Individual Socioeconomic Status Research Articles

Political competition and representation in municipal councils

ABSTRACT I study whether the numbers of high- and low-social status-individuals in French municipal councils are affected by the level of political competition. I argue that because the most-eligible positions within lists of candidates are obtained by high-social-status persons, political competition increases the number of high-status municipal councilors and is thus detrimental to the election of low-social-status candidates. Using the elections of 2008 and 2014, I provide suggestive evidence that the socioeconomic status of individuals is indeed correlated with their position within lists of candidates. Moreover, I show that the presence of an additional competing list during an election is associated with 0.2 additional high-social-status individuals within the municipal councils. I also observe that those additional municipal councilors are males, which is a result that might have been caused by the gender quota policy implemented in French local elections.

Abstract PO1-09-08: Mammography adherence modifies the relationship between multilevel social deprivation and tumor characteristics in the Carolina Breast Cancer Study

Abstract Objective: To describe associations of individual and community socioeconomic status (SES) with breast cancer tumor and treatment characteristics, and to assess potential modification by mammography receipt. Methods: The Carolina Breast Cancer Study is a population-based cohort of women diagnosed with breast cancer between 2008 and 2013. We restricted this analysis to participants with stage 1-3 cancer (n=2,841). Socio-demographic information was obtained during in-home study interviews, and tumor characteristics were obtained from medical records and pathology reports. Community characteristics were obtained from American Community Survey census-tract level data. SES subgroups were identified using latent class analysis, a method for identifying group membership based on multiple shared characteristics. This was done separately using individual data (e.g. household income) and census-tract level data (e.g. poverty rate). We reported prevalence differences (PDs) and 95% CIs for each outcome. Finally, analyses were repeated with stratification by race (Black/non-Black) and receipt of at least one mammogram every 2 years (yes/no), based on self-reported mammography history. Results: Based on the latent class models, participants were sorted into 4 groups based on their individual/community SES: “high/high”, “high/low”, “low/high”, and “low/low”. Black women made up 81% of the low/low group compared to 26% of the high/high. All high individual-SES participants were combined as one referent group because they had similar clinical characteristics regardless of community status. We found that participants with low/low SES had more aggressive tumor characteristics at diagnosis compared to the referent group, such as stage 3 cancer (PD = 5.7%, 2.4-9.0), grade 3 tumor (PD = 9.9%, 5.3-14.4), and triple negative breast cancer (PD = 5.8%, 2.4-9.1). Low/low participants were also more likely to have an interval of at least 30 days between diagnosis and treatment (PD = 4.6%, 0.2-9.0). However, none of these associations were significant for low/high women. When reported separately by race, Black women with low/low SES had greater frequency of stage 3 cancer (PD = 6.3, 1.9-10.8) and prolonged treatment length (PD = 7.5%, 1.1-13.8) compared to high-SES Black women. Race-stratified SES differences were non-significant for genomic subtype and other tumor characteristics like grade and tumor size. After stratifying by screening status, we found that associations of SES with stage and tumor size were only present among those with < 1 mammogram every 2 years. The low/low PDs were (7.9%, 1.5-14.3) for stage 3 and (7.8%, 2.2-13.3) for tumor size >5 cm. Low/low women also had greater frequency of lump detected cancer (PD = 12.6%, 4.0-21.2). In contrast, these associations were not present among women with biannual mammography. Finally, screening status did not modify PDs for genomic subtype (ER+/HER2-, ER-/HER2+, TNBC). Conclusions: Lower community-level SES is associated with less favorable tumor characteristics at diagnosis, mainly among those with low individual SES. Access to mammography may explain part of the disparity in stage and tumor size, suggesting public health benefit for targeted screening initiatives in disadvantaged communities. Still, screening and SES are only 2 mechanisms that contribute to racial disparities; our future work will explore additional intervention points. Demographic and clinical characteristics of CBCS participants by individual and community socioeconomic status (n=2,841) SES groups were derived from latent class models. P-values were assessed by chi-square tests. Participants with race classified as “other” includes all those not identifying as Black or White, including American Indian/Alaska Native, Asian, or another race not listed on the questionnaire. Urbanicity is defined at the census tract-level Citation Format: Matthew Dunn, Marc Emerson, Louise Henderson, Katherine Reeder-Hayes, Terry Hyslop, Melissa Troester. Mammography adherence modifies the relationship between multilevel social deprivation and tumor characteristics in the Carolina Breast Cancer Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-08.

