Individual-level Socioeconomic Status Research Articles

Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices

Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used in advanced heart failure patients. Recent studies suggest that low socioeconomic status (SES) predicts worst survival after heart transplantation. Both individual-level and neighborhood-level SES (nSES) have been linked to cardiovascular health; however, the impact of SES in CF-LVAD patients remains unknown. We hypothesized that SES is a major determinant of CF-LVAD candidacy and postimplantation outcomes. A retrospective chart review was conducted on 362 patients between February 2009 and May 2016. Neighborhood-level SES was measured using the American Community Survey data and the Agency for Healthcare Research and Quality SES index score. Individual-level SES was self reported. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression determined survival statistics. Patients in the highest SES tertile were older (58 ± 13 vs. 53 ± 14; p < 0.001), less likely to be black or Hispanic (26% vs. 70%; p < 0.001), more likely to be married (87% vs. 65%; p < 0.001), more likely to have private insurance (50% vs. 39%; p < 0.001), and more likely to have employment (29% vs. 15%; p < 0.001) compared with patients in the lowest tertile. Low nSES was associated with a decreased risk of death (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.347-0.970; p = 0.038) in comparison to the high nSES. However, after adjusting for baseline clinical morbidities, the relationship was no longer present. When selecting patients for a LVAD, SES should not be thought of as an immutable risk factor. Carefully selected low-SES patients could be safely implanted with CF-LVAD with outcomes comparable to high-SES patients.

Socioeconomic Status in Relation to Risks of Major Gastrointestinal Cancers in Chinese Adults: A Prospective Study of 0.5 Million People.

Low socioeconomic status (SES) is associated with higher risk of certain gastrointestinal (e.g., colorectal, pancreatic, and liver) cancers in Western populations. Evidence is very limited in China, where correlates and determinants of SES differ from those in the West. The prospective China Kadoorie Biobank recruited 512,715 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) regions. During 10 years of follow-up, 27,940 incident cancers (including 3,061 colorectal, 805 pancreatic, and 2,904 liver) were recorded among 510,131 participants without prior cancer at baseline. Cox regression was used to estimate adjusted HRs for specific cancers associated with area-level (e.g., per capita gross domestic product, disposable income) and individual-level (e.g., education, household income) SES. Area-level SES and household income showed positive associations with incident colorectal and pancreatic cancers and inverse associations with liver cancer (P trend < 0.05). Education showed no association with colorectal cancer but inverse associations with pancreatic and liver cancers, with adjusted HRs comparing university to no formal schooling being 1.05 [95% confidence interval (CI), 0.85-1.29], 0.49 (95% CI, 0.28-0.85), and 0.61 (95% CI, 0.47-0.81), respectively. Potential risk factors (e.g., smoking, alcohol) partly explained the inverse associations of education with pancreatic and liver cancers (17.6% and 60.4%), respectively. Among Chinese adults, the associations of SES with gastrointestinal cancers differed by cancer type and SES indicator. Potential risk factors partially explained the inverse associations of education with pancreatic and liver cancers. The different associations between SES with gastrointestinal cancers may inform cancer prevention strategies.

Use of Electronic Nicotine Delivery Systems (ENDS) in China: Evidence from Citywide Representative Surveys from Five Chinese Cities in 2018.

China is the largest cigarette consuming country in the world. The emergence of electronic nicotine delivery systems (ENDS) in China may have important implications for the Chinese tobacco market. Unfortunately, research on ENDS in China, while growing, is still limited. This study was designed to examine the awareness and use of ENDS among adult urban residents in China. Data from five citywide representative surveys conducted in 2017–2018 were used. Percentages of residents who had ever heard of, ever used, or used ENDS in the past 30 days among all residents and smokers were estimated, in total and by demographic characteristics. Multiple logistic regression models were used to estimate the adjusted associations between awareness and use of ENDS and individual-level demographic characteristics and socioeconomic status (SES). Overall, 51.3% had ever heard, 4.8% ever used, and 0.9% used ENDS in the past 30 days. Men, young adults, those with high levels of education, and current smokers were more likely to be aware of and use ENDS. Among smokers, 67.8% had ever heard, 17.1% ever used, and 3.9% used ENDS in the past 30 days, respectively. Young adult smokers and smokers with high levels of education were more likely to be aware of and use ENDS. Our study results on ENDS awareness and use patterns and associated factors in China provide important evidence to inform research and policies related to ENDS manufacture, marketing, and sales in China.

