Socioeconomic Disparities Research Articles

Brexit and the London housing market: An empirical contribution

This study aims to analyse the impact of Brexit on London’s housing market, exploring socio-economic and regional disparities. By examining property transaction data from 2012 to 2022, the research seeks to understand how Brexit has influenced real housing prices across different boroughs of London. The methodology involves aggregating transaction data from the Her Majesty (HM) Price Paid database and normalizing prices using the Consumer Price Index (CPI) to obtain real price variations. These data were segmented into three distinct periods: pre-Brexit (2012–2016), post-plebiscite Brexit (2016–2019), and post-implementation Brexit (2020–2022). Spatial analysis was conducted using the software Quantum Geographic Information System (QGIS), transforming point data (postcodes) into polygonal data (wards) for better visualization and comparison. The findings reveal significant socio-economic impacts, with traditionally affluent areas such as Westminster, Kensington, and Chelsea experiencing notable declines in real housing prices. Conversely, certain outer boroughs like Newham and Barnet showed resilience, with positive real price variations despite decreased sales. This geographical disparity underscores the uneven distribution of Brexit’s economic consequences, highlighting the critical role of localized economic policies and development projects in mitigating adverse effects. The results confirm existing literature on the polarization and regional inequalities exacerbated by Brexit while providing new insights into the complex interplay of local and global factors affecting housing markets. The findings emphasize the need for targeted policy interventions to address the diverse challenges posed by Brexit, ensuring both affluent and disadvantaged areas receive adequate support. This research is crucial for informing public policy, urban planning, and housing market strategies in a post-Brexit context, promoting equitable and sustainable development across London.

A Disparate Disaster: Spatial Patterns of Building Damage Caused by Hurricane Ian and Associated Socio-Economic Factors

The literature shows that communities under different socio-economic conditions suffer different levels of damage in disasters. In addition to the physical intensity of hazards, such differences are also related to the varying abilities of communities to prepare for and respond to disasters. This study analyzes the spatial patterns of building damage in Hurricane Ian in 2022 and investigates the socio-economic disparities related to the damage. Specifically, this study employs NASA’s Damage Proxy Map (DPM2) to analyze spatial patterns of building damage caused by the hurricane. Then, it uses statistical analysis to assess the relationships between building damage and hurricane intensity, building conditions, and socio-economic variables at the building and census tract levels. Furthermore, the study applies geographically weighted regression (GWR) to examine the spatial variation of the damage factors. The results provide valuable insights into the potential factors related to building damage and the spatial variation in the factors. The results also reveal the uneven distribution of building damage among different population groups, implying socio-economic inequalities in disaster adaptation and resilience. Moreover, the study provides actionable information for policymakers, emergency responders, and community leaders in formulating strategies to mitigate the impact of future hurricanes by identifying vulnerable communities and population groups.

Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder

BackgroundOnly 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes. MethodsThirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured. ResultsCompared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, P = 0.003), 2.37 more hospital admissions (P = 0.002), and 28.40 additional inpatient days (P = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (P = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all P < 0.05). ConclusionsWe identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.

Socioeconomic disparities and cardio-cerebrovascular diseases: A nationwide cross-sectional study.

Although socioeconomic status (SES) is considered a risk factor for cardio-cerebrovascular diseases (CCVDs), few studies have examined this association. In this cross-sectional study, we aimed to assess the prevalence and trends of CCVDs across different SES groups over a 12-year period in a representative Korean population. We analysed 47 745 economically active adults aged ≥30 and <65 years from 97 622 patients in the Korean National Health and Nutrition Examination Survey (2007-18), where a new independent sample of the population was examined each year. We categorised the participants into four groups based on education level and income. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CCVD, including angina, myocardial infarction, and stroke, was analysed at four-year intervals. Average age, urban residence, white-collar occupation, and body mass index >30 increased, whereas CCVD prevalence did not change significantly (P = 0.410) over the study period. Low education (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04-1.47, P < 0.001) and low income (OR = 1.14; 95% CI = 1.02-1.28, P = 0.017) were significant determinants of CCVD in addition to existing traditional risk factors. CCVD prevalence was significantly higher in both the low-education and low-income groups compared to the high-education and high-income groups every four years, with no significant change in this gap over the study period (P = 0.239). Despite the increase in the elderly population and the prevalence of obesity, the incidence of CCVDs in Korea has remained unchanged. Individuals with low education or low income had a significantly higher prevalence of CCVD, with the lowest SES group, defined by both low education and low income, consistently having the highest prevalence of CCVDs.

