Low Socioeconomic Status Populations Research Articles

COVID-19 Incidence and Death Rates in the Southern Region of the United States: A Racial and Ethnic Association.

The SARS-CoV-2 virus responsible for the COVID-19 pandemic continues to spread worldwide, with over half a billion cases linked to over 6 million deaths globally. COVID-19 has impacted populations unequally based on income, age, race, sex, and geographical location. This study aimed to characterize COVID-19 incidence and death rate trends in six states of the southern region of the USA and to understand the demographic and racial differences in its incidence and death rates. Data for the study were collected from the COVID-19 Data tracker of the Centers for Disease Control and Prevention for the following southern states: Alabama (AL), Florida (FL), Georgia (GA), Louisiana (LA), Mississippi (MS), and Tennessee (TN). The results showed a significant geographical variation in the COVID-19 cases and related deaths. Significant variations in COVID-19 cases and death rates were observed among different races and ethnic groups. The highest number of COVID-19 cases were observed among the Hispanic and Black populations, and the highest death rates were found among non-Hispanic Blacks and Whites. The southern states included in this paper showed a high number of COVID-19 cases and high death rates during the study period. These increased rates may result from the low socioeconomic status and large minority populations.

Disparities In Tennis Participation And Level Of Play Based On Socioeconomic Status And Ethnicity

Tennis is a sport that has been evidenced to provide many health benefits. It is a form of physical activity that can be performed at any age. However, the sport of tennis has long been perceived as an expensive sport compared to other team sports. The United States Tennis Association (USTA) has been taking action to reduce disparities in access to the sport through diversity and inclusion initiatives such as offering grants and funding to low socioeconomic status populations and minorities. PURPOSE: The purpose of this study was to examine disparities in socioeconomic status and ethnicity as it relates to tennis participation and level of play. METHODS: Level of play was captured from the USTA’s Southern California section for the year 2020, with data consisting of a sample size of an N = 32,760 participants (17,933 male, 14823 female, 4 non-disclosed). The data for level of play was grouped as follows; Team Tennis (beginner), League Players (moderate), Tournament Players (advanced). Tennis participation was objectively quantified by membership enrollment in Southern California’s USTA programs. RESULTS: Our findings revealed a 12.5-fold tennis participation rate of White (non-Hispanic) players compared to Hispanic players, a 24.5-fold tennis participation rate of White tennis players compared to African-Americans, a 5.8-fold tennis participation rate of White tennis players compared to other minorities as an aggregate, and a 2.7-fold tennis participation rate of White tennis players compared to Asian players. In addition, when considering the population demographics of Southern California, the disparity is further exasperated, particularly for the Hispanic population. Our study revealed that level of play is statistically significantly negatively correlated with socioeconomic status, p < 0.05. CONCLUSION: The findings of this study exemplify the ethnic inequality prevalent in the sport of tennis. Moreover, the socioeconomic status influence on the level of play is evident across the tiers of the level of play. Therefore, we recommend growing and supporting endeavors that promote diversity and inclusion in efforts to reduce the disparity in tennis participation and level of play.

Different Causes and its Association in Children with Cerebral Palsy

Aim: To assess the different causes and their association of cerebral palsy in children. Methods: We conducted this cross-sectional survey using consecutive sampling technique at the orthopedic surgery department Mayo hospital, Lahore from October 2011 to November. The sample size was 200 children of all age groups, on history and clinical examination who were diagnosed with cerebral palsy were included in the study and children or their parents refused to participate in the study were excluded. Results: Out of the total 200 children, 42(21%) had &lt;1year of age, 80(40%) has 1-5 year age, 62(31%) has 5-15 year and 16(8%) had reached the skeletal maturity. Majority, 130(65%) were boy and 70(35%) were girls. None of the participant was married till study completion. When education status was asked, majority 127(63.5%) were illiterate and 28(14%) children were admitted in nursery, 27(13.5%) had primary education, 13(6.5%) completed the matriculation and only 5(2.5%) children were enrolled as undergraduate. Conclusion: Low socioeconomic status and illiterate population were in majority. Most children had age up to five years with one third of the children had associated illness. Keywords: Cerebral palsy, congenital disease, central nervous system, motor impairment syndrome, gait analysis.