COGNITIVE HABITS LINKED TO RESILIENCE: SURPRISING COMMONALITIES ACROSS THE UNITED STATES

Background: Research has documented many geographic inequities in health. Research has also documented that the way one thinks about health and quality of life (QOL) affects one’s experience of health, treatment, and one’s ability to cope with health problems. Purpose: We examined United-States (US) regional differences in QOL appraisal (i.e., the way one thinks about health and QOL), and whether resilience-appraisal relationships varied by region. Methods: Secondary analysis of 3,955 chronic-disease patients and caregivers assessed QOL appraisal via the QOL Appraisal Profile-v2 and resilience via the Centers for Disease Control Healthy Days Core Module. Covariates included individual-level and aggregate-level socioeconomic status (SES) characteristics. Zone improvement plan (ZIP) code was linked to publicly available indicators of income inequality, poverty, wealth, population density, and rurality. Multivariate and hierarchical residual modeling tested study hypotheses that there are regional differences in QOL appraisal and in the relationship between resilience and appraisal. Results: After sociodemographic adjustment, QOL appraisal patterns and the appraisal-resilience connection were virtually the same across regions. For resilience, sociodemographic variables explained 26 % of the variance; appraisal processes, an additional 17 %; and region and its interaction terms, just an additional 0.1 %. Conclusion: The study findings underscore a geographic universality across the contiguous US in how people think about QOL, and in the relationship between appraisal and resilience. Despite the recent prominence of divisive rhetoric suggesting vast regional differences in values, priorities, and experiences, our findings support the commonality of ways of thinking and responding to life challenges. These findings support the wide applicability of cognitive-based interventions to boost resilience.

COGNITIVE HABITS LINKED TO RESILIENCE: SURPRISING COMMONALITIES ACROSS THE UNITED STATES

Abstract Background: Research has documented many geographic inequities in health. Research has also documented that the way one thinks about health and quality of life (QOL) affects one’s experience of health, treatment, and one’s ability to cope with health problems. Purpose: We examined United-States (US) regional differences in QOL appraisal (i.e., the way one thinks about health and QOL), and whether resilience-appraisal relationships varied by region. Methods: Secondary analysis of 3,955 chronic-disease patients and caregivers assessed QOL appraisal via the QOL Appraisal Profile-v2 and resilience via the Centers for Disease Control Healthy Days Core Module. Covariates included individual-level and aggregate-level socioeconomic status (SES) characteristics. Zone improvement plan (ZIP) code was linked to publicly available indicators of income inequality, poverty, wealth, population density, and rurality. Multivariate and hierarchical residual modeling tested study hypotheses that there are regional differences in QOL appraisal and in the relationship between resilience and appraisal. Results: After sociodemographic adjustment, QOL appraisal patterns and the appraisal-resilience connection were virtually the same across regions. For resilience, sociodemographic variables explained 26 % of the variance; appraisal processes, an additional 17 %; and region and its interaction terms, just an additional 0.1 %. Conclusion: The study findings underscore a geographic universality across the contiguous US in how people think about QOL, and in the relationship between appraisal and resilience. Despite the recent prominence of divisive rhetoric suggesting vast regional differences in values, priorities, and experiences, our findings support the commonality of ways of thinking and responding to life challenges. These findings support the wide applicability of cognitive-based interventions to boost resilience. Keywords: appraisal; resilience; cognitive; quality of life; societal; geographic Abbreviations: MANOVA = Multivariate Analysis of Variance; PCA = principal components analysis; QOL = quality of life; SES = socioeconomic status; US = United States; ZIP = Zone Improvement Plan (postal code)