Does neighbourhood deprivation influence low back pain and arthritis: An empirical study using multilevel twin design.

Neighbourhood deprivation has been found to be associated with many health conditions, but its association with low back pain (LBP) and arthritis is unclear. This study aimed to examine the association between neighbourhood deprivation with LBP and arthritis, and its potential interaction with individual socioeconomic status (SES) on these outcomes. Monozygotic (MZ) twins from the Washington State Twin Registry were used to control for genetic and common environmental factors that could otherwise confound the purported relationship. Multilevel models were employed to examine the association between neighbourhood deprivation as well as individual-level SES with LBP/arthritis, adjusting for age, sex, body mass index (BMI) and residence rurality. There were 6,380 individuals in the LBP sample and 2,030 individuals in the arthritis sample. Neighbourhood deprivation was not associated with LBP (P = 0.26) or arthritis (P = 0.61), and neither was its interaction with individual-level SES. People without a bachelor's degree were more likely to report LBP (OR 1.44, 95% CI 1.26-1.65) or both LBP and arthritis (OR 1.67, 95% CI 1.14-2.45) than those with a bachelor's degree, but not for arthritis alone (P = 0.17). Household income was not significantly associated with LBP (P = 0.16) or arthritis (p = 0.23) independent of age, sex, and BMI. Our study did not find significant associations between neighbourhood deprivation and the presence of LBP or arthritis. More research using multilevel modelling to investigate neighbourhood effects on LBP and arthritis is recommended.

The association of socioeconomic status on kidney transplant access and outcomes: a nationwide cohort study in Taiwan.

Conflicting evidence exists regarding the relationship between socioeconomic status and access tooroutcomes after kidney transplantation. This study analyzed the effects of individual and neighborhood socioeconomic status on kidney transplant access and outcomes in Taiwan. We used a retrospective cohort study design and performed comparisons using the Cox proportional hazards model after adjusting for risk factors. Data were collected from the National Health Insurance Bureau of Taiwan data (2003-2012). Patients with high individual and neighborhood socioeconomic status had higher chances of receiving kidney transplants than those with low individual and neighborhood socioeconomic status [adjusted hazard ratio (aHR) = 2.04; 95% CI: (1.81-2.31), p < 0.001]. However, there were no significant differences in post-transplant graft failure or patient mortality in Taiwan between individuals of varying socioeconomic status after five years. When we stratified kidney transplants by domestic and overseas transplantation, there were no significant differences in post-transplant mortality and graft failure, but individualswho received a kidney graft in Taiwanwith high individual and neighborhood socioeconomic status experienced lower risks of graft failure (aHR = 0.55; [95% CI 0.33-0.89], p = 0.017). A relevant disparity exists in accessing kidney transplantation in Taiwan, depending on individual and neighborhood socioeconomic status. However, resultspost transplantation were not different after five years. Improved access to waitlisting, education, and welfare support may reduce disparities.

Crucial to Me and my society: How collectivist culture influences individual pro-environmental behavior through environmental values

While numerous studies have verified the norm-sustainability relationship, few have delved deeply into this set of relationships. To address this research gap, this study theoretically analyzes the roles of collectivist culture and individual self-construal in the norm-sustainability relationship in the Asian context. Drawing on the value-basis theory and the competitive altruism hypothesis and employing cultural data from an Asian context with hierarchical regression analysis, empirical findings indicate that collectivist culture positively promotes pro-environmental behavior, with altruistic values and biospheric values mediating this positive relationship. At the same time, individual socioeconomic status positively moderates the norm-sustainability relationship. The theoretical contribution of this study lies in theoretically identifying collectivist culture as a deep-seated cultural factor triggering the norm-sustainability relationship in the Asian context. Examining the moderating role of self-construal in the norm-sustainability relationship sheds light on the reasons for the gap between individual pro-environmental behavioral intentions and actions in the Asian context. Lastly, this study provides a new cultural perspective for understanding the formation of biospheric values. Policy implications suggest a focus on the collective atmosphere of collectivism in Asia to stimulate individual environmental responsibility alongside the cultivation of rational environmental perspectives to balance participation across socioeconomic strata in societal and economic development.

