Socioeconomic Status Inequalities Research Articles

Addressing Social Determinants in the Era of Precision Medicine in Breast Cancer: Is It Sufficient to Reduce Disparities?

The Oncotype DX (ODX) assay predicts recurrence risk and demonstrates the benefits of adjuvant therapy in patients with early-stage, hormone receptor (HR)-positive/HER2-negative breast cancer. ODX uptake varies by patients' racial/ethnic backgrounds and socioeconomic status (SES). However, community-level variability remains unknown, and research regarding the association between testing status and receipt of adjuvant chemotherapy is limited. To fill these knowledge gaps, Van Alsten and colleagues found a 6% lower prevalence of ODX uptake among patients residing in high SES-deprived areas than among those residing in low SES-deprived areas. Among patients with low and median ODX recurrence scores, those who underwent testing were 28% and 21% less likely to receive adjuvant chemotherapy than those who did not, respectively. The findings emphasize the role of social determinants of health. However, to further reduce or eliminate racial/ethnic disparities and SES inequities, we would need sufficient and effective multi-level approaches. These involve lower ODX testing costs, health insurance coverage expansion, re-classification and validation of ODX recurrence scores in patients of minority ancestry, and the development of a faster, more accurate, and affordable test. See related article by Van Alsten et al., p. 654.

Integrating Spatial and Non-Spatial Dimensions to Evaluate Access to Rural Primary Healthcare Service: A Case Study of Songzi, China

Access to rural primary healthcare services has been broadly studied in the past few decades. However, most earlier studies that focused on examining access to rural healthcare services have conventionally treated spatial and non-spatial access as separate factors. This research aims to measure access to primary healthcare services in rural areas with the consideration of both spatial and non-spatial dimensions. The methodology of study is threefold. First, the Gaussian two-step floating catchment area (G-2SFCA) method was adopted to measure spatial access to primary healthcare services. Then, a questionnaire survey was conducted to investigate non-spatial access factors, including demographic condition, patient’s household income, healthcare insurance, education level, and patient satisfaction level with the services. After that, a comprehensive evaluation index system was employed to integrate both spatial and non-spatial access. The empirical study showed a remarkable disparity in spatial access to primary healthcare services. In total, 78 villages with 185,137 local people had a “low” or “very low” level of spatial access to both clinics and hospitals. For the non-spatial dimension, the results depicted that Songzi had significant inequalities in socioeconomic status (e.g., income, education) and patient satisfaction level for medical service. When integrating both spatial and non-spatial factors, the disadvantaged areas were mainly located in the eastern and middle parts. In addition, this study found that comprehensively considering the spatial and non-spatial access had a significant impact on results in healthcare access. In conclusion, this study calls for policymakers to pay more attention to primary healthcare inequalities within rural areas. The spatial and non-spatial access should be considered comprehensively when the long-term rural medical support policy is designated.

Association of Socioeconomic Status and a Broad Combination of Lifestyle Factors With Adult-Onset Asthma: A Cohort Study

BackgroundThe prevalence of asthma is gradually increasing worldwide and there are socioeconomic inequalities in the risk of developing asthma. ObjectiveThis study aimed to evaluate whether the lifestyle is associated with asthma in adults, as well as whether and to what extent healthy lifestyles may modify socioeconomic status (SES) inequities in asthma. MethodsThis study included a total of 223951 participants from the UK Biobank. Smoking, physical activity, alcohol consumption, healthy diet patterns, sedentary time, and sleep duration items were used to construct the lifestyle score. Income, education, and occupation were used to assess SES. Cases of adult-onset asthma were identified based on electronic health records. The Cox proportional hazards regression was used to explore the association of socioeconomic inequality and lifestyle factors with asthma. ResultsCompared with the most healthy lifestyle category, the HRs (95% CIs) of the moderately healthy lifestyle and least healthy lifestyle categories for asthma were 1.08 (1.01-1.15) and 1.29 (1.20-1.39), respectively. A significant interaction (Pinteraction< 0.05) was found between lifestyle categories and socioeconomic status, and the association between them was more pronounced in participants with low socioeconomic status (HR least healthy vs most healthy: 1.58, 95%CI: 1.40-1.80). The joint analysis revealed that the risk of asthma was highest among participants with the lowest SES and the least healthy lifestyles (HR: 2.02, 95%CI: 1.74-2.33). ConclusionsUnhealthy lifestyle factors are associated with an increased risk of asthma in adults, and socioeconomically disadvantaged groups are more negatively affected by unhealthy lifestyles. Public health strategies for asthma prevention may need to be tailored according to socioeconomic status, and social policies to reduce poverty are needed alongside lifestyle interventions in areas of deprivation.