Cognitive Habits Linked to Resilience: Surprising Commonalities across the United States

Abstract: Background: Research has documented many geographic inequities in health. Research has also documented that the way one thinks about health and quality of life (QOL) affects one’s experience of health, treatment, and one’s ability to cope with health problems. Purpose: We examined United-States (US) regional differences in QOL appraisal (i.e., the way one thinks about health and QOL), and whether resilience-appraisal relationships varied by region. Methods: Secondary analysis of 3,955 chronic-disease patients and caregivers assessed QOL appraisal via the QOL Appraisal Profile-v2 and resilience via the Centers for Disease Control Healthy Days Core Module. Covariates included individual-level and aggregate-level socioeconomic status (SES) characteristics. Zone improvement plan (ZIP) code was linked to publicly available indicators of income inequality, poverty, wealth, population density, and rurality. Multivariate and hierarchical residual modeling tested study hypotheses that there are regional differences in QOL appraisal and in the relationship between resilience and appraisal. Results: After sociodemographic adjustment, QOL appraisal patterns and the appraisal-resilience connection were virtually the same across regions. For resilience, sociodemographic variables explained 26 % of the variance; appraisal processes, an additional 17 %; and region and its interaction terms, just an additional 0.1 %. Conclusion: The study findings underscore a geographic universality across the contiguous US in how people think about QOL, and in the relationship between appraisal and resilience. Despite the recent prominence of divisive rhetoric suggesting vast regional differences in values, priorities, and experiences, our findings support the commonality of ways of thinking and responding to life challenges. These findings support the wide applicability of cognitive-based interventions to boost resilience

COGNITIVE HABITS LINKED TO RESILIENCE: SURPRISING COMMONALITIES ACROSS THE UNITED STATES

Background: Research has documented many geographic inequities in health. Research has also documented that the way one thinks about health and quality of life (QOL) affects one’s experience of health, treatment, and one’s ability to cope with health problems. Purpose: We examined United-States (US) regional differences in QOL appraisal (i.e., the way one thinks about health and QOL), and whether resilience-appraisal relationships varied by region. Methods: Secondary analysis of 3,955 chronic-disease patients and caregivers assessed QOL appraisal via the QOL Appraisal Profile-v2 and resilience via the Centers for Disease Control Healthy Days Core Module. Covariates included individual-level and aggregate-level socioeconomic status (SES) characteristics. Zone improvement plan (ZIP) code was linked to publicly available indicators of income inequality, poverty, wealth, population density, and rurality. Multivariate and hierarchical residual modeling tested study hypotheses that there are regional differences in QOL appraisal and in the relationship between resilience and appraisal. Results: After sociodemographic adjustment, QOL appraisal patterns and the appraisal-resilience connection were virtually the same across regions. For resilience, sociodemographic variables explained 26 % of the variance; appraisal processes, an additional 17 %; and region and its interaction terms, just an additional 0.1 %. Conclusion: The study findings underscore a geographic universality across the contiguous US in how people think about QOL, and in the relationship between appraisal and resilience. Despite the recent prominence of divisive rhetoric suggesting vast regional differences in values, priorities, and experiences, our findings support the commonality of ways of thinking and responding to life challenges. These findings support the wide applicability of cognitive-based interventions to boost resilience. Abbreviations: MANOVA = Multivariate Analysis of Variance; PCA = principal components analysis; QOL = quality of life; SES = socioeconomic status; US = United States; ZIP = Zone Improvement Plan (postal code)

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study.

Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Database (1999/2000–2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17–3.23); Female HR 3.41 (2.81–4.13)) and being underweight (Male HR 1.98 (1.14–3.43); Female HR 2.78 (1.61–4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69–0.98); (Female HR 0.69 (0.57–0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.