Effect of maternal cigarette smoking and alcohol consumption during pregnancy on birth weight and cardiometabolic risk factors in infants, children and adolescents: a systematic review protocol

IntroductionTobacco smoking and alcohol consumption during pregnancy are particularly prevalent in low socioeconomic status populations, with an adverse association with birth outcomes and cardiometabolic risk factors. However, the direct and...

The Kidney Transplant Equity Index

To develop a scalable metric which quantifies kidney transplant (KT) centers' performance providing equitable access to KT for minority patients, based on the individualized prelisting prevalence of end-stage renal disease (ESRD). Racial and ethnic disparities for access to transplant in patients with ESRD are well described; however, variation in care among KT centers remains unknown. Furthermore, no mechanism exists that quantifies how well a KT center provides equitable access to KT for minority patients with ESRD. From 2013 to 2018, custom datasets from the United States Renal Data System and United Network for Organ Sharing were merged to calculate the Kidney Transplant Equity Index (KTEI), defined as the number of minority patients transplanted at a center relative to the prevalence of minority patients with ESRD in each center's health service area. Markers of socioeconomic status and recipient outcomes were compared between high and low KTEI centers. A total of 249 transplant centers performed 111,959 KTs relative to 475,914 nontransplanted patients with ESRD. High KTEI centers performed more KTs for Black (105.5 vs 24, P <0.001), Hispanic (55.5 vs 7, P <0.001), and American Indian (1.0 vs 0.0, P <0.001) patients than low KTEI centers. In addition, high KTEI centers transplanted more patients with higher unemployment (52 vs 44, P <0.001), worse social deprivation (53 vs 46, P <0.001), and lower educational attainment (52 vs 43, P <0.001). While providing increased access to transplant for minority and low socioeconomic status populations, high KTEI centers had improved patient survival (hazard ratio: 0.86, 95% confidence interval: 0.77-0.95). The KTEI is the first metric to quantify minority access to KT incorporating the prelisting ESRD prevalence individualized to transplant centers. KTEIs uncover significant national variation in transplant practices and identify highly equitable centers. This novel metric should be used to disseminate best practices for minority and low socioeconomic patients with ESRD.

Telehealth Across the Therapies: Examining the Impact of the COVID-19 Pandemic on Clinical Staff Working With Low Socioeconomic Status Populations

Purpose: This study examined how allied health professionals (e.g., speech-language pathology, physical therapy, and occupational therapy), who provide services to low socioeconomic–status (SES) families through a Texas-based pediatric home health agency, responded to a shift from in-person to telehealth service delivery during the COVID-19 pandemic. Method: A 28-item survey was sent out to the 308 clinical staff members at the Texas-based pediatric agency. One hundred thirty-eight respondents completed the survey in its entirety with a response rate of 44.8%. Results: Across the allied health professions, most therapists identified themselves as “somewhat prepared,” whereas few respondents identified themselves as “very prepared” or “not at all prepared” to transition to telehealth service delivery. Regardless of perceived differences in service delivery models and challenges faced during the rapid transition to telehealth, therapists largely rated client progress as similar between in-person and telehealth sessions despite reporting level of client engagement, response to cues, and ability to engage in hands-on activities as better in-person than in telehealth sessions. Comparisons among allied health professions and considerations related to the specific population served are discussed. Conclusions: Survey results from the allied health professionals at Care Options for Kids and the clinical population of low-SES, early intervention clients were consistent with findings from similar surveys conducted in which the clinical populations were not defined (client age, diagnosis, etc.), suggesting that during the pandemic, allied health professionals face similar challenges as they adopt a telehealth service delivery model. Additional training and access to resources may address some of these challenges. As the pandemic persists, results from this survey may be used to inform therapy companies in their decision-making processes related to the implementation of telehealth.

Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis

BackgroundThere remains a disproportionally high tobacco smoking rate in low-income populations. Multicomponent tobacco dependence interventions in theory are effective. However, which intervention components are necessary to include for low socioeconomic...

