Socioeconomic Status Patterns Research Articles

Wildfires and climate justice: future wildfire events predicted to disproportionally impact socioeconomically vulnerable communities in North Carolina.

Wildfire events are becoming increasingly common across many areas of the United States, including North Carolina (NC). Wildfires can cause immediate damage to properties, and wildfire smoke conditions can harm the overall health of exposed communities. It is critical to identify communities at increased risk of wildfire events, particularly in areas with that have sociodemographic disparities and low socioeconomic status (SES) that may exacerbate incurred impacts of wildfire events. This study set out to: (1) characterize the distribution of wildfire risk across NC; (2) implement integrative cluster analyses to identify regions that contain communities with increased vulnerability to the impacts of wildfire events due to sociodemographic characteristics; (3) provide summary-level statistics of populations with highest wildfire risk, highlighting SES and housing cost factors; and (4) disseminate wildfire risk information via our online web application, ENVIROSCAN. Wildfire hazard potential (WHP) indices were organized at the census tract-level, and distributions were analyzed for spatial autocorrelation via global and local Moran's tests. Sociodemographic characteristics were analyzed via k-means analysis to identify clusters with distinct SES patterns to characterize regions of similar sociodemographic/socioeconomic disparities. These SES groupings were overlayed with housing and wildfire risk profiles to establish patterns of risk across NC. Resulting geospatial analyses identified areas largely in Southeastern NC with high risk of wildfires that were significantly correlated with neighboring regions with high WHP, highlighting adjacent regions of high risk for future wildfire events. Cluster-based analysis of SES factors resulted in three groups of regions categorized through distinct SES profiling; two of these clusters (Clusters 2 and 3) contained indicators of high SES vulnerability. Cluster 2 contained a higher percentage of younger (<5 years), non-white, Hispanic and/or Latino residents; while Cluster 3 had the highest mean WHP and was characterized by a higher percentage of non-white residents, poverty, and less than a high school education. Counties of particular SES and WHP-combined vulnerability include those with majority non-white residents, tribal communities, and below poverty level households largely located in Southeastern NC. WHP values per census tract were dispersed to the public via the ENVIROSCAN application, alongside other environmentally-relevant data.

Sex-specific associations between socioeconomic status and ideal cardiovascular health among Korean adults: The Korea National Health and Nutrition Examination Survey, 2007-2017.

Socioeconomic status (SES) has a considerable impact on cardiovascular health (CVH), which may differ by sex. We aimed to investigate sex-specific socioeconomic disparities in CVH among 31,141 individuals aged 25-64 years who participated in the cross-sectional 2007-2017 Korea National Health and Nutrition Survey (KNHANES) and the Life's Simple 7 metrics were used to define ideal CVH. Latent class analysis was used to estimate overall SES patterns. Logistic regression models were used to estimate sex-specific odds ratios (ORs) and 95% confidence interval (95% CI) for the likelihood of ideal CVH across SES classes, with the highest SES as the reference group. Four SES classes were identified: (1) low class with low education and material property (2.4%), (2) lower-medium class (10.1%) and (3) higher-medium class (43.7%) with increasing material affluence, and (4) high class with highest education and income (43.8%). Lower SES was associated with decreased ideal CVH among women; compared to their high SES counterparts, women with lowest SES were least likely to achieve ideal overall CVH (OR: 0.55, 95%CI: 0.43-0.71). Similar SES gradients in ideal overall CVH for men were also observed but it was less clear (OR (95%CI) for lowest SES: 0.83, 0.51-1.34). Low SES was associated with poorer achievement of ideal CVH with some sex-heterogeneities. Interventions that equalize the distribution of power and resources and targeted sex-specific approaches to empower low socioeconomic subgroups are warranted to prevent the transition from ideal to suboptimal cardiovascular health and to close socioeconomic disparities in CVH among Korean adults.

Multiple socioeconomic risks and cognitive impairment among older men and women in India.