Individual-level and area-level socioeconomic inequalities in hearing impairment among Chinese adults: a population-based study

BackgroundIt is unclear whether individual-level and area-level socioeconomic status (SES) is associated with hearing impairment (HI). This study determines an association of individual SES, area SES and their interaction with...

Subjective Social Status and Financial Hardship: Associations of Alternative Indicators of Socioeconomic Status with Problem Drinking in Asian Americans and Latinos

Background: Prior research shows inconsistent associations between socioeconomic status (SES) and alcohol outcomes, particularly for immigrant populations. Conventional markers of SES may not fully capture how social position affects health in these groups. Objective: We examine: (1) the associations of two alternative indicators, subjective social status (SSS) and financial hardship, with problem drinking outcomes, heavy episodic drinking (HED) and alcohol use disorder (AUD), for Asian Americans and Latinos; and (2) moderation of these relationships by educational level and nativity status. Methods: Multiple logistic regression modeling was performed using nationally-representative Asian American (n = 2,095) and Latino samples (n = 2,554) from the National Latino and Asian American Study. Age, gender, nativity, individual-level SES (income and education), unfair treatment, racial discrimination, and social support were adjusted. Results: Financial hardship was independently associated with AUD in both Asians and Latinos. Lower SSS was associated with increased AUD risk among individuals with college degrees or with US nativity in both populations. The association between financial hardship and HED was positive for US-born Latinos and foreign-born Asians, and negative for foreign-born Latinos. Conclusions: SSS and financial hardship are indicators of SES that may have particular relevance for immigrant health, independently of education and income, with SSS particularly meaningful for AUD in the more conventionally advantaged subgroups. There may be underlying processes affecting Asian and other Latino subgroups with similar socioeconomic and nativity profiles and exposing them to common risk/protective factors of AUD.

Abstract MP71: Socioeconomic Status, Guideline Directed Medical Therapy, and Prognosis in Heart Failure With Reduced Ejection Fraction: The Atherosclerosis Risk in Community (ARIC) Study

Introduction: Current research suggests racial differences exist in the utilization of guideline directed medical therapy (GDMT) and prognosis in heart failure with reduced ejection fraction (HFrEF). Whether individual and community level socioeconomic status (SES) impacts prescription patterns of GDMT and prognosis in HFrEF has not been studied. Methods: We studied 669 ARIC participants with incident HFrEF (EF&lt;50%) (mean age 77.6 (SD 6.5) years; 39% black; 46% women) during 2005-2017 (median 1.8 years of follow-up). We assessed the proportion of patients on optimal GDMT (defined as ß-blockers [BB] and ACE inhibitors [ACEI] or angiotensin receptor blockers [ARB]) or adequate GDMT (one of either BB, ACEI/ARB, aldosterone antagonists [AA], or hydralazine and nitrates [H-ISDN]) at hospital discharge by individual SES (education and income), neighborhood SES (area deprivation index: ADI) and their combination (Table). We also examined the contribution of GDMT prescription to prognosis overall, and by SES. Subsequently, we quantified the association of SES with mortality and re-hospitalization for HFrEF. Results: The proportion of patients prescribed optimal and adequate GDMT was 54% and 81%, respectively. BB were most frequently prescribed (83%), followed by ACEI/ARB (61%), AA (11%), and H-ISDN (9%). Overall, BB were associated with lower mortality, while H-ISDN were associated with higher mortality, compared to their non-use counterparts. ACEI/ARB were associated with lower re-hospitalization, compared to non-users of ACEI/ARB. The prescription of GDMT and the effect of GDMT on prognosis did not significantly differ by SES. Despite that, lower SES was independently associated with higher risk of mortality and re-hospitalization (Table). Conclusions: Overall, optimal GDMT was low at discharge, but did not differ by SES. Despite that, there were significant differences in death and re-hospitalization by SES, suggesting a potential need for tailored approaches to HFrEF management for low SES individuals.

