Social Risk Score Research Articles

Youth and Their Artificial Social Environmental Risk and Promotive Scores (Ya-TASERPS): An Agent-Based Model of Interactional Theory of Delinquency

Youth and Their Artificial Social Environmental Risk and Promotive Scores (Ya-TASERPS): An Agent-Based Model of Interactional Theory of Delinquency

The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III)

Objective─ To assess the role of traditional risk factors in explaining the association between cumulative social risk exposure and disparities in CVD death among US adults. Methods─ The study included 15,906 participants from the Third National Health and Nutrition Examination Survey III who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio<1, education<12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). CVD death served as the primary outcome. We assessed the contribution of each major CVD risk factor to the link between cumulative social risk exposure and CVD death. Results─ During a median follow-up of 14 years, 1309 CVD deaths occurred. Participants with elevated cumulative social risk score were at increased risk of CVD death, with hazard ratio 1.19(95%CI 1.01–1.41), 1.52(95%CI 1.28–1.79), and 1.46 (95%CI 1.23–1.74) in individuals with score 1, 2 and ​≥ ​3 respectively, compared with individuals with score of 0. Traditional CVD risk factors explained about one third of the disparities in CVD death in individuals with the elevated social risk exposure. Among the one third effect by combined CVD risk factors, current smoking contributed the largest proportion, accounting for approximately one half of the combined risk factors effect, followed by obesity and diabetes. Conclusions─Among the traditional risk factors, control of smoking appears to be the greatest opportunity to attenuate the social disparities in CVD death. While these findings call for further studies to identify other pathways that explain the elevated CVD mortality in socially disadvantaged population.

Association Between Patient Social Risk and Physician Performance Scores in the First Year of the Merit-based Incentive Payment System

The US Merit-based Incentive Payment System (MIPS) is a major Medicare value-based payment program aimed at improving quality and reducing costs. Little is known about how physicians' performance varies by social risk of their patients. To determine the relationship between patient social risk and physicians' scores in the first year of MIPS. Cross-sectional study of physicians participating in MIPS in 2017. Physicians in the highest quintile of proportion of dually eligible patients served; physicians in the 3 middle quintiles; and physicians in the lowest quintile. The primary outcome was the 2017 composite MIPS score (range, 0-100; higher scores indicate better performance). Payment rates were adjusted -4% to 4% based on scores. The final sample included 284 544 physicians (76.1% men, 60.1% with ≥20 years in practice, 11.9% in rural location, 26.8% hospital-based, and 24.6% in primary care). The mean composite MIPS score was 73.3. Physicians in the highest risk quintile cared for 52.0% of dually eligible patients; those in the 3 middle risk quintiles, 21.8%; and those in the lowest risk quintile, 6.6%. After adjusting for medical complexity, the mean MIPS score for physicians in the highest risk quintile (64.7) was lower relative to scores for physicians in the middle 3 (75.4) and lowest (75.9) risk quintiles (difference for highest vs middle 3, -10.7 [95% CI, -11.0 to -10.4]; highest vs lowest, -11.2 [95% CI, -11.6 to -10.8]; P < .001). This relationship was found across specialties except psychiatry. Compared with physicians in the lowest risk quintile, physicians in the highest risk quintile were more likely to work in rural areas (12.7% vs 6.4%; difference, 6.3 percentage points [95% CI, 6.0 to 6.7]; P < .001) but less likely to care for more than 1000 Medicare beneficiaries (9.4% vs 17.8%; difference, -8.3 percentage points [95% CI, -8.7 to -8.0]; P < .001) or to have more than 20 years in practice (56.7% vs 70.6%; difference, -13.9 percentage points [95% CI, -14.4 to -13.3]; P < .001). For physicians in the highest risk quintile, several characteristics were associated with higher MIPS scores, including practicing in a larger group (mean score, 82.4 for more than 50 physicians vs 46.1 for 1-5 physicians; difference, 36.2 [95% CI, 35.3 to 37.2]; P < .001) and reporting through an alternative payment model (mean score, 79.5 for alternative payment model vs 59.9 for reporting as individual; difference, 19.7 [95% CI, 18.9 to 20.4]; P < .001). In this cross-sectional analysis of physicians who participated in the first year of the Medicare MIPS program, physicians with the highest proportion of patients dually eligible for Medicare and Medicaid had significantly lower MIPS scores compared with other physicians. Further research is needed to understand the reasons underlying the differences in physician MIPS scores by levels of patient social risk.