Association of socioeconomic status and poststroke cognitive function: A systematic review and meta-analysis.

Stroke survivors are at high risk of coping with cognitive problems after stroke. In recent decades, the relationship between socioeconomic status (SES) and health-related outcomes has been a topic of considerable interest. Learning more about the potential impact of SES on poststroke cognitive dysfunction is of great importance. The purpose of this systematic review and meta-analysis was to summarize the association between SES and poststroke cognitive function by quantifying the effect sizes of the existing studies. We searched studies from PubMed, Ovid, Embase, Cochrane, Scopus, and PsychINFO up to January 30th 2024 and the references of relevant reviews. Studies reporting the risk of poststroke cognitive dysfunction as assessed by categorized SES indicators were included. The Newcastle-Ottawa scale and the Agency for Healthcare Research and Quality were used to evaluate the study quality. Meta-analyses using fixed-effect models or random-effect models based on study heterogeneity were performed to estimate the influence of SES on cognitive function after stroke, followed by subgroup analyses stratified by study characteristics. Thirty-four studies were eligible for this systematic review and meta-analysis. Of which, 19 studies reported poststroke cognitive impairment (PSCI) as the outcome, 13 reported poststroke dementia (PSD), one reported both PSCI and PSD, and one reported vascular cognitive impairment no dementia. The findings showed that individuals with lower SES levels had a higher risk of combined poststroke cognitive dysfunction (odds ratio (OR)=1.91, 95% confidence interval (CI)=1.59-2.29), PSCI (OR=2.09, 95% CI=1.57-2.78), and PSD (OR=1.95, 95% CI=1.48-2.57). Subgroup analyses stratified by SES indicators demonstrated the protective effects of education and occupation against the diagnoses of combined poststroke cognitive dysfunction, PSCI, and PSD. Stroke survivors belonging to a low SES are at high risk of poststroke cognitive dysfunction. Our findings add evidence for public health strategies to reduce the risk of poststroke cognitive dysfunction by reducing SES inequalities.

Association of socioeconomic status and overactive bladder in US adults: a cross-sectional analysis of nationally representative data.

Socioeconomic status inequality is an important variable in the emergence of urological diseases in humans. This study set out to investigate the association between the prevalence of overactive bladder (OAB) and the poverty income ratio (PIR) that served as a more influential indicator of socioeconomic status compared to education and occupation. Data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2020 were used in this cross-sectional study. The association between the PIR and OAB was examined using weighted multivariate logistic regression and weighted restricted cubic splines (RCS). Additionally, interaction analysis was used for investigation to the connections between PIR and OAB in various covariate groups in order to confirm the stability of the results. We observed a noteworthy inverse association between PIR and OAB after adjusting for potential confounding variables (OR = 0.87, 95% CI, 0.84-0.90, p < 0.0001). PIR was transformed into categorical variables, and the association held steady after that (1.0 < PIR <4.0 vs. PIR ≤ 1.0, OR = 0.70, 95% CI =0.63-0.77, p < 0.0001; PIR ≥ 4.0 vs. PIR ≤ 1.0, OR = 0.56, 95% CI =0.48-0.65, p < 0.0001). Additionally, RCS analysis showed that PIR and OAB had a negative nonlinear response relationship. Subgroup analyses showed that the inverse association between PIR and prevalence of OAB was stronger in obese than in nonobese individuals (P for interaction < 0.05). In our study, we observed a significant negative association between the PIR and the prevalence of OAB. In the future, PIR could be used as a reference standard to develop strategies to prevent and treat OAB.

Walkability and socio-economic status in relation to walking, playing and sports practice in a representative Spanish sample of youth: The PASOS study.

