SES Measures Research Articles

Rural and urban disparities in selective attention in Chinese young adults: An event-related potential study

Previous studies showed that attention system and its underlying neural mechanisms were profound affected by social inequalities. However, previous studies on social inequalities were mainly focused on family-based factors, such as parental education, parental occupation, and household income. In the present study, we investigated the neural mechanisms underlying more broader social context (e.g., rural verse urban) disparities in selective attention among young adults in China. Event-related potentials (ERPs) were recorded from 22 college students who had born and grown up in rural areas and 22 students who had born and grown up in urban areas during an auditory selective attention task. Although behavioral performance was not significantly different between groups, attentional differences in the negativity difference (Nd) were significantly larger in the urban group than the rural group. Whole sample analysis with hierarchical regression showed that rural/urban status still made a significant contribution to the prediction of Nd amplitudes even after the effects of age, sex, and various family SES measures (include parents’ educational levels and annual household income) were controlled for. These findings represent a first step toward understanding the ways in which broad social environmental factors shape the neural basis of selective attention.

Testing sampling bias in estimates of adolescent social competence and behavioral control

In 5 of the 6 large Dutch developmental cohorts investigated here, lower SES adolescents are underrepresented and higher SES adolescents overrepresented. With former studies clearly revealing differences between SES strata in adolescent social competence and behavioral control, this misrepresentation may contribute to an overestimation of normative adolescent competence. Using a raking procedure, we used national census statistics to weigh the cohorts to be more representative of the Dutch population. Contrary to our expectations, in all cohorts, little to no differences between SES strata were found in the two outcomes. Accordingly, no differences between weighted and unweighted mean scores were observed across all cohorts. Furthermore, no clear change in correlations between social competence and behavioral control was found. These findings are most probably explained by the fact that measures of SES in the samples were quite limited, and the low SES participants in the cohorts could not be considered as representative of the low SES groups in the general population. Developmental outcomes associated with SES may be affected by a raking procedure in other cohorts that have a sufficient number and sufficient variation of low SES adolescents.

The relationship between executive processing and computational growth among monolingual and english learners with and without math difficulties: Does it help to be bilingual?

Does the commonly reported math achievement gap among elementary school monolingual and English learners (ELs) with and without math difficulties reflect variations in executive processing? This cohort-sequential study (N = 841) explored the cognitive processes that underlie in elementary school children’s math computational growth who are monolingual (English-only) or English learners with Spanish as a first language. Three language subgroups (proficient ELs [relatively proficient in both English and Spanish vocabulary], less proficient ELs [more proficient in English when compared to Spanish vocabulary] and monolingual [English-only]) children with and without math difficulties (MD) were compared on measures of math computation and cognitive growth. As expected, children with MD identified at wave 1 underperformed children without MD in their rate of growth and their level of computational and working memory (WM) performance in the final testing wave. However, two additional findings occurred. First, executive processing measures (working memory and inhibition) were significantly related to computational growth even when measures of reading, fluid intelligence, STM, naming speed and SES were partialed in the analysis. Second, no statistical advantages in executive processing or computation emerged in favor of EL children relative to monolingual children. Taken together, the results support the notion that (a) growth in math computation is tied to growth in the executive system and (b) EL children relatively proficient in English and Spanish experience no growth advantages in WM or computation compared to monolingual children.

Alexithymia, Not Autism Spectrum Disorder, Predicts Perceived Attachment to Parents in School-Age Children.

Alexithymia is defined as a limited ability in the cognitive processing of emotions. Literature suggested its negative influence on interpersonal relationship, documenting elevated alexithymia in individuals with Autism Spectrum Disorder (ASD) compared to control groups. However, the study of alexithymia in school-age children with ASD remains largely unexplored as well as its effect on specific child socioemotional outcomes such as quality of attachment relationships. This study examines alexithymia and perceived attachment to parents in twenty-four children with ASD (without intellectual disability) and 24 typically developing (TD) children (mean age 10 years) using the self-reported Alexithymia Questionnaire for Children (AQC) and the Inventory of Parent and Peer Attachment (IPPA). Measures of family SES as well as child intelligence were collected. Data revealed that ASD children showed higher levels of Alexithymia compared to TD group. In addition, 21% of participants with ASD exceed alexithymia categorical cut-off. By contrast, no difference emerged in the perception of attachment to parents. Moreover, alexithymia, but not ASD status, was found to predictive of child perception of attachment to parents. We observed no significant effect of child age and verbal IQ. Our findings showed that alexithymia was more common in children with ASD, whereas attachment was similar between groups. Difficulties in identifying and describing one’s own feelings may hinder the construction of a positive representation of parent-child attachment relationship regardless of child clinical status. Thus, alexithymia seems to play a key role on the way school-age children with and without ASD perceive their relationship with their parents.