Social life cycle assessment of Swedish organic and conventional pork production

PurposeSustainable animal food systems are increasingly important to society. Yet for pork, the most consumed meat product in Europe, there is no social life cycle assessment (S-LCA) in the literature. The breath and complexity of social issues and lack of data makes the task challenging. This study examines the risk of negative social impacts in Swedish pork production systems and includes workers, farmers, consumers, local community, society, and pigs as stakeholders.MethodsThe objective was to assess the risk of negative social impacts for the production and consumption of 1000-kg pork (fork weight—bone free meat including cooking losses) originating from two different systems: organic and conventional pork production. Relevant social sustainability issues for pork production systems were identified through a literature search and a consultative workshop with experts. A life cycle inventory was conducted to collect data for activity variables and compute Social Risk (SR), a measure of the risk of negative social impacts related to a reference (here the average European social conditions). Analytical Hierarchical Process (AHP) was used to obtain weights for subcategories. The SR scores and the weights were used to calculate Social Risk Time (SRT) that relates the Social Risk to the functional unit by considering the ‘exposure’ to the risk, and the Social Hotspot Index (SHI), which relates the SRT to the worst possible situation for that system.Results and discussionThe conventional pork system had 42% of inventory indicators with SR > 0.5 and the organic pork system had 32%. For all stakeholders, the pig farm had the largest SRT in both production systems except for workers in the organic pork system where the soybean farm had the largest SRT. In the conventional pork system, society as well as farmers at the pig farm had SHI > 0.5 slightly, meaning performing the same as European average. In the organic pork system, SHI < 0.5 for all stakeholders and subsystems.ConclusionSwedish pork production has lower risk of negative social impacts than the average European social conditions for most of the stakeholders: workers, pigs, local community, and consumers. Farmers and society at the subsystem pig farm have the same risk of negative social impacts as the average European social conditions. Due to the dependence of the results of the chosen reference level, the reliance on certification, and the indicators included, results should be interpreted and used with care.

Cumulative Social Risk and Cardiovascular Disease Among Adults in South Korea: A Cross-Sectional Analysis of a Nationally Representative Sample.

IntroductionThe Framingham risk score (FRS) is widely used to predict cardiovascular disease (CVD), but it neglects to account for social risk factors. Our study examined whether use of a cumulative social risk score in addition to the FRS improves prediction of CVD among South Korean adults.MethodsWe used nationally representative data on 19,147 adults aged 19 or older from the Korea National Health and Nutrition Examination Survey 2013–2016. We computed a cumulative social risk score (range, 0–3) based on 3 social risk factors: low household income, low level of education, and single-living status. CVD outcomes were stroke, myocardial infarction, and angina. Weighted logistic regression examined the associations between cumulative social risk, FRS, and CVD. McFadden pseudo-R 2 and area under receiver operating characteristic curve (AUC) assessed model performance. We conducted mediation analyses to quantify the association between cumulative social risk score and CVD outcomes that is not mediated by the FRS.ResultsA unit increase in social risk was associated with 89.4% higher risk of stroke diagnosis, controlling for the FRS (P < .001). The FRS explained 8.0% of stroke diagnosis (R 2) with fair discrimination (AUC = 0.728), and adding the cumulative social risk score enhanced R 2 and AUC by 2.4% and 0.039. In the association between cumulative social risk and stroke, the proportion not mediated by the FRS was 65% (P < .001). We observed similar trends in myocardial infarction and angina, such that an increase in social risk was associated with increased relative risk of disease and improved disease diagnosis, and a large proportion of the association was not mediated by the FRS.ConclusionControlling for the FRS, cumulative social risks predicted stroke, myocardial infarction, and angina among adults in South Korea. Future research is needed to examine non-FRS mediators between cumulative social risk and CVD.