Neighborhood-level measures of socioeconomic status are more correlated with individual-level measures in urban areas compared with less urban areas

PurposeWe tested the hypothesis that individual- and neighborhood-level measures of socioeconomic status (SES) are more concordant in urban than rural areas, and we used the previously established association between obesity and self-rated health to illustrate the effect of residual confounding by individual-level SES when only neighborhood-level SES is considered. MethodsUsing data from two population-based surveys, we calculated Spearman's rank correlations between household income and neighborhood socioeconomic advantage across eight Pennsylvania counties. We applied multivariable Poisson regression models with robust variance estimates to estimate the degree to which individual SES confounds the association between obesity and self-rated health when the analysis accounts for neighborhood SES only, and we examined how this confounding varied by county urbanicity. ResultsConcordance between household income and neighborhood advantage increased with county urbanicity (ρ = 0.16–0.26 vs. 0.31–0.45 vs. 0.47 in medium metro/micropolitan, suburban, and large metro counties, respectively), while confounding by individual SES on the obesity and self-rated health association decreased with urbanicity (15%–22% vs. 6%–13% vs. 3% in medium metro/micropolitan, suburban, and large metro counties, respectively). ConclusionsIndividual- and neighborhood-level SES measures are poorly correlated outside of urban areas, suggesting that neighborhood-level measures inadequately account for individual SES in rural settings.

Spatial clustering of diabetes among reproductive age women and its spatial determinants at the district level in southern India

BackgroundFew recent studies have demonstrated that in India diabetes prevalence varies geographically. Differences in individual-level factors and socioeconomic status are common explanations for this variation. However, we have not come across any study on diabetes spatial clusters at the district-level among reproductive-age women in southern India. Therefore, the study was carried out to understand the spatial clustering of diabetes prevalence among reproductive-age women and its spatial determinants in southern India. MethodsNational Family Health Survey (2015–16) data was used to estimate High Blood Glucose (HBG) and Very High Blood Glucose (VHBG) prevalence for women aged 15–49 years in 99 districts of southern India. We adopted advanced spatial statistical analysis such as Moran's Index and spatial regression techniques to address the study objectives. ResultsRemarkable variations were found in HBG and VHBG prevalence among 99 districts in southern India. Spatial association of HBG was found in 4 districts, and VHBG was found in 7 districts, which were hotspots. The value of the bivariate Moran's I statistics confirmed the spatial dependence between HBG and VHBG with a set of independent variables. District-level prevalence of HBG and VHBG have shown significant spatial clustering across southern Indian districts. The adjusted coefficients from the spatial error model confirmed that district-level proportion of tobacco use, overweight, obese, and general caste had significant associations with HBG and VHBG prevalence. ConclusionThe study suggests that there is need for targeted intervention programs to address diabetes among reproductive-age women in high priority districts in southern India.

Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders

ObjectiveRecent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). MethodsData were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. Results143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. ConclusionsThis study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.

Association of Neighborhood-Level Disadvantage With Cerebral and Hippocampal Volume