Socioeconomic status (SES) is negatively associated with innumerable health outcomes, including cognitive functioning. Yet much remains undiscovered about SES patterns in later-life cognition in low-and middle-income countries (LMICs). The purpose of this study was to examine the association between separate and combined socioconomic risks and cognitive impairment among older adults in India. Further, given gender disparities in later life cognitive functioning and SES, the study examines the associations between socioeconomic risks and cognitive impairment separately, for older men and women. Data come from the 2017-18, first wave of the Longitudinal Aging Study in India (LASI), with 31,464 older adults aged 60years and above. Cognitive impairment was assessed using multiple broad measures of memory, orientation, arithmetic function, and visuo-spatial construction skills. We present descriptive statistics along with cross-tabulation of the outcome variable. Additionally, binary logistic regression analysis was used to test the association between outcome and explanatory variables. SES is measured using education, paid work status, and household wealth measured using monthly per-capita consumption expenditure (MPCE). A proportion of 7.14% of the older men and 20.03% of older women reported cognitive impairment. The odds of cognitive impairment were higher among uneducated older men and women, and older men and women in lowest wealth quintile. Surprisingly, older women without current or prior work history report lower odds of cognitive impairment compared to their peers in labor force. While odds of cognitive impairment are higher among non-working older men, this association is not statistically significant. In older men, the odds of cognitive impairment were 5.34, 7.14, and 13.05 times higher with one, two, and three risk factors, respectively, compared with those with no risk exposure. A similar trend was observed for women but with comparatively lower odds. Our findings underscore the need to distinguish between varying elements of SES to construct "upstream" health policies and programs that redistribute resources. In particular, the findings support the use of multiple SES indicators in identifying older adults most susceptible to cognitive deficits, and planning gender-based interventions to improve cognitive health in late life.

Causal effects of later-eating rhythm on adiposity in children through the comparison of two cohorts in the UK and China: a cross-cohort study

BackgroundLater-eating rhythm (LER) refers to a later timing, greater energy intake, and higher meal frequency in the evening. The role of childhood LER in obesity development is emerging, but most evidence is cross-sectional. Cross-context comparison allows the improvement of causal inference in observational studies by comparing cohorts with different confounding structures. This method is applied to assess the causal effects of LER on adiposity, by exploring the likelihood of residual confounding due to socioeconomic status. MethodsIn this cross-cohort analysis, we used ongoing birth cohort data from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) established in 1991, and the nationally representative China Health and Nutrition Survey (CHNS) collected in 1989–2011. Children with available data at age 7 years were eligible. We applied indices of inequality for assessing confounding structure by regressing LER/adiposity on the standardised score of socioeconomic status (SES) in each cohort. We used multivariable linear and binary logistic regressions to model cross-sectional and prospective associations between LER at 7 years of age and body-mass index (BMI) at ages 7 and 9 years in both cohorts. Analyses were adjusted by age, sex, ethnicity, residency, and socioeconomic status. We used a p value for the Cochrane Q-test obtained from meta-analysis to test for heterogeneity between cohorts. FindingsWe analysed data from 4019 children (2170 [54·0%] female; 1849 [46.0%] male) in ALSPAC and 1749 (788 [45·1%] female; 961 [54.9%] male) in CHNS. The associations between SES and LER or adiposity differed between ALSPAC and CHNS (SES and energy intake for evening main meal: b=1·81 [95% CI 0·81 to 2·81] vs –3·02 [–4·76 to –1·27]; SES and frequency of evening snacks: odds ratio [OR]=0·51 [95% CI 0·41–0·63] vs 5·71 [3·54–9·22]; SES and BMI: b=–0·42 [–0·65 to –0·18] vs 1·29 [0·75 to 1·84]). Positive associations between frequency of evening snacks and BMI were seen in both cross-sectional and longitudinal analyses in both cohorts (mean change of BMI with 1 day increase of consuming evening snacks b=0·09 [0·02 to 0·15]; 0·13 [0·03 to 0·22] kg/m2 per day in ALSPAC, and b=0·11 [–0·07 to 0·28]; 0·30 [0·07 to 0·52] kg/m2 per day in CHNS). No associations were found for energy intake. p values for heterogeneity ranged from 0·107 to 0·932. InterpretationBoth cohorts showed consistent results despite varied dietary cultures and SES patterning of LER or adiposity. Energy intake in the evening or night was not associated with adiposity, whereas evening snacking was. More recent, high-quality cohorts are warranted to enhance the strength of the conclusions. FundingNone.