Abstract P552: The Role of Traditional Risk Factors in Mediating the Influence of Cumulative Social Risk Exposure on Cardiovascular Death

Introduction: Cumulative social risk exposure, defined as experiencing more than one social risk factor and captured through an index of cumulative social risk, is associated with a significant increase in cardiovascular disease (CVD) mortality. However, the role of CVD risk factors in explaining this association is unclear. Methods: This analysis included 15,906 participants (45.6±19.5 years, 53.4% women, 57.7% minority race) from the Third National Health and Nutrition Examination Survey (NHANES-III) who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio&lt;1, education&lt;12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). The mediation by each CVD risk factor was assessed by estimating the magnitude of attenuation in the hazard ratio for the association between social risk score and CVD death adjusted by demographics and risk factors. Results: During a median follow up of 14 years, 1,309 CVD deaths occurred. Participants with more than one social risk factor were at increased risk of CVD death (Table) . The risk of CVD death in demographic adjusted models was attenuated by 31%, 21% and 36% in people with social risk score 1, 2, and ≥3 versus 0, respectively, after further adjustment for traditional CVD risk factors. Among all CVD risk factors included in the analysis, current smoking was the most powerful mediating effect, accounting for approximately one half of the combined risk factor effect, followed by obesity and diabetes ( Table ). Conclusions: Traditional CVD risk factors explain about one third of the association between cumulative social risk exposure and CVD death. While these findings underscore the importance of management of traditional CVD risk factors, particularly smoking, in socially disadvantaged population, they call for further studies to identify other pathways that explain the link between social risk exposure and CVD.

A Randomized Control Trial of a Targeted High-Risk Offender Program Across Three Jurisdictions

This study reviews findings from Project Regional Analytics for the Safety of Our Residents, a modified focused deterrence program operated across three jurisdictions in Massachusetts. Unlike most other evaluations of targeted high-risk offender programs, the impact on individual-level offending is examined. Data from records management systems in three police agencies were extracted and used to create social harm risk scores. The top 150 offenders were selected for inclusion in this study. Subjects were blocked into three groups according to their composite score and then randomly assigned into treatment and control groups. All treatment group offenders were invited to a notification meeting where they decided whether to participate in the program with a police and social worker case management team. The outcome examined in this study is time to a new arraignment. Nonparametric and semiparametric methods detected no significant difference between groups after approximately one year. Implications for future research and practice are then discussed.

Early Exposure to Cumulative Social Risk and Trajectories of Body Mass Index in Childhood.

Childhood social risk has been associated with increased risk of childhood obesity. However, little is known about early exposure of cumulative social risk on BMI percentile (BMIp) trajectories in early childhood. Public data from the Fragile Families and Child Wellbeing Study were analyzed (N = 3809). Maternal reports of experiences of multiple social risk factors were obtained at age 1 and 3 assessments of children. Two cumulative social risk scores were calculated by summing social factors assessed at age 1 and at age 3. Child BMIp was assessed at ages 3, 5, and 9. Linear mixed models were used to examine the effect of cumulative social risk on sex-specific BMIp trajectories. Compared with girls experiencing low social risk at either age 1 or 3, girls experiencing high social risk (≥ 2 factors) at age 1 or 3 only had higher initial BMIp at age 3 [β0 = 5.70 (95% confidence interval, CI: 0.15-1.26) and 1.37 (95% CI: -2.25 to 4.99), respectively] and had nonsignificantly greater BMIp growth rate [β1 = 0.39 (95% CI: -0.86 to 1.63) and 0.32 (95% CI: -0.86 to 1.63)]. Girls experiencing high social risk at both ages had nonsignificantly but consistently lower BMIp [β1 = -1.24 (95% CI: -2.93 to 0.46)]. In addition, girls experiencing a sum of ≥4 risk factors at both ages had lower BMIp growth rate [β1 = -1.77 (95% CI: -3.39 to -0.15)] compared to girls experiencing no risk factor. No associations were observed among boys. Early exposure to cumulative social risk may have long-term impact on BMIp trajectories among girls, depending on timing of exposure. Understanding the effect of cumulative social risk in different contexts, including sex, chronicity, and timing of exposure, may have practical implications for informing effective intervention to combat childhood obesity.

Using State Administrative Data to Identify Social Complexity Risk Factors for Children.

Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use. Nine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14). State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children.

The Association Between Physical Activity and Cognitive Function With Considerations by Social Risk Status.