Socioeconomic disparities in reception of limb-sparing surgery versus amputation for lower extremity sarcoma

BackgroundIn lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery. MethodsPatients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (p < 0.05). ResultsA total of 6465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12–2.85, p = 0.015). Nonmetropolitan residence (OR: 1.69, 95% CI: 1.43–2.00, p < 0.001) also conferred higher risk of amputation compared with residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (p < 0.001) even when controlled by sociodemographic and clinical characteristics. ConclusionsThere are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes.

A Feasibility Study of a Music Enrichment Program on Relative Reinforcing Value of Food and Home Environmental Enrichment among Families of Low Socioeconomic Status.

Emerging evidence suggests that low socioeconomic status (SES) home environments may play a role by promoting excess energy intake through a lack of access to non-food reinforcers. Because of the deleterious effects of SES-related disparities on child health and development, feasible and culturally acceptable interventions are urgently needed. Community-based music enrichment programs may be an ideal intervention strategy. In collaboration with a local non-profit organization and music studio, we conducted a pilot randomized controlled trial to assess the effects of a music enrichment program versus a play date control in a group of 9-24-month-old healthy infants (N = 16). The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Children's Mercy Hospital Kansas City. This study is registered with clinicaltrials.gov (NCT05868811). Overall, we found some intervention effects on the relative reinforcing value of food (RRVfood) and the home environmental enrichment measures (i.e., increased music use at home and the home language environment). Our intervention demonstrated large effects on the increased use of music at home. We did not find significant group differences in the RRVfood and home language environment, but some of the effect sizes were medium-to-large. Results also suggest that our intervention is feasible and acceptable. Parent feedback indicated that the intervention was well-liked and that the steps we took to help reduce barriers worked. Music enrichment programs may be a high-impact, low-cost strategy to address socioeconomic disparities.

Uncovering mediational pathways behind racial and socioeconomic disparities in brain volumes: insights from the UK Biobank study.

Mediation pathways explaining racial/ethnic and socioeconomic (SES) disparities in structural MRI markers of brain health remain underexplored. We examined racial/ethnic and SES disparities in sMRI markers and tested total, direct, and indirect effects through lifestyle, health-related, and cognition factors using a structural equations modeling approach among 36,184 UK Biobank participants aged 40-70years at baseline assessment (47% men). Race (non-White vs. White) and lower SES-predicted poorer brain sMRI volumetric outcomes at follow-up, with racial/ethnic disparities in sMRI outcomes involving multiple pathways and SES playing a central role in those pathways. Mediational patterns differed across outcomes, with the SES-sMRI total effect being partially mediated for all outcomes. Over 20% of the total effect (TE) of race/ethnicity on WMH was explained by the indirect effect (IE), by a combination of different pathways going through SES, lifestyle, health-related, and cognition factors. This is in contrast to < 10% for total brain, gray matter (GM), white matter (WM), and frontal GM left/right. Another significant finding is that around 57% of the total effect for SES and the normalized white matter hyperintensity (WMH) was attributed to an indirect effect. This effect encompasses many pathways that involve lifestyle, health-related, and cognitive aspects. Aside from WMH, the percent of TE of SES mediated through various pathways ranged from ~ 5% for WM to > 15% up to 36% for most of the remaining sMRI outcomes, which are composed mainly of GM phenotypes. Race and SES were important determinants of brain volumetric outcomes, with partial mediation of racial/ethnic disparities through SES, lifestyle, health-related, and cognition factors.

Impact of racial, ethnic, and socioeconomic disparities on presentation and survival of HCC: A multicenter study

Impact of racial, ethnic, and socioeconomic disparities on presentation and survival of HCC: A multicenter study

Robotic availability, not payor status, determines access to robotic emergency general surgery hernia repair in California and Florida.