Work alienation and its gravediggers: Social class, class consciousness, and activism

Work activity is central to human psychology. However, working conditions under capitalist socioeconomic relations have been posited as psychologically alienating. Given the negative impact of work alienation on well-being and mental health, we conducted two studies of the relations between social class, work conditions, and alienation. We also examined factors that might counteract alienation – class consciousness and activism. The utility of a Marxist measure of social class – based on objective work relations – was compared with that of SES and subjective class measures. Study 1 surveyed 240 U.S. adults from diverse socioeconomic backgrounds using Amazon’s Mechanical Turk; Study 2 was a replication with 717 adults recruited via a sampling company. Across studies, alienation was predicted by perceived work exploitation, poor work relationships, and lack of self-expression, meaningfulness, self-actualization, autonomy, and intrinsic motivation at work. Only the Marxist class measure – not SES or subjective class measures – predicted alienation and alienating work conditions across studies. Working-class participants experienced more alienating work conditions and greater alienation. Alienation was correlated with class consciousness, and class consciousness was associated with activism. While SES measures have dominated the psychological study of social class, results suggest benefits to integrating Marxist measures and conceptions of social class.

How important are socioeconomic background and other factors to the university career vis-à-vis prior student performance: evidence from Australian longitudinal data

ABSTRACT The literature on the relationship between socioeconomic background (SES) and university education is inconsistent. Some studies conclude SES is important to university entry and course completion, others find trivial SES effects, net of students’ prior performance, and a third group concludes that SES effects are important and policy relevant even when considering prior performance. Parallel arguments apply to demographic, school sector, and institutional differences in the university career, that is, are they unimportant when considering student performance? Using comprehensive and accurate measures of SES and student performance, and a statistical method that utilizes all non-missing data, this study quantifies the effects of socioeconomic, demographic, and institutional factors and prior student performance. SES has only weak effects on university entry and attrition, and no effects on course completion. Student performance has strong effects on entry and has moderate effects on attrition and completion. Demographic other differences mostly disappear when controlling for student performance.

MEASURING SOCIOECONOMIC STATUS IN OLDER POPULATIONS: A SCOPING REVIEW AND INTERNATIONAL PERSPECTIVE

Socioeconomic status (SES) is often measured using indicators that are less relevant to older populations. Building on earlier debates about these issues, an up-to-date, critical review of contemporary evidence and approaches is needed. A key question is how these challenges might vary between countries and different socio-cultural contexts. An international systematic scoping review was undertaken to a) identify which measures of SES have been used in studies of older adults’ health, healthcare utilization and social care utilization, and b) critically appraise the application and validity of these measures in older populations. Systematic searches were conducted in five databases (Medline, Scopus, EMBASE, PsychInfo, Web of Science and Health Management Information Consortium) in May 2018. Studies were eligible if they reported data about the relationship between a measure of SES and self-rated health, healthcare use or social care use for people aged 60+ years, and were published after 2000 in a high-income country (as defined by the Organisation for Economic Cooperation and Development). Sixty-two studies across seventeen countries were included. Measures used included: education (n=41), income (n=37), subjective SES (n=8), occupational or employment (n=10), area deprivation (n=10), combined wealth (n=7), home ownership (n=13), and housing conditions (n=2). A minority (n=7) used a range of proxy variables. The challenges of applying these measures to older populations will be considered. Attention is given to how these challenges may differ by country, whilst considering the added complexities of age, gender and socio-cultural context. Implications for future research on older adults’ health inequalities are discussed.

