chronic hip pain that was disabling. Hip pain affected 1-5 sites (oligolocular) in 47% of cases, and was widespread (6-19 sites) in 50%. Obesity and increased values on the depression scale were associated with an increased likelihood of chronic hip pain (odds ratio [OR] 2.55 and 8.53, respectively) compared with subjects without pain. Increased values on the depression scale (OR 28.22) increased the likelihood of experiencing disabling chronic hip pain in comparison with pain free individuals. Hip pain is rarely the sole site of pain. Obesity and increased values on the depression scale are associated with chronic hip pain. Increased values on the depression scale are associated with disabling chronic hip pain.

Health inequalities: child development in different social groups.

To analyze child development in different social groups. A cross-sectional study with children under 3 years old enrolled in basic health units of a municipality in the state of São Paulo, Brazil. Child development was verified by the Ministry of Health's Development Monitoring Form. The Social Class Index was used to classify families into social groups and the predefined hierarchical theoretical model for univariate and multiple logistic regression analysis. The sample consisted of 348 children, in which 29% of the children presented the absence of some developmental milestone expected for their age, while social group and age group were associated with child development in the final model. Children from the least socially inserted groups aged 12 months or older were more likely to be missing some developmental milestone. The proportion of children with the absence of some developmental milestones is high and associated with lower social inclusion. The importance of developmental surveillance by the primary care nursing team is emphasized in order to identify the most vulnerable groups and to implement early interventions which can minimize the negative effects which worsen with age.

Social Class Index: A New Measurement for Gender Social Stratification

This research studied the Chinese gender social stratification by creating the Direct and Indirect 'Social Class Index' (SCI) for each observation. Adopting the Principal Component Analysis, both indices combined many social aspects, such as occupation, ownership, industry, job stability, year of school and hourly earnings etc. In addition, with a changed variable set, which included the occupation concerning information in labour market, and also the household redistribution and exchange impact, a new 'SCI' was formed. This new 'SCI' reconstructed the original social structure and changed the individual's social rank. After comparing the two indices, it was found that the impact of the household in China helped diminish social disparities between couples, genders and social groups. Marital status had a positive effect on the lower social strata and on women.

Toward a Psychological Study of Class Consciousness: Development and Validation of a Social Psychological Model

While social class has recently become a prominent topic in social psychological research, much of this effort has focused on the psychological consequences of objective and subjective indices of class (e.g., income, perceived status). This approach sheds light on the consequences of social class itself, but overlooks a construct of central importance in earlier theorizing on class: class consciousness, or the extent to which individuals acknowledge and situate themselves within class relations. The current paper offers a psychological model of class consciousness comprised of five elements: awareness of social class, perceptions of class conflict, beliefs about the permeability of class groups, identification with a class group, and personal experience of being treated as a member of one’s class. We offer a measure assessing those central dimensions and assess differences in these dimensions by age, gender, indices of social class, political ideology, and among different class groups. Finally, we offer suggestions for how an awareness of class consciousness may enrich social psychology and ultimately foster political change.

Is alcohol consumption in older adults associated with poor self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing.

BackgroundIncreases in alcohol related mortality and morbidity have been reported among older people in England over the last decade. There is, however, evidence that drinking is protective for some health conditions. The validity of this evidence has been questioned due to residual confounding and selection bias. The aim of this study is to clarify which drinking profiles and other demographic characteristics are associated with poor self-rated health among a community-based sample of older adults in England. The study also examines whether drinking designated as being “increasing-risk” or “higher-risk” is associated with poorer self-rated health.MethodThis study used data from Wave 0, Wave 1 and Wave 5 of the English Longitudinal Study of Ageing [ELSA]. Logistic regression analysis, was used to examine the association between drinking profiles (based on quantity and frequency of drinking) and self-rated health, adjusting for gender, age, wealth, social class, education, household composition, smoking and body mass index [BMI].ResultsTwenty percent of the sample reported drinking above the recommended level at wave 0. Rates of poor self-rated health were highest among those who had stopped drinking, followed by those who never drank. The rates of poor self-rated health among non-drinkers were significantly higher than the rates of poor self-rated health for any of the groups who reported alcohol consumption. In the adjusted logistic regression models there were no drinking profiles associated with significantly higher rates of poor self-rated health relative to occasional drinkers.ConclusionsAmong those who drank alcohol, there was no evidence that any pattern of current alcohol consumption was associated with poor self-rated health, even after adjustment for a wide range of variables. The results associated with the stopped drinking profile indicate improvement in self-rated health can be associated with changes in drinking behaviour. Although several limitations of the study are noted, policy makers may wish to consider how these findings should be translated into drinking guidelines for older adults.

Thinking about Aging: Experience, Identity and Meaning among an Elderly Population in the Philippines

The paper aims to know the idioms that the elderly use to describe and make sense of their experience of aging. It is based on ethnographic data gathered through the in-depth interview of 30 normal and community dwelling elderly in Marikina City, Metro Manila, Philippines in 2012-2013. The participants were chosen through compulsive sampling from the registry of 1385 senior citizens screened free from dementia. Their age ranged from 60 to 90 years, regardless of social class, gender, ethnicity, religion and other indices of difference. The interviews were transcribed, verbatim, and coded for the idioms, their meanings and contexts in which the elderly used them. The elderly communicate in idioms, which maybe basic to denote identity that obtains from aging or secondary in that they develop from the basic ones and help define identity further. The idioms relate to either continuity or discontinuity theory of aging or help rationalize what it means to be human and elderly.

Distribution of lipid parameters according to different socio-economic indicators- the EPIC-Norfolk prospective population study.

