Poverty-to-income Ratio Research Articles

Associations between Cadmium Exposure and Taste and Smell Dysfunction: Results from the National Health and Nutrition Examination Survey (NHANES), 2011-2014.

Background: Cadmium is a ubiquitous environmental pollutant and has been associated with many adverse health outcomes. However, little is known about the effect of cadmium exposure on taste and smell dysfunction. Methods: We used the National Health and Nutrition Examination Survey (NHANES) 2011–2014 to investigate the associations between blood cadmium and taste and smell dysfunction among 5038 adults aged 40–80 years old. Taste and smell dysfunction were defined by questionnaires, examinations, or both criteria. Results: In survey weighted logistic regression models adjusting for age, gender, race/ethnicity, income-to-poverty ratio (IPR), and education, individuals with a blood cadmium level in the highest tertiles had significantly higher odds of having perceived smell dysfunction (odds ratio (OR) = 1.41, 95% confidence interval (CI): 1.08, 1.84), perceived taste dysfunction (OR = 1.48, 95% CI: 1.16, 1.89), and taste dysfunction defined by both self-reported and objectively measured data (OR = 1.46, 95% CI: 1.03, 2.07). After further adjusting for body mass index (BMI), cigarette smoking, and alcohol drinking, consistent results were observed for perceived taste dysfunction (OR = 1.49, 95% CI: 1.10, 2.00), and no significant associations were found between cadmium exposure and other outcomes. Conclusions: Our findings suggest that cadmium exposure is associated with perceived taste dysfunction.

1658-P: Socioeconomic Position and All-Cause Mortality among Adults with Diagnosed Diabetes across Racial/Ethnic Groups—United States, 1997-2011

Among all adults with diagnosed diabetes (DM), the rate of all-cause mortality is inversely associated with socioeconomic position (SEP). However, the social patterning among adults of different racial/ethnic origin is less clear. We examined changes in 5-year all-cause mortality rates in U.S. adults with diagnosed DM across racial/ethnic groups [non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic] by SEP [education and income to poverty ratio (IPR)]. Using data on 32,986 participants aged ≥25 years with DM from the National Health Interview Survey during 1997-2011, we calculated race/ethnicity stratified mortality rates and changes in rates using predictive margins from Poisson regression adjusted for age. From 1997-2001 to 2007-2011 in adults with education of <high school, mortality rates decreased in NHW [from 30.4 to 24.6 deaths/1000 person-years: change = -5.8 (95% confidence interval: -10.4, -1.2)], NHB [21.7 to 16.8: -4.9 (-9.5, -0.4)], and Hispanics [16.7 to 11.4: -5.3 (-9.7, -1.0)]. In those with a high school education, although mortality rates did not change significantly in NHB and Hispanics, there was a decrease in mortality rate in NHW [25.9 to 21.4: -4.5(-8.2, -0.7)]. No significant changes were observed in those with >high school education during this time. When considering changes related to IPR, there were significant decreases in mortality rates in NHW adults with IPR between 200-399% [26.0 to 20.4: -5.7 (-10.1, -1.2)] and ≥ 400% [23.1 to 15.4: -7.7 (-12.5, -2.9)] but no significant changes for IPR of <100% and 100-199%. In contrast, there was a decrease in mortality rates for IPR <100% in NHB [28.7 to 17.5: -11.2 (-19.6, -2.8)] and Hispanics [16.3 to 10.2: -6.1 (-11.4, -0.7)] but no significant changes for IPRs of 100-199%, 200-399%, or ≥ 400% in these groups. Improvements in mortality rates in U.S. adults with DM by educational attainment were similar across racial/ethnic groups but varied when considering IPR for SEP. Disclosure C. Mercado: None. Y.J. Cheng: None. S. Saydah: None. G. Imperatore: None.