Ambient air pollution and mortality: The role of socioeconomic conditions.

There is a vast body of literature covering the association between air pollution exposure and nonaccidental mortality. However, the role of socioeconomic status (SES) in this relationship is still not fully understood. We investigated if individual and contextual SES modified the relationship between short-term exposure to ozone (O3), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter <10 µm (PM10) on cardiovascular, respiratory, and all nonaccidental mortality. We conducted a time-stratified case-crossover study. Analyses were based on information on 280,685 deaths from 2011 to 2015 in the city of São Paulo. Education was used as an individual SES, and information on the district of residence was used to build a contextual SES. Exposure to PM10, NO2, and O3 was accessed from monitoring stations and linked to each case based on the date of death. Conditional logistic regression models were used to estimate the effects of air pollutants, and interaction terms were added to access the effect modification of SES. Individuals with lower education had an increased chance of dying for all nonaccidental outcomes (1.54% [0.91%, 2.14%]) associated with exposure to PM10. Individuals living in lower SES areas had an increased chance of dying for nonaccidental (0.52% [0.16%, 0.88%]), cardiovascular (1.17% [0.88%, 1.46%]), and respiratory (1.70% [0.47%, 2.93%]) causes owing to NO2 exposure. Exposure to air pollutants increases the chance of dying by nonaccidental, cardiovascular, and respiratory causes. Lower educational levels and living on lower contextual SES increased the risk of mortality associated with air pollution exposure.

787 Higher County-Level Socioeconomic Status Is Associated With Increased Meningioma Survival But Does Not Impact Likelihood of Surgical Treatment: A CBTRUS Analysis

INTRODUCTION: Prior literature suggests that individual socioeconomic status (SES) may influence access to treatment and outcomes for primary brain tumors. To date, no population-level studies have assessed the correlation between meningioma treatment and outcome with county-level SES. METHODS: Incidence data were extracted from the Central Brain Tumor Registry of the United States(CBTRUS), a combined dataset including the CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results Program data, for diagnosis years 2006-2019, and survival data were extracted from the NPCR survival analytic dataset from 2006-2018. SES quintiles were created using American Community Survey data. Logistic regression and Cox proportional hazards models were used to assess the relationship the odds of receiving treatment and overall survival and SES and the individual SES factors. RESULTS: There were 409,681 meningioma cases available from CBTRUS. Asian/Pacific-Islander non-Hispanic individuals (odds ratio [OR] = 1.28, p &lt; 0.001) were more likely and Black non-Hispanic (BNH) individuals (OR = 0.90, p &lt; 0.001) were less likely to receive surgery than White non-Hispanic (WNH) individuals. Female sex (OR = 1.31, p &lt; 0.001), living in a metropolitan area (OR = 0.96, p &lt; 0.001), and increased age at diagnosis (OR = 0.96, p &lt; 0.001) were associated with decreased likelihood of surgery. There was no association between SES and likelihood to receive surgery. Overall median survival was 137 months and survival was higher in higher SES counties, which held true for both WNH and BNH. Age at diagnosis(hazard ratio [HR] = 1.01, p &lt; 0.001), male sex (HR = 1.51, p &lt; 0.001), BNH (HR = 1.31, p &lt; 0.001), subtotal resection (HR = 1.38, p &lt; 0.001), and malignant behavior(HR = 1.64, p &lt; 0.001) were associated with increased hazard of death. CONCLUSIONS: In the US, county-level SES did not impact treatment patterns, but higher SES was associated with increased survival. These findings provide valuable insight into socioeconomic factors influencing treatment and outcomes in meningioma patients.