Previous studies have demonstrated that access to robotic surgery is influenced by socioeconomic factors, including insurance status. The 2010 Affordable Care Act established an avenue for states to expand Medicaid coverage, which has increased access to surgical care for many conditions. We hypothesized that socioeconomic disparities in access to robotic repair of non-elective emergency general surgery (EGS) hernias are less prevalent in California, a Medicaid expansion state, compared to Florida, which has not adopted Medicaid expansion. The 2021 California and Florida State Inpatient Databases were used to identify all EGS admissions with an ICD-10 procedure code for ventral or inguinal hernia repair. Elective procedures and those with concurrent unrelated abdominal procedures were excluded. Patient demographics, comorbidity burden, payor status, and income quartile were abstracted. Aggregation of hospital data identified high-volume trauma, robotic, and EGS centers. There were 15,683 EGS hernia procedures of which 11% underwent robotic repair: 14% in Florida and 8% in California. On multivariable logistic regression, older age, male sex, lower income, and Medicare insurance were associated with reduced odds of robotic hernia repair in California, but not in Florida, despite an uninsured rate of 10%. The greatest predictor of robotic surgery in both states was treatment at a robotic surgery center. Overall, accounting for patient- and hospital-level factors, hernia surgeries in Florida were more likely to involve robotics (OR 1.61, CI 1.42-1.81, p < 0.001) compared to California. There were fewer disparities in access to EGS robotic hernia repairs in Florida than in California. This suggests that robotic surgery access for EGS hernia repairs is primarily determined by institutional adoption of robotic surgery, not income or payor status. Compared to California, Florida appears to have greater market penetration of robotic surgery, which has increased access to robotic EGS for all patients.

Socioeconomic inequalities in dementia risk among a population-based cohort: Quantifying the role of a broad combination of lifestyle factors.

The complex associations of socioeconomic status (SES) and lifestyle with dementia are unclear. Our objective was to examine whether a broad combination of lifestyle factors mediates the associations of SES with incident dementia and the extent of interaction or joint relations of lifestyles and SES with dementia. A total of 274,871 participants from the UK Biobank were included. SES was assessed using the Townsend Deprivation Index. A lifestyle index was created based on smoking status, alcohol consumption, physical activity, social connections, sleep duration, diet, and sedentary behavior. Cox proportional hazards models were fitted. Mediation and interaction analyses were conducted to explore the relationship between lifestyles and SES in dementia. The HRs (95% CIs) for when participants with low SES were compared with participants of high SES were 1.32 (1.22-1.42) for all-cause dementia, 1.25 (1.11-1.40) for Alzheimer's disease (AD), and 1.61 (1.37-1.90) for vascular dementia (VD). Lifestyles explained ≤ 7.8% of socioeconomic disparities in dementia. Unhealthy lifestyle categories were associated with a higher risk of dementia and its subtypes across all SES levels. The HRs (95% CIs) for all-cause dementia, AD, and VD comparing participants with low SES and the least healthy lifestyle versus those with high SES and the healthiest lifestyle were 1.82 (1.56-2.11), 1.51 (1.20-1.90), and 2.56 (1.81-3.61), respectively. Adhering to a healthy lifestyle may prevent dementia across all socioeconomic groups, but socioeconomic inequalities in dementia cannot be fully addressed by promoting healthy lifestyles alone. The social determinants of dementia need to be better addressed.