1623-P: Changes in Glycemic and Insulin Distributions among U.S. Adults without Diabetes by Socioeconomic Position, 1988-2016

National surveys in the U.S. have shown an increased incidence of diagnosed diabetes through 2009 followed by consistent reductions. Whether similar population-level changes are occurring in A1C, fasting glucose (FPG), and fasting insulin (FI) is unknown. It is also unknown whether changes in these glucose metabolism measures vary by socioeconomic position (SEP). We analyzed morning fasting data on 22,492 men and non-pregnant women aged ≥20 years without any diabetes from the National Health and Nutrition Examination Survey 1988 through 2016. Family income to poverty ratio (IPR) and education level were used as measures of SEP (Table). We adjusted all estimates for age, sex, and race/ethnicity accounting for the sampling design using linear/quantile regression. There were significant increases in mean levels of A1C (annual percentage change: 0.1%) and FI (1.8%) from 1988-1994 to 2011-2016 (all p <0.05) and no statistically significant changes in FPG. Patterns for medians of measurements by SEP and year were similar (Table). The risk of hyperinsulinemia was increasing among the U.S. adults, especially among lower IPR population. The increases in insulin levels in the context of little changes in glucose levels suggests a worsening of insulin resistance at the population level. Disclosure Y.J. Cheng: None. G. Imperatore: None. K.M. Bullard: None. C. Mercado: None. E.W. Gregg: None.

Disparities in osteoporosis by race/ethnicity, education, work status, immigrant status, and economic status in the United States

AimsOsteoporosis is one of the most common bone health diseases affecting older adults in US. Addressing disparities in osteoporosis will help to enhance the quality of bone care in the nation's bone health programs. Materials & methodsWe used the data of adult participants of the National Health and Nutrition Examination Survey with reported bone mineral density measured during the periods of 2005–2010 and 2013–2014 to examine disparities in osteoporosis based on race/ethnicity, educational attainment, work status, immigrant status, and economic status in US. ResultsBased on educational attainment, the age- and sex-standardized osteoporosis prevalence (SOP) was highest among those with less than a high school education (HSE) (5.1%, 95% CI (CI): 4.3%–5.9%), whereas it was lowest among those with more than HSE (3.2%, CI: 2.7%–3.6%). Based on work status, SOP was highest among unemployed participants (5.4%, CI: 1.9%–8.9%), whereas it was lowest among working participants (2%, CI: 1.6%–2.4%). Based on immigrant status, SOP was highest among non-citizens (6.4%, CI: 5%–7.8%), whereas it was lowest among those born in US (3.4%, CI: 3.1%–3.7%). Based on economic status, SOP was highest among those with poverty-to-income ratio (PIR) <1 (5.5%, CI: 4.4%–6.5%), whereas it was lowest among those with PIR ≥ 4 (2.4%, CI: 1.9%–2.9%). ConclusionsOsteoporosis was more prevalent among US adults who were non-citizens, less educated, unemployed, and had lower income. The observed disparities suggest a need for interventions to promote better quality bone care among the socioeconomically disadvantaged groups.

Persistent socioeconomic and racial and ethnic disparities in pathogen burden in the United States, 1999-2014.

The disproportionate burden of prevalent, persistent pathogens among disadvantaged groups may contribute to socioeconomic and racial/ethnic disparities in long-term health. We assessed if the social patterning of pathogen burden changed over 16 years in a U.S.-representative sample. Data came from 17 660 National Health and Nutrition Examination Survey participants. Pathogen burden was quantified by summing the number of positive serologies for cytomegalovirus, herpes simplex virus-1, HSV-2, human papillomavirus and Toxoplasma gondii and dividing by the number of pathogens tested, giving a percent-seropositive for each participant. We examined sex- and age-adjusted mean pathogen burdens from 1999-2014, stratified by race/ethnicity and SES (poverty-to-income ratio (PIR); educational attainment). Those with a PIR < 1.3 had a mean pathogen burden 1.4-1.8 times those with a PIR > 3.5, with no change over time. Educational disparities were even greater and showed some evidence of increasing over time, with the mean pathogen burden among those with less than a high school education approximately twice that of those who completed more than high school. Non-Hispanic Black, Mexican American and other Hispanic participants had a mean pathogen burden 1.3-1.9 times non-Hispanic Whites. We demonstrate that socioeconomic and racial/ethnic disparities in pathogen burden have persisted across 16 years, with little evidence that the gap is closing.

Disparities in State-Specific Adult Fruit and Vegetable Consumption - United States, 2015.