Socioeconomic status of international students and its relation to the brain drain: evidence from Greek PhD holders

PurposeThe study examines potential differences in socioeconomic status (SES) and emigration patterns between Greek international students (IS) and non-international students (non-IS) and their relationship to the brain drain from Greece.Design/methodology/approachThe study draws on a unique database including all the Greek PhD holders and provides detailed information on their SES and mobility patterns. Furthermore, an individual-level SES index is constructed including both human capital and socioeconomic indicators to estimate the magnitude of the brain drain in terms of the SES that emigrated abroad between 1,985 and 2,018.FindingsFirst, Greek IS have a higher educational, professional and economic status compared to Greek non-IS. Moreover, they exhibit a more international profile, inasmuch as they are more likely to remain abroad after graduation to seek employment. Second, the magnitude of the brain drain in terms of SES emigrated abroad (22.5% of the total) is greater than in terms of individuals who moved abroad (13.4% of the total). Specifically, the SES that outflows with an additional Greek skilled emigrant (that is, an additional IS and non-IS residing abroad) is 1.1 times greater than the SES that remains in Greece with an additional non-IS residing in Greece.Originality/valueThe study contributes to the scientific discussion that relates the SES of IS and highly skilled migrants to brain drain and fills the gap in the relevant literature.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-09-2022-0607.

Associations of healthy lifestyle and three latent socioeconomic status patterns with physical multimorbidity among middle-aged and older adults in China

BackgroundMultimorbidity is an emerging global public health concern. However, complex associations of healthy lifestyle and socioeconomic status (SES) with multimorbidity have not been identified. MethodsThis population-based prospective cohort study used data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) to explore these relationships. Physical multimorbidity was measured using 12 non-communicable diseases. Latent class analysis (LCA) was conducted to determine the optimal SES patterns based on annual per-capita household expenditure, occupation, education level, and health insurance. The healthy lifestyle score (0–5) was constructed comprising information on smoking, drinking, physical activity, sleep, and body shape. ResultsOf 17,708 participants in the CHARLS, 7776 were eligible for inclusion in our analysis (13.3% with high SES, 26.1% with medium SES, and 60.6% with low SES). Compared with high SES participants, those with low SES had higher risks of incident physical multimorbidity (OR 1.22, 95% CI 1.05, 1.42), which was competitively mediated by lifestyle (mediation proportion, −10.17%, 95% CI -19.12%, −1.23%). Significant interactions were observed between lifestyle factors and SES in patients with incident diabetes. Participants with low SES and no or one healthy lifestyle factor had a higher risk of incident physical multimorbidity than those with high SES and four to five healthy lifestyle factors (OR 2.19, 95% CI 1.57, 3.04). ConclusionHealthy lifestyles competitively mediate a fractional proportion of socioeconomic inequity in incident physical multimorbidity. Furthermore, healthy lifestyles were associated with lower multimorbidity risk in the SES subgroups, supporting the important role of lifestyle in reducing physical multimorbidity burden.

Sugar-sweetened beverage consumption and socioeconomic status: A systematic review and meta-analysis.