A wake-up call for social epidemiologists studying health inequalities: Response to Dijkstra & Horstman

In their paper, published in this journal, Dijkstra & Horstman critically reflect on a selection of social epidemiological articles and examine how low socioeconomic status populations are constructed in these articles. They identify four components which they argue represent the “dominant thought style” of this literature: 1) proliferation, 2) generalization, 3) problematization and 4) individualization. We largely agree with their first two points, but strongly disagree with the other two, and explain why in our reply. All in all, we believe that their analysis is a wake-up call for social epidemiologists, rightly pointing to the risk that the relevance and moral origins of the use and study of categories, like ‘low socioeconomic status’, can easily become less visible, and therefore should be articulated and explained every time.

MO416: Predicting Serum Bicarbonate in Non-Dialysis Dependent CKD Patients

Abstract BACKGROUND AND AIMS Metabolic acidosis (HCO3 &amp;lt; 22 mmol/L) is associated with an increased hazard of death in patients with chronic kidney disease (CKD) [1, 2]. It is further associated with muscle wasting, bone disease, hypoalbuminemia, increased inflammation, protein malnutrition, and progression of CKD [3]. Hospital Civil de Guadalajara is an urban public hospital serving a population of low socioeconomic status for whom HCO3 measurements are not included in their healthcare services and create costs around 70% of which our population cannot afford. We aimed to develop a model allowing us to predict HCO3 in CKD patients and tested its diagnostic performance. METHOD Patients at CKD stage 3–5 from our pre-dialysis clinic were included in this retrospective, cross-sectional study which served as a model development. Creatinine, weight, height, calcium, phosphorus, sodium, potassium, chloride, urea, presence of diabetes, total body water calculated by the Watson equation and eGFR calculated with the CKD-EPI formula were utilized. We performed uni- and multivariate linear regression between measured serum HCO3 and the available variables. A hypothesis-driven step-wise approach for parameter inclusion based on the Akaike Information criterion and optimization of the coefficient of determination was employed to construct the final model predicting serum HCO3. Diagnostic performance for detecting metabolic acidosis using the estimated HCO3 (eHCO3) was evaluated by receiver operating characteristics curve (ROC) analysis and computation of sensitivity, specificity and the positive and negative predictive values (PPV, NPV). Post-test probabilities at different pre-test probabilities (prevalence) were assessed using Bayes’ theorem. RESULTS We screened 1089 patients and included 284 patients [62 (21 IQR), 56% male, 69±14kg, 27% at CKD stage 3 and 34% and 40% at stage 4 and 5, respectively] in the analysis. The final model [eHCO] = 21.47 + 0.61 Ca + 0.43 Na + 0.95 TBW-0.61 Pi-0.51 K-0.53 Cl-0.008 Urea + 0.95 If diabetic had an adjusted R2:0.57, RMSE 2.4 on 275df, P-value: &amp;lt;0.001. The mean difference between HCO3 and eHCO was 0 (95% CI −4.9 to 4.9). Diagnostic performance quantified as AUC ROC 0.87 (95% CI 0.83–0.91). At a prevalence of metabolic acidosis of 56% with a chosen threshold of 20 mEq/L, the model has a sensitivity of 56% and specificity of 95% and a PPV of 94% and NPV of 63%, at a prevalence of 56%. Simulation of the post-test probabilities using Bayesian analysis is shown in Figure 1. CONCLUSION At a considerably high specificity of 95%, we can make predictions with a relatively low risk of treating subjects without metabolic acidosis with bicarbonate. Given the cost saving for the patients and the added insights and diagnostic capability, we believe that the prediction of serum HCO3 by biochemical parameters as done in our model will prove useful in settings with limited resources such as our uninsured urban population in Mexico. Validation of our model is the next step and planned future research.

Socio-Economic Status and Clinical Breast Examination Screening Uptake: Findings from the First Cohort Study among Iranian Kurdish Women.

Clinical Breast Examination (CBE) is utilized as a screening modality in many low income countries without widespread mammography capability. The aim of the current study was to evaluate the impact of socio-economic status (SES) on CBE screening rates in Iranian Kurdish women. A cross-sectional study was conducted in the western region of Iran. A sample of 5,289 Iranian Kurdish women aged 35-65 years old was analyzed. Data were collected from July 2014 to September 2018. The Concentration Index-CI and Concentration Curve were used to estimate the socioeconomic inequalities in CBE rate. The analysis of data was done by STATA software (Version 14). 12.3% of the women had received CBE at least once. CBE rates in the 46-50 age group were higher than in other age groups (OR = 2.06; 95% CI = 1.56-2.71). Women with 6-9 years of education had higher odds ratio of receiving CBE (OR = 1.41; 95% CI = 1.02-1.94). Women living in rural areas were less likely to have received CBE compared to those living in urban areas (OR=0.54; 95% CI = 0.42-0.61). The overall concentration index for receipt of CBE was 0.188. In countries without widespread mammography programs, strategies for the promotion of CBE should focus on the lower SES population.

