Individual-level Socioeconomic Factors Research Articles

Abstract IA038: Race and immune microenvironments in context of individual- and community-level covariates

Abstract Black women and women with African Ancestry have higher frequency of aggressive breast cancer subtypes, namely triple-negative breast cancer (TNBC) or Basal-like breast cancer, and often have tumors that show immunogenic features. Under a cells-to-society conceptual model of racialized breast cancer outcomes, differences in tumor biology and microenvironment interact with individual- and community-level variables so that differences in tumor biology reflect ancestry in combination with social determinants of health. Using data and biospecimens from the Carolina Breast Cancer Study, we evaluated immune expression by gene expression analysis and by immunofluorescence and other spatial techniques. Our results show that Black women more frequently have immunogenic tumors with a robust adaptive immune response, in accordance with higher frequency of Basal-like breast cancers. Adaptive immune response was also associated with specific breast cancer genetic features, such as p53 status, and was associated with differential recurrence outcomes. Immunogenic tumors of Basal-like subtype were also associated with individual-level socioeconomic factors (education, income, prediagnostic health care utilization) and community-level socioeconomic factors (census tract-level poverty and disadvantage). These data suggest that while some biologically-targeted therapies may help narrow disparities in breast cancer outcomes among those diagnosed with breast cancer, individual- and community-level variables are also important and may help to identify intervention strategies for prevention of aggressive subtypes. Citation Format: Melissa A. Troester. Race and immune microenvironments in context of individual- and community-level covariates [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA038.

Inequalities in common mental health disorders: understanding the predictors of lifetime prevalence, treatment utilisation, and helpfulness across 113 countries

BackgroundSocioeconomic inequalities in common mental health disorders (CMDs) cut across each step in the cascade of care: less affluent individuals have a higher lifetime prevalence of CMDs, are less likely to utilise treatment, and less likely to perceive the treatment as helpful when they do receive it. Here, I test whether such socioeconomic inequalities exist globally across 113 countries and, additionally, which psychological and country-level factors are associated with the three health outcomes (ie, CMD prevalence, treatment utilisation, and helpfulness). MethodsThis study uses cross-sectional survey data from the Wellcome Global Monitor 2020 (n=119 088 from 113 countries) to test whether individual-level socioeconomic factors, individual-level psychological factors (stigma and trust), and country-level factors (GDP, GINI, and health expenditure) predict CMD lifetime prevalence, utilisation, and perceived helpfulness of talking to a mental health professional and taking prescribed medication. Multi-level logistic regression models were used, which included the three types of predictors (socioeconomic, psychological, and country-level factors) and controlled for age and gender. FindingsIndividuals with higher household income are less likely to experience anxiety or depression (odds ratio [OR] 0·90 for each income quintile [95% CI 0·89–0·91]), more likely to talk to a mental health professional (1·05 [1·03–1·07]; 1·34 [1·22–1·46] for higher education), and more likely rate this treatment as very helpful (1·06 [1·03–1·10]) across countries. By contrast, income is not linked with utilisation (OR 0·99 [95% CI 0·97–1·01]) and helpfulness of taking prescribed medication for CMDs (1·02 [0·99–1·05]). Among the psychological predictors, stigma reduces utilisation (OR 0·95 [95 CI 0·92–0·99]) and helpfulness of talking therapy (0·77 [0·72–0·81]), whereas trust in health practitioners increases both (OR 1·07 [95% CI 1·04–1·10] for utilisation and 1·31 [1·24–1·39] for helpfulness). Country-level health expenditure is related to higher treatment utilisation (OR 1·11 [95% CI 1·04–1·18]), but not perceived treatment helpfulness (1·03 [0·97–1·09]). InterpretationAcross 113 countries, socioeconomic inequalities in the three mental health outcomes deepen disadvantages for less affluent individuals along the cascade of care. For pharmacological treatment, however, socioeconomic factors are not associated with treatment utilisation and helpfulness. Finally, psychological factors as well as structural country-level factors also determine utilisation and helpfulness. FundingEconomic and Social Research Council.