Aircraft noise exposure and body mass index among female participants in two Nurses’ Health Study prospective cohorts living around 90 airports in the United States

ObjectiveAircraft noise exposure is linked to cardiovascular disease risk. One understudied candidate pathway is obesity. This study investigates the association between aircraft noise and obesity among female participants in two prospective Nurses’ Health Study (NHS and NHSII) cohorts. MethodsAircraft day-night average noise levels (DNL) were estimated at participant residential addresses from modeled 1 dB (dB) noise contours above 44 dB for 90 United States (U.S.) airports in 5-year intervals 1995–2010. Biennial surveys (1994–2017) provided information on body mass index (BMI; dichotomized, categorical) and other individual characteristics. Change in BMI from age 18 (BMI18; tertiles) was also calculated. Aircraft noise exposures were dichotomized (45, 55 dB), categorized (<45, 45–54, ≥55 dB) or continuous for exposure ≥45 dB. Multivariable multinomial logistic regression using generalized estimating equations were adjusted for individual characteristics and neighborhood socioeconomic status, greenness, population density, and environmental noise. Effect modification was assessed by U.S. Census region, climate boundary, airline hub type, hearing loss, and smoking status. ResultsAt baseline, the 74,848 female participants averaged 50.1 years old, with 83.0 %, 14.8 %, and 2.2 % exposed to <45, 45–54, and ≥55 dB of aircraft noise, respectively. In fully adjusted models, exposure ≥55 dB was associated with 11 % higher odds (95 % confidence interval [95 %CI]: −1%, 24 %) of BMIs ≥30, and 15 % higher odds (95 %CI: 3 %, 29 %) of membership in the highest tertile of BMI18 (ΔBMI 6.7 to 71.6). Less-pronounced associations were observed for the 2nd tertile of BMI18 (ΔBMI 2.9 to 6.6) and BMI 25.0–29.9 as well as exposures ≥45 versus <45 dB. There was evidence of DNL-BMI trends (ptrends ≤ 0.02). Stronger associations were observed among participants living in the West, arid climate areas, and among former smokers. DiscussionIn two nationwide cohorts of female nurses, higher aircraft noise exposure was associated with higher BMI, adding evidence to an aircraft noise-obesity-disease pathway.

106 Transforming Health Equity with an Innovative Social Determinants of Health Platform: Application of HOUSES Index to Colorectal Cancer Screening

OBJECTIVES/GOALS: To tackle population-level health disparities, quality dashboards can leverage individual socioeconomic status (SES) measures, which are not always readily accessible. This study aimed to assess the feasibility of a population health management strategy for colorectal cancer (CRC) screening rates using the HOUSES index and heatmap analysis. METHODS/STUDY POPULATION: We applied the 2019 Minnesota Community Measurement data for optimal CRC screening to eligible Mayo Clinic Midwest panel patients. SES was defined by HOUSES index, a validated SES measure based on publicly available property data for the U.S. population. We first assessed the association of suboptimal CRC screening rate with HOUSES index adjusting for age, sex, race/ethnicity, comorbidity, and Zip-code level deprivation by using a mixed effects logistic regression model. We then assessed changes in ranking for performance of individual clinics (i.e., % of patients with optimal CRC screening rate) before and after adjusting for HOUSES index. Geographical hotspots of high proportions of low SES AND high proportions of suboptimal CRC screening were superimposed to identify target population for outreach. RESULTS/ANTICIPATED RESULTS: A total of 58,382 adults from 41 clinics were eligible for CRC screening assessment in 2019 (53% Female). Patients with lower SES defined by HOUSES quartile 1-3 have significantly lower CRC screening compared to those with highest SES (HOUSES quartile 4) (adj. OR [95% CI]: 0.52 [0.50-0.56] for Q1, 0.66 [0.62-0.70] for Q2, and 0.81 [0.76-0.85]) for Q3). Ranking of 26 out of 41 (63%) clinics went down after adjusting for HOUSES index suggesting disproportionately higher proportion of underserved patients with suboptimal CRC screening. We were able to successfully identify hotspots of suboptimal CRC (area with greater than 130% of expected value) and overlay with higher proportion of underserved population (HOUSES Q1), which can be used for data-driven targeted interventions such as mobile health clinics. DISCUSSION/SIGNIFICANCE: HOUSES index and associated heatmap analysis can contribute to advancing health equity. This approach can aid health care organizations in meeting the newly established standards by The Joint Commission, which have elevated health equity to a national safety priority.

