Individuals Of Lower Socioeconomic Status Research Articles

Forecasting Inequalities in Survival to Retirement Age by Socioeconomic Status in Denmark and Sweden

In Denmark and Sweden, statutory retirement age is indexed to life expectancy to account for mortality improvements in their populations. However, mortality improvements have not been uniform across different sub-populations. Notably, in both countries, individuals of lower socioeconomic status (SES) have experienced slower mortality improvements. As a result, a uniform rise in the statutory retirement age could disproportionally affect these low-SES groups and may unintentionally lead to a reverse redistribution effect, shifting benefits from short-lived low-SES individuals to long-lived high-SES individuals. The aim of this study is twofold: to quantify and contextualise mortality inequalities by SES in Denmark and Sweden, and to assess how indexing retirement age will affect future survival to retirement age by SES in these countries. We used Danish and Swedish registry data (1988–2019), to aggregate individuals aged 50 + based on their demographic characteristics and SES. We computed period life tables by year, sex, and SES to estimate the difference in survival across different SES groups. We then forecast mortality across SES groups to assess how indexing retirement age will affect survival inequalities to retirement age, using two forecasting models—the Mode model and the Li-Lee model. Mortality inequalities are comparable in Denmark and Sweden, even though the latter generally has higher survival. We also find that indexing retirement age to life expectancy will have two main consequences: it will reduce the probability of reaching retirement for all SES groups, particularly those of low SES, and time spent in retirement will be reduced, particularly for those of high SES.

Defamilization? Not for everyone. Unequal labour-market participation among informal caregivers in Europe

Growing care dependencies among the elderly due to population ageing in Europe challenge the labour-market participation of informal caregivers. While familiarized care regimes incentivize family caregiving by providing many cash-for-care-benefits, resulting in reduced labour supply, defamiliarized care regimes allocate more public spending to care infrastructure, alleviating the care responsibilities placed on family members. At the same time, care provision on the micro-level is distributed unequally across gender, age, and socioeconomic status. The question then emerges: Does the labour-market participation of informal caregivers vary between and within countries depending on the social-expenditure policy of welfare states? To answer this research question, a multilevel design was used, employing SHARE data and macro-indicators from OECD and Eurostat databases. The results reveal higher probabilities of labour-market participation for informal caregivers in general when social expenditures on formal care infrastructure are higher. However, labour-market participation was observed as being unequally distributed among the heterogeneous group of persons with and without caregiving duties. Women and individuals of lower socioeconomic status did not benefit from social expenditures in the same way as their counterparts, leading to lower levels of labour-market participation.

Serving Those Who Served: Enhancing Colorectal Surgery Care for Veterans

AbstractThe Department of Veterans Affairs (VA) is the largest provider of integrated health care services in the United States and its mission is to honor veterans by providing timely, effective, and high-quality health care that improves individuals' health and functionality. The VA provides comprehensive primary and specialty care, including colorectal surgery services, to eligible veterans who suffer from a disproportionately high burden of medical comorbidities and often belong to vulnerable populations, including individuals of low socioeconomic status, those who identify as lesbian, gay, bisexual, transgender, and questioning, racial minorities, and those suffering from severe mental health illness. There are many challenges to caring for a population of veterans with benign and malignant colorectal disease due to both patient and system level factors. Despite these challenges, the VA has demonstrated a commitment to ensuring culturally competent, equitable, and inclusive care and to conducting research that establishes evidence-based best practices in the management of colorectal diseases. These efforts have led to outcomes for patients undergoing care for colorectal diseases within the VA that are par with or better than civilian outcomes. The VA is uniquely positioned on a system level to provide nationwide efforts that improve care delivery and serve those who served.

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.

Menarche and Time to Cycle Regularity Among Individuals Born Between 1950 and 2005 in the US.