The influence of neighbourhood-level socioeconomic deprivation on developing type 2 diabetes in older men: a longitudinal analysis of the British Regional Heart Study cohort data

BackgroundEvidence from the British longitudinal studies on the influence of neighbourhood-level socioeconomic deprivation in older men on developing type 2 diabetes mellitus is scarce. This study investigates the prospective associations of neighbourhood-level deprivation and individual socioeconomic position with type 2 diabetes mellitus incidence in older men. MethodsThe British Regional Heart Study comprises a cohort of 4252 men aged 60–79 years in 1998–2000 from 24 towns across the UK. Neighbourhood-level deprivation was based on the country specific 2004–05 Index of Multiple Deprivation (IMD) quintiles for participants' postcode of residence at baseline. Individual socioeconomic position was defined as occupational social class based on longest-held occupation at recruitment. Participants with prevalent diabetes were excluded. The incidence of type 2 diabetes mellitus was ascertained from biannual reviews of primary care records over 18 years of follow-up. Cox proportional hazard models were undertaken to examine associations. FindingsThe incidence of type 2 diabetes mellitus cases observed was 368 (9·9%), amongst the 3706 male participants. Age-adjusted rates of type 2 diabetes mellitus increased from IMD quintile 1 (least deprived) to quintile 4 (second most deprived), before decreasing in quintile 5. Compared with quintile 1, the age and individual social class adjusted hazard ratio (aHR) in quintile 4 was 1·52 (95% CI 1·09–2·13), remaining significant after further adjustments for obesity and family history of type 2 diabetes mellitus. Participants in the lowest social class had the highest rates of type 2 diabetes mellitus. The aHR by age and IMD scores for type 2 diabetes mellitus in the lowest social class compared with the highest social class was 2·12 (95% CI 1·15–3·89). InterpretationNeighbourhood-level and individual-level socioeconomic factors remain important predictors of developing type 2 diabetes mellitus in older men, demonstrating that inequalities persist in later life. Inequalities in diabetes and its underlying modifiable risk factors need to be addressed to reduce the burden of this disease in socioeconomically deprived older-age populations. FundingNone.

Multimorbidity in Large Canadian Urban Centres

Abstract Introduction Although health outcomes are related to the characteristics of the geographic areas in which people live, there is limited knowledge on how the prevalence of multimorbidity varies within and across major Canadian urban centres. Our goal was to assess the level of between-neighbourhood variation in the prevalence of multimorbidity in Canada's large urban centres, controlling for compositional effects associated with demographic and socioeconomic factors. Methods Cross-sectional data from the 2015-2018 cycles of the Canadian Community Health Survey (CCHS) were used. Respondents (20 years and older) residing in one of the 35 census metropolitan areas (CMAs) were included (N = 100,803). Census tracts (CTs), relatively small and stable geographic areas nested within CMAs, were used as a measure of neighbourhood. To assess the between-neighbourhood differences in multimorbidity prevalence, we fitted sequential random intercept logistic regression models. Results During the 2015-2018 period, 8.1% of residents of large urban centres in Canada had multimorbidity. The results from the unadjusted model indicate that 13.4% of the total variance in multimorbidity could be attributed to the between-neighbourhood differences. After adjustment for overall characteristics of the CMAs in which these neighbourhoods are located, as well as for individual-level demographic and socioeconomic factors related to compositional effects, 11.0% of the individual variance in multimorbidity could still be attributed to the between-neighbourhood differences. Discussion and Conclusions There is significant and substantial geographic variation in multimorbidity prevalence across neighbourhoods in Canada's large urban centres. Residing in some neighbourhoods could be associated with increased odds of having multimorbidity, even after accounting for overall characteristics of the CMAs in which these neighbourhoods are located, as well as individual-level factors.

Socio-economic factors determine maternal and noenatal outcomes in women with peripartum cardiomyopathy: a study of the ESC EORP PPCM registry