Socioeconomic inequalities in type 2 diabetes mellitus: a study based on a population-based survey in Iran

BackgroundType 2 diabetes mellitus (T2DM) is the most prevalent form of Diabetes Mellitus (DM), with social and economic determinants significantly influencing its prevalence. This study aimed to analyze the socioeconomic inequalities associated with T2DM in Iran.MethodsData from an observational survey in Iran, titled “Diabetes Care (DiaCare),” were utilized for this study. Socioeconomic inequalities were assessed through variables including Hemoglobin A1C (HbA1c), Fasting Blood Glucose (FBG), and Triple target (HbA1c, blood pressure, LDL-C), using concentration indices (CIs) and a multivariate logistic regression analysis. Individual socioeconomic status (SES) was determined by calculating an asset index using principle component analysis (PCA) based on their properties. Data analysis was conducted using STATA software version 14.ResultsA total of 13,321 participants were included in the study. The CIs were significantly positive for controlled HbA1c (0.0324) and triple target (0.1067), while for controlled FBG, it was 0.0125, although not significant. Among females, the CIs were significantly positive for controlled HbA1c (0.0745), FBG (0.0367), and triple target (0.209). Additionally, in the 45–55 and 65–75 age groups, the CIs were significantly positive for controlled HbA1c (0.0607) and FBG (0.0708), respectively. This index was significant for controlled Triple target in the 35–45 (0.376) and 65–75 (0.124) age groups. The CI for controlled FBG was significant in rural dwellers (-0.044) while the concentration of controlled triple target was significant in urban dwellers (0.0967). Controlled HbA1c showed significant concentration in both urban (0.0306) and rural (-0.0576) dwellers. Furthermore, the CIs were significant for controlled HbA1c in regions with medium prevalence (0.0534) and FBG in regions with low prevalence (-0.0277). This index was significantly positive for controlled triple target in regions with high prevalence (0.124).ConclusionsDiabetes care is more concentrated among individuals with higher SES. Policymakers should consider this to mitigate the inequality and alleviate the burden of T2DM.

Post-acute care transitions during COVID-19: Racial, ethnic, and socioeconomic differences in older adults with Alzheimer's disease and related dementia.

Differences in the post-acute care (PAC) destinations among racial, ethnic, and socioeconomic groups have been documented before the COVID-19 pandemic. Yet, the pandemic's impact on these differences remains unknown. We examined the impact of the COVID-19 pandemic on PAC destinations and its variation by individual race, ethnicity, and socioeconomic status among community-dwelling older adults with Alzheimer's disease and related dementia (ADRD). We linked 2019-2021 national data (Medicare claims, Minimum Data Set, Master Beneficiary Summary File) and several publicly available datasets, including Provider of Services File, Area Deprivation Index, Area Health Resource File, and COVID-19 infection data. PAC discharge destinations included skilled nursing facilities (SNFs), home health agencies (HHA), and homes without services. Key variables of interest included individual race, ethnicity, and Medicare-Medicaid dual status. The analytic cohort included 830,656 community-dwelling Medicare fee-for-service beneficiaries with ADRD who were hospitalized between 2019 and 2021. Regression models with hospital random effects and state-fixed effects were estimated, stratified by the time periods, and adjusted for the individual, hospital, and county-level covariates. SNF discharges decreased while home and HHA discharges increased during the pandemic. The trend was more prominent among racial and ethnic minoritized groups and even more so among dual-eligible beneficiaries. For instance, the reduction in the probabilities of SNF admissions between the pre-pandemic period and the 2nd year of COVID was 4.6 (White non-duals), 18.5 (White duals), 8.7 (Black non-duals), and 20.1 (Black duals) percentage-point, respectively. We also found that non-duals were more likely to replace SNF with HHA services, while duals were more likely to be discharged home without HHA. The COVID-19 pandemic significantly impacted PAC destinations for individuals with ADRD, especially among socioeconomically disadvantaged and racial and ethnic minoritized populations. Future research is needed to understand if and how these transitions may have affected health outcomes.

Interplay of socioeconomic status, cognition, and school performance in the ABCD sample

Coming from a disadvantaged background can have negative impact on an individual’s educational trajectory. Some people however seem unaffected and cope well with the demands and challenges posed by school education, despite growing up in adverse conditions, a phenomenon termed academic resilience. While it is uncertain which underlying factors make some people more likely to circumvent unfavorable odds than others, both socioeconomic status (SES) and cognitive ability have robustly been linked to school performance. The objective of the present work is to investigate if individual cognitive abilities and SES interact in their effect on grades. For this purpose, we analyzed SES, cognitive, and school performance data from 5001 participants from the Adolescent Brain Cognitive Development (ABCD) Study. Ordinal logistic regression models suggest similar patterns of associations between three SES measures (parental education, income-to-needs ratio, and neighborhood deprivation) and grades at two timepoints, with no evidence for interaction effects between SES and time. Parental education and income-to-needs ratio were associated with grades at both timepoints, irrespective of whether cognitive abilities were modeled or not. Neighborhood deprivation, in contrast, was only a statistically significant predictor of reported grades when cognitive abilities were not factored in. Cognitive abilities interacted with parental education level, meaning that they could be a safeguard against effects of SES on school performance.

