SES Measures Research Articles

Low Socioeconomic Status Is Associated with Worse Patient-Reported Outcomes Following Total Joint Arthroplasty: A Systematic Review

BackgroundSocioeconomic status (SES)—an individual or group’s social standing or class, as measured by education, income, and occupation—has been associated with poor surgical outcomes in orthopaedics. Total knee (TKA) and total hip (THA) arthroplasties are the most commonly investigated orthopaedic surgeries regarding SES and patient-reported outcome measures (PROMs), yet the results are contradictory. The aim of this systematic review was to assess the impact of SES on PROMs following total joint arthroplasty (TJA). MethodsWe performed a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines utilizing MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library from database inception (1971, 1974, and 1996, respectively) to August 2, 2023, to identify studies investigating SES and PROMs in adults undergoing primary elective TJA. Studies were included if they evaluated one of three SES variables (income, education, or employment status) and reported at least one-year scores using a validated PROM. There were two reviewers who independently screened studies and extracted data. ResultsThere were 16 studies included in this systematic review. A total of 55,875 arthroplasties, including 24,055 TKAs and 31,820 THAs, were analyzed. Of the studies, eight evaluated income, 15 evaluated education, and two evaluated employment status. The majority of studies investigating income found a statistically significant association between lower income and worse postoperative PROMs. There were ten studies, involving 90% of all patients from the included education studies, that found a statistically significant association between education and postoperative PROMs. There were two studies that found unemployed THA patients had lower improvements in PROMs compared to employed and retired patients. ConclusionOur systematic review found several significant associations between income, education, employment, and PROMs after TJA. Providers should pay special attention to lower-income, less educated, and unemployed patients. These patients may benefit from targeted interventions to achieve substantial clinical benefit after TJA.

Abstract B152: Joint Associations of Neighborhood Socioeconomic Status and Education on the Incidence of Colorectal Cancer: The Multiethnic Cohort Study

Abstract Background: Colorectal cancer (CRC) is the 3rd most diagnosed cancer worldwide. When considered separately, both neighborhood- and individual-level SES exposures have been associated with CRC incidence. However, the joint associations of neighborhood- and individual-level SES on CRC incidence have not been examined. Methods: In a prospective study of 153,725 Multiethnic Cohort (MEC) participants (24,764 African American, 44,447 Japanese American, 34,974 Latino, 11,511 Native Hawaiian, and 38,029 White participants) recruited from predominantly Los Angeles County, California (CA), and Hawaii (HI), we examined the joint association of neighborhood SES (nSES) and individual-level education with CRC incidence (CA: 2,519, HI: 2,210 cases). Education, other demographics, and health behaviors were self-reported in the baseline questionnaire (1993-1996). CRC diagnosis was determined via linkages with state cancer registries. nSES was derived using a composite score based on 1990 US Census block group data and assigned to geocoded baseline addresses. Our joint SES measure included four categories: high nSES (quintiles 4-5) and high education (> high school), high nSES and low education (≤ high school), low nSES (quintiles 1-3) and high education, and low nSES and low education. State-specific hazards ratios (HR) for CRC incidence were estimated for joint SES categories. Cox regression adjusted for age at cohort entry, CRC family history, polyp history, obesity, diabetes, diet, alcohol, smoking, physical activity, and NSAID, multivitamin, and hormone therapy use. Subgroup analyses were conducted by sex, race, and ethnicity. Results: For HI MEC participants, compared to individuals with high nSES and high education, risk for CRC was highest among those with low nSES and low education (HR=1.27; 95% CI:1.11-1.45) followed by high nSES and low education (HR=1.25; 95% CI:1.12-1.41), and low nSES and high education (HR=1.17; 95% CI: 1.03-1.31). This pattern of association was observed across sex but differed across race and ethnicity (p-heterogeneity=0.04). The overall pattern of association was observed among White participants in HI. However, for Japanese American individuals in HI, compared to those with high nSES and high education, risk for CRC was highest for low nSES and high education (HR=1.29; 95% CI:1.09-1.53) and high nSES and low education (HR= 1.28; 95% CI; 1.10-1.50). For Native Hawaiian individuals, compared to those with high nSES and high education, CRC risk was highest for those with low nSES and low education (HR=1.70; 95% CI: 1.20-2.42). Associations were not statistically significant between the joint SES measure and CRC risk in CA (HRs: 0.92-0.97). Conclusion: Among MEC participants in HI, CRC risk varied with the joint measure of nSES and education across racial and ethnic groups. These findings emphasize the importance of considering the joint associations of neighborhood- and individual-level SES in understanding racial and ethnic disparities in CRC. Citation Format: Catherine Walsh, Meera Sangaramoorthy, Songyi Park, Sung-shim (Lani) Park, Gertraud Maskarinec, Lynne Wilkens, Christopher Haiman, Anna Wu, Salma Shariff-Marco, Loic Le Marchand, Iona Cheng. Joint Associations of Neighborhood Socioeconomic Status and Education on the Incidence of Colorectal Cancer: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B152.