We evaluated the association between physical activity and cognitive function among a national sample of the broader U.S. adult population, with consideration by social risk. Data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) were used to identify 2031 older adults, ages 60-85. Social risk was classified by measuring four NHANES variables, namely poverty level, education, minority status, and social living status, which were graded on a scale of 0-4, with higher scores corresponding with higher social risk. The Digit Symbol Substitution Test (DSST) was used to assess cognitive function. Physical activity was assessed via a validated self-report questionnaire. After adjustments, meeting physical activity guidelines (vs not) was associated with greater cognitive function (β = 3.0, 95% CI [1.5, 4.4], p < 0.001). In this same model, social risk status was also independently associated with cognitive function. Meeting physical activity guidelines (vs. not) was not associated with higher cognitive function among those with a social risk score of of 3 (β = -0.01; 95% CI [-6.3, 6.4], p = 0.99) or a social risk score of 4 (β = -6.8, 95% CI [-15.7, 2.0], p = 0.12). In this national sample of older adults, meeting physical activity guidelines, and degree of social risk were independently associated with cognitive function. However, physical activity was not associated with cognitive function among older adults with the highest degree of social risk.

Cumulative social risk exposure in childhood and smoking and excessive alcohol use in adulthood.

Social inequalities in adult smoking and excessive alcohol intake may be associated with exposure to multiple childhood social risk factors across different domains of risk within the household. We used data from a cross-sectional cohort study of adults (40-75 years) in 1993-97 living in England (N = 19466) to examine the association between clusters of childhood social risks across different domains with adult smoking and excessive alcohol use. Participants reported exposure to six childhood social risk factors, current smoking behaviour and alcohol intake. Factor analysis was used to identify domains of social risk. We created a childhood cumulative domain social risk score (range 0-2) from summing the total number of domains. Factor analysis identified two domains of childhood social risk within the household: maladaptive family functioning (parental unemployment, substance misuse, physical abuse) and parental separation experiences : maternal separation, divorce, being sent away from home). Compared to those children with risk exposure in no single domain, children with risk exposure in both domains (i.e. maladaptive family functioning, parental separation experiences) had a higher prevalence of adult smoking [men: Prevalence ratio (PR) = 1.74, 95% confidence intervals (CI): 1.35-2.26; women: PR = 1.71 95% CI: 1.34-2.18]. There was a trend association between the number of childhood social risk domains and adult smoking (both sexes: P < 0.001) and excessive alcohol use (men: P <0.008). Further work is needed to understand if addressing cumulative risk exposure to maladaptive family functioning and parental separation experiences can reduce social inequalities in adult smoking and excessive alcohol intake.

Cumulative social risk and type 2 diabetes in US adults: The National Health and Nutrition Examination Survey (NHANES) 1999-2006.

The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cross-sectional analysis of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006. We included 10,276 adults aged ≥20 years. Diabetes mellitus was defined by physician diagnosis or fasting plasma glucose (≥126 mg/dl) or glycated hemoglobin (≥6.5%). Social risk factors (low family income, low education level, minority racial/ethnic group status, and single-living status) and health-related behaviors (physical activity and dietary intake) were self-reported. Social risk factors were combined in a cumulative social risk index (range 0 to ≥3) and logistic regression used to assess the association of cumulative social risk and diabetes, taking into account complex survey design and sampling weights. Of 10,276 participants, 1515 (weighted proportion - 10%) had diabetes, 3295 (32.3%) and 1830 (9.0%) were exposed to ≥1 adverse social risk factor and ≥3 social risk factors, respectively. Diabetes was associated with increasing cumulative social risk in a graded manner (p for trend <0.001). Compared with a cumulative social risk score of 0, the age- and sex-adjusted diabetes odds for a cumulative social risk score of ≥3 was 2.84 (95% confidence interval: 2.23-3.62), and 2.72 (95% confidence interval: 2.05-3.60) after further adjustment for family history of diabetes, body mass index, smoking, dietary intake and leisure time physical activity. Health behaviors and adiposity only partially influenced the cumulative social risk and diabetes relationship. Simultaneous exposure to several adverse social risk factors significantly influences the odds of diabetes. Better prevention and control of diabetes needs accounting for all aspects of social disadvantage.

Cumulative social risk exposure and risk of cancer mortality in adulthood.

BackgroundAdults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults.MethodsThe study included 8745 adults (aged ≥ 40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers.ResultsDeaths from all-cancers combined (P for trend = 0.001), tobacco-related cancers (P for trend = <0.001), and lung cancer (P for trend = 0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR = 1.8, 95 % CI = 1.3-2.4), tobacco-related cancers (HR = 2.6, 95 % CI: 1.6-4.0), and lung cancer (HR = 2.3, 95 % CI = 1.3-4.1).ConclusionsU.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.

Predicting factors of health-related quality of life in octogenarians: a 3-year follow-up longitudinal study.