Abstract Background Peripartum cardiomyopathy (PPCM) is a global disease associated with substantial morbidity and mortality. Purpose The aim of this study was to analyse to what extent country- and individual-level socioeconomic factors were associated with maternal and neonatal outcomes. Methods In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EORP Programme. Country-level sociodemographic factors were Gini coefficient (GINI), health expenditure (HE) and human developmental index (HDI). Individual-level sociodemographic factors were income and educational attainment. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-specific socioeconomic status. Results 739 women from 49 countries were enrolled (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]). Overall, 142 (19%) of women were from countries with low HDI, 307 (42%) medium HDI and 290 (39%) high HDI. Patients of Black African ethnicity were almost all from low HDI countries (99.3%), Middle Eastern and Asian patients from medium HDI (37.7% and 26.2%), and Caucasian patients were mostly from high HDI (72%, p<0.001). Women from countries with low HDI had lower income and educational attainment. They also underwent fewer Caesarian sections, but breastfed for longer (20 versus 6 months, p<0.001). Low HDI and low GINI were associated with greater LV dilatation at time of diagnosis (p<0.001), but LV ejection fraction (LVEF) did not differ according to HDI, HE or GINI. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Low HE was associated with more frequent mortality (p<0.002), whereas HDI and GINI were not. Women from countries with low HDI and low HE had significantly less recovery of LV function. Analysis of maternal outcome as per highest level of educational attainment (i.e., primary [n=154], secondary [n=342], tertiary [n=126]), showed significant differences in LVEF at 6 months (43.7+12.9, 46.5+13.0 and 48.9+11.7 respectively, p=0.022). Low maternal income, irrespective of region of origin, was independently associated with poor outcome (composite of maternal death, re-hospitalization, or LV non-recovery). Neonatal death was more prevalent in countries with low HE (p=0.009) and low HDI (p=0.023) but was not influenced by maternal sociodemographic parameters. Conclusion Maternal and neonatal outcomes depended on country-specific socioeconomic characteristics, with a greater prevalence of maternal and neonatal deaths in women from countries with low HE. Globally, women with low income and lower levels of educational attainment had poorer outcomes, irrespective of region. Attempts should be made to improve patient education, and allocation of adequate health resources to improve maternal and neonatal outcomes in PPCM. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 1. EurObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy2. Cape Heart Institute, University of Cape Town, Cape Town, South Africa

Mortality in persons with recent primary or secondary care contacts for mental disorders in Finland

Mortality in persons with recent primary or secondary care contacts for mental disorders in Finland

Individual-level income and out-of-hospital cardiac arrest survival in men and women

ObjectiveArea-level socioeconomic factors are known to associate with chances to survive out-of-hospital cardiac arrest (OHCA survival). However, the relationship between individual-level socioeconomic factors and OHCA survival in men and women...

Examining the association between HIV prevalence and socioeconomic factors among young people in Zambia: Do neighbourhood contextual effects play a role?

BackgroundThe study examined the association between HIV infection and individual and neighbourhood-level socioeconomic factors in Zambia.MethodsWe used multilevel mixed effects logistic regression to examine the association of individual and neighbourhood level variables on HIV prevalence based on data from the 2013–14 and 2018 Zambia Demographic and Health Surveys, population-based cross-sectional surveys. The analysis was restricted to young people (15–24 years) with HIV serostatus results (n = 11,751 and n = 10,154). HIV serostatus was the outcome variable and socioeconomic status was measured by wealth, education and employment.ResultsOverall, at individual level, education was associated with reduced odds of HIV infection among young women and men. Conversely, relative wealth was generally associated with increased odds of infection for both young women and men. Young, employed men were at reduced odds of HIV infection than the unemployed. Living in neighbourhoods with higher average level of education was associated with higher odds of HIV infection. In 2013–14, 13% and 11% of the variation in HIV infection among young men and women was attributed to neighbourhoods, while 20% and 11% variation was attributed to neighbourhoods in 2018. Inclusion of individual and neighbourhood variables in the full regression model accounted for 65.7% and 59.5% of explained variance in 2013–14 and 64.6% and 44.3% in 2018, for women and men, respectively. This reduced unexplained variance by an average of 56% in 2013–14 and 29% in 2018.ConclusionWe found that HIV infection among young people in Zambia is more strongly associated with individual-level socioeconomic factors compared to neighbourhood factors. Individual-level education remains an important socioeconomic factor associated with reduced odds of HIV infection. This suggests that the HIV response in Zambia should still focus on individual level prevention strategies.

Inequalities in Income and Education Are Associated With Survival Differences After Out-of-Hospital Cardiac Arrest: Nationwide Observational Study.

Despite the acknowledged importance of socioeconomic factors as regards cardiovascular disease onset and survival, the relationship between individual-level socioeconomic factors and survival after out-of-hospital cardiac arrest is not established. Our aim was to investigate whether socioeconomic variables are associated with 30-day survival after out-of-hospital cardiac arrest. We linked data from the Swedish Registry for Cardiopulmonary Resuscitation with individual-level data on socioeconomic factors (ie, educational level and disposable income) from Statistics Sweden. Confounding and mediating variables included demographic factors, comorbidity, and Utstein resuscitation variables. Outcome was 30-day survival. Multiple modified Poisson regression was used for the main analyses. A total of 31 373 out-of-hospital cardiac arrests occurring in 2010 to 2017 were included. Crude 30-day survival rates by income quintiles were as follows: Q1 (low), 414/6277 (6.6%); Q2, 339/6276 (5.4%); Q3, 423/6275 (6.7%); Q4, 652/6273 (10.4%); and Q5 (high), 928/6272 (14.8%). In adjusted analysis, the chance of survival by income level followed a gradient-like increase, with a risk ratio of 1.86 (95% CI, 1.65-2.09) in the highest-income quintile versus the lowest. This association remained after adjusting for comorbidity, resuscitation factors, and initial rhythm. A higher educational level was associated with improved 30-day survival, with the risk ratio associated with postsecondary education ≥4 years being 1.51 (95% CI, 1.30-1.74). Survival disparities by income and educational level were observed in both men and women. In this nationwide observational study using individual-level socioeconomic data, higher income and higher educational level were associated with better 30-day survival after out-of-hospital cardiac arrest in both sexes.