Approaches and Alternatives to the Wealth Index to Measure Socioeconomic Status Using Survey Data: A Critical Interpretive Synthesis

Monitoring progress towards the Sustainable Development Goals by 2030 requires the global community to disaggregate targets along socio-economic lines, but little has been published critically analyzing the appropriateness of wealth indices to measure socioeconomic status in low- and middle-income countries. This critical interpretive synthesis analyzes the appropriateness of wealth indices for measuring social health inequalities and provides an overview of alternative methods to calculate wealth indices using data captured in standardized household surveys. Our aggregation of all published associations of wealth indices indicates a mean Spearman’s rho of 0.42 and 0.55 with income and consumption, respectively. Context-specific factors such as country development level may affect the concordance of health and educational outcomes with wealth indices and urban–rural disparities can be more pronounced using wealth indices compared to income or consumption. Synthesis of potential future uses of wealth indices suggests that it is possible to quantify wealth inequality using household assets, that the index can be used to study SES across national boundaries, and that technological innovations may soon change how asset wealth is measured. Finally, a review of alternative approaches to constructing household asset indices suggests lack of evidence of superiority for count measures, item response theory, and Mokken scale analysis, but points to evidence-based advantages for multiple correspondence analysis, polychoric PCA and predicted income. In sum, wealth indices are an equally valid, but distinct measure of household SES from income and consumption measures, and more research is needed into their potential applications for international health inequality measurement.

Brain cancer survival in Canada 1996-2008: effects of sociodemographic characteristics.

Literature suggests that factors such as rural residence and low socioeconomic status (ses) might contribute to disparities in survival for Canadian cancer patients because of inequities in access to care. However, evidence specific to brain cancer is limited. The present research estimates the effects of rural or urban residence and ses on survival for Canadian patients diagnosed with brain cancer. Adults diagnosed with primary malignant brain tumours during 1996-2008 were identified through the Canadian Cancer Registry. Brain tumours were classified using International Classification of Diseases for Oncology (3rd edition) site and histology codes. Hazard ratios (hrs) and 95% confidence intervals (cis) were estimated using Cox proportional hazards models. Events were restricted to individuals whose underlying cause of death was cancer-related. Postal codes were used to match patient records with Statistics Canada data for rural or urban residence and neighbourhood income as a surrogate measure of ses. Of 25,700 patients included in the analysis, 78% died during the study period, 21% lived in rural areas, and 19% were in the lowest income group. A modest variation in survival by rural compared with urban residence was observed for patients with glioblastoma (first 5 weeks after diagnosis hr: 0.86; 95% ci: 0.79 to 0.99) and oligoastrocytoma (first 3 years after diagnosis hr: 1.41; 95% ci: 1.03 to 1.93). Small effects of low compared with high income were seen for patients with glioblastoma (first 1.5 years after diagnosis hr: 1.15; 95% ci: 1.08 to 1.22) and diffuse astrocytoma (first 6 months after diagnosis hr: 1.17; 95% ci: 1.00 to 1.36). Our analysis did not yield evidence of strong effects of rural compared with urban residence or ses strata on survival in brain cancer. However, some variation in survival for patients with specific histologies warrants further research into the mechanisms by which rural or urban residence and income stratum influences survival.

Which social measures relate to cancer screening & healthy behaviors?

e18142 Background: Much of cancer health services research relies on administrative data, yet, there have been calls for more granular racial & social disparities data. Subjective SES (sSES) is associated with health status & behaviors, independent of objective SES (oSES) measures like income, education and race. We assessed the relationship between breast cancer patients’ oSES and sSES with their cancer screening and health behaviors. Methods: Data are part of a large prospective study evaluating the role of insulin resistance in women with newly diagnosed breast cancer. Patients were asked to place where they stand in their communities on the MacArthur Scale of Subjective Social Status ladder (sSES). oSES measures include race, income & education. We assessed diet, activity, breast & pap screening. Group comparisons used chi-square and t-tests as appropriate. We ran logistic multivariate models with age, race, insurance, comorbidity & income. Results: Of 1035 breast cancer patients with an average age of 58±12 yrs, 81% were White and 19% Black, 63% graduated college, 47%W & 16%B women reported an income of > $100,000/yr. The median sSES = 8; 20% had high sSES ( > 8). There were no racial differences observed in sSES (high sSES: 22% B vs 20% W; p = 0.7). More patients with high sSES graduated college (76% vs 61%, p = 0.0002) & had income > $100K/yr (62% vs 36%, p < .0001) than patients with lower sSES. Of the oSES, women with higher income were more likely to undergo both cancer screenings as compared to patients with lower income. College education did not impact cancer screenings. Black women were less likely to get pap smears. Patients with high as compared to low sSES had higher cancer screening rates and healthy behaviors. Conclusions: Income and sSES are positively associated with cancer screening and health behaviors; education & race are associated with activity & diet. Race is associated with pap screening.[Table: see text]

