Lowest SES Group Research Articles

603 Socioeconomic Status and Caregiver Perception of Young Children’s Sleep

Abstract Introduction Socioeconomic status (SES) has been associated with variation in child sleep problems, but few studies have examined variation by SES in caregiver-reported early childhood sleep problems, patterns, and health behaviors. We hypothesized that, compared to higher-SES caregivers, lower-SES caregivers would report poorer sleep outcomes and sleep health behaviors, but lower rates of caregiver-perceived sleep problems. Methods A total of 309 caregivers (97% parents) of young children (M child age=3.59 years; 53.1% girls; 15% non-Hispanic/Latinx White, 57% non-Hispanic/Latinx Black, 20% Hispanic/Latinx White, 8% Hispanic/Latinx Black) completed the Brief Child Sleep Questionnaire. SES was measured via income level (lowest=$0-$20,000; middle= $20,001-$50,000; highest= $50,001 or greater). Results The prevalence of a caregiver-reported child sleep problem was similar across SES (17.6% of lowest SES group, 8.8% of middle, and 15.5% of highest, p>.05). However, ANCOVA models covarying for child race/ethnicity, age, caregiver age and education indicated sleep outcomes varied by SES. Caregivers in the lowest SES group reported significantly longer child sleep onset latency (SOL) than the middle or highest groups (p=.008), more frequent night wakings than those of middle SES (p=.009), and longer night waking duration than those of the highest SES, (p=.047). There were no significant differences by SES for child bedtime, total nighttime sleep, and total (24-hour) sleep duration. Logistic regression models with the same covariates showed no variation by SES for sleep behaviors, including caffeine consumption, presence of bedroom electronics, and bedtime resistance. Within each SES group, logistic regression models indicated that increased night wakings were uniquely associated with greater likelihood of endorsing a child sleep problem in the middle SES (p=.045) and highest SES groups (p=.040), but not in the lowest SES group. Conclusion Although caregiver-reported child sleep problems did not significantly differ across SES, lower-SES caregivers reported longer child sleep onset latency and increased number and duration of night wakings. Furthermore, night wakings were associated with perceived sleep problems, but only in middle and highest SES families. Clinicians should consider specific sleep parameters, such as SOL and night wakings, in addition to caregiver-reported child sleep problems when assessing and addressing child sleep problems, especially in lower-SES families. Support (if any) Funding: NIH K23HD094905 (AAW)

Socio-demographic differences in Colombian children's muscular fitness: Does scaling for differences in body size present a challenge to conventional thinking?

In low- to middle-income countries, children from less-deprived areas (from families of higher socio-economic status [SES]) have superior muscular fitness than those from low-SES groups. They are also taller and heavier, factors associated with muscular fitness. The purpose of this study was to identify any socio-demographic differences in Colombian children's muscular fitness and examine how these conclusions can be modified by scaling for differences in body size. A total of 38,098 youths (46% girls), ninth grade students (aged 14-15 years), participated in a study of cross-sectional design. We recorded SES and family incomes, stature, and mass. Standing broad jump and handgrip strength were used to assess muscular fitness. A multiplicative allometric model was adopted to adjust for body-size differences. Children from the mid- to high-SES groups jumped significantly higher than children from the lowest SES group, although no SES group difference in grip strength was observed. After adjusting for body size, children from higher SES and with higher family incomes had significantly lower handgrip strength, and their superior jump height performances remained but were greatly reduced. Only children from the highest SES now jumped significantly higher that the lowest SES group. The superior jump performance and no difference in handgrip strength of Colombian children from higher SES may simply reflect their superior physiques. When body size is accounted for, these differences are reduced or even reversed, suggesting that children from higher SES groups should not be complacent regarding their apparent superior muscular fitness.

SES, Heart Failure, and N-terminal Pro-b-type Natriuretic Peptide: The Atherosclerosis Risk in Communities Study

Compared with coronary heart disease and stroke, the association between SES and the risk of heart failure is less well understood. In 12,646 participants of the Atherosclerosis Risk in Communities Study cohort free of heart failure history at baseline (1987-1989), the association of income, educational attainment, and area deprivation index with subsequent heart failure-related hospitalization or death was examined while accounting for cardiovascular disease risk factors and healthcare access. Because SES may affect threshold of identifying heart failure and admitting for heart failure management, secondarily the association between SES and N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels, a marker reflecting cardiac overload, was investigated. Analysis was conducted in 2016. During a median follow-up of 24.3 years, a total of 2,249 participants developed heart failure. In a demographically adjusted model, the lowest-SES group had 2.2- to 2.5-fold higher risk of heart failure compared with the highest SES group for income, education, and area deprivation. With further adjustment for time-varying cardiovascular disease risk factors and healthcare access, these associations were attenuated but remained statistically significant (e.g., hazard ratio=1.92, 95% CI=1.69, 2.19 for the lowest versus highest income), with no racial interaction (p>0.05 for all SES measures). Similarly, compared with high SES, low SES was associated with both higher baseline level of NT-proBNP in a multivariable adjusted model (15% higher, p<0.001) and increase over time (~1% greater per year, p=0.023). SES was associated with clinical heart failure as well as NT-proBNP levels inversely and independently of traditional cardiovascular disease factors and healthcare access.