A critical evaluation of the validity of socioeconomic measures used in PISA

PurposeGiven the scientific and practical difficulties inherent in measuring and comparing socioeconomic deprivation (SED), and the further complexity added in cross national measurements, the main aim of this paper was to check the validity of SED measures used in PISA 2018 dataset. The SED measure used in PISA 2018 was the PISA index of economic, social and cultural status abbreviated as the ESCS index. This assessment was important as PISA analysis is based on variables derived from this instrument and the ESCS index and these reports influence and reflect international and comparative education policies and practice.Design/methodology/approachThis study critically evaluates the socioeconomic status measures in the PISA 2018 dataset, focusing on their convergent validity and cross-national comparability. Using responses from over 600,000 students in 73 countries, it examines the validity of SES indicators and their comparability across countries. The study employs principal component analysis to construct local SES measures and compares them with the existing Economic, Social, and Cultural Status (ESCS) index. It explores the relationship between these SES measures and academic achievement in reading, science, and mathematics, aiming to understand their predictive validity in diverse educational settings. Statistical analyses were conducted using the IEA’s IDB Analyser and SPSS, ensuring robustness and generalisability across the diverse participant countries.FindingsOur research findings challenge the assumed superiority of local measures over broader constructs like the Economic, Social, and Cultural Status (ESCS). It suggests that standardised measures like ESCS may provide more reliable predictions of academic achievement across various educational contexts, underscoring the complex relationship between SES measures and academic performance.Originality/valueOur novel analysis shows that local and cross-national SED measures are poorly correlated. Our findings raise questions about the measures' validity while acknowledging the methodological challenges. We provide empirical evidence to support ongoing debates on the topic.

How Education Shapes Indigenous Health Inequalities in the USA and Mexico.

Indigenous peoples around the world face significant health disparities relative to the dominant groups in their countries, yet the magnitude and patterns of health disparities vary across countries. We use data from the National Health Interview Survey and Mexican Family Life Survey to examine the health of Indigenous peoples in Mexico and American Indians and Alaska Natives in the USA and to evaluate how they fare relative to the majority populations in their countries (non-Indigenous Mexicans and non-Hispanic Whites, respectively). We assess disparities in self-rated health and activity limitations, with a focus on how Indigenous health disparities intersect with educational gradients in health. Regression analyses reveal three primary findings. First, Indigenous health disparities are larger in the USA than in Mexico. Second, differences in educational attainment account for most of the differences between Indigenous and non-Indigenous populations in Mexico, but less than half in the USA. Third, in both countries, health is moderated by educational attainment such that between-group disparities are largest at the highest levels of education. However, for Indigenous Mexicans there is a "cross-over" in which Indigenous Mexicans report better health at the lowest level of education. Overall, this study finds a weak relationship between education and Indigenous health, and raises the question about the validity of using traditional measures of SES in Indigenous contexts.

Systematic comparison of household income, consumption, and assets to measure health inequalities in low- and middle-income countries

There has been no systematic comparison of how the three most common measures to quantify household SES—income, consumption, and asset indices—could impact the magnitude of health inequalities. Microdata from 22 Living Standards Measurement Study surveys were compiled and concentration indices, relative indices of inequality, and slope indices of inequality were calculated for underweight, stunting, and child deaths using income, consumption, asset indices, and hybrid predicted income. Meta-analyses of survey year subgroups (pre-1995, 1995–2004, and post-2004), outcomes (child deaths, stunting, and underweight), and World Bank country-income status (low, low-middle, and upper-middle) were then conducted. Asset indices and the related hybrid income proxy result in the largest magnitudes of health inequalities for all 12 overall outcomes, as well as most country-income and survey year subgroupings. There is no clear trend of health inequality magnitudes changing over time, but magnitudes of health inequality may increase as country-income levels increase. There is no significant difference between relative and absolute inequality measures, but the hybrid predicted income measure behaves more similarly to asset indices than the household income it is supposed to model. Health inequality magnitudes may be affected by the choice of household SES measure and should be studied in further detail.