The Global Increase in the Socioeconomic Achievement Gap, 1964 to 2015

The “socioeconomic achievement gap”—the disparity in academic achievement between students from high- and low-socioeconomic status (SES) backgrounds—is well-known in the sociology of education. The SES achievement gap has been documented across a wide range of countries. Yet in most countries, we do not know whether the SES achievement gap has been changing over time. This study combines 30 international large-scale assessments over 50 years, representing 100 countries and about 5.8 million students. SES achievement gaps are computed between the 90th and 10th percentiles of three available measures of family SES: parents’ education, parents’ occupation, and the number of books in the home. Results indicate that, for each of the three SES variables examined, achievement gaps increased in a majority of sample countries. Yet there is substantial cross-national variation in the size of increases in SES achievement gaps. The largest increases are observed in countries with rapidly increasing school enrollments, implying that expanding access reveals educational inequality that was previously hidden outside the school system. However, gaps also increased in many countries with consistently high enrollments, suggesting that cognitive skills are an increasingly important dimension of educational stratification worldwide.

Socioeconomic and insurance status are independent prognostic indicators of higher disease stage and worse prognosis in bladder cancer

ObjectivesBladder cancer is the fourth most common cancer among males and poses a significant financial burden, yet there are no large-scale studies focused on the correlation between socioeconomic (SES) and insurance status and bladder cancer outcomes. The objective of this study was to determine the effect of SES and insurance type on outcomes in bladder cancer. Materials and methodsA population-based search was performed using the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 database. Patients aged 18 or older and diagnosed with bladder cancer between 2011 and 2015 were identified. Data on patient demographics, SES features, insurance status, tumor characteristics, and survival were collected. A county-level SES measure was created in a method consistent with prior literature. Primary outcomes were overall survival (OS) and disease-specific survival (DSS). ResultsA total of 91,308 patients were identified. Factors predictive of having muscle invasive disease included having Medicaid insurance, having no insurance, and being in the lowest SES quartile (all P < 0.001). Having Medicaid or no insurance was predictive of having node positive or metastatic disease (P < 0.001). Independent of T stage, patients in the lowest and second lowest SES quartiles had worse OS (P = 0.004 and P = 0.022, respectively) and DSS (P < 0.001 for both). Patients with Medicaid or no insurance had worse OS and DSS (P < 0.001 for all). ConclusionsLower SES status, Medicaid insurance, and having no insurance were all predictive of having higher tumor stage. Independent of tumor stage, being of lower SES, having Medicaid insurance, and having no insurance predicted worse OS and DSS.

Socioeconomic differences in nicotine exposure and dependence in adult daily smokers

BackgroundSocioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence.MethodsThe Pennsylvania Adult Smoking Study is a cross-sectional study of smoke exposure and nicotine dependence among adults conducted in central Pennsylvania between June 2012 and April 2014. The study included several measures of SES, including assessments of education and household income, as well as occupation, home ownership, health insurance, household density and savings accounts. Measurements included saliva for the nicotine metabolites cotinine (COT), 3-‘hydroxycotinine (3HC) and total metabolites (COT +3HC). Puffing behavior was determined using portable smoking topography devices.ResultsThe income levels of lighter smokers (< 20 cigarettes per day) was $10,000 more than heavier smokers. Higher Fagerström Test for Nicotine Dependence scores were associated with lower income and job status, scores ranged from 5.4 in unemployed, 4.4 in blue-collar, and 3.8 in white-collar workers. In principal components analysis used to derive SES indicators, household income, number in household, and type of dwelling were the major SES correlates of the primary component. Job category was the major correlate of the second component. Lower SES predicted significantly higher adjusted total nicotine metabolite levels in the unemployed group. Job category was significantly associated with total daily puffs, with the highest level in the unemployed, followed by blue-collar workers, after adjustment for income.ConclusionsAmong smokers, there was a relationship between lower SES and increased nicotine dependence, cigarettes per day and nicotine exposure, which varied by job type.

Investigating disparities: The effect of social environment on pancreatic cancer survival.