Sugar-sweetened beverages (SSB) are an independent risk factor for obesity and other non-communicable diseases. Socioeconomic status (SES) is one of the key drivers for the purchase and consumption of SSBs among children and adults; however, there is a lack of strong evidence. This study aims to determine the association between SES and consumption patterns of SSBs across populations. The review was conducted according to PRISMA guidelines. PubMed, MEDLINE, Scopus, EMBASE, LILACS, Web of Science, Cochrane, and CINHAL databases were searched for relevant articles until 2022. Participants included children, adolescents, and adults who consumed different SSBs and were assessed based on their SES. The random-effects model was used to obtain the pooled odds ratio (OR). Twenty-one studies (152,070 participants) met the inclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa tool, with the majority of the studies indicating medium to high quality. Eight ORs from four studies (34,454 participants) were considered for meta-analysis. Results showed those belonging to high SES had 48% lower odds of consuming the SSBs (OR 0.52; 95% CI: 0.42-0.61; p = 0.017). The overall quality of evidence was ascertained using GRADE criteria, illustrating a moderate certainty of evidence between SSB consumption and SES. Meta-analysis suggests that SES influences the consumption pattern of SSBs, with high SES having lower odds of SSB consumption.

Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region.

Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.

Association between socioeconomic status and longitudinal sleep quality patterns mediated by depressive symptoms.

Study ObjectivesWe aimed to examine whether associations between socioeconomic status (SES) and longitudinal sleep quality patterns are mediated by depressive symptoms.MethodsWe utilized data on 3347 participants in the Korean Genome and Epidemiology Study aged 40–69 years at baseline from 2001 to 2002 who were followed up for 16 years. A group-based modeling approach was used to identify sleep quality trajectories using the Pittsburgh Sleep Quality Index (years 2, 6, 8, 10, and 12). Educational attainment (college graduated or less), monthly household income (≥$2500 or less), and occupation (unemployed, manual labor, and professional labor) at baseline (year 0) were used for analyses. Depressive symptoms were assessed using Beck’s Depression Inventory at year 4. Associations between SES and sleep quality patterns were examined using a multinomial logistic regression model. The mediation effect of depressive symptoms was further examined using PROC CAUSALMED.ResultsWe identified five distinct sleep quality trajectories: “normal-stable” (n = 1697), “moderate-stable” (n = 1157), “poor-stable” (n = 320), “developing to poor” (n = 84), and “severely poor-stable” (n = 89). Overall, associations between SES levels and longitudinal sleep patterns were not apparent after full adjustment for sociodemographic and lifestyle factors measured at baseline. Depressive symptoms, however, tended to fully mediate associations between SES levels and sleep quality patterns (odds ratio range for indirect effects of depressive symptoms: for education, 1.05-1.17; for income, 1.05-1.15).ConclusionA significant mediating role for depressive symptoms between SES levels and longitudinal sleep quality warrants consideration among mental healthcare professionals.

Abstract B100: Developing an integrated understanding of access to care and tumor characteristics patterns by race and age in the Carolina Breast Cancer Study Phase III, 2008 – 2013

Abstract Purpose: Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. We compared socioeconomic status (SES) and comorbidity factors from the Carolina Breast Cancer Study Phase III (CBCS3, 2008-2013) to North Carolina and examined factors related to race and age in CBCS. Methods: Distributions of SES and comorbidity factors in CBCS3 cases were compared to those of North Carolina women in the 2010 Behavioral Risk Factor Surveillance Study. Using latent class analysis of CBCS3 data, we identified covariate patterns by SES/comorbidities, barriers to care, and tumor characteristics and examined their associations with race and age using multinomial logistic regression. Results: Major SES and comorbidity patterns in CBCS3 participants were generally similar to patterns in the state. Latent classes were identified for SES/comorbidities, barriers to care, and tumor characteristics that varied by race and age. Compared to white women, black women had lower SES (odds ratio (OR)=6.3, 95% confidence interval (CI); 5.2, 7.8), more barriers to care (OR=5.6, 95% CI; 3.9, 8.1) and several aggregated tumor aggressiveness features. Compared to older women, younger women had higher SES (OR=0.5, 95% CI; 0.4, 0.6), more barriers to care (OR=2.1, 95% CI; 1.6, 2.9) and aggregated tumor aggressiveness features. Conclusions: CBCS3 is representative of North Carolina on comparable factors. Patterns of access to care and tumor characteristics are intertwined with race and age, suggesting that interventions to address disparities will need to target both access and biology. Citation Format: Marc A Emerson, Yvonne M Golightly, Xianming Tan, Allison E Aiello, Katherine E Reeder-Hayes, Andrew F Olshan, Shelley A Earp, Melissa Troester. Developing an integrated understanding of access to care and tumor characteristics patterns by race and age in the Carolina Breast Cancer Study Phase III, 2008 – 2013 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B100.