Socioeconomic inequalities in vaccine uptake: A global umbrella review.

This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.

Preterm birth and stillbirth rates during COVID-19 pandemic: differences by socioeconomic status

Abstract Background At the onset of the COVID-19 pandemic, there were concerns about maternal and newborn health because of increased stress, economic difficulties and restrictions to healthcare. However, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth (SB) rates remained stable or were slightly elevated. Hypotheses for the PTB result include positive consequences of lockdowns (more rest, less pollution, less exposure to infection) or restricted healthcare, leading to fewer indicated preterm births. These effects have not been examined on a population-level by socioeconomic (SES) group. Methods The Euro-Peristat network developed a Common Data Model and R scripts to produce aggregated data tables from vital statistics and birth registers. This analysis uses data from 2015 to 2020 on singleton PTB rates and SB rates as well as on mother's educational level (preferred) or area level deprivation/occupation of mother (if education unavailable). SES measures were harmonised into 3 groups (low, medium, high). We computed observed versus expected risks of the outcomes for the year 2020, given linear trends from 2015 to 2019, overall and by SES group; these estimates were pooled using random effects meta-analysis. Results 19 countries provided data on perinatal outcomes by SES group. The overall pooled mixed effect measure for PTB was -0.04 (95%CI of -0.06 to -0.02), corresponding to a 4% decline in 2020 over expected levels. This estimate was the same in low and high SES groups (-0.04 (-0.07 to 0.02) versus -0.04 (-0.06 to -0.02)). For stillbirth, the overall pooled measure was 0.02 (-0.03 to 0.07), corresponding to an increase of 2%, with higher estimates in the low SES group 0.05 (-0.02 to 0.11) versus 0.2 (-0.3 to 0.7) in the high group, although confidence limits overlapped. Conclusions A small decrease in PTB was observed in all SES groups, while results are suggestive of increases in SB rates among women in lower SES groups. Key messages • Previous results in some countries of decreased preterm birth rates in the general population in 2020 were confirmed in this European study, with similar associations in all socioeconomic groups. • Stillbirth rates were not increased in the overall population, but a 5% increase was observed in lower SES groups.

Challenges in studying the interplay of genes and environment. A study of childhood financial distress moderating genetic predisposition for peak smoking.

Smoking is one of the leading causes of preventable disease and death in the U.S., and it is strongly influenced both by genetic predisposition and childhood adversity. Using polygenic indices (PGIs) of predisposition to smoking, we evaluate whether childhood financial distress (CFD; a composite measure of financial adversity) moderates genetic risk in explaining peak-cigarette consumption in adulthood. Using the Health and Retirement Study (HRS), we find a substantial reduction in the relationship between genetic risk and peak smoking for those who did not suffer financial adversity in childhood. Among adult smokers who grew up in high-CFD households, a one standard deviation higher PGI is associated with 2.9 more cigarettes smoked per day at peak. By contrast, among smokers who grew up in low-CFD households, this gradient is reduced by 37 percent (or 1.1 fewer). These results are robust to controlling for a host of prime confounders. By contrast, we find no evidence of interactions between the PGI and typical measures of childhood SES such as parental education - a null result that we replicate in the Wisconsin Longitudinal Study (WLS) and the English Longitudinal Study of Aging (ELSA). This suggests the role of childhood financial distress in the relationship with peak smoking is distinct from that of low childhood SES, with high CFD potentially reflecting more acute distress than do measures of low childhood SES. Our evidence also suggests low childhood SES is a weaker proxy for acute distress, providing an alternative explanation for the childhood SES null result.

Has Cognitive Ability Become More Important for Education and the Labor Market? A Comparison of the Project Talent and 1979 National Longitudinal Survey of Youth Cohorts.