The 2015-2020 Dietary Guidelines for Americans recommend that Americans consume more fruits and vegetables as part of an overall dietary pattern to reduce the risk for diet-related chronic diseases such as cardiovascular disease, type 2 diabetes, some cancers, and obesity (1). Adults should consume 1.5-2.0 cup equivalents of fruits and 2.0-3.0 cups of vegetables per day.* Overall, few adults in each state met intake recommendations according to 2013 Behavioral Risk Factor Surveillance System (BRFSS) data; however, sociodemographic characteristics known to be associated with fruit and vegetable consumption were not examined (2). CDC used data from the 2015 BRFSS to update the 2013 report and to estimate the percentage of each state's population meeting intake recommendations by age, sex, race/ethnicity, and income-to-poverty ratio (IPR) for the 50 states and District of Columbia (DC). Overall, 12.2% of adults met fruit recommendations ranging from 7.3% in West Virginia to 15.5% in DC, and 9.3% met vegetable recommendations, ranging from 5.8% in West Virginia to 12.0% in Alaska. Intake was low across all socioeconomic groups. Overall, the prevalence of meeting the fruit intake recommendation was highest among women (15.1%), adults aged 31-50 years (13.8%), and Hispanics (15.7%); the prevalence of meeting the vegetable intake recommendation was highest among women (10.9%), adults aged ≥51 years (10.9%), and persons in the highest income group (11.4%). Evidence-based strategies that address barriers to fruit and vegetable consumption such as cost or limited availability could improve consumption and help prevent diet-related chronic disease.

Total Usual Intake of Shortfall Nutrients Varies With Poverty Among US Adults

ObjectiveTo examine shortfall nutrient intakes (ie, calcium, folate, potassium, magnesium, and vitamins A, C, D, and E) by poverty-to-income ratio (PIR). DesignNational Health and Nutrition Examination Survey 2011–2012, a nationally representative, cross-sectional survey. ParticipantsUS adults with complete data on poverty status and diet were included (n = 4,524). AnalysisThe National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24-hour dietary recalls using measurement error correction. Main Outcome MeasuresCalcium, folate, potassium, magnesium, and vitamins A, C, D, and E across 3 PIR categories: <130%, 130% to 350%, and ≥350%. ResultsMean intakes of folate, vitamin C, and vitamin D were significantly greater in men, and magnesium in women, across all PIR categories. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimated Average Requirement across all micronutrients compared with those in the lower PIR categories. Conclusions and ImplicationsEven with dietary supplements, large proportions of US adults have micronutrient intakes below the Estimated Average Requirement. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those with lower incomes.

Total Usual Intake of Most Shortfall Nutrients Varies with Poverty among U.S. adults

Demographic trends indicate that the proportion of Americans living in poverty has been steadily increasing, and that those in poverty are more likely to be overweight or obese. Paradoxically, a combined over‐consumption of energy exists simultaneously with nutrient shortfalls. However, little is known about how poverty affects total micronutrient intakes, including dietary supplements. The objective of this study was to examine total usual shortfall micronutrient intakes (i.e., calcium, folate, potassium, magnesium, and vitamins A, C, D, E) by poverty‐to‐income ratio (PIR). Adults (≥19 y) who participated in NHANES 2011–2012, a nationally‐representative, cross‐sectional survey, and had complete data on poverty status and diet were included (n = 4,524); three PIR categories were constructed: &lt;130%, 130%–350%, and ≥350%. The National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24‐hour dietary recalls using measurement error correction. Dietary supplement use was significantly different in each PIR group: 38% (&lt;130%), 49% (130–350%), and 63% (≥350%); women had a higher prevalence of supplement use, and a higher percentage of micronutrients contributed from dietary supplements than men across all PIR categories. Within each PIR category, mean intakes of folate, vitamin C, vitamin D significantly increased in men and magnesium significantly increased in women. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimate Average Requirement (EAR) across all micronutrients compared with those in the lower PIR categories. Even with dietary supplements, large proportions of U.S. adults have micronutrient intakes below the EAR. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those than those with lower incomes.Support or Funding InformationThis work was supported through an unrestricted educational grant to Columbia University by Pharmavite, LLC.