Promoting Physical Activity in a Spanish-Speaking Latina Population of Low Socioeconomic Status With Chronic Neurological Disorders: Proof-of-Concept Study.

BackgroundPhysical activity (PA) is known to improve quality of life (QoL) as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latina women are less likely to participate in recommended levels of PA due to common socioeconomic barriers, including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting PA.ObjectiveThe aim of this study was to determine the feasibility and efficacy of a community-based intervention to promote PA through self-monitoring via a Fitbit and behavioral coaching among Latina participants with chronic neurological disorders. MethodsWe conducted a proof-of-concept study among 21 Spanish-speaking Latina participants recruited from the Los Angeles County and University of Southern California (LAC+USC) neurology clinic; participants enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital in Los Angeles. Demographic data were assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. PA promotion was determined by examining change in time spent performing moderate-to-vigorous PA (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days when coaching occurred versus on days without coaching. Change in psychometric measures (baseline vs postintervention) and medical center visits (16 weeks preintervention vs during the intervention) were also examined.ResultsParticipants were of low socioeconomic status and acculturation. A total of 19 out of 21 (90%) participants completed the study (attrition 10%), with high Fitbit wear adherence (mean 90.31%, SD 10.12%). Time performing MVPA gradually increased by a mean of 0.16 (SD 0.23) minutes per day (P<.001), which was equivalent to an increase of approximately 18 minutes in MVPA over the course of the 16-week study period. Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent on MVPA on days when coaching occurred via phone (37 min/day, P=.02) and in person (45.5 min/day, P=.01) relative to days without coaching (24 min/day). Participants improved their illness perception (effect size g=0.30) and self-rated QoL (effect size g=0.32). Additionally, a reduction in the number of medical center visits was observed (effect size r=0.44), and this reduction was associated with a positive change in step count during the study period (P.=04).ConclusionsSelf-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion among Latina women of low socioeconomic status with chronic neurological conditions. PA is known to be important for brain health in neurological conditions but remains relatively unexplored in minority populations.Trial RegistrationClinicalTrials.gov NCT04820153; https://clinicaltrials.gov/ct2/show/NCT04820153

Willingness and Accessibility of a Hypnosis Intervention for Anxiety Among a Low Socioeconomic Status Population.

Objective: This survey study aimed to investigate the willingness and accessibility of a hypnosis intervention for anxiety among low socioeconomic status patients in a primary care setting. Methods: Participants were asked to complete a one-page survey during a scheduled office visit with their primary care provider. Survey questions included participants' interest in hypnosis as a treatment for anxiety, how many sessions they would be willing/able to attend, how they would prefer access to a recorded hypnosis intervention, and items relating to anxiety, including the Generalized Anxiety Disorder-7 measure. Results: Two hundred participants (71.5% female) completed the survey with a mean age of 43.16 (standard deviation = 15.78). Over half (54.6%) of the survey participants reported that they experience anxiety, and 74% of the participants indicated that they would be interested in hypnosis if it were recommended by their provider for anxiety. Discussion: Given the high prevalence of anxiety among survey participants, there exists a clear need for effective and accessible treatment options. These results demonstrate the willingness of individuals to use hypnosis for anxiety and to engage in remote hypnosis interventions.

The Influence of Socioeconomic Status on Esophageal Cancer in Taiwan: A Population-Based Study.