Modernization and meritocratic theories contend that with modernization, socioeconomic background (SES) becomes less important for educational and socioeconomic attainments, while cognitive ability becomes more important. However, the evidence is mixed. This study investigates if the effects of SES and cognitive ability on educational and labor market outcomes have changed in the US by comparing two longitudinal cohort studies: the 1960 Project Talent and the 1979 National Longitudinal Survey of Youth. For all outcomes-grades-at-school, educational and occupational attainment, and income-cognitive ability clearly has stronger effects than a composite and broad measure of SES. The effects of cognitive ability for grades-at-school and income are notably stronger in the more recent cohort, whereas its effects on educational and occupational attainment are similar. SES effects, net of ability, for educational and occupational attainment are only moderate and for school grades and income are very small (β < 0.10). However, for each outcome SES effects are stronger in the more recent NLSY79 cohort. This is attributed to ability being a stronger influence on the educational and socioeconomic attainments of NLSY79 parents compared to Project Talent parents. These analyses suggest that in the US, cognitive ability has long been an important, and SES a much weaker, influence on educational and subsequent socioeconomic outcomes.

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

BackgroundSocioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status.MethodsA systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study.ResultsFifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories.ConclusionsThere are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.

Generating data to facilitate more equitable distribution of health resources: an illustration of how local health surveys can identify probable need in mixed socio-economic regions

ObjectivesThis study aimed to (1) encourage allocation of governmental and grant funds to the administration of local area health surveys and (2) illustrate the predictive impact of socio-economic resources on adult health status at the local area level to provide an example of how health surveys can identify residents with the greatest health needs. Study designRandomly sampled and weight-adjusted regional household health survey (7501 respondents) analyzed with categorical bivariate and multivariate statistics, combined with Census data. Survey sample consists of the lowest, highest, and near highest ranked counties in the County Health Rankings and Roadmaps for Pennsylvania. MethodsSocio-economic status (SES) is measured regionally with Census data consisting of seven indicators and individually with Health Survey data consisting of five indicators based on poverty level, overall household income, and education. Both of these composite measures are examined jointly for their predictive effects on a validated health status measure using binary logistic regression. ResultsOnce county-level measures of SES and health status are broken down into smaller areas, better identification of pockets of health need is possible. This was most strongly revealed in an urban county, Philadelphia, which is ranked lowest of 67 counties on health measures in the state of Pennsylvania, yet when broken down into ‘neighborhood clusters’ contained both the highest- and lowest-ranked local area in a five-county region. Overall, regardless of the SES level of the County subdivision one lives in, a low-SES adult has close to six times greater odds of reporting ‘fair or poor health status’ than does a high-SES adult. ConclusionLocal health survey analysis can lead to a more precise identification of health needs than surveys attempting to cover broad areas. Low-SES communities within counties, and low-SES individuals, regardless of the community they live in, are substantially more likely to experience fair to poor health. This adds urgency to the need to implement and investigate socio-economic interventions, which can hopefully improve health and save healthcare costs. Novel local area research can identify the impact of intervening variables such as race in addition to SES to add more specificity in identifying populations with the greatest health needs.

Abstract P259: Associations of Adverse Childhood Experiences With Cardiovascular Health (Life’s Essential 8) Among Women in Midlife

Introduction: Many women experience suboptimal cardiovascular health (CVH) during midlife and CVH is related to upstream social, behavioral and environmental factors. However, associations of adverse childhood experiences (ACEs) - more common among women - with CVH are understudied. Hypothesis: ACEs would be associated with poorer CVH among women in midlife. Methods: At mean (SD) 50.9 (5.1) years, participants in the Project Viva cohort completed questionnaires and research staff measured their height, weight, blood pressure, and blood levels of glucose, HbA1c and cholesterol. We calculated Life’s Essential 8 (LE8), a 0-100-point score that includes 8 components of CVH: heart healthy levels of diet, physical activity, sleep, avoidance of nicotine, body mass index (BMI), blood lipids, blood glucose and blood pressure. In 2021, women reported their personal history of ACEs (10 possible types) prior to age 18y. We used linear regression models adjusted for childhood SES measures (race/ethnicity, parental education, US birth) and age at outcome. Results: Among 319 participants, 114 (36%) reported 0 ACEs and 58 (18%) reported ≥4 ACEs. In midlife, mean (SD) LE8 score was 77 (12) points. In age-adjusted models, ACEs (4+ vs 0) were associated with poorer LE8 score (β -6.15; 95% CI -9.91, -2.40) and behavioral (β -5.84; CI -9.98, -1.69) and biological (β -6.47; CI -11.8, -1.12) domains; covariate adjustment attenuated the results, though the trends remained significant for LE8 and behavioral domain (Figure). In fully adjusted models, each additional ACE was associated with poorer LE8 score (β -0.74; CI -1.44, -0.04) and associations were stronger for ACEs related to abuse (β -2.72; CI -5.57, 0.12) and neglect (-2.48; CI -5.81, 0.85). Of the LE8 components (0-100-points), associations were strongest for glucose (β -1.76; CI -2.85, -0.67) and physical activity (β -1.86; CI -3.92, 0.20). Conclusions: Adverse childhood experiences may have persistent associations with several measures of cardiovascular health among women into midlife.