Early menarche is associated with adverse health outcomes. Trends toward earlier menarche have been observed in the US, but data remain limited on differences by sociodemographic factors and body mass index (BMI). Time from menarche to cycle regularity is another understudied early-life characteristic with health implications. To evaluate the temporal trends and disparities in menarche and time to regularity and explore early-life BMI as a mediator. This ongoing cohort study enrolled participants from an ongoing mobile application-based US cohort from November 14, 2019, to March 20, 2023. Birth year (categorized as 1950-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2005). Main outcomes were age at menarche and time to regularity, which were self-recalled at enrollment. In addition, early (aged <11 years), very early (aged <9 years), and late (aged ≥16 years) age at menarche was assessed. Among the 71 341 female individuals who were analyzed (mean [SD] age at menarche, 12.2 [1.6] years; 2228 [3.1%] Asian, 3665 [5.1%] non-Hispanic Black, 4918 [6.9%] Hispanic, 49 518 [69.4%] non-Hispanic White, and 8461 [11.9%] other or multiple races or ethnicities), 5223 were born in 1950 to 1969, 12 226 in 1970 to 1979, 22 086 in 1980 to 1989, 23 894 in 1990 to 1999, and 7912 in 2000 to 2005. The mean (SD) age at menarche decreased from 12.5 (1.6) years in 1950 to 1969 to 11.9 (1.5) years in 2000 to 2005. The number of individuals experiencing early menarche increased from 449 (8.6%) to 1223 (15.5%), the number of individuals experiencing very early menarche increased from 31 (0.6%) to 110 (1.4%), and the number of individuals experiencing late menarche decreased from 286 (5.5%) to 137 (1.7%). For 61 932 participants with reported time to regularity, the number reaching regularity within 2 years decreased from 3463 (76.3%) to 4075 (56.0%), and the number not yet in regular cycles increased from 153 (3.4%) to 1375 (18.9%). The magnitude of the trend toward earlier menarche was greater among participants who self-identified as Asian, non-Hispanic Black, or other or multiple races (vs non-Hispanic White) (P = .003 for interaction) and among participants self-rated with low (vs high) socioeconomic status (P < .001 for interaction). Within a subset of 9865 participants with data on BMI at menarche, exploratory mediation analysis estimated that 46% (95% CI, 35%-61%) of the temporal trend in age at menarche was explained by BMI. In this cohort study of 71 341 individuals in the US, as birth year increased, mean age at menarche decreased and time to regularity increased. The trends were stronger among racial and ethnic minority groups and individuals of low self-rated socioeconomic status. These trends may contribute to the increase in adverse health outcomes and disparities in the US.

Three-Pronged Resentment: How Status Insecurity, Relative Deprivation, and Powerlessness Mediate Between Social Positions and Populist Attitudes

Populist attitudes are frequently tied to a specific social position, namely the constituent’s status as a “loser of globalization.” Adding nuance to this explanatory framework, we investigate whether and how resentment mediates between social positions and populist attitudes. We distinguish three constitutive components of resentment—status insecurity, relative deprivation, and powerlessness—and analyze to what extent these sentiments explain the prevalence of two key populist attitudes: anti-elitism and demands for popular sovereignty. Using survey data from the Belgian National Election Study 2014, we show that although both populist attitudes are more likely among individuals of low socioeconomic status, this effect is mediated by a sense of group relative deprivation (anti-elitism and popular sovereignty) and feelings of powerlessness (anti-elitism). The effect of individual-level status insecurities on populist attitudes is, however, not significant. These results suggest that people do not simply adhere to antagonistic and people-centric views about politics because they experience economic precariousness; they embrace populist attitudes if their vulnerability is perceived in terms of a threatened sense of group position and understood as the outcome of an unjust society, wherein they feel powerless to alter their circumstances.

Cohort study on incidence of new-onset type 2 diabetes in patients after bariatric surgery and matched controls.