Background: Esophageal cancer has extreme worldwide demographic and histologic variations in occurrence; thus, understanding the pathogenesis of esophageal cancer must be region- or country-based. We examined the incidence and tumor stage at diagnosis of esophageal cancer in relation to patients’ socioeconomic status (SES) in Taiwan. Method: This retrospective cohort study used data from Taiwan’s National Health Insurance Research Database and Taiwan Cancer Registry collected between January 2008 and December 2014. The records of 40- to 79-year-old patients diagnosed with esophageal cancer were retrieved. The distribution of the crude incidence rates of esophageal cancer by occupation and income variables was studied retrospectively. Cox proportional hazard model was used to adjust for potential confounders and compare the esophageal cancer incidence among four independent variables: age, gender, occupation, and income. Logistic regression analysis was applied to find the power of the independent variables on the odds ratio of late-stage presentation. Results: The analysis included 7763 subjects. Esophageal squamous cell carcinoma (ESCC) was the predominant histological type (96.6%) and 94.4% of patients were male. The peak affected age for ESCC was 50 to 59 years, whereas the risk of esophageal adenocarcinoma increased progressively with age. The risk of ESCC was significantly unfavorable for the most disadvantaged group, either in occupation or income, while in EAC, risk was unrelated to either factor. The stage of cancer at diagnosis was lower in the highest income groups than in the other two groups. Conclusion: Significant SES disparities in esophageal cancer incidence, based on occupation and income, are present in Taiwan. Low SES populations have a higher percentage of late-stage diagnosis. Resolution of the increasing socioeconomic disparities and narrowing the gaps in health inequities in Taiwan are needed.

Using inquiry-based learning to develop Earth science pedagogical content knowledge: impact of a long-term professional development program

ABSTRACT Background Science teachers represent the critical link to the development of a scientifically literate citizenry who is capable of addressing societal problems and global challenges in ways that positively affect the quality of life. Purpose We investigated how a long-term, inquiry-based professional development program could be utilized to increase teachers’ pedagogical content knowledge of topics related to 8th grade Earth Science. Sample The sample included 17 eighth-grade science teachers working in Title 1 schools serving students of low socioeconomic status and high populations of English language learners. Design and methods A mixed-method approach of exploratory design was used in this study. A paired samples t-test for the weighted score of the Earth Space Science Diagnostic Science Assessment for Middle School Teachers (DTAMS) was used to investigate changes in teacher knowledge of Earth Science topics. Qualitative data was collected via reflective prompts and thematically analyzed using NVIVO software (Clarke and Braun 2017). Results DTAMS results showed a statistically significant difference in the scores for the pretest (M = 14.53, SD = 3.83) and posttest (M = 17.01, SD = 3.39) results; t (14) = −2.4, p = .03. Eleven themes emerged from the NVIVO analysis that align with and demonstrate the inclusion of four essential components of constructivism (Baviskar, Hartle and Whitney 2009) including prior knowledge (connecting and building blocks); creation of cognitive dissonance (hands on, field trip, pacing, scaffolding, technology, and collaboration/relationship); assessment (informal and formal assessment); and reflection. Conclusion Based on DTAMS results, the novice teachers gained content knowledge of Earth Science topics. The reflective prompts demonstrated the teachers used constructivism (inquiry- based instruction) during lesson planning and implementation documented with 11 themes associated with the four components of constructivism (Baviskar, Hartle and Whitney 2009).

A multilevel approach to social support as a determinant of mental health during COVID-19.

The COVID‐19 pandemic has detrimentally affected the mental health of lower income communities. We sought to investigate the relationship among multilevel social support, specifically individual‐, network‐, and neighborhood‐level social supports, COVID‐19‐related stressors, and probable diagnoses of depression, anxiety, and posttraumatic stress (PTS), within a racially diverse and predominantly low‐socioeconomic status population. We used multiple logistic regressions to assess the odds of diagnosis for high versus low social support and stressor levels. Participants who endorsed high levels of stress had significantly higher odds of probable diagnoses. Participants who endorsed low individual‐level social support had higher odds of probable depression and anxiety. Those who endorsed low neighborhood‐level social support had higher odds of probable depression and probable PTS. Network‐level social support was not significantly associated with the health indicators of interest. Results indicate the importance of both individual‐ and neighborhood‐level support to protect mental health during COVID‐19.