Gains in income during early childhood are associated with decreases in BMI z scores among children in the United States

Evidence suggests that changes in family income are an important determinant of children's body mass index (BMI). However, few studies have leveraged longitudinal data to investigate the association of changes in family income on changes in BMI z score. This study aimed to assess whether gains in family income are associated with changes in BMI z score among children in the United States by using the nationally representative Early Childhood Longitudinal Survey Birth Cohort (ECLS-B). We used longitudinal data from the ECLS-B to assess whether gains in family income, assessed by using the poverty to income ratio (PIR), were associated with changes in BMI z score among children aged 2-6 y. Child anthropometric characteristics and family income were assessed at 2-y, 4-y, 5-y, and 6-y visits. Sex-stratified, individual fixed-effects linear regression models compared children with themselves over time to control for time-invariant measured and unmeasured confounding factors. Models also controlled for time-varying confounders, including number of siblings, household structure (2 parents, one parent, or unrelated guardian), age, and age squared. Children (n = ~9200) had a mean ± SE change in BMI z score of 0.12 ± 0.022, and family income increased by ~$3361 ± $536 during the 4-y period of observation (2003-2007). The association between increased PIR and change in BMI z score varied by sex but not by race-ethnicity. Among girls, an increase in PIR was associated with a statistically significant decrease in BMI z score (βPIR = -0.022; 95% CI: -0.042, -0.0016). There was a statistically significant association between PIR and BMI z score among preterm boys (βPIR + β PIRXpreterm = -0.067; 95% CI: -0.12, -0.018), but the relation was not statistically significant among boys born at term (βPIR = -0.0049; 95% CI: -0.024, 0.014). By comparing children with themselves over time, we overcome many barriers that typically impede causal inference in observational studies. In this way, our study provides stronger evidence that gains in income during early childhood may promote healthy weight outcomes among girls.

Association between latent toxoplasmosis and cognition in adults: a cross-sectional study.

Latent infection from Toxoplasma gondii (T. gondii) is widespread worldwide and has been associated with cognitive deficits in some but not all animal models and in humans. We tested the hypothesis that latent toxoplasmosis is associated with decreased cognitive function in a large cross-sectional dataset, the National Health and Nutrition Examination Survey (NHANES). There were 4178 participants aged 20-59 years, of whom 19.1% had IgG antibodies against T. gondii. Two ordinary least squares (OLS) regression models adjusted for the NHANES complex sampling design and weighted to represent the US population were estimated for simple reaction time, processing speed and short-term memory or attention. The first model included only main effects of latent toxoplasmosis and demographic control variables, and the second added interaction terms between latent toxoplasmosis and the poverty-to-income ratio (PIR), educational attainment and race-ethnicity. We also used multivariate models to assess all three cognitive outcomes in the same model. Although the models evaluating main effects only demonstrated no association between latent toxoplasmosis and the cognitive outcomes, significant interactions between latent toxoplasmosis and the PIR, between latent toxoplasmosis and educational attainment, and between latent toxoplasmosis and race-ethnicity indicated that latent toxoplasmosis may adversely affect cognitive function in certain groups.

Urinary Bisphenol A and Phthalate Metabolite Concentrations and the Secondary Sex Ratio: The Life Study

Urinary Bisphenol A and Phthalate Metabolite Concentrations and the Secondary Sex Ratio: The Life Study

Illicit drug use and cardiometabolic disease risk: an analysis of 2005-2008 National Health and Nutrition Examination Survey data

To explore the association between illicit drug use (IDU) and cardiometabolic disease risk factors (CDRF) in a nationally representative sample of adults. The 2005-2008 National Health and Nutrition Examination Surveys data from 20- to 45-year-old adults (n=8738) were utilised to analyze the relationship between IDU (ever used, repeated use and current use) and CDRF (hyperlipidemia, hyperinsulinemia, hypertension, elevated C-reactive protein, body mass index, waist circumference and cigarette use) via chi square and logistic regression analyses. Age, gender, race/ethnicity, education level, poverty to income ratio (PIR), and alcohol use were included as confounders in the models. Individuals who reported drug use (DU) at least once in lifetime were more likely to have CDRF than non-DU (NDU) (OR=1.3, p=0.004). Females with DU, IDU at least once in lifetime, and with repeated IDU were about 1.5 times more likely than their NDU counterparts to have CDRF (p<0.0001, p=0.02, p=0.02, respectively). Results from this study suggest that healthcare professionals should be aware that patients with a history of DU may be at heightened risk for cardiometabolic disease. Females in particular have a heightened cluster of CDRF across drug-use categories.