Geographic Association Between Incidence of Acute Appendicitis and Socioeconomic Status

Some studies based on proportions of patients with perforated appendicitis (PA) among all patients with acute appendicitis (AA) have found an association between socioeconomic status (SES) and risk of perforation. A potential limitation is their use of proportions, which assumes that incidence of AA is evenly distributed across populations at risk. This assumption may be invalid, and SES may have a more complex association with both AA and PA. To generate population-based incidences of AA and PA and to examine geographic patterns of incidence alongside geographic patterns of SES. Retrospective study of data from Washington's Comprehensive Hospital Abstract Reporting System and the 2010 US census. Geographic methods were used to identify patterns of age- and sex-standardized incidence in Washington State between 2008 and 2012. The study included all patients discharged with International Classification of Diseases, Ninth Revision codes for AA or PA. Data were analyzed between November 2016 and December 2018. Location of primary residence. Age- and sex-standardized incidence for AA and PA was generated for each census tract (CT). Global spatial autocorrelation was examined using Moran index (0.0 = completely random incidence; 1.0 = fully dependent on location). Clusters of low-incidence CTs (cold spots) and high-incidence CTs (hot spots) were identified for AA. Census-based SES data were aggregated for hot spots and cold spots and then compared. Statewide, over the 5-year study period, there were 35 730 patients with AA (including 9780 cases of PA), of whom 16 574 were women (46.4%). Median age of the cohort was 29 years (IQR, 16-48 years). Statewide incidence of AA and PA was 106 and 29 per 100 000 person-years (PY), respectively. Crude incidence was higher within the male population and peaked at age 10 to 19 years. Age- and sex-standardized incidence of AA demonstrated significant positive spatial autocorrelation (Moran index, 0.30; P < .001), but autocorrelation for PA was only half as strong (0.16; P < .001). Median incidence of AA was 118.1 per 100 000 PY among hot spots vs 86.2 per 100 000 PY among cold spots (P < .001). Socioeconomic status was higher in cold spots vs hot spots: mean proportion of college-educated adults was 56% vs 26% (P < .001), and mean per capita income was $44 691 vs $30 027 (P < .001). Age- and sex-standardized incidence of appendicitis is not randomly distributed across geographic subunits, and geographic clustering of AA is twice as strong as PA. Socioeconomic advantages, such as higher income and secondary education, are strongly associated with lower incidence of AA. These findings challenge conventional views that AA occurs randomly and has no predisposing characteristics beyond age/sex. Socioeconomic status, and likely other geographically circumscribed factors, are associated with incidence of AA.

Socioeconomic status and disease-modifying therapy prescribing patterns in people with multiple sclerosis

