Levels Of Educational Attainment Research Articles

Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US

BackgroundThis study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. MethodsUsing restricted-access 2018–2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. ResultsRacial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5–1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9–2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3–1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4–1.6]) populations in the East. Relative to those with a Bachelor’s degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4–8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7–13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0–13.7]). ConclusionDisparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region.

Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment.

Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.

Employment effects of childcare availability: Evidence from European Union

There are several factors that contribute to the success of a society. Economic and demographic developments are known as important drivers, while the role of parental employment as a key component is sometimes overlooked. This paper focuses on the effects of childcare availability on female and male employment in the European Union regions. Regional differences may be significant, therefore separate panel regression models (with economic and demographic control variables) are established for regions in old and new member states, and the results are compared across different levels of male and female educational attainment. The findings suggest that there is a considerable difference between old and new members states. The availability of early childhood educational development significantly increases employment both for female and male employees with higher education levels in new members states, while this effect is not significant in old member states. For male employees with relatively low education levels, the availability of early childhood educational development does have a significant effect on employment both in old and new member states but this does not hold for female employees with lower education levels.

The Long-Run Effects of the 1930s Redlining Maps on Children

We estimate the long-run effects of the 1930s Home Owners Loan Corporation (HOLC) redlining maps by linking children in the full count 1940 census to 1) the universe of Internal Revenue Service (IRS) tax data in 1974 and 1979 and 2) the long form 2000 census. We use two identification strategies to estimate the potential long-run effects of differential access to credit along HOLC boundaries. The first strategy compares cross-boundary differences along HOLC boundaries to a comparison group of boundaries that had statistically similar preexisting differences as the actual boundaries. A second approach only uses boundaries that were least likely to have been chosen by the HOLC based on our statistical model. We find that children living on the lower-graded side of HOLC boundaries had significantly lower levels of educational attainment, reduced income in adulthood, and lived in neighborhoods during adulthood characterized by lower educational attainment, higher poverty rates, and higher rates of single-parent households. (JEL G21, I26, I32, J13, N32, R23, R31)

Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population

ObjectiveClimate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and...

Exploring the causality between educational attainment and gastroesophageal reflux disease: A Mendelian randomization study.

Observational studies suggest that higher educational attainment (EA) contributes to the prevention and treatment of gastroesophageal reflux disease (GERD). However, the causality of this relationship is not supported by strong evidence. We used publicly available genetic summary data, including that on EA, GERD, and the common risk of GERD, to prove this causality. Multiple methods in Mendelian randomization (MR) were employed to evaluate the causality. The leave-one-out sensitivity test, MR-Egger regression, and multivariable MR (MVMR) analysis were applied to evaluate the MR results. Higher EA was significantly associated with lower GERD risk (inverse variance weighted method, odds ratio [OR]: 0.979, 95% confidence interval [CI]: 0.975-0.984, P <0.001). Similar results were obtained when the weighted median and weighted mode were used for causal estimation. After adjusting for potential mediators, the MVMR analysis showed that body mass index (BMI) and EA were still significantly correlated and negatively correlated with GERD (OR: 0.997, 95% CI: 0.996-0.998, P =0.008 and OR: 0.981, 95% CI: 0.977-0.984, P <0.001), respectively. Higher levels of EA may have a protective effect against GERD by having a negative causal relationship. Additionally, BMI may be a crucial factor in the EA-GERD pathway.