Race, demographics, and socioeconomics as they relate to newly diagnosed metastatic prostate cancer in the United States.

195 Background: As screening practices evolve, understanding the influence race, demographics, and socioeconomic status have on the presentation of metastatic prostate cancer (mPCa) can lead to improved diagnostic strategies in high-risk populations. Methods: Men diagnosed with prostate cancer in the National Cancer Data Base from 2004-2013 were identified. Characteristics of men presenting with and without metastatic disease were compared. A four-level composite metric of SES was created using census-based income and education data. Multivariable logistic regression analysis evaluated the association of age, SES, race/ethnicity, insurance status and other relevant covariates with the likelihood of presenting with mPCa. Results: Of the 1,034,754 PCa patients identified, 4% presented with mPCa. Compared to the highest SES group, odds of mPCa increased continuously with decreasing SES. A total of 24% of White men were in the lowest SES while more than half of Black and Hispanic men were in lowest SES category. Black and Hispanic men had higher overall rates of metastases (5.9% and 6.2%; OR 1.47, 95% CI 1.43-1.51 and OR 1.22, 95% CI 1.17-1.28, respectively) compared to Whites (3.6%). Having Medicaid or no insurance increased the odds of being diagnosed with mPCa compared to having other insurance (13% vs 4%; OR 3.91, 95% 3.78-4.05) with all other variables held constant, including SES. Among men in the lowest SES, the effect of SES appeared to be additive to race: OR 1.34 (95% CI 1.29-1.39), OR 2.09 (95% CI 2.00-1.78), and OR 1.66 (95% CI 1.56-1.77), for White, Black, and Hispanic ethnicity all in the lowest SES group, respectively. Across each race, men aged 75 and older had the highest rates of mPCa. Overall, Black men over age 74 had a higher rate of mPCa (14%) relative to Whites (9%) and Hispanics (11%). Conclusions: There is an inverse relationship between SES and odds of presenting with mPCa. Having no insurance or Medicaid increased the odds of mPCa, even when accounting for SES. Black and Hispanic race was associated with increased odds of mPCa, and the effects of race and SES appeared to be additive.

Inpatient Outcomes Associated With Intestinal Carcinoid

Introduction: Carcinoid tumors are slow-growing neuroendocrine malignancies that classically originate from either the gastrointestinal (GI) tract or pulmonary system. Methods: Retrospective analysis of National Inpatient Sample from January 2008 to December 2011 was performed. International Classification of Diseases, Ninth revision, Clinical Modifications codes were used to identify discharges with a primary diagnosis of carcinoid tumors (CNT). Outcomes analyzed include intestinal obstruction, and inpatient mortality among colonic, small intestinal and appendiceal CNT. Results: There were 21,147 hospital discharges with a principal diagnosis of CNT. Among those discharges, there were 60 % small bowel carcinoid (SBCNT), 22 % colon carcinoid (CCNT) and 18 % appendiceal carcinoid (APCNT). Out of the total number of CNT, 30% were classified as benign and 70% were malignant. The percent malignancy varied between SBCNT (33%), CCNT (31%) and APCNT (7%), p< 0.0001. Figure 1 shows the distribution of metastasis among sites.Figure 1Thirteen percent of the total CNT population was admitted with obstruction of the intestine, and 2% developed ischemia. CCNT and APCNT had lower odds of obstruction compared with SBCNT (aOR=0.51, 95 % CI, 0.39-0.66) and (aOR=0.25, 95 % CI, 0.15-0.40) respectively. Malignant CNT had 1.5 times increased odds of developing obstruction particularly if the metastatic site was the peritoneum (aOR=2.85, 95 % CI, 1.87-4.37). Increased odds of obstruction was also observed among patients who were > 85 years (aOR=3.08, 95 % CI, 2.02-4.69) and in the lowest SES group (aOR=1.48, 95 % CI, 1.07-1.96. The overall in-hospital mortality for all CNT was 2%. A significantly higher proportion of CCNT patients that died 4% compared with SBCNT 2%, p< 0.0001. Less than 1% of the APCNT patients died. Malignant CNT were two times more likely to influence inpatient mortality, especially metastasis with peritoneal metastasis (aOR=2.93, 95 % CI, 1.20-7.47). ICU admissions were associated with twelve times increased odds of inpatient mortality. Conclusion: Among hospital discharges, SNCNT was the most frequent form of intestinal CNT encountered. The majority of admission were associated with malignant CNT and found either in the small intestine and colon. Intestinal obstruction was more commonly seen in malignant CNT, SBCNT, patients above 85 years old and those with peritoneal metastasis as well as from the lowest SES group. Mortality was highest in those with CCNT, malignancy, and ICU admission.