Factors Associated with Health Inequalities in Infectious Disease Pandemics Predating COVID-19 in the United States: A Systematic Review

ObjectivePrevious pandemics may offer evidence on mediating factors that contributed to disparities in infection and poor outcomes, which could inform the effort to mitigate potential unequal outcomes during the current COVID-19 pandemic. This systematic review sought to examine those factors.MethodsWe searched MEDLINE, PsycINFO, and Cochrane to May 2020. We included studies examining health disparities in adult U.S. populations during infectious disease epidemics or pandemics. Two investigators screened abstracts and full text. We assessed study quality using the Newcastle/Ottawa Scale or the Critical Appraisal Skills Programme Checklist for Qualitative Studies.ResultsSixteen articles were included, of which 14 focused on health disparities during the 2009 H1N1 influenza pandemic. Studies showed that disparities during the H1N1 pandemic were more related to differential exposure to the virus than to susceptibility or access to care. Overall, pandemic-related disparities emanate primarily from inequalities in social conditions that place racial and ethnic minorities and low socioeconomic status populations at greater risk of exposure and infection, rather than individual-level factors such as health behaviors and comorbidities.ConclusionsPolicy- and systems-level interventions should acknowledge and address these social determinants of heightened risk, and future research should evaluate the effects of such interventions to avoid further exacerbation of health inequities during the current and future pandemics.

Abstract EP36: Socioeconomic Status And Spontaneous Coronary Artery Dissection Outcomes

Introduction: Spontaneous coronary artery dissection (SCAD) is an emerging cause of myocardial infarction. The epidemiology of SCAD is elucidated with recent investigations and analyses. However, the association between socioeconomic status (SES) and SCAD remains to be studied. We performed this study to identify the effects of SES on SCAD. Methods: We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. Socioeconomic status was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. Results: During the study period, total 106,970,745 patients were hospitalized of which 30.17% were from 1 st (lowest), 26.26% from 2 nd , 23.76% from 3 rd and 19.82 from 4 th (highest) quartile. 0.02 % (24,560 of 106,970,745) patients were diagnosed with spontaneous coronary artery dissection. When lowest SES was compared to the highest SES quartile, the patients from the lowest SES tended to be diabetic (34.17 % v 18.39%) and younger (48.39 ± 0.01 v 50.16 ± 0.01) and less prevalence of hyperlipidemia (2.79% v 3.86%). The prevalence of hypertension (29.78% v 28.31%) and proportion of male (43.59% v 43.33%) were similar. After adjusting for age, sex and comorbid burden, the lowest SES quartile was associated with lower risk of SCAD when it was compared to highest quartile (OR 0.70; 95% CI 0.65-0.76; p&lt;0.0001). However, the lowest SES quartile was associated with higher in-hospital mortality (OR 1.51; 95%CI 1.07-2.15; p=0.02) and 30-day readmission rate (OR 1.56; 95%CI 1.39 -1.88; p&lt;0.0001) with SCAD when it compared to the highest quartile. Discussion: In this study, the lowest SES was associated with lower risk of SCAD. Individuals with low SES carry substantial burden of cardiovascular diseases. It is possible that SCAD is underdiagnosed in low SES population due to the presence of traditional cardiovascular risk factors. The unfavorable effects of low SES on SCAD can be identified with in-hospital mortality and rate of 30-day readmission. Further research is required to better understand the impact of SES on the outcomes of SCAD.

Racial and Social Determinants of Health Disparities in Spine Surgery Affect Preoperative Morbidity and Postoperative Patient Reported Outcomes: Retrospective Observational Study.

Retrospective observational study. To elucidate racial and socioeconomic factors driving preoperative disparities in spine surgery patients. There are racial and socioeconomic disparities in preoperative health among spine surgery patients, which may influence outcomes for minority and low socioeconomic status (SES) populations. Presenting, postoperative day 90 (POD90), and 12-month (12M) outcome scores (PROMIS global physical and mental [GPH, GMH] and visual analog scale pain [VAS]) were collected for patients undergoing deformity arthrodesis or cervical, thoracic, or lumbar laminotomy or decompression/fusion; these procedures were the most common in our cohort. Social determinants of health for a patient's neighborhood (county, zip code, or census tract) were extracted from public databases. Multivariable linear regression with stepwise selection was used to quantify the association between a patient's preoperative GPH score and sociodemographic variables. Black patients presented with 1 to 3 point higher VAS pain scores (7-8 vs. 5-6) and lower (worse) GPH scores (6.5-10 vs. 11-12) than White patients (P < 0.05 for all comparisons); similarly, lower SES patients presented with 1.5 points greater pain (P < 0.0001) and 3.5 points lower GPH (P < 0.0001) than high SES patients. Patients with lowest-quartile presenting GPH scores reported 36.8% and 37.5% lower (worse) POD-90 GMH and GPH scores than the highest quartile, respectively (GMH: 12 vs. 19, P < 0.0001; GPH: 15 vs. 24, P < 0.0001); this trend extended to 12 months (GMH: 19.5 vs. 29.5, P < 0.0001; GPH: 22 vs. 30, P < 0.0001). Reduced access to primary care (B = -1.616, P < 0.0001) and low SES (B = -1.504, P = 0.001), proxied by median household value, were independent predictors of worse presenting GPH scores. Racial and socioeconomic disparities in patients' preoperative physical and mental health at presentation for spine surgery are associated adversely with postoperative outcomes. Renewed focus on structural factors influencing preoperative presentation, including timeliness of care, is essential.Level of Evidence: 3.