Examining the Black Gender Gap in Educational Attainment: The Role of Exclusionary School Discipline &amp; Criminal Justice Contact

Abstract Black men and women have different levels of average educational attainment, yet few studies have focused on explaining how and why these patterns develop. One explanation may be inequality in experiences with institutional punishment through exclusionary school discipline and criminal justice exposure. Drawing on intersectional frameworks and theories of social control, I examine the long-term association between punishment and the Black gender gap using data from the Children of the National Longitudinal Survey of Youth 1979 cohort (NLSY-C). Decomposition analyses reveal that about one third of the gender gap can be explained by gender differences in experiences with institutional punishments, net of differences in observed behaviors. These measures are predictive at key educational transition points, including finishing high school and earning a 4-year college degree. Though Black boys and girls have similar family backgrounds and grow up in similar neighborhoods, results suggest that Black girls have a persistent advantage in educational attainment due in part to their lower levels of exposure to exclusionary school discipline and the criminal justice system. In addition, I find that gender differences in early achievement, early externalizing behavioral problems, school experiences, and substance use in adolescence and early adulthood are associated with gender differences in educational attainment. Taken together, these results illustrate the importance of punishment disparities in understanding disparate educational outcomes over the life course of Black men and women.

Binge drinking and oral health-related quality of life in older adults: Socioeconomic position matters.

The objective of the study was to investigate whether the association between binge drinking and oral health-related quality of life (OHRQoL) differs by socioeconomic position (SEP) in Brazilian older adults. The adverse health effects of alcohol consumption disproportionately affect socioeconomically disadvantaged and older individuals. Moreover, measures of binge drinking may capture different domains of the association between alcohol misuse and health that might be independent of the traditional markers of volume or frequency of consumption. Evidence of the association between alcohol use and oral health outcomes has failed to consider binge drinking and possible effect modification by SEP. We conducted a secondary cross-sectional analysis using the baseline data from The Brazilian Longitudinal Study of Ageing (2015-2016). Effect Measure Modification analyses using multivariable Poisson regression models tested whether the association between past-month binge drinking and higher scores of the Oral Impacts on Daily Performance (OIDP) questionnaire differed in magnitude by level of household wealth and educational attainment, assessed using Relative Excess Risk due to Interaction (RERI) and simple slope test. The analytical sample comprised 8857 individuals. Participants who were from low-wealth households or with lower education and reported past-month binge drinking had 27% (95% CI: 1.16 to 1.39) and 28% (95% CI: 1.18 to 1.40) higher OIDP scores, respectively, than those not binge drinkers from higher SEP, and super-additive associations were detected (RERI for household wealth: 0.12; RERI for educational attainment: 0.14). Binge drinkers from low SEP have poorer OHRQoL. Public oral health initiatives aiming to combat binge drinking are likely to disproportionately benefit vulnerable groups.

Women’s empowerment and uptake of sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria during pregnancy: results from a cross-sectional baseline survey in the Lake endemic region, Kenya

BackgroundMalaria in pregnancy remains a major public health problem in endemic areas of the sub-Saharan African (SSA) region. However, there is limited understanding of the association between women’s empowerment and the uptake of sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp-SP) in Kenya. This study examines the association between women’s empowerment indicators (decision-making power, control of assets, education, and employment status) and the uptake of three or more doses of IPTp-SP in the Lake endemic region of Kenya.MethodsThe analysis utilized a dataset from a cross-sectional baseline survey of 3129 women aged 15–49 years in Kisumu and Migori Counties who had a live birth within the last 2 years preceding the study. Data were collected between June to August 2021. A descriptive analysis was conducted to show the distribution of respondents by key background characteristics, and bivariate and multivariate logistic regression to examine statistically significant associations between women’s empowerment measures and the uptake of 3+ doses of IPTp-SP.ResultsAmong the 3129 women surveyed, 1978 (65.7%) received 3+ doses of IPTp-SP during their most recent pregnancy. Controlling for individual characteristics and the number of ANC visits, the odds of taking 3+ doses of IPTp-SP increased among women who had high decision-making autonomy (AOR = 2.33; CI = 1.81–3.01; P < 0.001); and tertiary level of educational attainment (AOR = 1.51; CI = 1.10–2.06). However, the association between control of assets and uptake of IPTp-SP was positive but not statistically significant.ConclusionWomen’s decision-making autonomy and educational attainment were positively associated with the uptake of IPTp-SP. As a result, maternal health interventions should focus on less empowered women, specifically those with less decision-making autonomy and no/low formal education, as they are less likely to achieve optimal uptake of IPTp-SP during pregnancy.

Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway.

Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway. Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.

Demographic and socioeconomic predictors of religious/spiritual beliefs and behaviours in a prospective cohort study (ALSPAC) in Southwest England: Results from the parental generation

Background: We explored associations between possible demographic and socioeconomic causes of religious/spiritual beliefs and behaviours (RSBB) in the parental generation of the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: We used a prospective birth cohort study (ALSPAC) in Southwest England with 14,157 enrolled mothers and 14,154 associated partners. Three RSBB outcome measures collected during pregnancy were examined: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other) and religious attendance (frequency of attendance at a place of worship). Multiple demographic and socioeconomic exposures were assessed (23 in mothers and 22 in partners). We explored age-adjusted associations between each exposure and outcome using multinomial regression, in addition to exposure-age interactions. Results: Many demographic and socioeconomic factors were associated with RSBB, including age, ethnicity, marital status, education, income and deprivation. Overall, higher socioeconomic position was associated with increased levels of RSBB, particularly regarding religious attendance. For instance, compared to mothers with the lowest level of educational attainment, a degree-level education was associated with a six-fold increase in the relative risk ratio of religious attendance at least once a week, relative to not attending at all (RRR=5.90; 95% CI=[4.44; 7.86]). The magnitude of these associations often varied by outcome, e.g., income was associated with religious attendance, but only weakly with religious affiliation. Although results were demographically and socially patterned, overall effect sizes were relatively small, with a largest pseudo-R2 value of 2.4%. Patterns of association were similar for mothers and partners. Conclusion: The observed positive association between socioeconomic position and RSBB is contrary to much previous theoretical and empirical work. Potential reasons for these differences are discussed, including cross-cultural variation in religiosity and state support, and differences between RSBB measures. This descriptive paper can also help inform future studies using these data regarding the consideration of appropriate confounders.

Educational attainment and anxiety in middle-aged and older Europeans

We examined the relationship between educational attainment (EA) and anxiety symptoms in a sample of 77,792 individuals (median age = 64 years, 55% female) from the Survey of Health, Ageing and Retirement in Europe. Using logistic regression, we estimated odds ratio (OR) with 95% confidence interval (CI) for the association between EA (7 educational levels based on International Standard Classification of Education) and anxiety symptoms (12 or more points from the shortened 5-item version of the Beck Anxiety Inventory), adjusting for sociodemographic and health-related factors. We further explored whether the relationship varied by region, sex and age group. Independent of sociodemographic and health-related factors, higher levels of EA were associated with lower odds of anxiety symptoms. The magnitude of this association plateaued at first stage of tertiary education (OR 0.40; 95% CI 0.35–0.47, p < 0.001). The association was stronger in females, middle-aged individuals and in Central and Eastern Europe while not apparent in Northern Europe. Our findings suggest that individuals with higher education might be protected against anxiety throughout life. The protective effect of education against anxiety symptoms is more pronounced in less egalitarian regions and in females.

Impact of a Cancer Education Curriculum on Appalachian Kentucky Middle and High School Students.

Appalachian Kentucky is disproportionately affected by elevated cancer incidence and mortality rates. This disparity is driven by inequities in health behaviors and social determinants of health including decreased education attainment levels that cause lower health literacy. To increase cancer literacy in the region, a three-part cancer education curriculum was designed for Appalachian Kentucky middle and high school students. This study was designed to evaluate the effect the curriculum had on students' cancer literacy. The curriculum lessons were disseminated to Appalachian Kentucky middle and high school teachers who engaged 223 students with the material. For each lesson, students filled out a 10-question pretest and an identical 10-question posttest. The average and median percent of correct responses from the pre- to posttests were analyzed. The average percentage of correct responses significantly increased from 40% to 70%, 52% to 69%, and 33% to 53% on lessons 1, 2, and 3, respectively. A significant increase in the average percentage of correct responses on each individual question was also observed. The results demonstrate that the three-part cancer education curriculum intervention can significantly increase Appalachian Kentucky middle and high school students' cancer literacy. Increased cancer knowledge has the potential to encourage behavioral modifications that could reduce cancer incidence and mortality rates over time. Future work will include further improving the content relative to the target age/grade level and implementing the material with a broader group of teachers and students.