Metabolic bariatric surgery the reduces risk of new-onset type 2 diabetes in individuals with obesity, but it is unclear whether the benefit varies by sex, age, or socioeconomic status. The aim was to assess the risk of new-onset type 2 diabetes after metabolic bariatric surgery in these subgroups. The Finnish Public Sector study, a follow-up study with matched controls nested in a large employee cohort, included patients without type 2 diabetes and with a diagnosis of obesity or self-reported BMI of at least 35 kg/m2. For each patient who had laparoscopic metabolic bariatric surgery (2008-2016), two propensity-score matched controls were selected. New-onset type 2 diabetes was ascertained from linked records from national health registries. The study included a total of 917 patients and 1811 matched controls with obesity. New-onset type 2 diabetes was diagnosed in 15 of the patients who had metabolic bariatric surgery (4.1 per 1000 person-years) and 164 controls (20.2 per 1000 person-years). The corresponding rate ratio (RR) was 0.20 (95% c.i. 0.12 to 0.35) and the rate difference (RD) was -16.1 (-19.8 to -12.3) per 1000 person-years. The risk reduction was more marked in individuals of low socioeconomic status (RR 0.10 (0.04 to 0.26) and RD -20.6 (-25.6 to -15.5) per 1000 person-years) than in those with higher socioeconomic status (RR 0.35 (0.18 to 0.66) and RD -11.5 (-16.9 to -6.0) per 1000 person-years) (Pinteraction = 0.017). No differences were observed between sexes or age groups. Metabolic bariatric surgery was associated with a reduced risk of new-onset type 2 diabetes in men and women and in all age groups. The greatest benefit was observed in individuals of low socioeconomic status.

Youth Violence Does not Discriminate: Inclusive Violence Prevention Support Services Focused on Counseling and Peer Support are Essential for Youth and Young Adults.

Violence disproportionately affects individuals of low socioeconomic status, and rates of injury amongst youth and young adults (YYAs) are rising. Little is known about how the social needs of this high-risk subgroup compared to the overall violently injured population. This is a retrospective review of an intake assessment of violently injured victims admitted to a level I trauma center (Jan 2022-Aug 2023). Data collected include race, age, mechanism of injury, and protective and predisposing factors for violent injury. We compared the risk factors of YYAs (=≤ 24years) to those of adults (>24) and evaluated rates and types of violence prevention services requested by age group. Of 350 individuals surveyed, 94 (27%) were <= 24years and 256 (73%) were >24years. Younger patients were less likely to be male (77% vs 86%, P = .03) and experienced more firearm injury (76% vs 51%, P < .001). They reported less alcohol use (20% vs 38%, P < .001), similar rates of mental illness (25% vs 26%, P = .62), less housing instability (5% vs 22%, P < .001), and similar access to government benefits (20% vs 29%, P = .2) compared to the older cohort. Services were requested by 41% of the study population (N = 142); the younger cohort was 2.9 times more likely to request non-financial services (P = .042). Violently injured youth and young adults (YYAs) experience disproportionately high rates of gun violence. Efforts should be made to prioritize legal, peer support, and mental health services over financial services for this population.

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.

The relationship between socioeconomic status and perinatal outcomes in in vitro fertilization conceptions

ObjectiveTo evaluate whether socioeconomic status has an impact on perinatal outcomes in in-vitro-fertilization pregnancies. We hypothesize that with greater coverage there may be an alleviation of the financial burden of IVF which can facilitates application of evidence-based practices. BackgroundIn-vitro fertilization (IVF) is the most used assisted reproductive technology in the United States, with growing efficiency and demand for in-vitro fertilization. Certain states have mandated coverage that enable low-income individuals to undergo in-vitro fertilization treatment. Study DesignA retrospective population-based observational study was conducted in accordance with the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database over the six-year period from 2008 to 2014 examining 10,000 in-vitro-fertilization deliveries. Maternal outcomes of interest included preterm pre-labor rupture of membranes (PPROM), preterm birth (i.e., before 37 weeks of gestation), placental abruption, Caesarean Section (C/S), operative vaginal delivery, spontaneous vaginal delivery (SVD), maternal infection, chorioamnionitis, hysterectomy, and postpartum hemorrhage. Neonatal outcomes included small for gestational age (SGA) defined as birth weight less than tenth percentile, intrauterine fetal death (IUFD), and congenital anomalies. ResultsOur study found that socioeconomic status did not have a statistically relevant effect on perinatal outcomes in women who underwent in-vitro-fertilization to conceive after adjusting for the potential confounding effects of maternal demographic, pre-existing clinical characteristics, and comorbidities. ConclusionThe literature suggests that in states with mandated in-vitro-fertilization coverage, there are better perinatal outcomes due in part to greater utilization of best IVF practices, such as single-embryo transfers. Moreover, the quality of medical care in states with coverage is in the highest quartile in the country. Therefore, our findings of equivalent perinatal outcomes in IVF care irrelevant of socio-economic status suggests that a possibly of lack of access to quality medical care may be a factor in the health disparities usually seen in lower socioeconomic status individuals.

Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity

BackgroundTo assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents.MethodsProspective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour.ResultsAdjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020–2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected.ConclusionsResults support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population.Trial RegistrationNot a trial.

Extracellular vesicles in parasitic diseases – from pathogenesis to future diagnostic tools

Parasitic diseases are still a major public health problem especially among individuals of low socioeconomic status in underdeveloped countries. In recent years it has been demonstrated that parasites can release extracellular vesicles that participate in the host-parasite communication, immune evasion, and in governing processes associated with host infection. Extracellular vesicles are membrane-bound structures released into the extracellular space that can carry several types of biomolecules, including proteins, lipids, nucleic acids, and metabolites, which directly impact the target cells. Extracellular vesicles have attracted wide attention due to their relevance in host-parasite communication and for their potential value in applications such as in the diagnostic biomarker discovery. This review of the literature aimed to join the current knowledge on the role of extracellular vesicles in host-parasite interaction and summarize its molecular content, providing information for the acquisition of new tools that can be used in the diagnosis of parasitic diseases. These findings shed light to the potential of extracellular vesicle cargo derived from protozoa parasites as novel diagnostic tools.

Prevalence of Frailty Phenotypes in Older People Living with HIV: A Cross-Sectional Study from Brazil.

Frailty may affect people living with HIV (PLHIV) prematurely. Fried's frailty phenotype, composed of 5 criteria, is one of the most used instruments for its assessment. This study aimed to determine the prevalence of these criteria among PLHIV classified as prefrail and frail in Brazil. A cross-sectional study analyzed the prevalence of the Frailty Phenotype in Brazil with 670 individuals aged ≥ 50 years and undetectable viral load. The prevalence of prefrail and frail individuals was 50.7% and 13.6%, respectively. A low level of physical activity was the most prevalent criterion (50.9%). Except for unintentional weight loss, all other criteria were more prevalent among individuals with lower education levels. All criteria were more prevalent among individuals of lower socioeconomic status than among those of moderate or high status (P < .05). A low level of physical activity was the component that most contributed to PLHIV being considered prefrail or frail.

Family Health Equity in Chronic Disease Prevention and Management

Introduction/Purpose Efforts to improve chronic disease outcomes among US adults highlight families, particularly support from families, as a key aspect of disease prevention and management. To date, however, an overwhelming focus on individual-level outcomes and unidirectional support (eg, from a family caregiver to an identified care recipient) belies the existence of co-occurring health concerns and interdependent care. There are increasing calls for more sophisticated and intensive family health interventions that better integrate family-level factors, processes, and outcomes to provide comprehensive family support services in health care and community-based settings. Methods This commentary provides key considerations for advancing this work while centering family health equity and families themselves in health initiatives. Results Several critical barriers are identified and discussed. For example, a narrow focus on family and inadequate measures of family-level disease burden make it challenging to understand how the disproportionate burden of chronic disease observed among individuals of lower socioeconomic status and certain racial and ethnic groups compounds and complicates family health experiences. In addition, limited attention to the interaction between individuals, families, and broader sociocultural factors that influence family resources and constraints, such as racism, hamper program design, implementation, and evaluation. Conclusion To center families in efforts to reduce chronic disease disparities, it is necessary to move beyond superficial attention to the complexity of disease prevention and management within the family context. This commentary serves to enhance understanding of important drivers of family-level chronic disease outcomes, while providing important considerations for advancing research and practice.