Identifying risk factors for brain atrophy during the aging process can help direct new preventive approaches for dementia and cognitive decline. The association of neighborhood socioeconomic disadvantage with brain volume in this context is not well known. To test whether neighborhood-level socioeconomic disadvantage is associated with decreased brain volume in a cognitively unimpaired population enriched for Alzheimer disease risk. This study, conducted from January 6, 2010, to January 17, 2019, at an academic research neuroimaging center, used cross-sectional data on 951 participants from 2 large, ongoing cohort studies of Alzheimer disease (Wisconsin Registry for Alzheimer's Prevention and Wisconsin Alzheimer's Disease Research Center clinical cohort). Participants were cognitively unimpaired based on National Institute on Aging-Alzheimer's Association workgroup diagnostic criteria for mild cognitive impairment and Alzheimer disease, confirmed through a consensus diagnosis panel. The cohort was enriched for Alzheimer disease risk based on family history of dementia. Statistical analysis was performed from April 3 to September 27, 2019. The Area Deprivation Index, a geospatially determined index of neighborhood-level disadvantage, and cardiovascular disease risk indices were calculated for each participant. Linear regression models were fitted to test associations between relative neighborhood-level disadvantage (highest 20% based on state of residence) and hippocampal and total brain tissue volume, as assessed by magnetic resonance imaging. In the primary analysis of 951 participants (637 women [67.0%]; mean [SD] age, 63.9 [8.1] years), living in the 20% most disadvantaged neighborhoods was associated with 4.1% lower hippocampal volume (β = -317.44; 95% CI, -543.32 to -91.56; P = .006) and 2.0% lower total brain tissue volume (β = -20 959.67; 95% CI, -37 611.92 to -4307.43; P = .01), after controlling for intracranial volume, individual-level educational attainment, age, and sex. Robust propensity score-matched analyses determined that this association was not due to racial/ethnic or demographic characteristics. Cardiovascular risk score, examined in a subsample of 893 participants, mediated this association for total brain tissue but not for hippocampal volume. For cognitively unimpaired individuals, living in the most disadvantaged neighborhoods was associated with significantly lower cerebral volumes, after controlling for maximal premorbid (total intracranial) volume. This finding suggests an association of community socioeconomic context, distinct from individual-level socioeconomic status, with brain volume during aging. Cardiovascular risk mediated this association for total brain tissue volume but not for hippocampal volume, suggesting that neighborhood-level disadvantage may be associated with these 2 outcomes via distinct biological pathways.

The relationship of 25-hydroxyvitamin D concentrations and individual-level socioeconomic status

Socioeconomic status (SES), defined as the ability to access desired resources, is associated with behaviors that may affect vitamin D status. Most studies of the effect of vitamin D status on outcomes do not account for individual-level SES. The ability to adjust for SES in epidemiologic studies, when data on conventional SES measures have not been obtained, would be advantageous. We identified all serum 25(OH)D measurements in adults age 18 years and older residing in Olmsted County, MN, a mixed urban-rural setting, between January 1, 2005 and December 31, 2011, through the Rochester Epidemiology Project. The first 25(OH)D measurement was considered the index measurement for each subject. SES was determined for each subject by the HOUsing-based SocioEconomic Status (HOUSES) index, derived from real property data. The HOUSES index is an aggregated z-score of assessed housing value, area of living space, number of bedrooms, and number of bathrooms, with higher scores indicating higher SES. Multivariable analyses were adjusted for age, BMI, sex, race, season of 25(OH)D measurement, and Charlson comorbidity index. HOUSES was matched for 10,378 of 11,002 subjects (94 %) with 25(OH)D measurements available. The mean (SD) age was 54.3 (17.1) years with 26.9 % ≥65 years; 77.3 % were women, and 12.1 % were non-white. The mean 25(OH)D concentration was 30.0 (12.9) ng/mL, and 598 (5.8 %) had a 25(OH)D value <12 ng/mL. The mean (SD) HOUSES was -1.55 (3.09),-0.97 (3.34), 0.14 (3.52), 0.24 (3.51) for serum 25(OH)D categories of <12, 12–19, 20–50, and >50 ng/mL, respectively (P = 0.12 for trend). 25(OH)D increased by 0.43 (95 % CI 0.36-0.50) ng/mL for each unit increase in HOUSES in univariate analysis and by 0.28 (0.21-0.35; P < 0.001) ng/mL in multivariable analysis. This represents a change of 4 ng/mL across the entire range of observed HOUSES, an effect similar in magnitude to the seasonal variation of 25(OH)D values. SES was independently associated with serum 25(OH)D concentrations in a dose-response manner after adjustment for important covariates. HOUSES is a useful tool to assess the role of individual-level SES in health outcomes when other SES measures are unavailable and to control for confounding by SES in examining the effect of 25(OH)D on clinical and metabolic outcomes.

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999-2002 National Health and Nutrition Examination Survey.