Physical activity (PA) provides multiple health-related benefits in children and adolescents, however, at present, the majority of young people are insufficiently physically active. The aim of this study was to evaluate if neighborhood walkability and/or socio-economic status (SES) could affect the practice of walking, play outdoors and sports practice in a representative sample of Spanish children and adolescents. A sample of 4092 youth (aged 8-16 years old) from 245 primary and secondary schools in 121 localities from each of the 17 Spanish autonomous communities participated in the study. Walk Score was used to evaluate walkability of the neighborhood and household income was used as an indicator of SES. A 7-item self-reported validated questionnaire, was used to assess PA levels, and in a subsample of 10% of the participants, randomly selected from the entire sample, PA was objectively measured by accelerometers. Youth from more walkable areas reported more minutes walking per day compared with those from less walkable neighborhoods (51.4 vs 48.8 minutes, respectively). The lowest average minutes spent in playing outdoors was found among participants from low-SES and low-walkable neighborhoods. Neighborhood SES influenced on the participation in team sports during the weekend, being this participation higher in high SES neighborhoods. Providing high walkable environments seems a good strategy to promote PA regardless SES levels. It seems that improving the walkability is a key component to partially overcome the SES inequalities, especially in urban areas with low SES. High-SES environments can offer better sports facilities and more organized physical activities than low-SES ones.

Individual values predict desiring more economic inequality: The moderator role of social mobility.

Attitudes towards economic inequality are crucial to uphold structural economic inequality in democratic societies. Previous research has shown that socioeconomic status, political ideology, and the objective level of economic inequality associated with individuals' attitudes towards economic inequality. However, some have suggested that people are aware of the individual and social features that are more functional according to the level of economic inequality. Therefore, individual predispositions such as cultural values could also predict these attitudes. In the current research, we expand previous results testing whether cultural variables at the individual level predict attitudes towards economic inequality. After analysing survey data including samples from 52 countries (N = 89,565), we found that self-enhancement values predict positively, and self-transcendence negatively, attitudes towards economic inequality as the ideal economic inequality measures. This result remained significant even after controlling by socioeconomic status, political ideology, and objective economic inequality. However, this effect is only true in high and middle social mobility countries, but not in countries with low social mobility. The present research highlights how cultural values and country social mobility are crucial factors to addressing attitudes towards economic inequality.

Urban sprawl and racial inequality in intergenerational mobility

Abstract Persistent racial inequality in socioeconomic status within urban areas has been a significant concern in both the US and European countries. Differences across racial groups in intergenerational mobility (IM) have been identified as a key source of this persistence. However, efforts to understand racial inequality in IM have rarely considered the role of urban sprawl. This article argues that urban sprawl affects differences in IM between racial groups directly and indirectly through racial segregation, racial bias, and social capital. We analyze data from 874 metropolitan counties in the US using structural equation models to test these direct and indirect effects of sprawl on racial inequality in IM. We found that urban sprawl was negatively associated with racial inequality in IM. The direct effect, which we partially attribute to higher racial disparities in social capital in more compact counties, was statistically significant. For the indirect effects, racial segregation had the largest mediating effects between urban sprawl and racial inequality in IM, followed by economic connectedness (EC) and racial bias. The net indirect effect of sprawl on racial inequality in IM was negative because negative indirect effects through racial segregation and EC outweigh positive indirect effects through racial bias. Our findings demonstrate the significant role of urban form in racial inequality in IM.

Socioeconomic disparity in mortality and the burden of cardiovascular disease: analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study