Abstract C108: Employer-based implementation of Galleri multi-cancer early detection testing to address socioeconomic disparities in receipt of screening

Abstract Background: Multi-cancer early detection (MCED) tests are designed to complement USPSTF-recommended screening to detect many cancers for which no established screening methods exist. Implementing an MCED test as an employee benefit offers an approach to detect cancers for which there is no screening method and to address socioeconomic disparities in receipt of screening. Methods: Galleri, a blood-based MCED test, was implemented in companies with employees in industrial/manufacturing spaces. We approximated educational attainment (≤12 years vs &amp;gt;12 years) as a dichotomous measurement of socioeconomic status (SES). The industrial locations with employees of lower SES were selected based on data from individual companies and focused on diverse employees, low rates of preventive screenings, high healthcare costs, and low health literacy. Enrollment was accomplished through on-site events where consent and blood draws were available, as well as telehealth visits with subsequent blood draws. Results: From October 2021 to May 2023, 812 Galleri MCED tests were administered in a population of industrial employees. Of the participants, 317 (39%) were female and 495 (61%) were male, and the median age was 54 years. A total of 217 (27%) participants were aged 35-49, 531 (65%) were aged 50-64, and 62 (8%) were aged 65-79. Four tests returned a cancer signal detected result with a predicted cancer signal origin of colorectal (n=2), anus (n=1), and breast (n=1). Of the four participants with a cancer signal detected result, three were in the 50-64 age group and one was in the 65-79 age group. The breast cancer diagnosis was confirmed, and follow-up is ongoing in the participants with a cancer sign origin of colorectal and anus. A total of 676 (83%) tests were administered during 9 on-site events and 136 (17%) were obtained by telehealth visits. Factors that were important for taking the Galleri test were onsite events, trusted long-time employees onsite that spoke their language and helped translate the request form, explanation of the test in their native language, and the ability to administer the test without a computer or other digital requirements. Conclusion: MCED testing may be implemented more widely among individuals of lower SES when it is included as an employee benefit with in-person communication by trusted employee messengers and by limiting digital requirements. Supporting the unique needs of individuals before administering an MCED test and those with a cancer signal detected result are important steps for improving access and achieving diagnostic resolution. Citation Format: Ahmedin Jamal, Robert Winn, William Cance, Tim Johnson, Wayne Lilyestrom. Employer-based implementation of Galleri multi-cancer early detection testing to address socioeconomic disparities in receipt of screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C108.

Medical Insurance Coverage and Clinical Outcomes for Patients with Hematological Malignancies in a Rural State

Background Hematological malignancies, such as leukemia, lymphoma, and multiple myeloma, affect blood, bone marrow, and/or the lymphatic system. They can be difficult to treat and often require prolonged and expensive interventions such as chemotherapy, radiation therapy, stem cell transplant, and/or targeted immunotherapy. Due to the complexity and cost of treatment, they pose a significant financial burden on patients and their families. Medical insurance coverage plays a crucial role in providing access to these treatments. This is particularly important for individuals of lower socioeconomic status, and patients in rural states. Aim This retrospective study is focused at examining the relationship between various medical insurance coverage options and/or its absence in influencing the treatment regime and clinical outcomes of patients with hematological malignancies in a statewide cancer registry. Methods This is a retrospective cohort study, conducted by analyzing data in the cancer registry of patients with various hematological malignancies in a single rural state between 2015 and 2022. The patients were divided into study groups based on their insurance providers (Medicare, Medicaid, Private, Military, and Other). Demographic data, cancer treatment data as well as survival data was collected for all patients included in the study. Descriptive statistics were calculated for the overall sample and for each Insurance type subgroup. Due to normality violations, Kruskal Wallis tests (a non-parametric alternative to Analysis of Variance) were utilized to determine if there were statistically significant differences in age, number of treatments, and survival months between the Insurance type groups. To quantify the magnitude of the effect, epsilon-squared (2) was calculated for all between-group comparisons, as a recommended effect size for Kruskal-Wallis tests. Post-hoc group comparisons were conducted when necessary. All categorical variables were evaluated to determine if there were differences present between Insurance type groups using chi-square tests, with post-hoc group comparisons made when necessary. A log-rank test was utilized to compare the survival curves between the Insurance type groups. Univariable and multivariable Cox proportional-hazards regression analysis was used to examine the relationship between survival and Insurance type, when additionally accounting for demographics such as age, race, and sex. All analyses were conducted using R Version 4.3.1 with statistical significance defined as p&amp;lt;0.05. Results The study cohort included 2,472 patients from a single state cancer registry. The study groups differed significantly on age, race, current cancer status, overall treatment summary, chemotherapy, hormone treatment, immunotherapy, hematologic transplant and endocrine treatment, other/palliative treatment, number of treatments, survival length, and overall survival (Table 1). In addition, the survival curves significantly differed by insurance type (Figure 1). Independent predictors of death were age, sex, and insurance type. Multivariable analysis revealed only age and insurance were significant predictors of death with increased risk for older individuals relative to younger and increased risk of death for Medicare, Medicaid, and those that listed their insurance as ‘Other’ relative to those with Private insurance. All assumptions for Cox proportional-hazards regression were tenable. Conclusion There is a strong correlation between insurance types and the outcomes in cancer patients. It revealed that patients with private insurance were more likely to live longer and have more treatment options compared to patients without insurance or other types of coverage. This is reflected in the stratified insurance cohort which showed a 72.8% 5-year survival rate for patients with private insurance, as opposed to Medicare patients who ranked lowest at 49.3%. In addition, the study also highlighted racial disparities in insurance coverage. For instance, evidencing that black &amp; white patients were more likely to be covered in equally by Medicare, while the white patients were over 50% more likely to be covered by other plans as compared to their black counterparts. Overall, the study thoroughly highlights the impact a patient's choice of insurance could portend in ensuring their longevity when battling hematological malignancies