Socioeconomic determinants of male contraceptive use in South Africa: a secondary analysis of the 2016 SADHS data

BackgroundHistorically, family planning discussions have predominantly centred on women, overlooking the crucial role men play in contraception. This is particularly concerning in regions like Sub-Saharan Africa (SSA), where reproductive health challenges are pronounced. South Africa, a key country within SSA, continues to grapple with issues such as high unintended pregnancy rates and increasing pregnancy-related mortality. Understanding the factors that deter male contraceptive use is essential for achieving universal access to sexual and reproductive health (SRH) services. This study investigates the socioeconomic disparities influencing male contraceptive use in South Africa, drawing on data from the 2016 South Africa Demographic Health Survey.MethodsThe study utilised data from the 2016 South African Demographic and Health Survey, which employed a stratified, two-stage sampling design across all provinces based on the 2011 Census. The survey focused on men aged 15–59 using the “Man’s Questionnaire.” Various socio-demographic and attitudinal variables were analysed using STATA 17. The analysis included multinomial logistic regression to identify determinants of male contraceptive use and the Erreygers Normalized Concentration Index to assess socioeconomic inequalities in contraceptive uptake.ResultsAmong the surveyed men, 47% reported not using any contraception, 40% used male methods, and 13% relied on their partners’ contraceptive use. A majority began sexual activity between the ages of 14–17 (54%), resided in urban areas (56%), were unmarried (67%), and had attained secondary education (70%). Notably, 78% disagreed that contraception is solely a woman’s responsibility, and 64% expressed positive attitudes toward contraception. Age, marital status, and education level emerged as significant factors influencing contraceptive use. The study revealed a slight pro-rich inequality in male contraception use, with socioeconomic status (SES) being the most significant contributor to this disparity (223.22%). This suggests that higher SES is associated with increased inequality in the adoption of modern male contraceptive methods.ConclusionThese findings highlight the impact of socioeconomic disparities and entrenched cultural beliefs on male contraceptive use in South Africa. To address these challenges, comprehensive strategies that prioritise education, expand family planning media campaigns and ensure equitable access to contraception are urgently needed.

Socioeconomic disparity in the natural history of cutaneous melanoma: evidence from two large prospective cohorts

BackgroundPrevious studies on the associations between socioeconomic status (SES) and cutaneous malignant melanoma (CMM) failed to distinguish the effects of different SES factors under an individual-data-based prospective study design.MethodsBased on...

Internações hospitalares por desnutrição infantil no Brasil: um panorama epidemiológico dos últimos 10 anos

Objective: To describe the number of hospital admissions due to child malnutrition in Brazil. Methods: This is an epidemiological, descriptive, observational study with a quantitative approach, focusing on hospitalizations of children aged 1 to 9 years due to malnutrition across Brazilian regions. Data were collected from the Notifiable Diseases Information System (SINAN) between January 2012 and December 2022. Results: A total of 20,855 cases of child malnutrition were reported in Brazil. The years with the highest incidence within the analyzed period were 2012, with 13.0% of cases, followed by 2014, with 12.4%. The Northeast region showed the highest number of hospitalizations, accounting for 34.2% of the total cases. Reports of malnutrition were more common among males (50.9%), children aged 1 to 4 years (70.9%), and those self-identified as brown (40.8%). Regarding the number of deaths, 286 cases were reported, with the highest incidence in 2012 (12.9%). Conclusion: Although there has been a significant decrease in hospitalizations due to malnutrition over the study period, child malnutrition remains a public health issue, driven by fac- tors related to socioeconomic inequalities and disparities in health services across the country.

Exploring risk factors for undernutrition in children aged under five years in Yemen.

Undernutrition is a global health concern, particularly in low-income countries, and can manifest as wasting, stunting and/or underweight. In Yemen, the recent armed conflict is likely to have significantly increased the incidence of undernutrition in young children, particularly those living in communities that were already experiencing socioeconomic and health disparities. To explore the risk factors associated with wasting, stunting and underweight in children aged between six months and five years living in one district of Yemen. A cross-sectional study was conducted using a two-part questionnaire to collect anthropometric measurements and sociodemographic characteristics of children enrolled on an outpatient programme for undernourished children at three healthcare facilities in the Jiblah district, and of their families and households. Of the 120 children included in the study, 58 (48%) had wasting, 27 (23%) had stunting and 35 (29%) were underweight. Risk factors for undernutrition included being under the age of three years, being a girl, having had a low birthweight, having siblings under the age of five years, having a mother who is a housewife, living in a household relying on unimproved sources of drinking water, living in a rural area, and living in a low-income household. The nutritional status of children in Yemen is under continuing threat. The identification of risk factors for undernutrition may increase awareness of the issue and influence the policy decisions of the international community.