Who gets treated at commission on cancer-approved programs and does it make a difference in survival?

114 Background: Commission on Cancer (CoC) approval has promoted improvements in cancer care in the United States. The purpose of this study is to determine if there are differences in who is treated at CoC approved versus non-approved sites and if CoC approval is associated with survival. Methods: We examined 130,655 cases of stages I-IV first primary female invasive breast cancer from the California Cancer Registry diagnosed between 2000-2010. Odds ratios (95% CI) adjusted for stage, age, grade, year of diagnosis, and ER/PR/HER2 were computed to determine if there were differences by race: white, black, Hispanic, Asian/Pacific Islander (API) and American Indian (AI); SES (low, intermediate, high) or location (urban versus rural) in the likelihood of treatment at CoC sites. Cox regression was used to assess the risk of cancer specific mortality at CoC approved versus non-approved sites. Results: CoC-approved hospitals were more likely to be urban (89%) than rural (11.2%). Race and SES were associated with being treated at CoC sites. In the lowest SES group, blacks (OR=0.82; 95% CI=0.77, 0.89) and Hispanics (OR=0.90; 95%CI=0.86, 0.95) were less likely than whites to be treated at CoC sites. Similar ORs were seen in the intermediate SES group for blacks and Hispanics. In the highest SES stratum, blacks (OR=0.67; 95%CI=0.62, 0.74), Hispanics (OR=0.76; 95%CI=0.72,0.81), and APIs (OR=0.79; 95%CI=0.75,0.83) were less likely to be treated at CoC sites. Unadjusted survival was better for CoC sites (87% vs 85%). For Stage I, only whites treated at CoC approved sites had decreased risk of mortality (HR=0.86; 95%CI=0.79, 0.95). For Stage 2, whites (HR=0.87; 95%CI=0.82, 0.93) and APIs (HR=0.71; 95%CI=0.59, 0.86) had decreased risk of mortality. Blacks (HR=0.82; 95%CI=0.70,0.99) had slightly decreased risk of mortality. For stages III and IV, no difference in risk of mortality was apparent for any race at CoC-approved sites. Conclusions: Patients treated at CoC approved sites vary by race/ethnicity and SES. While the risk of mortality is reduced for some race/ethnicities in Stages 1 and 2 when treated at CoC-approved sites, for stages III and IV patients, CoC-approval does not make a difference in risk of mortality.

THREE YEAR OUTCOME OF INFANTS WITH BRONCHOPULMONARY DYSPLASIA (BPD) AND VERY LOW BIRTHWEIGHT. † 1666

In a regional cohort, we investigated the relationship of BPD, relative to other perinatal risk factors, to developmental outcome at 3 years. Infants with BPD (n=122), VLBW without BPD (84), and term (T) infants (123) were given the Bayley Scales at 3 years. Groups did not differ in sex, race, SES, age. Drug exposed infants were excluded. BPD infants had more perinatal risk factors, i.e. lower GA, BW, more IVH, neurologic problems, sepsis and ROP,(p's <.05). Both mental (84 ± 24 v. 90 ± 16 v. 96 ± 12), and motor (84 ± 29 v. 98 ± 20 v. 103 ± 15, p's<.001) scores were lower for BPD children. Using multiple regression controlling for all other risk factors, BPD had an independent negative effect on motor outcome (p <.02), with neurologic risk and BPD the only significant predictors of motor delay, accounting for 25% (p <.001) of the variance. In contrast, social class, race and neurologic risk were the only significant predictors of cognitive outcome. The effect of SES on cognitive outcome was evident in differential rates of mental retardation within the BPD group. In the lowest SES group (IV-V) 26% of children were thus classified, vs. 14% in the middle/high SES group (I-III). This rate contrasts with 19% of VLBW infants thus classified in the lowest SES group vs. 2% in the middle/high SES groups, and 7% of term, low SES children vs. 3% of middle/high SES children. These findings suggest that the effects of BPD are primarily on the motor domain, and demonstrate the importance of postnatal factors and intervention on cognitive outcome. (HL38193, MCJ 390592).