Increasingly Unequal. Electoral Participation and Political Inequalities in a Context of Decreasing Unionization in Italy (1983-2018)

Turnout has become increasingly unequal in many advanced democracies over the last few decades. Disadvantaged social groups are found to exhibit lower turnout compared to their better-off counterparts. According to numerous scholars, this growing gap is mainly attributed to the weakening of mass organizations that traditionally appealed to socio-economically disadvantaged social groups, particularly trade unions. However, very few studies have investigated these trends in Italy, a country that has witnessed a significant decrease in electoral turnout since the late 1970s, and where the socioeconomic causes of this decline have not been systematically explored. Against this backdrop, this paper aims to analyse, first and foremost, whether electoral participation in Italy is becoming increasingly unequal. Then, it moves to explore the extent to which the turnout gap between individuals with low and high socio-economic status (SES) could be moderated by both de-unionization and trade unions’ membership. By utilizing a dataset that combines 10 waves of the Italian National Election Study (1983-2018), the paper demonstrates that the turnout gap between low and high SES individuals has substantially widened over the last decades. Furthermore, it suggests that while the overall turnout gap is at least partially affected by the strength of trade unions in the country, trade unions still seem to be able to mobilize their members, particularly among lower social groups. This finding underscores the potential of trade unions to continue playing a role in equalizing turnout.

Lifetime risk of developing peripheral arterial disease: a nationwide longitudinal study

Abstract Background Peripheral arterial disease (PAD) presents a substantial clinical and public health burden. It remains one of the most impactful cardiovascular conditions in terms of both number of affected individuals and its impact on the individual’s survival, functional ability, and quality of life. Nonetheless, comprehensive data on the risk of developing PAD in the general population is scant. Purpose We aimed to quantify the lifetime risk of physician-diagnosed PAD in an unselected, nationwide population. Methods We conducted analyses of the entire Danish population aged 40 years and older from 2000 through 2018 using nationwide health administrative data. All individuals free of PAD were followed for up to 19 years. The cumulative incidence and residual lifetime risk of PAD adjusted for the competing risk of death was estimated by a modified survival analysis technique. Results were stratified by age, sex, and socioeconomic status. Results The Danish population aged 40-99 years in 2000-2018 included 4,508,932 individuals, among whom 123,479 individuals were diagnosed with PAD during follow-up. The overall lifetime risk from age 40 years during the remaining lifetime was 19.9% (95% CI 19.8%-20.2%). Lifetime risk was higher in men than in women (22.7% vs. 17.8%) and among individuals living alone (22.4% among unmarried or divorced individuals vs. 19.4% among married individuals). The highest lifetime risks were observed among individuals of lower socioeconomic status, especially individuals receiving social welfare payments for whom the lifetime risk exceeded 26%. The residual risk of developing PAD fell with age; for example, a 50-year-old who had not been diagnosed with PAD would still have a 19.6% residual risk during the remaining lifetime, whereas it was 15.4% among individuals aged 70 years. Conclusions About one in five individuals are likely to be diagnosed and receive medical attention for PAD during their lifetime with substantial disparities among individual of lower socioeconomic status. This knowledge may be used in public health awareness campaigns and to promote effective strategies to prevent PAD and limit progression in those with the disease and ensure the highest life quality possible.