The gap that survived the transition: The gender wage gap in Estonia over three decades

This paper looks at the gender wage gap throughout the transition from communism to capitalism and a time of rapid economic convergence. The case of Estonia is used, and micro data from the Labour Force Survey from 1989 to 2020 are employed. The communist regime had highly regulated wage setting and high levels of educational attainment and labour market participation for women. Although the regime was formally egalitarian, the gender attitudes were conservative and the raw gender wage gap was as large as 41% at the end of the communist period in Estonia. The large gender wage gap under communist rule narrowed quickly during the first years of economic transition, but a further decline in the gap has been slow. The paper has two main messages. The first is that there is strong inertia in the gender wage gap persisting through the communist period and economic convergence. None of the known long-run cultural drivers of gender attitudes can explain this. The second is that the decline in the gap is related to the overall decline in wage inequality, the rise in minimum wages, and more egalitarian gender attitudes. The gender attitudes are responsible for a smaller effect compared to wage inequality.

Sociodemographic profiles and determinants of relapse risks among people with substance use disorders in the Philippines: A survey in community and residential care settings

BackgroundMethamphetamine use is a major social and health issue in the Philippines. Former president Rodrigo Duterte prioritized combating illicit drugs, and the government launched an anti-drug campaign. People with substance use disorders (SUD) receive treatment and care in the community or residential treatment at Treatment and Rehabilitation Centers (TRCs) established by the Department of Health. However, since the content and quality of service are not sufficient, there is an urgent need for improvement. To this end, it is necessary to understand demographic characteristics, the severity of drug use, and treatment needs of this population. MethodsWe conducted a questionnaire survey of people with SUD in the community (n=308) and all TRC patients (n=1770) to obtain their demographic profiles. We also used the Drug Abuse Screening Test-20 (DAST-20) and the Stimulant Relapse Risk Scale (SRRS). ResultsBased on DAST-20 scores, the severity of dependence was not well-matched to the care provided; 12.4% of the community sample was in the severe or substantial categories and 14.2% of the TRC sample was in the low category. The TRC sample had a significantly higher relapse risk than the community sample, which was associated with a lower educational attainment level and comorbid alcohol dependence. ConclusionsIt is important to use standardized psychometric tools to match treatment with the severity of drug dependence. In addition, a wide variety of medical and social services need to be provided based on consideration of treatment needs to improve the well-being of this population.

Impact of adverse childhood experiences on life expectancy with depression in the U.K. population: The mitigating role of educational attainment

BackgroundAdverse childhood experiences (ACEs) are associated with depression in later life. ObjectiveThis study aimed to measure the impact of ACEs on life expectancy with depression (DLE) and to assess how educational attainment affected expectations. Participants and settingThe study used data on 5597 participants from the English Longitudinal Study of Aging (2006–2013). MethodsDepression was assessed through the eight-item short version of the Centre for Epidemiologic Studies Depression. We used discrete-multistate life table models to estimate total life expectancy and life expectancy with depression. ResultsOlder adults with ACEs had longer DLE and a higher proportion of remaining life with depression compared with those without ACEs. For example, men aged 60 years with ACEs could expect to live 5.2 (95 % confidence interval (CI): 4.2, 6.2) years with depression compared with 2.8 (95 % CI: 2.3, 3.3) years for men without ACEs. Women aged 60 years who reported ACEs could expect to live 9.4 (95 % CI: 7.6, 11.1) years with depression compared with 6.0 (95 % CI: 5.1, 7.0) years for women without ACEs. With a high level of educational attainment, older adults from younger cohorts with ACEs lived fewer depression years and spent a higher proportion of their life being free of depression than adults with ACEs and had a low level of educational attainment. ConclusionOur results indicated that ACEs may increase years of life with depression among U.K. adults. Meanwhile, high educational attainment could mitigate the mental health burden associated with ACEs.