The proportion of very old people is rising, and so, describing their health-related quality of life (HRQoL) is an important point of interest. The aim of this study was to analyse the predictive factors on HRQoL throughout a 3-year follow-up period, in a community-based cohort of octogenarian people. From 290 subjects aged 85 and over, sociodemographic and geriatric data, including levels of frailty phenotype assessment, and HRQoL using the EuroQol 5D3L (EQ-5D) instrument were collected. A longitudinal analysis was performed by generalized estimating equations (jointly testing the bivariate effect of variables and its time dependence) and regression mixed models to evaluate the adjusted effect of variables on HRQoL after a 3-year follow-up. In the EQ-5D baseline assessment, the average visual analogue self-rating scale value was 63.82 (SD ± 19.45), the EQ-5D index was 0.67 (0.34) and the most significant issues were pain/discomfort (61.2 %), depression (45.3 %) and mobility (44.6 %). The third year index was 0.55 (0.38). Independent predictive factors of a lower HRQoL identified by the regression mixed models were female gender (marginal effect ME = -0.101; p = 0.003), being pre-frail (ME = -0.142; p = 0.011) or frail (ME = -0.071; p = 0.030), having heart failure (ME = -0.081; p = 0.037) and having a high social risk score (ME = -0.020; p = 0.015). In contrast, higher functional status (ME = 0.050; p < 0.001) and nutritional score (ME = 0.013; p = 0.011) appeared to be predictive factors of an enhanced HRQoL. The adjusted effect of "time of follow-up" had no statistical significance. Frail individuals at baseline have a significant lower HRQoL, whereas a higher functional status and nutritional status are independent predicting factors of an enhanced HRQoL after 3 years of follow-up. These findings may encourage clinicians in order to asses HRQoL.

Association between cumulative social risk and ideal cardiovascular health in US adults: NHANES 1999–2006

BackgroundThe American Heart Association developed the Life's Simple 7 metric for defining cardiovascular health. Little is known about the association of co-occurring social risk factors on ideal cardiovascular health. MethodsUsing data on 11,467 adults aged ≥25years from the National Health and Nutrition Examination Survey 1999–2006, we examined the association between cumulative social risk and ideal cardiovascular health in US adults. A cumulative risk score (range 0 to 3 or 4) was created by summing four social risk factors (low family income, low education level, minority race, and single-living status). Ideal levels for each component in Life's Simple 7 (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, and diet) were used to create an ideal Life's Simple 7 score [0–1 (low), 2, 3, 4, and 5–7 (high)]. ResultsAdults with low income (odds ratio [OR]=0.30 [95% CI 0.23–0.39]), low education [0.22 (0.16–0.28)], who are non-white (0.44 [0.36–0.54]) and single-living [0.79 (0.67–0.95)] were less likely to have 5–7 versus 0 ideal Life's Simple 7 scores after adjustment for age and sex. Adults were less likely to attain 5–7 versus 0 ideal Life's Simple 7 scores as exposure to the number of social risk factors increased [OR (95% CI) of 0.58 (0.49–0.68); 0.27 (0.21–0.35); and 0.19 (0.14–0.27) for cumulative social risk scores of 1, 2, and 3 or 4, respectively, each versus 0]. ConclusionsUS adults with an increasing number of socially risk factors, were progressively less likely to attain ideal levels of cardiovascular health factors.

Cumulative social risk and risk of death from cardiovascular diseases and all-causes