Pathways between objective and perceived neighborhood factors among Black breast cancer survivors

BackgroundMounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort.MethodsDemographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women’s Circle of Health Follow-up Study – a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant’s residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals.ResultsHigher perceived neighborhood disorder was associated with higher objective neighborhood disorder (β = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (β = − 0.11, 95% CI: − 0.24, 0.02).ConclusionObjective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Age Patterns in Self-Reported Cognitive Impairment Among Older Latino Subgroups and Non-Latino Whites in the United States, 1997-2018: Implications for Public Health Policy.

Background and ObjectivesU.S. Latinos are a heterogeneous population with unique characteristics related to individual-level socioeconomic and contextual factors based on nativity status and country of origin. Population aging and greater public awareness of dementia may contribute to an increasing prevalence of self-reported cognitive impairment. However, population-level trends in self-reported cognitive impairment among Latinos are unclear and it is unknown whether there are differences among Latino subgroups. Thus, this study aims to examine heterogeneity in self-reported cognitive impairment among older U.S. Latino subgroups.Research Design and MethodsWe used data from the 1997–2018 National Health Interview Survey to document age-specific patterns in self-reported cognitive impairment among U.S.-born Mexican, foreign-born Mexican, island-born Puerto Rican, foreign-born Cuban, and U.S.-born non-Latino Whites aged 60 and older. We estimated hierarchical age–period–cohort cross-classified random effects models (HAPC-CCREM) to isolate age patterns in self-reported cognitive impairment across disaggregated Latino subgroups and U.S.-born non-Latino Whites.ResultsThe overall prevalence of self-reported cognitive impairment increased from 6.0% in 1997 to 7.1% in 2018. This increase was evident among U.S.-born non-Latino Whites and U.S.-born and foreign-born Mexicans but not other Latino subgroups. Fully adjusted HAPC-CCREM estimates indicated that Latinos were more likely to self-report cognitive impairment than U.S-born non-Latino Whites (b = 0.371, p < .001). When disaggregated by Latino subgroup, the difference in the likelihood for self-reported cognitive impairment compared to U.S.-born non-Latino Whites was greatest for island-born Puerto Ricans (b = 0.598, p < .001) and smallest for foreign-born Cubans (b = 0.131, p > .05).Discussion and ImplicationsWe found evidence of considerable heterogeneity in the age patterns of self-reported cognitive impairment among U.S. Latino subgroups. We also detected large differences in the likelihood for self-reported cognitive impairment between U.S. Latino subgroups compared to U.S.-born non-Latino Whites. These results underscore the importance of differentiating between unique Latino subpopulations when studying population-level trends in cognitive function.

Neighborhood deprivation and epigenetic aging

BACKGROUND AND AIM: Recent research suggests widening socioeconomic disparities in life expectancy in the United States. Both individual-level and small-area socioeconomic status factors, such as living in a socioeconomically disadvantaged neighborhood, are independently associated with early onset of age-related disease, reduced life expectancy and all-cause mortality. Neighborhood deprivation may increase the risk of early onset of age-related disease, reduced life expectancy, and all-cause mortality. Mechanisms linking neighborhood deprivation and age-related disease are multifactorial and complex. Residence in a deprived neighborhood can lead to poor health behaviors, increased toxicant exposures, lack of access to health services, and low social cohesion. Living in a deprived neighborhood can also lead to chronic stress and induce biological weathering on endocrine and inflammatory systems. METHODS: Emerging evidence suggests epigenetics may be implicated in biological mechanisms underpinning this relationship. DNA methylation is the most well-understood epigenetic factor and involves the addition of a methyl group to DNA, typically at the 5-carbon of cytosine at cytosine-guanine (CpG) dinucleotides. Recently developed ‘epigenetic clocks’ are a class of biological age predictors that use DNA methylation at predetermined CpG sites to measure biological variation among those with the same chronologic age. These clocks are better at predicting chronologic age than other markers including telomere length and may be a more sensitive measure of biologic aging. RESULTS:This presentation will focus on recent findings of the association between neighborhood deprivation and epigenetic measures of age acceleration from the Sister Study, a prospective breast cancer cohort study. CONCLUSIONS:Findings from this study suggest that residing in a neighborhood with higher deprivation is associated with methylation-based markers of aging. African American/Black women in the U.S. may be more likely to live in disadvantaged neighborhoods. Planned research focused on methylation patterns in African American/Black individuals will allow researchers to evaluate how neighborhood disadvantage and methylation changes contribute to health disparities. KEYWORDS: ‘Advancing racial health equity through studies of the environment and epigenetic aging’, neighborhood environment, epigenetics, aging