AimsTo examine the association between socioeconomic status (SES) and disease-modifying therapy (DMT) prescribing patterns in people with relapsing-remitting multiple sclerosis (pwRRMS). MethodsA cross-sectional analysis was conducted among pwRRMS treated with a DMT in the neuroinflammation service at The Royal London Hospital (Barts Health NHS Trust). Study data were collected between July and September 2017. SES was determined by patient income and education extracted from the English Index of Multiple Deprivation. Based on their efficacy, DMTs were categorized as moderate efficacy (Glatiramer Acetate and Beta-Interferons), high efficacy (Cladribine, Fingolimod and Dimethyl Fumarate) and very-high efficacy therapies (Natalizumab and Alemtuzumab). Multinomial logistic regressions were performed for univariate and multivariate models to assess differences between SES and DMT prescribing patterns. ResultsTreatment consisted of moderate efficacy (n = 76, 12%), high efficacy (n = 325, 51.3%) and very-high efficacy therapies (n = 232, 36.7%). Medians for income and education deciles were 4 (IQR 3–7) and 6 (IQR 4–8), respectively. After multinomial logistic regression analysis, patient income was not associated with increased odds of being treated with high efficacy (OR, 0.92; 95% CI, 0.82–1.04; p = 0.177) or very-high efficacy DMTs (OR, 0.95; 95% CI, 0.85–1.06; p = 0.371). Similarly, patient education was not associated with being treated with high efficacy (OR, 0.91; 95% CI, 0.80–1.03; p = 0.139) or very-high efficacy therapies (OR, 0.92; 95% CI, 0.81–1.04; p = 0.188). ConclusionsSES was not predictive of DMT prescribing patterns in pwRRMS. Whilst this appears reassuring within this universal health care setting, the same methodology needs to be applied to other MS services for comparison. Data could then be further interrogated to explore potential socioeconomic inequities in DMT prescribing patterns across the UK.

Caste Differences in Hypertension Among Women in India: Diminishing Health Returns to Socioeconomic Status for Lower Caste Groups.

The caste system is a relatively rigid system of social hierarchy in India. The caste membership defines one's access to resources and life opportunities. A growing body of research suggests that lower caste groups have an excess burden of morbidity and mortality in India. However, it is not clear as to what extent caste differences in health are conditioned by socioeconomic status (SES) indicators. This study examined the caste differences in hypertension and tested whether caste differences in hypertension are conditioned by education and household wealth in a representative sample of women in India. This study used data from the National Family Health Survey (NFHS) 2015-2016, India. The analysis is based on a nationally representative sample of 648,064 adult women aged 15-49years. We used logistic regression to examine whether the association between caste and hypertension varied by education and wealth index using interactions and controlling for potential confounders. The regression models suggest that scheduled tribes and non-caste members have the highest odds of hypertension compared with privileged upper caste members. Interaction models indicate complex intersections of caste, education, and wealth index. The predicted probabilities derived from these interaction models suggest that while SES indicators are inversely associated with the odds of hypertension, the inverse patterning was significantly weaker in other backward classes and more protective in non-caste members compared with upper caste. Additionally, caste difference in predictive risk of hypertension tends to diverge at the lower levels of SES and become narrower at the higher levels of SES. These findings provide evidence of differential returns to SES and have implications for understanding the causes of SES patterning in health among disadvantaged caste groups in India.

Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008-2013.

Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. It is important to understand how these factors group together within patients. We compared socioeconomic status (SES) and comorbidity factors in the Carolina Breast Cancer Study Phase 3 (CBCS3, 2008-2013) to those for North Carolina using the 2010 Behavioral Risk Factor Surveillance Study. In addition, we used latent class analysis of CBCS3 data to identify covariate patterns by SES/comorbidities, barriers to care, and tumor characteristics and examined their associations with race and age using multinomial logistic regression. Major SES and comorbidity patterns in CBCS3 participants were generally similar to patterns in the state. Latent classes were identified for SES/comorbidities, barriers to care, and tumor characteristics that varied by race and age. Compared to white women, black women had lower SES (odds ratio (OR) 6.3, 95% confidence interval (CI) 5.2, 7.8), more barriers to care (OR 5.6, 95% CI 3.9, 8.1) and several aggregated tumor aggressiveness features. Compared to older women, younger women had higher SES (OR 0.5, 95% CI 0.4, 0.6), more barriers to care (OR 2.1, 95% CI 1.6, 2.9) and aggregated tumor aggressiveness features. CBCS3 is representative of North Carolina on comparable factors. Patterns of access to care and tumor characteristics are intertwined with race and age, suggesting that interventions to address disparities will need to target both access and biology.