6894 Disparities in Continuous Glucose Monitor Utilization and Real-Time Remote Sharing in Patients with Type 2 Diabetes Treated with Insulin on Medicare

Abstract Disclosure: K.L. Flint: None. T. Ting: None. K. Rivera: None. P. Tamang: None. C.A. Colling: None. J.H. Li: None. M.S. Putman: Consulting Fee; Self; Synspira Therapeutics. Research Investigator; Self; Dexcom. Other; Self; Vertex Pharmaceuticals Incorporated. Introduction: Continuous glucose monitors (CGM) are FDA-approved for the management of diabetes and have been shown to improve glycemic control. For optimal utilization, CGM can be connected to cloud-based clinic portals for real-time sharing of glycemic data with clinicians to guide clinical care. Although studies have previously identified disparities in access to CGM for patients who receive Medicare, limited data are available examining disparities in CGM utilization and data sharing. Hypothesis: We hypothesized that racial and socioeconomic disparities in CGM access exist both in utilization and in real-time remote sharing of CGM data. Methods: This was a retrospective cohort study examining patients with type 2 diabetes on insulin using Medicare as primary or secondary insurance in a single diabetes clinic affiliated with a tertiary care medical center. Clinical data extracted from the electronic health record (EHR) included age, self-reported race and ethnicity, sex, preferred language, education level, ZIP code-based median household income, and enrollment in the EHR-patient portal. The most recent diabetes clinic note for each patient as of October 2023 was reviewed to assess whether each patient was using CGM at the time of the visit. The clinic’s CGM portal accounts were reviewed to assess whether the patient was connected to and actively sharing CGM data with the clinic. Two sample t-tests and chi-square tests were used to evaluate continuous and categorical predictors of CGM use and real-time remote sharing, respectively. Results: Of the 847 patients who qualified for inclusion, 420 (49.6%) were using CGM and 213 (25.1%) were sharing CGM data in real-time. Compared to patients not using CGM (n=427), patients using CGM were younger (70.8 years vs 73.5 years, p&amp;lt;0.001) and more often enrolled in the EHR-based patient portal (91.9% vs 84.1%, p&amp;lt;0.001); however, there were no differences in racial, ethnic, or socioeconomic factors between the groups (p&amp;gt;0.05 for all). Of the patients using CGM, remote sharing of data was associated with younger age (69.5 years vs 72.3 years, p&amp;lt;0.01), identifying as White (74.2% vs 65.0%, p=0.04), using English as preferred language (92.5% vs 84.2%, p=0.02), higher levels of education (p=0.01), and using the EHR-based patient portal (97.2% vs 86.7%, p&amp;lt;0.001). Conclusions: In this cohort of patients with type 2 diabetes on insulin receiving Medicare, there were no significant socioeconomic disparities in CGM utilization. However, racial and socioeconomic disparities were pronounced in real-time remote sharing of CGM data, suggesting that patients from minoritized racial backgrounds, patients who do not use English as their preferred language, and patients with less education may benefit from additional support and training to connect and share their CGM with their providers. Presentation: 6/2/2024

Educational and income inequalities across diseases in Denmark: a register-based cohort study