Although socioeconomic inequality in cardiovascular health has long been a public health focus, the differences in cardiovascular-disease burden and mortality between people with different socioeconomic statuses has yet to be adequately addressed. We aimed to assess the effects of socioeconomic status, measured via three socioeconomic-status indicators (ie, education, occupation, and household wealth and a composite socioeconomic-status disparity index, on mortality and cardiovascular-disease burden (ie, incidence, mortality, and admission to hospital) in China. For this analysis, we used data from the Prospective Urban Rural Epidemiology (PURE)-China cohort study, which enrolled adults aged 35-70 years from 115 urban and rural areas in 12 provinces in China between Jan 1, 2005, and Dec 31, 2009. Final follow-up was on Aug 30, 2021. Indicators of socioeconomic status were education, occupation, and household wealth; these individual indicators were also used to create an integrated socioeconomic-status index via latent class analysis. Standard questionnaires administered by trained researchers were used to obtain baseline data and were supplemeted by physical measurements. The primary outcomes were all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital. Hazard ratios (HRs) and average marginal effects were used to assess the association between the primary outcomes and socioeconomic status. Of 47 931 participants enrolled in the PURE-China study, 47 278 (98·6%) had complete information on sex and follow-up. After excluding 1189 (2·5%) participants with missing data on education, household wealth, and occupation at baseline, 46 089 participants were included in this analysis. Median follow-up was 11·9 years (IQR 9·5-12·6); 26 860 (58·3%) of 46 089 participants were female and 19 229 (41·7%) were male. Having no or primary education, unskilled occupation, or being in the lowest third of household wealth was associated with a higher risk of all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital compared with having higher education, a professional or managerial occupation, or more household wealth. After adjustment for confounders, people categorised as having low integrated socioeconomic status based on the index had a higher risk of all-cause mortality (HR 1·65 [95% CI 1·42-1·92]), cardiovascular-disease mortality (2·19 [1·68-2·85]), non-cardiovascular disease mortality (1·43 [1·18-1·72]), major cardiovascular disease (1·43 [1·27-1·61]) and cardiovascular-disease admission to hospital (1·14 [1·01-1·28]) compared with people categorised as having high integrated socioeconomic status. Socioeconomic-status inequalities in mortality and cardiovascular-disease outcomes exist in China. Targeted policies of equal health-care resource allocation should be promoted to equitably benefit people with fewer years of education and less household wealth. Funding sources are listed at the end of the Article.

Socioeconomic inequalities in national transfers accounts in Ecuador 2006 and 2011: Did a new socialist government make a difference?

Latin America is the least egalitarian region in the world. A neo-socialist government in Ecuador prioritized the reduction of socioeconomic status (SES) inequalities. The generational economy is a framework to understand the economic lifecycle and to link demographic change with people's well-being. This article aims to uncover SES-driven inequalities in the generational economy of Ecuador: did public transfers modify them from 2006 to 2011? National transfer accounts (NTA) were disaggregated by SES quartiles, which were defined by the highest level of education attainment in each household. The accounts within SES quartiles were estimated using standard NTA methods. A pseudo-Gini coefficient summarized SES-driven inequalities by age and generational account. This secondary analysis was based on existing micro databases from the Ecuadorian NTA. ResultsNational averages do not represent well the generational economy of the low-SES population. The usual gradient of higher economic figures in higher SES strata shows up in almost all NTAs with the notable exceptions of reversal (progressive) gradients in conditional public cash transfers to low-SES households and public education at the elementary school level. Retirement pensions are extremely regressive public transfers, benefiting mostly high-SES strata. ConclusionsPopulation aging might worsen the high levels of inequality already existing in Ecuador and Latin America. Some progressive public policies worked well to reduce inequality in Ecuador. ContributionThis article demonstrates the importance of uncovering SES-driven inequalities existing in NTAs and their change through the lifecycle. It also identifies public policies that ameliorated inequality as well as public transfers that are regressive.

Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021.

This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels. We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model. The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening. Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.

Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey.

Most of the existing literature in developing countries focused on either the rising trend of CS or its determinants. There is a paucity of population-based studies on existing socioeconomic inequalities in availing CS services by women in Indonesia. This study aimed to assess the factors associated with caesarian section (CS) delivery and explore the various factors contributing to inequalities in CS delivery rates in Indonesia. The study utilized nationally representative cross-sectional data from the Indonesia Demographic and Health Survey (IDHS), 2017. We conducted multivariable logistic regression to find the factors associated with CS delivery. Concentration index and Wagstaff's decomposition analysis were used to examine the socioeconomic inequalities in CS delivery among women and associated factors. About 17% of women in Indonesia delivered babies through CS. A concentration index of 0.31 in CS delivery rate showed a higher CS delivery rate among women belonging to rich households. About 44.7% of socioeconomic status inequality in CS delivery was explained by educational status among women who went for CS delivery. Women's place of residence explained 30.1% of socioeconomic inequality, and women's age at first birth explained about 11.9% and reporting ANC visits explained 8.4% of the observed inequality. Highest socioeconomic inequality was witnessed in central Sulawesi (0.529), followed by Maluku (0.488) and West Kalimantan (0.457), whereas the lowest was recorded in Yogyakarta (0.021) followed by north Sulawesi (0.047) and east Kalimantan (0.171). Education (44.7%) followed by rural-urban place of residence (30.1%) and age of first birth (11.9%) contributed most to explain the gap in CS delivery among rich and poor women. The study highlighted the higher CS delivery rates among women from higher socioeconomic groups and thus, it is important to frame policies after identifying the population subgroups with potential underuse or overuse of CS method of delivery.