Race, Gender, Family Structure, Socioeconomic Status, Dietary Patterns, and Cardiovascular Health in Adolescents

ABSTRACTBackgroundDietary patterns represent a broad picture of food and nutrient consumption and may be more predictive of health outcomes than individual foods and nutrients.ObjectiveWe investigated the relations among race, gender, family structure, parental socioeconomic status (SES), dietary patterns, and cardiovascular disease (CVD) profiles among adolescents in the southeastern region of the United States.MethodsA total of 743 adolescents from a cross-sectional study were divided into 4 dietary pattern groups by K-means cluster analysis. Multinomial logistic regression was performed to determine the relations among the parental SES, family structures, and dietary patterns of the adolescents. Associations between dietary patterns and CVD profiles were analyzed by multiple linear regression.ResultsFour dietary patterns were derived: “healthy” (17%), “snacks and sweets” (26%), “processed meat” (20%), and “sugar-sweetened beverage (SSB) and fried food” (37%). Whites and females were more likely to have a “healthy” dietary pattern (Ps < 0.001). There were significant race/ethnicity differences in family structures, SES, and dietary patterns (Ps < 0.05). In whites, higher mother's education and father's education and occupation were associated with greater likelihood of a “healthy” dietary pattern (Ps < 0.05). Stay-at-home mother was associated with less likelihood of an “SSB and fried food” pattern (P = 0.023). In blacks, higher mother's occupation, father's education, and living with both parents were associated with more likelihood of a “healthy” dietary pattern (Ps < 0.05). Stay-at-home father was associated with less likelihood of the “snacks and sweets” (P = 0.025) and “SSB and fried food” dietary patterns (P = 0.044). Overall, adolescents with poor dietary patterns exhibited higher percentage body fat, waist circumference, systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance, C-reactive protein, and total triglyceride (Ps < 0.05).ConclusionsOur data suggest that family structure, parental working status, and SES are associated with the diet quality in adolescents. Moreover, “snacks and sweets,” “processed meat,” and “SSB and fried food” dietary patterns are all associated with worse CVD risk profiles.

Changes in socio-economic patterns of energy consumption and insufficient energy intake across India from 1993-94 to 2011-12.

To assess whether disparities in energy consumption and insufficient energy intake in India have changed over time across socio-economic status (SES). This cross-sectional, population-based survey study examines the relationship between several SES indicators (i.e. wealth, education, caste, occupation) and energy consumption in India at two time points almost 20 years apart. Household food intake in the last 30 d was assessed in 1993-94 and in 2011-12. Average dietary energy intake per person in the household (e.g. kilocalories) and whether the household consumed less than 80 % of the recommended energy intake (i.e. insufficient energy intake) were calculated. Linear and relative risk regression models were used to estimate the relationship between SES and average energy consumed per day per person and the relative risk of consuming an insufficient amount of energy. Rural and urban areas across India. A nationally representative sample of households. Among rural households, there was a positive association between SES and energy intake across all four SES indicators during both survey years. Similar results were seen for energy insufficiency vis-à-vis recommended energy intake levels. Among urban households, wealth was associated with energy intake and insufficiency at both time points, but there was no educational patterning of energy insufficiency in 2011-12. Results suggest little overall change in the SES patterning of energy consumption and percentage of households with insufficient energy intake from 1993-94 to 2011-12 in India. Policies in India need to improve energy intake among low-SES households, particularly in rural areas.

Socioeconomic status differences in parental immunization attitudes and child immunization in Canada: Findings from the 2013 Childhood National Immunization Coverage Survey (CNICS)