Association between physical activity and major depressive disorder among current or former smokers with pulmonary disease

ObjectiveTo examine the association between physical activity and major depressive disorder (MDD) in a nationally representative sample of current or former smokers with pulmonary impairments. MethodsThe analyzed sample from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 included 536 adults who indicated that they were current or former smokers, had at least mild pulmonary impairment (FEV1/FVC<0.70), and provided depression and physical activity data. ResultsAfter controlling for asthma status, pulmonary impairment, age, poverty-to-income ratio (PIR), education, gender, marital status, body mass index (BMI), cotinine, comorbidity index, race-ethnicity, and smoking status, those who met physical activity guidelines had a 59% (odds ratio (OR)=0.41; 95% confidence interval (CI): 0.18–0.94) lower odds of having MDD. Using multivariate linear regression with depression symptoms as the outcome variable, and after adjustments, physical activity was inversely associated with depression symptoms in a dose–response manner; lowest tertile was the referent group, middle tertile coefficient: −1.06 (95% CI: −1.98 to −0.14), and highest tertile coefficient: −1.10 (95% CI: −1.84 to −0.34). ConclusionsPhysical activity inversely associates with MDD in adults with pulmonary impairments, and does so in a dose–response manner. This suggests that individuals with pulmonary impairments should be encouraged to engage in enjoyable, safe forms of physical activity in a progressive manner.

Associations between soil lead concentrations and populations by race/ethnicity and income-to-poverty ratio in urban and rural areas

Lead (Pb) is a well-studied environmental contaminant that has many negative health effects, especially for children. Both racial/ethnic and income disparities have been documented with respect to exposure to Pb in soils. The objectives of this study were to assess whether soil Pb concentrations in rural and urban areas of South Carolina USA, previously identified as having clusters of intellectual disabilities (ID) in children, were positively associated with populations of minority and low-income individuals and children (≤ 6 years of age). Surface soils from two rural and two urban areas with identified clusters of ID were analyzed for Pb and concentrations were spatially interpolated using inverse distance weighted analysis. Population race/ethnicity and income-to-poverty ratio (ITPR) from United States Census 2000 block group data were aerially interpolated by block group within each area. Urban areas had significantly higher concentrations of Pb than rural areas. Significant positive associations between black, non-Hispanic Latino, individuals and children ≤ 6 years of age and mean estimated Pb concentrations were observed in both urban (r = 0.38, p = 0.0007) and rural (r = 0.53, p = 0.04) areas. Significant positive associations also were observed between individuals and children with an ITPR < 1.00 and Pb concentrations, though primarily in urban areas. Racial/ethnic minorities and low ITPR individuals, including children, may be at elevated risk for exposure to Pb in soils.

Effects of Socioeconomic Status and Acculturation on Accelerometer-Measured Moderate-to-Vigorous Physical Activity Among Mexican American Adolescents: Findings from NHANES 2003–2004

Socioeconomic status (SES) and acculturation are potential contributors of adolescent physical activity disparity among ethnic groups in the U.S. However, studies relying on self-report physical activity measures have reported inconsistent findings regarding sociocultural predictors of physical activity. Therefore, the current study examined the main and interactive effects of SES and acculturation on accelerometer-measured moderate-to-vigorous intensity physical activity (MVPA) among Mexican American adolescents. The National Health and Nutrition Examination Survey 2003-2004 was analyzed. Samples of 153 and 169 Mexican American boys and girls, respectively, were analyzed. SES was indicated by poverty-to-income ratio (PIR); and acculturation was measured by 5-item English preference scales and adolescent and parental country of birth. Regression models were tested separately for boys and girls. U.S.-born boys compared with immigrants did more MVPA (β = .48, P < .01). On the contrary, the effect of English preference on MVPA in boys was negative (β = -.05, P < .01) and amplified by higher SES (β = -.02, P < .01). For girls, none of the tested variables were significant. Higher SES was a risk factor for physical inactivity in Mexican American adolescents, by a moderating mechanism. In addition, physical activity promotion efforts need to consider English speaking and immigrant Mexican American adolescent boys as a target population.