208 Background: Incidence rates of pancreatic adenocarcinoma (PAC) are higher in Black compared to White patients (pts). Beyond race, exposure to poor neighborhoods or social environments also contribute to cancer disparities. However, social environmental effects on PAC are not well-studied. Social environment is defined as: 1) a neighborhood’s socioeconomic conditions (SES; i.e. a combination of education, income, poverty and employment levels); 2) racial segregation (RS) or the degree of isolation/separation of race/ethnic groups in a neighborhood. The goal of our study is to investigate whether poor social environments impact survival in a clinic population with metastatic PAC. Methods: Neighborhood SES and RS measures were derived from US census data (2011-2015) at the census tract level, which is a smaller geographic area than a county. Patient (pt) addresses were used to generate a geocode that identifies the census tract or neighborhood in which a pt lives. We joined medical records of PAC pts (n = 374; diagnosed 2010-2016 at Fox Chase Cancer Center) to neighborhood measures via the geocode. Pt variables included in the analysis were: age, sex, race, marital status, treatment, PAC family history, stage, Jewish ancestry, tobacco use and Charlson comorbidity index. Multivariable cox proportional hazards models with cluster adjustments were used and variables with p-values &lt; 0.05 were considered significant. Results: 342 PAC deaths occurred and median survival was 12m. 81% of pts were White; &lt; 40% resided in poor social environments (i.e. low SES or high RS). In multivariable analyses stratified by RS, median survival was lower in pts from high RS (11m) vs low RS areas (13m); however, this difference was not significant (p = 0.27). Variable effects differed by high/low RS. In high RS areas, sex, surgery, chemo, diabetes and neighborhood SES were significant predictors of survival; in low RS areas, surgery, chemo, radiation, PAC family history, tobacco use, Jewish ancestry and race were significant. Conclusions: While social environment did not appear to significantly affect survival time in metastatic pts, its potential moderating (interaction) effects on variable associations with PAC warrant further investigation.

Community violence exposure correlates with smaller gray matter volume and lower IQ in urban adolescents

Adolescents' exposure to community violence is a significant public health issue in urban settings and has been associated with poorer cognitive performance and increased risk for psychiatric illnesses, including PTSD. However, no study to date has investigated the neural correlates of community violence exposure in adolescents. Sixty-five healthy adolescents (age = 14-18 years; 36 females, 29 males) from moderate- to high-crime neighborhoods in Los Angeles reported their violence exposure, parents' education level, and free/reduced school lunch status (socio-economic status, SES), and underwent structural neuroimaging and intelligence testing. Violence exposure negatively correlated with measures of SES, IQ, and gray matter volume. Above and beyond the effect of SES, violence exposure negatively correlated with IQ and with gray matter volume in the left inferior frontal gyrus and anterior cingulate cortex, regions involved in high-level cognitive functions and autonomic modulation, and previously shown to be reduced in PTSD and combat-exposed military populations. The current results provide first evidence that frontal brain regions involved in cognition and affect appear to be selectively affected by exposure to community violence, even in healthy nondelinquent adolescents who are not the direct victims or perpetrators of violence.

Measures of SES for Electronic Health Record-based Research

Although infrequently recorded in electronic health records (EHRs), measures of SES are essential to describe health inequalities and account for confounding in epidemiologic research. Medical Assistance (i.e., Medicaid) is often used as a surrogate for SES, but correspondence between conventional SES and Medical Assistance has been insufficiently studied. Geisinger Clinic EHR data from 2001 to 2014 and a 2014 questionnaire were used to create six SES measures: EHR-derived Medical Assistance and proportion of time under observation on Medical Assistance; educational attainment, income, and marital status; and area-level poverty. Analyzed in 2016-2017, associations of SES measures with obesity, hypertension, type 2 diabetes, chronic rhinosinusitis, fatigue, and migraine headache were assessed using weighted age- and sex-adjusted logistic regression. Among 5,550 participants (interquartile range, 39.6-57.5 years, 65.9% female), 83% never used Medical Assistance. All SES measures were correlated (Spearman's p≤0.4). Medical Assistance was significantly associated with all six health outcomes in adjusted models. For example, the OR for prevalent type 2 diabetes associated with Medical Assistance was 1.7 (95% CI=1.3, 2.2); the OR for high school versus college graduates was 1.7 (95% CI=1.2, 2.5). Medical Assistance was an imperfect proxy for SES: associations between conventional SES measures and health were attenuated <20% after adjustment for Medical Assistance. Because systematically collected SES measures are rarely available in EHRs and are unlikely to appear soon, researchers can use EHR-based Medical Assistance to describe inequalities. As SES has many domains, researchers who use Medical Assistance to evaluate the association of SES with health should expect substantial unmeasured confounding.

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

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

Socioeconomic Status, Financial Strain, and Leukocyte Telomere Length in a Sample of African American Midlife Men.