Mortality rates for cardiovascular diseases (CVD) have declinedsteadily over the past few decades in high-income countries. Thisdeclinehasbyfardisproportionatelyfavoredthosewithhigherincome,educational attainment, and social support or those who are membersof ethnic majority groups [1–7]. Few studies have examined the cumu-lative effects of multiple social risk factors on CVD mortality rates [8].Disparate exposure to multiple social risk factors may contribute tosocial inequalities in CVD mortality rates.We used data on 10,035 adults (age ≥ 30 years) with no history ofCVD, from the NHANES III Mortality Study (1988–1994 survey datalinked to2006mortalitydata), toassesstheprospectiveassociationbe-tween cumulative social risk and CVD deaths, b65-year-old mortality,and all-cause mortality. Linkage with the National Death Index alloweddefinition of CVD deaths as ICD-9 codes 390–459orICD-10codesI00-I99. Income was assessed using the poverty income ratio (ratio offamily income to the federal poverty level) dichotomized into below1.00 (below the official definition of poverty) vs. 1.00 or greater (incomeabove the poverty level). Education level was dichotomized into low(b12 years, representing b high school diploma) vs. high (≥12 years,representinghighschooldiploma,somecollege,orcollegedegree)levels.Self-reported race/ethnicity was classified into a minority group (non-Hispanic Black, Mexican-American and Other) vs. non-Hispanic White.Single-livingstatus (proxyfor social isolation/lowlevel of socialsupport)was classified into two groups, married/living as married vs. never mar-ried, widowed, divorced, or separated. Each of the four social risk factorswere assigned a score of 1 for their presence or 0 for absence and weresummed to create a cumulative social risk score (range 0 to 4). Cox pro-portional models were used to estimate hazard ratios (HR) and 95%confidence intervals (CI) for the association between cumulative socialrisk and mortality. We evaluated the contribution of biological risk fac-tors(bodymassindex[BMI], HbA1c,systolic blood pressure[SBP],cho-lesterol, triglycerides, C-reactive protein [CRP] and estimatedglomerular filtration rate [eGFR]) to the association between cumula-tive social risk and CVD deaths. We hypothesized that these biologicalfactorsareonthepathwayintheassociationbetweenexposuretosocialrisk factors and occurrence of CVD deaths, and thus are mediators of thisassociation.HbA1cwasmeasured usingaBio-RadDiamantionexchangehigh-performanceliquid chromatographysystem. Serumtotalcholester-ol and triglycerides were measured enzymatically by a Hitachi 704 Ana-lyzer. eGFR was based on the Modification of Diet in Renal Diseasestudy equation. Serum CRP was measured using the Behring latex-enhanced CRP assay.Atotalof 31.7%of adultsreportedatleastonesocialriskfactor;7.1%reported3 or more. Over a median14-yearfollow-up, there were 2604deaths (1386 in males and 1218 in females) including 924 deaths relatedto cardiovascular diseases. Table 1 shows the age-and sex-adjusted asso-ciationsofeachsocialriskfactorwithCVDdeaths, b65-year-oldmortality,and all-cause mortality. Ha zard ratios for CVD deaths, b65-year-old mor-tality and all-cause mortality signi ficantly increased with an increasingnumber of social risk factors and were greatest in those exposed to 3 ormore social risk factors compared with those with 0 (Table 1). Table 2shows the association between exposure to 3 or more social risk factorsand CVD deaths, as well as the contribution of biological risk factors tothis association. Biological risk factors accounted for 12% (95% CI: 4% to18%) of the association between exposure to 3 or more social risk factorsand CVD deaths.PreviousstudiesonsocialinequalitiesinCVDmortalityhavetypicallyoperationalized social disadvantage using single measures of socioeco-nomicstatus(e.g.manualoccupationalclass,loweducationlevel,lowin-come) or a composite of socioeconomic measures in several periodsthrough the life course [8]. However, summing the number of times anindividualhadbeeninalowersocioeconomiccategoryasaproxyforcu-mulative social disadvantage, may erroneously attribute CVD mortalityto risks associated with the accumulation of only socioeconomic

Social and behavioral risk factors for obesity in early childhood.

Although multiple social and behavioral risk factors associated with obesity co-occur among young children, most studies have examined them separately. The purpose of this study was to examine the relationship between social risk factors, behavioral problems, health behaviors, and obesity among preschoolers in the Fragile Families and Child Wellbeing Study (N = 1589). A cumulative social risk score was created by summing maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father's incarceration, obtained when the child was 3 years old. Mothers reported on the child's internalizing and externalizing behaviors with the Child Behavior Checklist at age 5 years. Mothers also reported on hours the child spent watching television and sleeping as well as servings of soda or juice drinks the child consumed per day. Child height and weight were measured at age 5 years. Obesity was defined as body mass index ≥ 95th percentile. In regression analyses adjusted for health behaviors, behavioral problems, and sociodemographic factors, cumulative social risk was associated with obesity among girls. Externalizing behavioral problems were associated with obesity among girls (prevalence ratios [PRs], 1.5; 95% confidence interval [CI], 1.2-1.7) and boys (PR, 1.3; 95% CI, 1.1-1.6). Short sleep duration was also associated with obesity among girls (PR, 1.2; 95% CI, 1.0-1.4) and boys (PR, 1.3; 95% CI, 1.1-1.5) even after adjusting for behavioral problems and social risk factors. Watching more than 2 hours of television per day was associated with obesity among boys (PR 1.5; 95% CI, 1.2 to 1.9) but not girls. Co-occurring social and behavioral risk factors are associated with obesity among 5-year-old children.