Childhood vaccination efforts in Canada have been negatively impacted by parents' vaccine hesitancy based on their knowledge, attitudes, and beliefs (KAB) about vaccinations. Less understood is the extent to which child vaccination receipt and KAB vary by parents' socioeconomic status (SES). Analyzing different age groups of children and vaccinations, we examine the extent to which (a) family SES (parent education, household income) is a determinant of Canadian parents' vaccination KAB and child vaccination receipt, and (b) whether SES was indirectly associated with receipt via KAB. In 2017, we analyzed 2013 Childhood National Immunization Coverage Survey (CNICS) data. We estimated models for parental KAB and child vaccination receipt for measles, mumps, and rubella (MMR) at age 2 (n = 3620); diphtheria, pertussis, and tetanus (DPT) at age 7 (n = 3465); and human papillomavirus (HPV) at ages 12–14 (n = 5213 females). SES is inconsistently associated with KAB and vaccine receipt across the three age groups. SES differences in KAB mostly center on vaccine-specific side effect and safety concerns, with lower education and income levels associated with higher odds of being concerned. Non-receipt of minimum age-specific vaccination dosages was associated with concerns about vaccine effectiveness (DPT, HPV) and side effects (MMR, HPV) and lower perceived importance of immunizing a child (MMR, HPV). KAB mediation was mostly limited to SES patterns in MMR. We discuss the implications of these findings for designing general and population-specific vaccination education strategies and future studies of KAB and undervaccination.

Involvement Practices, Socioeconomic Status, and Student Science Achievement: Insights From a Typology of Home and School Involvement Patterns

The present study examines if higher socioeconomic status (SES) parents are more involved in their children’s education, and if greater involvement is associated with better student science achievement in Hong Kong (N = 5,353). Results showed that (a) there were three latent classes characterized by different patterns of parental involvement; (b) there was no simple relationship between SES and parental involvement patterns among the three latent classes; and (c) patterns of parental involvement were not significantly associated with levels of student science achievement. These findings support the contention that higher SES parents are not necessarily more involved than lower SES parents in all aspects, and that higher levels of parental involvement may not eventuate in higher levels of student achievement.

Socioeconomic Status and Biological Risks for Health and Illness Across the Life Course.

We assess the temporal properties and biosocial mechanisms underlying the associations between early-life socioeconomic status (SES) and later health. Using a life-course design spanning adolescence to older adulthood, we assess how early life and various dimensions of adult SES are associated with immune and metabolic function in different life stages and examine possible bio-behavioral and psychosocial mechanisms underlying these associations. Data for this study come from 3 national studies that collectively cover multiple stages of the life course (Add Health, MIDUS, and HRS). We estimated generalized linear models to examine the prospective associations between early-life SES, adult SES, and biomarkers of chronic inflammation and metabolic disorder assessed at follow-up. We further conducted formal tests of mediation to assess the role of adult SES in linking early SES to biological functions. We found that early-life SES exerted consistent protective effects for metabolic disorder across the life span, but waned with time for CRP. The protective effect of respondent education remained persistent for CRP but declined with age for metabolic disorder. Adult income and assets primarily protected respondents against physiological dysregulation in middle and old ages, but not in early adulthood. These findings are the first to elucidate the life-course patterns of SES that matter for underlying physiological functioning during the aging process to produce social gradients in health.

Early-Life Socioeconomic Status and Adult Physiological Functioning: A Life Course Examination of Biosocial Mechanisms

ABSTRACTA growing literature has demonstrated a link between early-life socioeconomic conditions and adult health at a singular point in life. No research exists, however, that specifies the life course patterns of socioeconomic status (SES) in relation to the underlying biological processes that determine health. Using an innovative life course research design consisting of four nationally representative longitudinal datasets that collectively cover the human life span from early adolescence to old age (Add Health, MIDUS, NSHAP, and HRS), we address this scientific gap and assess how SES pathways from childhood into adulthood are associated with biophysiological outcomes in different adult life stages. For each dataset, we constructed standardized composite measures of early-life SES and adult SES and harmonized biophysiological measurements of immune and metabolic functioning. We found that the relative importance of early-life SES and adult SES varied across young, mid, and late adulthood, such that early-life SES sets a life course trajectory of socioeconomic well-being and operates through adult SES to influence health as adults age. We also documented evidence of the detrimental health effects of downward mobility and persistent socioeconomic disadvantage. These findings are the first to specify the life course patterns of SES that matter for underlying biophysiological functioning in different stages of adulthood. The study thus contributes new knowledge critical for improving population health by identifying the particular points in the life course at which interventions might be most effective in preventing disease and premature mortality.