Sociobiome - Individual and neighborhood socioeconomic status influence the gut microbiome in a multi-ethnic population in the US

Lower socioeconomic status (SES) is related to increased incidence and mortality due to chronic diseases in adults. Association between SES variables and gut microbiome variation has been observed in adults at the population level, suggesting that biological mechanisms may underlie the SES associations; however, there is a need for larger studies that consider individual- and neighborhood-level measures of SES in racially diverse populations. In 825 participants from a multi-ethnic cohort, we investigated how SES shapes the gut microbiome. We determined the relationship of a range of individual- and neighborhood-level SES indicators with the gut microbiome. Individual education level and occupation were self-reported by questionnaire. Geocoding was applied to link participants’ addresses with neighborhood census tract socioeconomic indicators, including average income and social deprivation in the census tract. Gut microbiome was measured using 16SV4 region rRNA gene sequencing of stool samples. We compared α-diversity, β-diversity, and taxonomic and functional pathway abundance by SES. Lower SES was significantly associated with greater α-diversity and compositional differences among groups, as measured by β-diversity. Several taxa related to low SES were identified, especially an increasing abundance of Prevotella copri and Catenibacterium sp000437715, and decreasing abundance of Dysosmobacter welbionis in terms of their high log-fold change differences. In addition, nativity and race/ethnicity have emerged as ecosocial factors that also influence the gut microbiota. Together, these results showed that lower SES was strongly associated with compositional and taxonomic measures of the gut microbiome, and may contribute to shaping the gut microbiota.

Income Level and Impaired Kidney Function Among Working Adults in Japan

Chronic kidney disease (CKD) is a major public health issue, affecting 850 million people worldwide. Although previous studies have shown the association between socioeconomic status and CKD, little is known about whether this association exists in countries such as Japan where universal health coverage has been mostly achieved. To identify any association of income-based disparity with development of impaired kidney function among the working population of Japan. This was a nationwide retrospective cohort study of adults aged 34 to 74 years who were enrolled in the Japan Health Insurance Association insurance program, which covers approximately 40% of the working-age population (30 million enrollees) in Japan. Participants whose estimated glomerular filtration rate (eGFR) had been measured at least twice from 2015 to 2022 were included in the analysis, which was conducted from September 1, 2021, to March 31, 2023. Individual income levels (deciles) in the fiscal year 2015. Odds ratios were calculated for rapid CKD progression (defined as an annual eGFR decline of more than 5 mL/min/1.73 m2), and hazard ratios, for the initiation of kidney replacement therapy (dialysis or kidney transplant) by income level deciles in the fiscal year 2015. The study population totaled 5 591 060 individuals (mean [SD] age, 49.2 [9.3] years) of whom 33.4% were female. After adjusting for potential confounders, the lowest income decile (lowest 10th percentile) demonstrated a greater risk of rapid CKD progression (adjusted odds ratio, 1.70; 95% CI, 1.67-1.73) and a greater risk of kidney replacement therapy initiation (adjusted hazard ratio, 1.65; 95% CI, 1.47-1.86) compared with the highest income decile (top 10th percentile). A negative monotonic association was more pronounced among males and individuals without diabetes and was observed in individuals with early (CKD stage 1-2) and advanced (CKD stage 3-5) disease. The findings of this retrospective cohort study suggest that, even in countries with universal health coverage, there may be a large income-based disparity in the risk of rapid CKD progression and initiation of kidney replacement therapy. These findings highlight the importance of adapting CKD prevention and management strategies according to an individual's socioeconomic status, even when basic health care services are financially guaranteed.

Health Disparities Among Family Decision-Makers in China: An Ordered Probit Analysis of the China Family Panel Studies.