Subjective socioeconomic status and income inequality are associated with self-reported morality across 67 countries

Individuals can experience a lack of economic resources compared to others, which we refer to as subjective experiences of economic scarcity. While such experiences have been shown to shift cognitive focus, attention, and decision-making, their association with human morality remains debated. We conduct a comprehensive investigation of the relationship between subjective experiences of economic scarcity, as indexed by low subjective socioeconomic status at the individual level, and income inequality at the national level, and various self-reported measures linked to morality. In a pre-registered study, we analyze data from a large, cross-national survey (N = 50,396 across 67 countries) allowing us to address limitations related to cross-cultural generalizability and measurement validity in prior research. Our findings demonstrate that low subjective socioeconomic status at the individual level, and income inequality at the national level, are associated with higher levels of moral identity, higher morality-as-cooperation, a larger moral circle, and increased prosocial intentions. These results appear robust to several advanced control analyses. Finally, exploratory analyses indicate that observed income inequality at the national level is not a statistically significant moderator of the associations between subjective socioeconomic status and the included measures of morality. These findings have theoretical and practical implications for understanding human morality under experiences of resource scarcity.

Unequally Unequal? Contextual-level status inequality and social cohesion moderating the association between individual-level socioeconomic position and systemic chronic inflammation

BackgroundStatus inequality is hypothesised to increase socioeconomic inequalities in health by creating an environment in which social cohesion erodes and social comparisons intensify. Such an environment may cause systemic chronic inflammation. Although these are often-used explanations in social epidemiology, empirical tests remain rare. MethodsWe analysed data from the West of Scotland Twenty-07 Study. Our sample consisted of 1977 participants in 499 small residential areas. Systemic chronic inflammation was measured by high-sensitivity C-reactive protein (hs-CRP; <10 mg/L). An area-level measurement of status inequality was created using census data and contextual-level social cohesion was measured applying ecometrics. We estimated linear multilevel models with cross-level interactions between socioeconomic position (SEP), status inequality, and social cohesion adjusted for age and gender. Our main analysis on postcode sector-level was re-estimated on three smaller spatial levels. ResultsThe difference in hs-CRP between disadvantaged and advantaged SEPs (0.806 mg/L; p = 0.063; [95%CI: −0.044; 1.656]) was highest among participants living in areas where most residents were in advantaged SEPs. In these status distributions, high social cohesion was associated with a shallower socioeconomic gradient in hs-CRP and low social cohesion was associated with a steeper gradient. In areas with an equal mix of SEPs or most residents in disadvantaged SEPs, the estimated difference in hs-CRP between disadvantaged and advantaged SEPs was −0.039 mg/L (p = 0.898; [95%CI: 0.644; 0.566]) and −0.257 mg/L (p = 0.568; [95%CI: 1.139; 0.625]) respectively. In these status distributions, the gradient in hs-CRP appeared steeper when social cohesion was high and potentially reversed when social cohesion was low. Results were broadly consistent when using area-levels smaller than postcode sectors. ConclusionsInequalities in hs-CRP were greatest among participants living in areas wherein a majority of residents were in advantaged SEPs and social cohesion was low. In other combinations of these contextual characteristics, inequalities in systemic chronic inflammation were not detectable or potentially even reversed.

Determinants of Inequities in Neurologic Disease, Health, and Well-being: The NINDS Social Determinants of Health Framework.