An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis.

Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. This study aimed to explore the factors associated with portal messaging use by rural patients. We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.

Essence of culture and nature: Governance as the emerging correlates of quality‐of‐life experiences in the communities of Himachal, India

AbstractThe aim of this work is to uncover factors influencing the quality of life in the study area. The idea is operationalized by collecting data at the household level on subjective and objective aspects of quality of life. For this study, data were collected from 18 sample villages using a stratified random sampling method. The villages were chosen to represent two distinct communities, namely the scheduled castes (SC) and the general population, spread across three altitudinal zones. In all, 436 households (about 20% of the total) were surveyed with respect to 10 domains of quality of life, namely environment and cleanliness, housing, education, health, personal well‐being, democratic and social participation, information and communication, employment, income and wealth and governance. To identify the key domains of quality of life, the principal components analysis (PCA) technique was applied. The findings support the idea that Asian predictors of satisfaction with life are similar to those of the Western world, but social and cultural backgrounds determine some culture‐oriented predictors. The PCA results show that governance is the key determinant of life satisfaction. This study reveals that due to higher levels of educational attainment, good income conditions, and greater participation in community affairs, the general community has reported higher quality of life satisfaction compared to the SC community population.

Knowledge, Attitude, and Practices of English Teachers in Utilizing Integrative Performance Tasks in English

The study “Knowledge, Attitude and Practices of English Teachers in Utilizing Integrative Performance Tasks in English” described and then analyzed the knowledge, attitude and practices of English teachers in designing and utilizing Integrative Performance Task in the New Normal Education. To achieve this aim, the researcher used a sample of 50 English Senior and Junior High School public school teachers in Talavera, Nueva Ecija. The researcher used the descriptive-correlational method of research, which utilized a researcher-made questionnaire to gather the data needed for the study. The findings showed that the majority of the teacher-respondents of Junior and Senior High Schools of Talavera, Nueva Ecija are Teacher III with previously earned units in Master's Degree who are handling Grade 10 students. Additionally, most of them are female, single, and between the ages of 23 and 29. Furthermore, the result shows that there was no significant relationship found between the profile of the respondents and their knowledge, attitude, and practices in using integrative performance tasks. Moreover, it showed that the teacher-respondents’ Highest Educational Attainment and Grade Level Taught significantly correlated with their Individual Performance Commitment and Review (IPCR) ratings. Lastly, it was found to have no significant relationship between the teachers’ utilization of Integrative Performance Task (IPT) in terms of their knowledge, attitude, and practices and their Individual Performance Commitment and Review (IPCR) ratings. Conclusions were drawn based on the findings of the study and recommendations were presented and offered.

Tracking the Uneven Outcomes of COVID-19 on Racial and Ethnic Groups: Implications for Health Policy.

The socioeconomic shocks of the first COVID-19 pandemic wave disproportionately affected vulnerable groups. But did that trend continue to hold during the Delta and Omicron waves? Leveraging data from the Johns Hopkins Coronavirus Resource Center, this paper examines whether demographic inequalities persisted across the waves of COVID-19 infections. The current study utilizes fixed effects regressions to isolate the marginal relationships between socioeconomic factors with case counts and death counts. Factors include levels of urbanization, age, gender, racial distribution, educational attainment, and household income, along with time- and state-specific COVID-19 restrictions and other time invariant controls captured via fixed effects controls. County-level health outcomes in large metropolitan areas show that despite higher incidence rates in suburban and exurban counties, urban counties still had disproportionately poor outcomes in the latter COVID-19 waves. Policy makers should consider health disparities when developing long-term public health regulatory policies to help shield low-income households from the adverse effects of COVID-19 and future pandemics.