Association of socioeconomic status with arterial stiffness in older African American and White adults: The ARIC study cohort

ObjectiveTo examine the cross-sectional associations of individual measures of SES—educational attainment and household income—and the joint effects of SES with PWV, as well as the SES-race interaction, in a cohort of older African American and White adults. MethodsData from the Atherosclerosis Risk in Communities (ARIC) Study were used to evaluate the cross-sectional associations of individual and joint SES [education and income] and carotid femoral pulse wave velocity (cfPWV), a subclinical marker of arterial stiffness, and the interaction of SES and race using adjusted multivariable linear regression models in a cohort of 3342 men and women aged 67–89 years free of CVD in 2011–2013. ResultsParticipants were 64% female, 23% African American, mean cfPWV (12.3±3.5-African American and 11.6±3.9-White participants). Post-graduate education compared to less than high school was significantly associated with lower cfPWV (less stiffness) in African American (β = -1.28 m/s; 95% CI, -1.97, -0.59) but not in White (β = -0.69 m/s; 95% CI, -1.39, 0.01) participants. Income ≥$50K as compared to <$25K, was associated with lower cfPWV both in African American (β = -0.82 m/s; 95% CI, -1.42, -0.22) and White (β = -0.76 m/s; 95% CI, -1.19, -0.32) participants. The interaction of race and individual measures of SES on cfPWV in African American and White adults were not statistically significant (p-value >0.10). ConclusionsHigher SES was cross-sectionally associated with lower arterial stiffness in this cohort; the data did not support differences by race. Prospective studies of SES and cfPWV are needed to efficiently compare larger racially and regionally diverse populations with a wider range of socioeconomic profiles to better identify subgroup CVD risk.

Allostatic load and the influence of economic adversity and neighborhood disadvantage on cognitive function in a multiethnic cohort

AbstractBackgroundPrevious research has demonstrated a link between objective socio‐economic indicators and cognitive test performance. Although some studies include subjective indicators, such as perceived neighborhood environment, little is known about which specific factors are most strongly associated with cognitive performance and whether these measures are useful beyond traditional SES proxies. Further, in addition to being disproportionately at risk of experiencing neighborhood disadvantage and lower SES, racial/ethnic minorities are more likely to be diagnosed with dementia and receive less timely care compared with White individuals. This study aims to investigate how perceived neighborhood environment and neighborhood disadvantage are related to cognitive performance within a large diverse sample.MethodA probability‐based sample of participants (N = 3858; Female = 59%; Black = 51%; Hispanic = 14%) from the Dallas Heart Study Phase 2 (DHS‐2; Mean: Age = 50, Education = 13) were administered the Montreal Cognitive Assessment (MoCA), in addition to measures of perceptions of neighborhood physical environment and violence, and perceived SES. Multiple regression was used to determine associations of these variables with MoCA scores relative to traditional SES measures (i.e., income, education), controlling for demographic and relevant health factors. Post‐hoc analyses stratified by racial/ethnic group were conducted to determine whether indicators differentially influenced test scores.ResultAfter controlling for socio‐demographic and health factors, reporting lower quality neighborhood resources and difficulty paying for “very basics like food and heating” and “medical care” were associated with lower MoCA scores in the overall sample. Post‐hoc analyses revealed significant relationships between MoCA scores and quality of neighborhood resources, “food and heating,” and “medical care” only in Black participants, while “violence” was significantly associated with lower MoCA scores in Hispanics. There were no significant relationships found in Whites. Overall, subjective measures of SES and neighborhood environment contributed modest variance in the overall model, specifically for Black and Hispanic participants (R 2 = 3% to 5%).ConclusionExperiencing neighborhood and economic adversity was associated with lower scores on a cognitive screening measure and accounted for more variance than income or education in Black individuals and income in Hispanic individuals, while no relationship was seen in White participants. Future research is needed to determine whether these allostatic stressors influence cognitive impairment or dementia later in life.