A National Institute of Neurological Disorders and Stroke working group developed the Determinants of Inequities in Neurological Disease, Health, and Well-being framework. Our goal was to guide and inspire a new generation of neurologic research that pushes the field to design and test new approaches in pursuit of health equity, population health, and social justice. We seek to expand the lens of those looking to reduce or eliminate racial, socioeconomic status, and other inequities in neurologic disease, health, and well-being to improve our collective ability to create research, programs, and policies that lead to larger, more impactful, and more sustainable change in neurologic disease patterns. In this context, we outline a framework that includes and highlights "upstream" factors in the hopes of enhancing the focus of research, programmatic, and policy efforts to reduce and eliminate inequities in neurologic health and well-being. We explicitly discuss racism and other structural factors to clarify that social determinants are not natural and unchangeable. Populations with a disproportionate burden of neurologic disease are not inherently deficient, despite what some approaches to framing health inequities imply. The framework is presented linearly, but the pathways linking the determinants of neurologic disease, health, and well-being are far more complex than those demonstrated by the arrows included in the figure. The framework highlights the different levels and scale of causation, including the structural and intermediary social determinants and their impact on neurologic health. We offer this framework to refine efforts to contextualize the interpretation of neurologic research findings and suggest new avenues for their application. We illustrate how behavioral and biological factors occur in a social and economic context, factors that have been understudied as points of intervention to reduce inequities in neurologic disease. Considering social and structural determinants of health provides promising new opportunities to achieve neurologic health equity, reach social justice, and improve our science. Extending our work in this fashion is not simply about health equity or social justice but to fundamentally improve the quality of neurologic research by enhancing underlying theory and improving study design and implementation.

Tuberculosis risk factors in South Africa, 2008 to 2017: A Generalised Estimating Equations approach

&#x0D; Background: Although, death due to tuberculosis has been on the decline. In 2016, 124 000 people died of tuberculosis in South Africa and the disease was declared the leading cause of death by Statistics South Africa. Continued efforts to use research to create a nation free of tuberculosis are underway. &#x0D; Methods: A repeated measures investigation was performed with the aim of identifying the persistent predictors and the long-term patterns of tuberculosis infection in South Africa for the period 2008 to 2017. The most suitable Generalised Estimating Equations that describe the population average probability of infection over time were applied to a sample of respondents taken from the National Income Dynamics Survey data, wave 1 to wave 5. The response variable was binary with the outcome of interest being the respondents that self-reported to have been diagnosed with tuberculosis. To improve estimation efficiency, the best working correlation matrix for this data was selected. &#x0D; Results: We used a sample of 8510 individuals followed for five waves, of these, 3.7%, 2.54%, 4.15%, 5.72% and 5.99% for waves 1, 2, 3, 4 and 5 respectively, reported to have been diagnosed with tuberculosis. Findings revealed that the independent working correlation matrix with the model-based standard error estimates gave the most robust results for the repeated measures tuberculosis data in South Africa. Furthermore, over the years, the average probability of being diagnosed with tuberculosis was positively associated with being single, male, middle-aged (30- 59 years), black African, unemployed, smoking, lower education levels, lack of regular exercise, asthma, suffering from other diseases, lack of access to improved sanitation, lower household income and expenditure. &#x0D; Conclusion: The probabilities of tuberculosis infection are independent within individuals over time. The inequalities in socioeconomic status in South Africa caused the poor to be more at risk of tuberculosis over time from 2008 to 2017. &#x0D;

Caregivers on the move: Gender and socioeconomic status in the care mobility in Bogotá

The concept of mobility of care is relatively new and generating growing interest, because it allows a greater understanding of daily mobility and the differences in time use (TU) and unpaid workloads in the population. There is a large unexplored field of study in the relationships between the socioeconomic and gender characteristics of the population and care trips in large Latin American cities. This study uses the Mobility Survey for Bogotá − 2019 to characterizes travel for caregivers in the city, identifying trips made for care reasons, and then relating the analysis to variables of gender, age, socioeconomic status, occupation, and time and mode of transport used, in order to highlight and deepen the understanding of interdependence relationships between caregivers and care receivers. Results show that care work and care trips are carried out mostly by women, and we also find an unequal burden among caregivers and their socioeconomic conditions, with the lower strata population assuming a greater burden for care trips and time use when caring for others. Our findings contribute to the understanding of a phenomenon of growing importance and allow progress in the design and implementation of public policies towards a triple objective: transparency for care tasks and mobility, facilitation of their execution, and minimizing gender and socioeconomic status inequalities.