Prospective Surveillance Study of Blood Stream Infections Associated With Central Venous Access Devices (Port-type) in Children With Acute Leukemia

The use of intensive chemotherapy and central devices has improved patients survival, but it is associated with catheter-related blood-stream infections (CRBSI). An educational program was instituted for preventing CRBSI occurrence in acute leukemia pediatric patients having totally implanted central devices. The Centers of Disease Control and Prevention criteria were used as definition for CRBSI. Data collected were age, sex, diagnosis, chemotherapy, inpatient versus outpatient, microbiological data, risk factors, social risk score, and treatment performed. CRBSI rate decreased from 6.7 to 3.7/1000 catheter-days with preventive measures (P=0.05). A further decrease to 1.5/1000 catheter-days was reached after the intensification of the educational program (P=0.01). Severe neutropenia at the time of catheter insertion was related to CRBSI and to infection recurrence (P<0.05). Most of the episodes occurred during induction chemotherapy. Thirty-six CRBSI episodes occurred in 25 of 73 patients. The most frequent microorganism isolated was Staphylococcus spp. Antibiotherapy was successful in 83.3% of episodes. Six patients needed a central venous access device replacement. Our intervention program was successful to decrease the CRBSI rates and its intensification allowed a further decrease, approaching reported rates in this setting. Severe neutropenia at the time of central venous access device insertion was related to CRBSI occurrence and recurrence.

The Key Role of Psychosocial Risk on Therapeutic Outcome in Obese Children and Adolescents. Results from a Longitudinal Multicenter Study

Objective: Childhood obesity is high on the global public health agenda. Although risk factors are well known, the influence of social risk on the therapeutic outcome of lifestyle intervention is poorly examined. This study aims to investigate the influence of migration background, low education, and parental unemployment. Methods: 62,147 patients participated in multidimensional lifestyle intervention programs in 179 pediatric obesity centers. Data were collected using standardized software for longitudinal multicenter documentation. 12,305 (19.8%) attended care for 6-24 months, undergoing an intensive therapy period and subsequent follow-ups for up to 3 years. A cumulative social risk score was calculated based on different risk indicators. Results: Migration background, low education, and parental employment significantly influenced the outcome of lifestyle intervention. The observed BMI-SDS reduction was significantly higher in the subgroup with low social risks factors (Δ BMI-SDS -0.19) compared to those presenting moderate (Δ BMI-SDS -0.14) and high social risk (Δ BMI-SDS -0.11). Conclusion: Our data underline the effect of children's social setting on the outcome of multidimensional lifestyle intervention. The presence of a high social risk burden is a negative predictor for successful weight loss. Specific therapeutic programs need to be developed for disadvantaged children and adolescents.

Cumulative Social Risk and Obesity in Early Childhood

The goal of this study was to examine the relationship between cumulative social adversity and childhood obesity among preschool-aged children (N = 1605) in the Fragile Families and Child Wellbeing Study. Maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father's incarceration were obtained when the child was 1 and 3 years of age. Two cumulative social risk scores were created by summing the 6 factors assessed at ages 1 and 3 years. Child height and weight were measured at 5 years of age. Logistic regression models stratified according to gender were used to estimate the association between cumulative social risk and obesity, adjusting for sociodemographic factors. Seventeen percent of children were obese at age 5 years, and 57% had at least 1 social risk factor. Adjusting for sociodemographic factors, girls experiencing high cumulative social risk (≥2 factors) at age 1 year only (odds ratio [OR]: 2.1 [95% confidence interval [CI]: 1.1-4.1]) or at 3 years only (OR: 2.2 [95% CI: 1.2-4.2]) were at increased odds of being obese compared with girls with no risk factors at either time point. Those experiencing high cumulative risk at age 1 and 3 years were not at statistically significant odds of being obese (OR: 1.9 [95% CI: 0.9-4.0]). No significant associations were noted among boys. There seems to be gender differences in the effects of cumulative social risk factors on the prevalence of obesity at 5 years of age. Understanding the social context of families could make for more effective preventive efforts to combat childhood obesity.