Individual-level and country-level socio-economic factors and health outcomes in spondyloarthritis: analysis of the ASAS-perSpA study.

The aim of this study was to investigate the association between individual-level and country-level socio-economic (SE) factors and health outcomes across SpA phenotypes. Patients with axial SpA (axSpA), peripheral SpA (pSpA) or PsA from the ASAS-perSpA study (in 23 countries) were included. The effect of individual-level (age, gender, education and marital status) and country-level [e.g. Gross Domestic Product (GDP)] SE factors on health outcomes [Ankylosing Spondylitis Disease Activity Score (ASDAS) ≥ 2.1, ASDAS, BASFI, fatigue and the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI)] was assessed in mixed-effects models adjusted for potential confounders. Interactions between SE factors and disease phenotype were tested. A mediation analysis was conducted to explore whether the impact of country-level SE factors on ASDAS was mediated through biologic/targeted synthetic (b/ts) DMARD uptake. In total, 4185 patients (61% males, mean age 45) were included (65% axSpA, 25% PsA, 10% pSpA). Female gender [β= 0.14 (95% CI: 0.06, 0.23)], lower educational level [β = 0.35 (0.25, 0.45)) and single marital status [β = 0.09 (0.01, 0.17)] were associated with higher ASDAS. Living in lower GDP countries was also associated with higher ASDAS [β = 0.39 (0.16, 0.63)], and 7% of this association was mediated by b/tsDMARD uptake. Higher BASFI was similarly associated with female gender, lower education and living alone, without the effect of country-level SE factors. Female gender and lower educational level were associated with worse ASAS-HI, while more fatigue was associated with female gender and higher country-level SE factors [lower GDP, β = -0.46 (-0.89 to -0.04)]. No differences across disease phenotypes were found. Our study shows country-driven variations in health outcomes in SpA, independently influenced by individual-level and country-level SE factors and without differences across disease phenotypes.

Association between individual and country-level socioeconomic factors and work participation in spondyloarthritis including psoriatic arthritis: Analysis of the ASAS-perSpA study

ObjectiveTo examine whether associations between socioeconomic factors and work outcomes in spondyloarthritis (SpA) differ across axial (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA), and whether associations for individual-level socioeconomic factors are modified by country-level factors. MethodsPatients with a physician diagnosis of SpA within working age (18–65 years) were included. Associations between individual- (age, gender, education, marital status) and country-level factors (Human Development Index, Health Care Expenditure (HCE), Gross Domestic Product, percentage unemployed) with work outcomes (employment status, absenteeism, presenteeism) were assessed using multivariable mixed-effects models. Associations between individual factors and outcomes were compared according to SpA phenotypes and country-level factors using interaction terms. ResultsA total of 3835 patients (mean age 42 years, 61% males) from 23 countries worldwide were included (66% axSpA, 10% pSpA, 23% PsA). Being employed was associated with gender (male vs. female OR 2.5; 95%CI 1.9–3.2), education (university vs. primary OR 3.7; 2.9–4.7), marital status (married vs. single OR 1.3; 1.04–1.6), and age in a non-linear manner. University (vs primary) education was associated with lower odds of absenteeism (OR 0.7; 0.5–0.96) and presenteeism (OR 0.5; 0.3–0.7). Associations were similar across SpA phenotypes. Higher HCE was associated with more favourable work outcomes, e.g., higher odds of employment (OR 2.5; 1.5–4.1). Gender discrepancy in odds of employment was greater in countries with lower socioeconomic development. ConclusionHigher educational attainment and higher HCE were associated with more favourable work outcomes, independently of SpA phenotype. The disadvantageous effect of female gender on employment is particularly strong in countries with lower socioeconomic development.