Early socioeconomic status, social mobility and cognitive trajectories in later life: A life course perspective

Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018 accompanied by the growth curve model, we examined the association between early socioeconomic status, social mobility, and divergent cognitive trajectories in later life within a society undergoing significant transformation. The study confirmed a positive relationship between socioeconomic status in early life and cognitive ability in later life. However, socioeconomic status in adulthood is associated with better cognitive ability in old age compared to that in childhood. Meanwhile, upward social mobility mitigates the negative correlation between socioeconomic disadvantage in early life and cognitive ability in later life. In addition, the inequality in socioeconomic status at earlier stages resulted in heterogeneous cognitive trajectories, with the double cumulative disadvantage effect resulting from education being particularly noteworthy. Thus, Chinese health policy should focus on the earlier stages of life, actively promoting inclusive family policies and improving the family's role in protecting childhood from an adverse environment. Simultaneously, education and employment fairness should be strengthened to accelerate social mobility and enhance the “Health Repair Mechanism” of the second life course.

Socioeconomic inequalities in type 2 diabetes comorbidities in different population subgroups: trend analyses using German health insurance data

While socioeconomic inequalities in the prevalence and management of type 2 diabetes (T2D) are well established, little is known about whether inequalities exist in the prevalence and the temporal development of T2D comorbidities. Previous research points towards expansion of morbidity in T2D as depicted mainly by a rising trend of T2D comorbidities. Against this background, and using German claims data, this study aims to examine whether socioeconomic status (SES) inequalities exist in the rates and the temporal development of T2D comorbidities. Since previous research indicates varying risk levels for T2D prevalence in the population subgroups: working individuals, nonworking spouses and pensioners, the analyses are stratified by these three population subgroups. The study is done on a large population of statutory insured individuals with T2D in three time-periods between 2005 and 2017. Predicted probabilities of three comorbidity groups and the number of comorbidities were estimated using logistic and ordinal regression analyses among different income, education and occupation groups. Interaction analyses were applied to examine whether potential SES inequalities changed over time. The study showed that neither the cross-sectional existence, nor the temporal development of T2D comorbidities differed significantly among SES groups, ruling out SES inequalities in the prevalence and the temporal development of T2D comorbidities in Germany. In men and women of all examined population subgroups, predicted probabilities for less severe cardiovascular (CVD) comorbidities, other vascular diseases and the number of comorbidities per individual rose significantly over time regardless of SES, but little if any change took place for more severe CVD comorbidities. Another important finding is that the population subgroup of nonworking spouses had markedly higher predicted probabilities for most of the examined outcomes compared to working individuals. The study indicates that the expansion of morbidity in T2D in Germany does not appear to be SES-dependent, and applies equally to different population subgroups. Yet, the study highlights that nonworking spouses are a susceptible population subgroup that needs to be focused upon when planning and implementing T2D management interventions.

64-OR: Trends in Racial, Ethnic, and Socioeconomic Inequalities in Diagnosed Diabetes Prevalence and Incidence among U.S. Adults, 2008–2021

We examined national trends in racial, ethnic, and socioeconomic status (SES) inequalities for diagnosed diabetes prevalence and incidence. Self-reported data were from adults aged ≥18 years in the National Health Interview Survey 2008-2021. Annual prevalence and incidence estimates were age-standardized to the 2010 U.S. Census population. Absolute measures of inequality in diagnosed diabetes prevalence and incidence included between-group variance (BGV) for race and ethnicity (nominal categories) and the slope index of inequality (SII) for SES (educational attainment and family poverty-to-income ratio (PIR) ordinal categories). We calculated BGV and SII for each year along with the average annual percent change (AAPC) to assess trends in inequalities over time. PIR inequalities in diabetes prevalence increased (AAPC for SII: -1.7%, p=.010) while racial and ethnic (AAPC for BGV: -10.9%, p=.010) and education (AAPC for SII: 5.8%, p=.001) inequalities in diabetes incidence decreased over time (Figure). From 2008-2021, racial, ethnic, and education inequalities in diagnosed diabetes incidence improved but persisted. Income-related inequalities in diagnosed diabetes prevalence worsened over time. To close these gaps, future research could focus on identifying factors driving these trends including the contribution of morbidity and mortality. Disclosure R.Saelee: None. I.A.Hora: None. M.E.Pavkov: None. G.Imperatore: None. S.R.Benoit: None. C.S.Holliday: None. K.M.Bullard: None.