Abstract 12275: Neighborhood Deprivation Predicts All-Cause and Cardiovascular Mortality in a Low-Income Population in the Southeastern United States

Background: Neighborhood disadvantage impacts individuals’ morbidity and mortality and contributes to health disparities, but prospective cohort data from individuals of low socioeconomic status (SES) are limited. Hypothesis: Greater neighborhood deprivation associates with higher all-cause and cardiovascular (CV) mortality beyond individual SES, lifestyle, and clinical factors in a multi-racial, low-income population. Methods: The Southern Community Cohort Study is a population-based cohort of mostly low SES individuals recruited from 12 southeastern US states between 2002-2009. Participant addresses were linked with a census tract-based neighborhood deprivation index (NDI) derived from neighborhood level income, education, employment, housing, and occupation data. Date and cause of death were ascertained via the National Death Index. Cox proportional hazard models were used to test associations between NDI and death adjusted for enrollment age, sex, self-reported race, education, income, insurance, smoking, physical activity, alcohol intake, diet, sleep duration, BMI, and diabetes, hypertension, depression, cancer, heart disease, and stroke. Results: Among 79,631 participants, median age was 51 years (25 th -75 th percentiles: 45-58), 69% were Black, and 60% were female. Over a median 13-year follow-up, 23,356 participants died, of which 7,214 (30.9%) were CV. With adjustment for age, sex, and race, per standard deviation (SD) increase in NDI was associated with a 19% increase in all-cause mortality (HR 1.19, 95% CI 1.18-1.21) and 16% increase in CV mortality (HR 1.16, 95% CI 1.13-1.19). Even with adjustment for individual SES, lifestyle, and clinical factors, NDI was associated with a 6% increased risk in all-cause mortality (HR per SD increase 1.06, 95% CI 1.03-1.08) and 8% increase in CV mortality (HR 1.08, 95% CI 1.05-1.11). NDI showed similar significant associations with all-cause and CV mortality in Black and White participants. Conclusion: Among low-income Americans, greater neighborhood deprivation associates with higher all-cause and CV mortality independent of individual SES, lifestyle, and clinical risk factors. More research is needed to examine factors underlying the health effects of neighborhood deprivation.

Abstract 11652: The Addition of Social Determinants of Health to Coronary Heart Disease Risk Prediction

Introduction: Coronary heart disease (CHD) remains a leading cause of death worldwide, with an unequal distribution of this burden placed on individuals of lower socioeconomic status. Individual social determinants of health (SDoH) have been shown to be associated with CHD; however, whether the addition of SDoH can improve current CHD risk prediction algorithms has not been delineated. Hypothesis: We hypothesize that the addition of SDoH to the Multi-Ethnic Study of Atherosclerosis (MESA) risk score improves the prediction of 10-year CHD events. Methods: In 6,286 individuals from the MESA cohort, we evaluated the additional predictive value of SDoH beyond the traditional factors included in the existing MESA Risk Score. SDoH considered were employment, family income, house tenure, financial strain, education, marital status, social support, chronic stress, discrimination, neighborhood characteristics, healthcare access, and health insurance, which were organized into five composite domains. A penalized Cox proportional hazards model was used to select SDoH variables with the potential to improve prediction, then an unpenalized Cox regression model was fitted with traditional risk factors plus the selected SDoH variables. Results: Statistically significant differences in the distribution of SDoH were observed between racial and ethnic groups. Notably, unfavorable SDoH were concentrated in Black and Hispanic/Latino persons. Economic stability, education, and community and social context were associated with CHD events. The area under the curve (AUC) for prediction of a 10-year CHD event was 0.816 without SDoH factors and 0.818 with the addition of SDoH. Conclusions: Racial and ethnic differences in social determinants of health were obsserved. Economic stability, education, and community and social context were significantly associated with cardiovascular events, however the addition of SDoH did not significantly improve CHD risk prediction.