Abstract 264: Socioeconomic Status And Outcomes After In-Hospital Cardiac Arrest

Introduction: We aimed to investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark. Methods: We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses using regression models were performed to assess the association between socioeconomic status and outcomes after in-hospital cardiac arrest. Outcomes included return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, and the duration of resuscitation among patients without ROSC. Results: A total of 3,223 patients with in-hospital cardiac arrest were included in the study. In the analyses adjusted for patient and cardiac arrest characteristics, patients with high household assets had 1.20 (95%CI: 0.96, 1.51) times the odds of ROSC, 1.49 (95%CI: 1.14, 1.96) times the odds of survival to 30 days, 1.40 (95%CI: 1.04, 1.90) times the odds of survival to one year, and 2.8 (95%CI: 0.9, 4.7) minutes longer duration of resuscitation compared to patients with low household assets. Similar albeit attenuated associations were observed for education. While high household income was associated with better outcomes in the unadjusted analyses, these associations largely disappeared in the adjusted analyses. Conclusions: In this study of patients with in-hospital cardiac arrest, we found that high household assets were associated with a higher odds of survival and a longer duration of resuscitation among patients without ROSC compared to low household assets. However, the results varied pertinent to SES measure, outcome of interest, and across adjusted analyses.

Socioeconomic differences in perinatal health outcomes: perinatal health surveillance through a health-equity prism

Abstract Background Socioeconomic status (SES) is strongly associated with perinatal health outcomes, perpetuating intergenerational health inequalities. Our aim was to assess the utility of population data in Europe to monitor social inequalities in key perinatal health indicators. Methods Using the PHIRI federated analysis protocol to aggregate routine birth data from across Europe, we collected data on selected perinatal health indicators by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were provided. The International Standard Classification of Occupations was used to group parents’ occupations into 4 categories, while area-based deprivation scores were measured in quintiles. For each country, we calculated risk ratios (RR) for preterm birth, stillbirth, neonatal death and caesarean delivery (CD) comparing the most with the least disadvantaged group Results 17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation and 2 could not provide data. For preterm birth, stillbirth and neonatal death, lower SES was associated with worse outcomes with most RR between lowest and highest groups in the range of 1.5 to 3.0. In contrast, in some countries, such as Croatia, Latvia, Lithuania and Spain, CD rates were higher for socially advantaged groups whereas the gradient was reversed in others (Denmark, Luxembourg, the Netherlands and Italy). Conclusions European countries can provide perinatal health indicators by SES, revealing marked socioeconomic inequalities in perinatal health. The differing SES gradient between countries for CD raise questions about care organization and clinical practice. Further exploration of the harmonization of differing SES measure across countries is required, while countries that do not monitor SES data should aim to improve existing systems.

Socioeconomic and genomic roots of verbal ability from current evidence

This research examines how the human genome and SES jointly and interactively shape verbal ability among youth in the U.S. The youth are aged 12–18 when the study starts. The research draws on findings from the latest GWAS as well as a rich set of longitudinal SES measures at individual, family and neighborhood levels from Add Health (N = 7194). Both SES and genome measures predict verbal ability well separately and jointly. More interestingly, the inclusion of both sets of predictors in the same model corrects for about 20% upward bias in the effect of the education PGS, and implies that about 20–30% of the effects of parental SES are not environmental, but parentally genomic. The three incremental R2s that measure the relative contributions of the two PGSs, the genomic component in parental SES, and the environmental component in parental SES are estimated to be about 1.5%, 1.5%, and 7.8%, respectively. The total environmental R2 and the total genomic R2 are, thus, 7.8% and 3%, respectively. These findings confirm the importance of SES environment and also pose challenges to traditional social-science research. Not only does an individual’s genome have an important direct influence on verbal ability, parental genomes also influence verbal ability through parental SES. The decades-long blueprint of including SES in a model and interpreting their effects as those of SES needs to be amended accordingly. A straightforward solution is to routinely collect DNA data for large social-science studies granted that the primary purpose is to understand social and environmental influences.