African American men in the USA experience poorer aging-related health outcomes compared to their White counterparts, partially due to socioeconomic disparities along racial lines. Greater exposure to socioeconomic strains among African American men may adversely impact health and aging at the cellular level, as indexed by shorter leukocyte telomere length (LTL). This study examined associations between socioeconomic factors and LTL among African American men in midlife, a life course stage when heterogeneity in both health and socioeconomic status are particularly pronounced. Using multinomial logistic regression, we examined associations between multiple measures of SES and tertiles of LTL in a sample of 92 African American men between 30 to 50years of age. Reports of greater financial strain were associated with higher odds of short versus medium LTL (odds ratio (OR)=2.21, p=0.03). Higher income was associated with lower odds of short versus medium telomeres (OR=0.97, p=0.04). Exploratory analyses revealed a significant interaction between educational attainment and employment status (χ 2=4.07, p=0.04), with greater education associated with lower odds of short versus long telomeres only among those not employed (OR=0.10, p=0.040). Cellular aging associated with multiple dimensions of socioeconomic adversity may contribute to poor aging-related health outcomes among African American men. Subjective appraisal of financial difficulty may impact LTL independently of objective dimensions of SES. Self-appraised success in fulfilling traditionally masculine gender roles, including being an economic provider, may be a particularly salient aspect of identity for African American men and have implications for cellular aging in this population.

Improving the Accuracy of Length of stay Risk Adjustment Models using Linked Data

ABSTRACT&#x0D; BackgroundHospital length of stay (LOS) is a widely used measure for assessing cross-jurisdiction health system performance and informs resource allocation decisions. However, the accuracy of existing LOS risk adjustment models are limited, because they are mostly derived from administrative data, which mostly contain clinical/diagnostic information but lack detailed information on relevant demographic, socio-economic (SES), and self-reported health-related quality of life (HRQOL) risk factors, which have been shown to improve the accuracy of LOS risk adjustment models. The study investigates the relative contribution of demographic, socio-economic, and health status risk factors derived through data linkage in improving the accuracy of LOS risk adjustment models.&#x0D; MethodsPopulation-based data on 8000 individuals hospitalized for coronary heart disease were obtained from Alberta Provincial Project on Outcomes Assessment in Coronary Heart Disease (APPROACH) registry and linked to Alberta Discharge Abstract Database (DAD). SES was measured using multi-domain measure of SES derived from area-level census information, while the health-related quality of life outcome was measured using the Seattle Angina Questionnaire. LOS risk adjustment model based on hierarchical logistic regression models was developed to assess relative impact of each SES measure and HRQOL measure improving the predictive accuracy of LOS adjustment models. The relative impact of each predictor was assessed by its adjusted odds ratio (OR) and improvement over the predictive accuracy of a reference model that included patients’ clinical risk factors only. &#x0D; ResultMore than 80% of the hospitalized individuals had prolonged LOS more than 10 days. The HRQOL and single-domain measures of SES had significant impact in accurately predicting LOS. But the inclusion of the multi-domain measure SES did not significantly improve the accuracy of LOS risk adjustment models&#x0D; ConclusionUsing large population-based Canadian data, our study suggests that the inclusion of patients’ SES and health status information through data linkage can improve the accuracy of LOS risk adjustment models. The development of more accurate risk adjustment models can aid the identification of individuals at risk of prolonged LOS and comparison of health system performance across several cross-jurisdictions.

An Odd Ladder to Climb: Socioeconomic Differences Across Levels of Subjective Social Status

Subjective social status (SSS), a promising measure of social class or standing, is linked robustly to diverse indicators of mental and physical well-being. However, the processes behind SSS remain poorly understood. Socioeconomic status (SES; e.g., education, income, or occupation) is among the strongest predictors of SSS, but when and how much does SES matter for understanding differences between given SSS ranks? Drawing on multiple years of national US data (2010–2014 General Social Survey), I show that a quartic form closely describes relationships between SSS and SES: namely, education, income and occupational attainment increase at the bottom of the SSS ladder (between rungs 1–2 and 3) and before the top (between rungs 5–8), increase more modestly (“plateau”) across other ranks, and decrease markedly at the very top (across rungs 9–10). Auxiliary data on wealth accumulation among older Americans (2005 National Survey of Midlife Development in the United States; MIDUS) replicate the quartic form for education and occupation while also suggesting that high personal net worth (e.g., millionaire status) may help to explain why individuals assign themselves to the very top of the ladder despite holding less education, income or occupational prestige relative to others who rank just below. Additional multinomial analyses showed how probabilities of occupying specific rungs of the SSS ladder shift across levels of SES, confirming that the very top of the ladder is more responsive to gains in personal net worth than to traditional SES measures.