A Role of Socioeconomic Status in Cognitive Impairment Among Older Adults in Macau: A Decomposition Approach.

BackgroundTo explore the prevalence and inequality of cognitive impairment among older adults in Macau and the contributions of influencing factors to inequality in cognitive impairment.MethodsThe Montreal Cognitive Assessment (MoCA) was used to measure the prevalence of cognitive impairment. Socioeconomic status scores were used to describe economic level of the subjects. The concentration index was applied to measure the inequality of cognitive impairment associated with socioeconomic status (SES) and decomposed into its influencing factors.ResultsThe prevalence of cognitive impairment was 44.35% in Macau. The concentration index of cognitive impairment among the elderly was −0.165 (95% CI: −0.232 to −0.098), indicating that the prevalence of cognitive impairment was concentrated in households with poor SES. Older age, poor SES, long or short sleep duration, other marital status, poor appetite, no tea/coffee drinking, no religious belief, and depression contributed positively to the inequality of cognitive impairment. Among these factors, SES made the largest contribution to inequality, accounting for 76.74%.ConclusionIn Macau, the prevalence of cognitive impairment among people aged 65 years and older is concentrated among those who are in poor economic conditions. Reducing the gap between the rich and the poor at the source, increasing educational level of low SES population and improving their access to healthcare services will help to improve the inequity of cognitive impairment.

Outcomes Following eHealth Weight Management Interventions in Adults With Overweight and Obesity From Low Socioeconomic Groups: Protocol for a Systematic Review.

BackgroundObesity is a complex health condition with multiple associated comorbidities and increased economic costs. People from low socioeconomic status (SES) backgrounds are more likely to be overweight and obese and are less successful in traditional weight management programs. It is possible that eHealth interventions may be more successful in reaching people from low SES groups than traditional face-to-face models, by overcoming certain barriers associated with traditional interventions. It is not yet known, however, if eHealth weight management interventions are effective in people living with overweight and obesity from a low SES background.ObjectiveThe primary aim of this study is to evaluate the efficacy of eHealth weight management interventions for people with overweight and obesity from low SES groups.MethodsA systematic review on relevant electronic databases (MEDLINE, Embase, Emcare, and CINAHL) will be undertaken to identify eligible studies published in English up until May 2021. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to guide the systematic review, two reviewers will independently screen, select, and extract data and complete a risk of bias assessment of search results according to predefined criteria. Studies that have investigated an eHealth weight management intervention within a low SES population will be included. Primary outcomes include weight, BMI, and percentage weight change compared at baseline and at least one other time point. Secondary outcomes may include a range of anthropometric and physical fitness and activity measures. If sufficient studies are homogeneous, then we will pool results of individual outcomes using meta-analysis.ResultsSearches have been completed, resulting in 2256 studies identified. Once duplicates were removed, 1545 studies remained for title and abstract review.ConclusionsThe use of eHealth in weight management programs has increased significantly in recent years and will continue to do so; however, it is uncertain if eHealth weight management programs are effective in a low SES population. The results of this systematic review will therefore provide a summary of the evidence for interventions using eHealth for people living with overweight and obesity and from a low SES background.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021243973; https://tinyurl.com/2p8fxtnwInternational Registered Report Identifier (IRRID)DERR1-10.2196/34546