Socioeconomically disadvantaged neighborhoods have been associated with poor health outcomes. Little is known about the biological mechanism by which deprived neighborhood conditions exert negative influences on health. Data from the 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were used to assess the relationship between neighborhood deprivation index (NDI) and log-transformed leukocyte telomere length (LTL) via multilevel modeling to control for census tract level clustering. Models were constructed using tertiles of NDI (ref = low NDI). NDI was calculated using census tract level socioeconomic indicators from the 2000 U.S. Census. The sample (n = 5,106 adults) was 49.8% female and consisted of 82.9% non-Hispanic whites, 9.4% non-Hispanic blacks, and 7.6% Mexican Americans. Mean age was 45.8 years. Residents of neighborhoods with high NDI were younger, non-white, had lower educational attainment, and had a lower poverty to income ratio (all p < 0.0001). Neighborhood deprivation was inversely associated with LTL among individuals living in neighborhoods with medium NDI (β = −0.043, SE = 0.012, p = 0.0005) and high NDI (β = −0.039, SE = 0.013, p = 0.003). Among men, both medium (β = −0.042, SE = 0.015, p = 0.006) and high (β = −0.047, SE = 0.015, p = 0.001) NDI were associated with shorter LTL. Among women, only medium NDI (β = −0.020, SE = 0.016, p = 0.009) was associated with shorter LTL. After controlling for individual characteristics, including individual-level socioeconomic status, increasing neighborhood socioeconomic deprivation is associated with shorter LTL among a nationally representative sample of US adults. This suggests that telomere shortening may be a mechanism through which neighborhood deprivation results in poor health outcomes.

Temporal Trends in Mortality from Major Cancers by Education in the United States, 2001-2016

Abstract Data on recent trends in mortality from major cancers by individual-level socioeconomic status (SES) are lacking in the US. We examined mortality trends and disparities by educational attainment (rate ratio ≤12 vs. ≥16 years of education) from 2001-2016 for lung, colorectal, female breast, and prostate cancers among persons aged 25-74 years. During 2001-2016, death rates continued to decrease in each stratum of sex/education categories for all four cancers, with the steepest decline among those with ≥16 years of education. Consequently, relative educational disparities widened over time. Among men for example, lung cancer death rates from 2001-2016 decreased 2.70% per year in persons with ≤12 years of education compared to 5.44% per year among those with ≥16 years of education, and the rate ratio increased from 2.96 (95%CI, 2.84-3.09) to 4.58 (95%CI, 4.41-4.76). Enhanced interventions targeting low SES populations are needed to reduce the inequality and accelerate progress against cancer.

NEIGHBORHOOD AND HEALTH AMONG CHINESE ADULTS: BEYOND THE URBAN AND RURAL DICHOTOMY

The associations between physical frailty and depressive symptoms among older individuals were established in existing literature. Taking the person-environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study are to explore 1) to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms, 2) if there were rural-urban differences in the moderation effects, and 3) whether some of the environmental factors worked beyond the contextual influences of the rural-urban scope. Using the China Health and Retirement Longitudinal Study 2011 wave, 6,246 individuals ages 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socio-economic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics. Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural-urban contexts. Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping and the need to redefining China’s rural-urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.

COMMUNITY CAPACITY AND SOCIAL PARTICIPATION AMONG COMMUNITY-DWELLING MIDDLE-AGED AND OLDER CHINESE

Objectives. This study investigates how social participation of the aging population is associated with the community capacity, measured by the number of amenities and organizations within the community. Method. Using nationally representative survey data from the China Health and Retirement Longitudinal Study (2011), this study examines the availability of community amenities and organizations in rural and urban areas, and investigates the associations between community capacity and social participation among the middle aged and older Chinese using multilevel analysis. Results. The results of this study indicate that both community amenities and community organizations are positively associated with the social participation of the middle-aged and older Chinese. Additionally, the association between community organizations and the frequency of formal social participation is stronger among urban communities than rural ones, even after controlling for the individual-level socioeconomic status and health conditions. Conclusion. This study highlights the importance of building the community capacity by developing community-based grassroots organizations to promote the social engagement and participation of the aging population.