The family decision-makers serve as the backbone of the family, and their health status warrants consideration. This study aims to explore how the health status of this group of people, namely the family decision-making group, is affected, and to delve into the mechanisms of influence based on this. The goal is to provide reliable evidence and strategies for the health management of the family decision-makers group, contributing to the achievement of the "Healthy China 2030" Planning Outline. Drawing on data from the China Family Panel Studies (CFPS), this study utilizes an Ordered Probit Model to analyze and compare the health status of family decision-makers and non-decision-makers. The findings indicate that decision-makers tend to experience poorer health outcomes than other family members, with increased pressure related to decision-making identified as a significant contributor to their declining health. Heterogeneity analysis reveals that the negative effect is less pronounced in households with higher net worth but more pronounced in those with more significant housing, education, and medical spending pressures. Moreover, this study analysis highlights that enhancing individual or family socioeconomic status can alleviate the adverse health effects experienced by family decision-makers. The study reveals the presence of certain health adverse effects among family decision-makers. The implications drawn from this research hold significance for the health management of this demographic, underscoring the necessity for tailored interventions aimed at addressing the distinctive challenges confronted by this group.

Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: A 10-year cohort study.

To evaluate the effect of individual and contextual socioeconomic inequalities in the occurrence of untreated dental caries during the transition from childhood to adolescence. This 10-year prospective cohort study followed up an initial sample of 639 1-5 years old schoolchildren from southern Brazil. After 7 and 10 years from the baseline (T1), two other reassessments were conducted (T2 and T3), respectively. Untreated dental caries was measured through the International Caries Detection and Assessment System (ICDAS- scores 3, 5 and 6) at T1 and T3. Socioeconomic status (SES) at the contextual and individual level was assessed at T1. At T2, socioeconomic, behavioural and psychosocial characteristics were evaluated as possible pathways of explanation. Structural equation modelling was used to estimate the direct and indirect effects among the variables over 10 years. A total of 429 adolescents were reevaluated at 10-year follow-up (cohort retention rate of 67.1%). About 30.6% presented untreated dental caries at T3. Low individual SES at T1 directly impacted a higher occurrence of dental caries at T3. Non-white skin colour at T1 also indirectly impacted a higher occurrence of dental caries at T3 through low individual SES at T1 and lower household income at T2. Contextual SES did not predict, directly or indirectly, dental caries at T3. There is strong evidence that socioeconomic inequalities at the individual level play an important role on the occurrence of dental caries from childhood to adolescence. On the other hand, there was no evidence that contextual SES influences the occurrence of dental caries over time.

Does the population size of a city matter to its older adults' self-rated health? Results of China data analysis.

Clarifying the association between city population size and older adults' health is vital in understanding the health disparity across different cities in China. Using a nationally representative dataset, this study employed Multilevel Mixed-effects Probit regression models and Sorting Analysis to elucidate this association, taking into account the sorting decisions made by older adults. The main results of the study include: (1) The association between city population size and the self-rated health of older adults shifts from a positive linear to an inverted U-shaped relationship once individual socioeconomic status is controlled for; the socioeconomic development of cities, intertwined with the growth of their populations, plays a pivotal role in yielding health benefits. (2) There is a sorting effect in older adults' residential decisions; compared to cities with over 5 million residents, unobserved factors result in smaller cities hosting more less-healthy older adults, which may cause overestimation of health benefits in cities with greater population size. (3) The evolving socioeconomic and human-made environment resulting from urban population growth introduces health risks for migratory older adults but yields benefits for those with local resident status who are male, aged over 70, and have lower living standards and socioeconomic status. And (4) The sorting effects are more pronounced among older adults with greater resources supporting their mobility or those without permanent local resident status. Thus, policymakers should adapt planning and development strategies to consider the intricate relationship between city population size and the health of older adults.