Studying Socioeconomic Status: Conceptual Problems and an Alternative Path Forward

Socioeconomic status (SES; or social class) is considered an important determinant of psychological and life outcomes. Despite this importance, how to appropriately conceive of and measure it remains unsettled. In this article, I argue that SES is, under conventional conceptions of the construct, an unmeasurable construct and present an alternative strategy for studying socioeconomic conditions. I make this argument using several lines of analysis. First, a literature review of 20 years of psychological research on SES reveals that psychologists rarely define SES theoretically (79.6% of articles did not) but call a great number of operationalizations measures of SES (147 in total). Second, current recommendations for studying SES permit contradictory predictions, rendering the recommendations unsatisfactory. Third, the appropriate measurement model for SES inhibits accumulation of results across studies, which makes studying the construct practically impossible. To rectify these issues, I reconceptualize SES as a set of socioeconomic conditions and develop a measurement strategy for studying these conditions. I conclude by considering implications for ongoing research on socioeconomic conditions and for interpreting past research on SES.

Subjective Social Status, Area Deprivation, and Gender Differences in Health among Chinese Older People.

This study examined the gender differences in the main and interactive effects of subjective social status and area deprivation on health among older adults in Hong Kong. Data for this study came from the baseline of MrOs and MsOs studies, including 4000 Chinese men and women ≥ 65 in Hong Kong. Subjective social status was assessed using the MacArthur Scale of subjective social status scale. Our results reaffirm that subjective social status is an independent indicator of health after adjusting for objective SES measures (e.g., education and income). Perceived rank on the community ladder was more closely related to health among older people than was the society ladder, particularly for women. Although area-level social deprivation was not significantly associated with the health of older people, it may moderate the effect of subjective social status on health. Women with a lower perceived status in the community were more likely to experience depressive symptoms but better grip strength when living in more deprived neighborhoods. The findings suggested that subjective social status provides important information for the physical and mental health of the older population. Policymakers may implement interventions to enhance the subjective social status of older adults. Given the greater contribution of relative status in the community to the health of women, these policies and interventions should target to improve women’s perceived status in the community.

1014-P: Characteristics Associated with Diabetes Device Use Before and During the Pandemic in Youth with T1D

Introduction: The impact of the Covid-pandemic on diabetes device uptake and use in youth with T1D is unclear. We assessed demographic, diabetes, and SES characteristics associated with diabetes technology (pump, CGM) use in youth with T1D, aged ≤18 years, pre- and during the pandemic. Methods: EHR provided ∼18 months of data pre- and during the pandemic. Pump and CGM use were defined as device use at ≥50% of visits. Geocoding provided census tract-specific SES measures from the 20American Community Survey. Logistic regression models analyzed the probability of device use vs. non-use in the pre- and pandemic periods by geocoded SES status, adjusted for age, gender, baseline A1c, and T1D duration. Results: Pre-pandemic sample had 734 youth (male 49%, aged 13.8±3.3 years, T1D duration 7.3±3.4 years) ; pandemic sample had 800 youth (male 51%, aged 13.4±3.7 years, T1D duration 6.6±3.9 years) ; 689 were in both periods. Pre- and during pandemic, respectively, there were 25% and 22% device non-users; 19% and 21% pump only; 13% and 16% CGM only; 43% and 41% both. Pre-pandemic baseline A1c differed by the 4 device use groups: non-users 9.1±1.7%; pump 8.5±1.2%; CGM 8.2±1.2%; both 8.1±1.0%; p&amp;lt;.05.In both periods, the odds of device non-users starting a device were reduced in those from low-income tracts (≤$40,000) (pre: OR 0.60, 95%CI 0.40-0.91; during: OR 0.59, 95%CI 0.39-0.88; respectively, both p=.01) and low education tracts (≥30% high school or less) (pre: OR 0.57, 95%CI 0.39-0.85; during: OR 0.65, 95%CI 0.44-0.97; both p≤.03) . While the odds of CGM uptake were significantly reduced by ∼40% in presence of unfavorable census SES factors (p≤.01) , the odds of pump start were not (p≥.05) . Odds of uptake of both devices were significantly reduced by ∼45% in presence of unfavorable census SES factors (p≤.02) in both periods. Conclusion: During the pandemic, there remained decreased uptake and less continued use of diabetes device in lower SES patients. Further work is needed to decrease the inequality gap. Disclosure C.Chen: None. A.Adam: None. S.Ojukwu: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (P30DK036836,T32DK007260)