Improving pathways to care through interventions cocreated with communities: a qualitative investigation of men’s barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi

IntroductionMen have a higher prevalence of undiagnosed tuberculosis (TB) than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment. Health...

Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence.

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis

ObjectiveThere has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant...

Association between area- and individual-level socio-economic factors with glycated haemoglobin-Evidence from a Portuguese population-based study.

This study aims to estimate the associations between area-level deprivation and individual-level socio-economic factors, as well as their interaction, with glycated haemoglobin (HbA1c ) levels. We conducted a gamma multilevel regression analysis using individual-level data from the Portuguese National Health Examination Survey and a deprivation index built through factor analysis, at municipality level, with census variables. Living in a municipality with high material deprivation and having a low level of education were independently associated with an increase of 2.3% (95% confidence interval [CI] 0.6, 4.0) and of 1.6% (95% CI 0.6, 2.7) in the mean levels of HbA1c , respectively. The interaction between area material deprivation and individual-level education was not associated with the levels of HbA1c (0.5%, 95% CI -1.3, 2.3). Our findings support the collective resources model that argues that people in less deprived areas have better health because there are more collective resources. The results suggest that to reduce socio-economic inequalities associated with the levels of HbA1c and, consequently, with diabetes, will require attention to the area material deprivation and individual-level education. Upstream social determinants of health are thus highlighted.

Multimorbidity in large Canadian urban centres: A multilevel analysis of pooled 2015-2018 cross-sectional cycles of the Canadian Community Health Survey.

BackgroundThere is limited knowledge on how the prevalence of multimorbidity varies within and across major Canadian urban centres. The objective of this study was to investigate the between-neighbourhood variation in the prevalence of multimorbidity in Canada’s large urban centres, controlling for compositional effects associated with individual-level demographic and socioeconomic factors.MethodsCross-sectional data from the 2015–2018 cycles of the Canadian Community Health Survey (CCHS) were pooled at the microdata level. Respondents (20 years and older) residing in one of the 35 census metropolitan areas (CMAs) were included (N = 100,803). Census tracts (CTs) were used as a measure of neighbourhood. To assess the between-neighbourhood differences in multimorbidity prevalence, we fitted three sequential random intercept logistic regression models.ResultsDuring the 2015–2018 period, 8.1% of residents of large urban centres had multimorbidity. The results from the unadjusted model indicate that 13.4% of the total individual variance in multimorbidity could be attributed to the between-neighbourhood differences. After adjustment for overall characteristics of the CMAs in which these neighbourhoods are located, as well as for individual-level demographic and socioeconomic factors related to compositional effects, 11.0% of the individual variance in multimorbidity could still be attributed to the between-neighbourhood differences.ConclusionThere is significant and substantial geographic variation in multimorbidity prevalence across neighbourhoods in Canada’s large urban centres. Residing in some neighbourhoods could be associated with increased odds of having multimorbidity, even after accounting for overall characteristics of the CMAs in which these neighbourhoods are located, as well as individual-level factors.

Social Inequalities in Cancer Survival in Belgium: A Population-Based Cohort Study.

Socioeconomic status (SES) is an important factor in cancer survival; however, results are heterogeneous and linked to characteristics of the study population and health care system. This population-based cohort study evaluates the association between individual-level socioeconomic and demographic factors and cancer survival for the first time in Belgium. From the Belgian Cancer Registry, we identified 109,591 patients diagnosed between 2006 and 2013 with one of eight common cancer types. Information on treatment, socioeconomic parameters, and vital status were retrieved from multiple data sources and linked using a unique personal identification number. The outcome was 5-year observed survival. Associations between survival and socioeconomic and demographic factors were assessed using multivariable Cox proportional-hazard regression models. Lower income, unemployment, and living alone were all associated with worse cancer survival. These associations were most pronounced for certain lifestyle-related cancer types (e.g., head and neck cancers) and those with good to moderate prognosis (e.g., colorectal and female breast cancer). These results indicate that, despite a comprehensive and nationwide health insurance program in which equity in rights and access to health care are pursued, SES is associated with disparities in cancer survival in Belgium. This population-based study with individual-level socioeconomic information of more than 100,000 patients with cancer identifies patient groups that may be at highest risk for socioeconomic disparities in cancer survival. Reasons behind the observed disparities are multiple and complex and should be further examined. Health policy interventions should consider the observed deprivation gap to plan targeted actions.