Abstract WP112: Neighborhood Level Characteristics Associated With Adequate Transition of Stroke Care: The Transition of Care Stroke Disparities Study

Objective: Transition of Care Stroke Disparities Study is an observational prospective cohort aimed to investigate disparities in the transition of stroke care (TOSC) post-hospitalization to home and to identify factors associated with adequate TOSC and stroke outcomes. we have demonstrated that higher individual socioeconomic status is associated with adequate TOSC. The present study explores the association between neighborhood-level characteristics (NLC) and adequate TOSC in ischemic stroke patients 1 month after discharge. Methods: Data from 925 ischemic stroke patients discharged from 10 Comprehensive Stroke Centers (CSCs) was obtained from three sources: a. NLC: demographic composition, level of education, and median household income from publicly available data using participants’ Zip codes (independent variables); b. 30-day post-discharge data for 6 categories of TOSC-related behaviors (dependent variables) including medication adherence, weekly exercise, medical follow-up, rehabilitation attendance, toxic habit cessation, diet modification. c. Clinical characteristics from Get with the Guidelines-Stroke (covariates). The primary outcome was 100% adequate transition of care (ATOC), a combined index of ideal adherence to all applicable behavior modifications. Results: The sample included 46% Women, 23% Non-Hispanic Black and 22% Hispanic, the average age was 64 years. NLC ranged as follows: % Black (0-93.9, median 9.1), %Hispanic (3-99.9, median 82.3), % bachelor’s degree (6.3-77.3, median 26.2), and median household income ($18,920-159,914, median $48,816). Almost a third (34%) of participants achieved 100% ATOC. In the adjusted analysis of NLC variables, higher %Hispanic (OR=1.45, 95% CI=1.03-2.04), higher %bachelor's degree recipients (OR=1.62, 95% CI=1.21-2.18), and higher median income (OR=1.12, 95%CI=1.04-1.21) were significantly associated with achieving 100% ATOC. Conclusions: Results suggest that NLC plays a crucial role in adherence to care transition instructions, underscoring the importance of interventions targeted at lower socioeconomic status populations. Future work will determine the impacts of NLC on stroke recurrence and readmission.

From Cybercrime to Digital Balance: How Human Development Shapes Digital Risk Cultures

This article examines configurations of digital concerns within the European Union (EU27), a leading hub of innovation and policy development. The core objective is to uncover the social forces shaping technology acceptance and risk awareness, which are essential for fostering a resilient digital society in the EU. The study draws upon Bourdieu’s concept of capital to discuss technological capital and digital habitus and Beck’s risk society theory to frame the analysis of individual and national attitudes towards digital risks. Utilizing Eurobarometer data, the research operationalizes technological capital through proxy indicators of individual socioeconomic status and internet use, while country-level development indicators are used to predict aggregated national risk perception. Article contributions rely on individual- and country-level statistical analysis. Specifically, the study reveals that digital concerns are better predicted at a national level rather than individual level, being shaped by infrastructure, policy, and narrative rather than by personal technological capital. Key findings highlight a positive and a negative correlation between digital advancement with cybersecurity fears and digital literacy, respectively. HDI and DESI are relevant country-level predictors of public concerns, while CGI values are not. Using cluster analysis, we identify and interpret four digital risk cultures within the EU, each with varying foci and levels of concern, which correspond to economic, political, and cultural influences at the national level.

Neighbourhood socioeconomic status and pain among older adults-A cross-sectional study.

Pain is associated with falls, disability and a poor quality of life among older adults. It is highly prevalent in many societies, and studies have shown that pain could be preventable or managed more effectively at the population level. However, few studies have investigated who is at higher risk of pain in the general population, which is important for development of effective interventions. The purpose of this study was to investigate, by using nationally representative samples in Sweden, whether neighbourhood socioeconomic status (SES) is associated with pain among older adults after considering other important risk factors. The study used the Statistics on Income and Living Conditions (EU-SILC), which is a nationwide annual survey of the living conditions of residents in Sweden. We used the data of individuals who were over 65 years of age between 2008 and 2013. Multivariable logistic regression was conducted to investigate the association between neighbourhood SES and severe pain. Those who resided in low SES neighbourhoods had a 30% higher odds of having severe pain than those who resided in high SES neighbourhoods after controlling for individual risk factors, such as the sex, age, individual SES, smoking, exercise habits and body mass index. Exercise was protective against severe pain. Given the high prevalence of pain across populations, interventions targeting geographic areas (such as those in the current study) in combination with individual risk factors could be effective to reduce the burden of pain at the population level. Those who reside in neighbourhoods with low SES may have higher risks of pain due to a lack of health-promoting resources as well as psychological stress. Further studies identifying the specific mechanisms behind the association between neighbourhood SES and pain would be useful in order to develop effective interventions.