BackgroundData on the relationship between plasma levels of cholesterol and triglycerides and social class have been inconsistent. Most previous studies have used one classification of social class.MethodsThis was a cross-sectional population based study with data on occupational social class, educational level obtained using a detailed health and lifestyle questionnaire. A total of 10,147 men and 12,304 women aged 45–80 years living in Norfolk, United Kingdom, were recruited using general practice age-sex registers as part of the European Prospective Investigation into Cancer (EPIC-Norfolk). Plasma levels of cholesterol and triglycerides were measured in baseline samples. Social class was classified according to three classifications: occupation, educational level, and area deprivation score according to Townsend deprivation index. Differences in lipid levels by socio-economic status indices were quantified by analysis of variance (ANOVA) and multiple linear regression after adjusting for body mass index and alcohol consumption.ResultsTotal cholesterol levels were associated with occupational level among men, and with educational level among women. Triglyceride levels were associated with educational level and occupational level among women, but the latter association was lost after adjustment for age and body mass index. HDL-cholesterol levels were associated with both educational level and educational level among men and women. The relationships with educational level were substantially attenuated by adjustment for age, body mass index and alcohol use, whereas the association with educational class was retained upon adjustment. LDL-cholesterol levels were not associated with social class indices among men, but a positive association was observed with educational class among women. This association was not affected by adjustment for age, body mass index and alcohol use.ConclusionsThe findings of this study suggest that there are sex differences in the association between socio-economic status and serum lipid levels. The variations in lipid profile with socio-economic status may be largely attributed to potentially modifiable factors such as obesity, physical activity and dietary intake.

A population-based study of atopic disorders and inflammatory markers in childhood before psychotic experiences in adolescence

ObjectiveSchizophrenia is associated with atopy and increased inflammatory markers. We report a population-based longitudinal study of the associations between childhood atopic disorders, subsequent serum inflammatory markers, interleukin 6 (IL-6) and C-reactive protein (CRP), and the risk of psychotic experiences (PEs). MethodPEs were assessed at age 13years (n=6785). Presence of clinician-diagnosed atopic disorders (asthma and eczema) was determined from parent-completed questionnaires at age 10years (n=7814). Serum IL-6 and CRP were measured at age 9years (n=5076). Logistic regression examined the association between (1) atopy and PEs, (2) inflammatory markers and PEs, and (3) mediating effects of inflammatory markers on the atopy–PEs association. Linear regression examined the association between atopy and inflammatory markers. Age, gender, social class, ethnicity and body mass index were included as potential confounders. ResultsAt age 10years, about 14% of the sample was reported to have asthma, 12% eczema, and 7% both asthma and eczema. Compared with children with no atopy, risk of PEs at age 13years was increased for all of these groups; adjusted odds ratios (95% CI) were, respectively, 1.39 (1.10–1.77), 1.33 (1.04–1.69), and 1.44 (1.06–1.94). Atopy was associated with increased serum IL-6 and CRP; however, this did not mediate association between atopy and PEs. Inflammatory markers were not associated with later PEs. ConclusionChildhood atopic disorders increase the risk of psychotic experiences in adolescence. Follow-up of these individuals will be useful to determine the effect of atopy and inflammation on different trajectories of early-life PEs.

Abstract 129: Race-specific social gradients in breast cancer burden in Maryland: 1992-2003.

Abstract There is substantial evidence linking adverse breast cancer characteristics, including more aggressive histology, larger tumor size, and advanced stage at diagnosis, to both African American race, and lower social class. However, it is not well known if social class affects black and white women similarly, and what behavioral or environmental factors may contribute to the social class gradient for each racial group. Using data from approximately 55,000 cases of breast cancer reported to the Maryland Cancer Registry between 1992-2003, we used multi-level random effects models to examine the relationship between case race, age, year of diagnosis, area-level social class indices (area-level rates of high school graduation, employment, white collar work, and income) and three characteristics associated with adverse cancer outcomes: SEER stage at diagnosis (stage 2-7 versus 1), large tumor size at diagnosis (&amp;gt;2 cm versus &amp;lt;=2 cm), and aggressive histological grade of tumor (grade 3 or 4, versus 1 or 2). We then examined the additional contribution to the model of an estimate of area-level smoking behavior, using estimates of area-level average per household tobacco spending. Finally, we examined whether effects of social class and tobacco use varied for white and black women. Results demonstrate that black women were more likely to be diagnosed with later stage cancers (O.R. =1.29, 95% C.I.= 1.22,1.35), larger tumors (O.R.= 1.45, 95% C.I.= 1.34, 1.56), and more aggressive tumor histology (O.R. 1.65, 95% C.I.= 1.56,1.74). Social class was protective for all three outcomes, but statistically significant interactions showed that this protective effect of social class was reduced for black women compared to white women. In addition, each $1000 increase in average household level of tobacco spending was significantly associated with aggressive grade (O.R.=1.01 per $1000) and larger tumor size (O.R. =1.03, 95% C.I.=1.01,1.06) but not significantly associated with late stage diagnosis. There were no statistically significant interactions of tobacco spending by race, indicating that the effect of tobacco spending are similar for black and white cases. Findings suggest that social class effects differ by race, and that intersectionality - the context-based understanding of multiple simultaneous social effects on health - may be an important approach to understanding excess breast cancer burden in women. This analysis also suggests that health risk behaviors, such as group-level tobacco use, may contribute additional risk, and should be further explored with more robust designs and data. Citation Format: Ann C. Klassen, Aaron Pankiewicz, Frank Curriero. Race-specific social gradients in breast cancer burden in Maryland: 1992-2003. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 129. doi:10.1158/1538-7445.AM2013-129