Educational attainment and income are often, but not always, associated with disease incidence. Existing research typically examines single diseases, resulting in disparate analyses with little comparability. In this study, we aimed to assess educational and income inequalities across diseases in Denmark. This register-based study included all Danish residents aged at least 30 years between Jan 1, 2013, and Dec 31, 2022, who were born after 1920, and with known educational attainment and income. We used a disease-wide approach to assess associations between education and income and the incidence of 751 diagnostic codes determined upon hospital admission. We estimated age-standardised incidence rates and incidence rate ratios (IRRs) using Poisson regression, adjusted for birth cohort and stratified by sex. Participants were followed up until time of diagnosis, death, emigration, or until Dec 31, 2022. 4 541 309 individuals aged 30 years and older were registered as living in Denmark between Jan 1, 2013, and Dec 31, 2022. 121 083 were excluded due to limited or missing information about educational attainment. 4 420 226 individuals were included in the analysis of educational inequalities (2 232 200 [50%] were female and 2 188 026 [50%] were male). 23 708 were excluded due to absence of income information, and 4 396 518 were included in the analysis of income inequalities (2 223 217 (51%) were female and 2 173 301 (49%) were male). Socioeconomic differences in incidence rates were observed across all disease groups; incidence rates of most diseases decreased with higher educational attainment and income. The magnitude of the socioeconomic inequalities varied substantially. Among non-communicable diseases, the strongest positive association with regard to education was observed in chronic obstructive pulmonary disease for female individuals (low education vs high education, IRR 2·7 [95% CI 2·4-3·0]) and schizophrenia for male inividuals (low education vs high education, IRR 4·4 [2·2-8·8]), and the strongest negative association was in melanoma and other skin cancers for females (low education vs high education, IRR 0·7 [0·7-0·8]) and melanoma and skin cancers for males (low education vs high education, 0·7 [0·6-0·8]). With regard to income, for females, the strongest positive association was observed in schizophrenia (quartile 1 [Q1] vs quartile 4 [Q4], IRR 10·1 [6·1-17·2]), whereas the strongest negative association was in melanoma and other skin cancers (Q1 vs Q4, IRR 0·5 [0·5-0·6]). For males, the strongest positive assocation was schizophrenia (Q1 vs Q4, IRR 18·4 [95% CI 8·5-39·9]) and the strongest negative association was also melanoma and other skin cancers (Q1 vs Q4, IRR 0·5 [0·5-0·6]). The most prevalent disease category, other digestive diseases, was also strongly positively associated with education (low education vs high education, IRR 1·6 [95% CI 1·6-1·6] for females; IRR 1·5 [1·4-1·5] for males) and income (Q1 vs Q4, IRR 1·5 [1·5-1·5] for females; IRR 1·3 [1·3-1·4] for males). Our study provides a detailed representation of the association between two socioeconomic indicators and disease incidence. A broad spectrum of diseases, and not only the most prevalent, show socioeconomic disparities. This finding highlights the need for not only policies that address specific diseases, but also universal policies addressing the root causes of socioeconomic disparities and their health consequences. The Novo Nordisk Foundation.

Accelerating the fight towards malaria elimination: bridging gaps to achieve health equity in India.

Malaria continues to remain a serious threat to public health, especially in regions with socio-economic and healthcare disparities. The paper attempts to contextualise the current scenario of malaria transmission, the advancement made towards its elimination and the multi-dimensional strategies that may be required to overcome cultural and regional barriers; with a focus on India's goal to eliminate malaria by 2030.

8054 Temporal Trends In Thyroidal Endocrine Disruptor Exposure Among United States Reproductive-Age And Pregnant Women Over 20 Years And Differences By Socioeconomic Status

Abstract Disclosure: C. Han: None. S. Lee: None. E.N. Pearce: None. Background: Widespread exposure to endocrine disrupting chemicals (EDCs) poses a risk to public health and environmental safety. Women of reproductive age and pregnant women may be uniquely vulnerable to adverse thyroidal effects of EDCs. A better understanding of thyroidal EDCs exposure is needed to inform public health strategies. Objective: To examine temporal trends in EDC exposure and their effects on thyroid function among reproductive-age and pregnant women in the U.S. over the last two decades, with a focus on the impact of socioeconomic status. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 in 25,320 reproductive-age women and 2,525 pregnant women to assess the levels of exposure to thyroid-disrupting chemicals, including dioxins, organochlorides, polyfluoroalkyl substances (PFAS) from serum samples, and polyaromatic hydrocarbons, perchlorates, and metabolites from personal care products, phthalates, and plasticizers from urine samples. We used Kruskal-Wallis tests to analyze changes in EDC exposures over the past 20 years and multivariate linear regression models to identify factors influencing these levels. Results: We found a significant decline in exposures to 20 types of dioxins, 7 organochlorides, 6 PFAS, 5 personal care product chemicals, 6 phthalate metabolites, perchlorate, and thiocyanate, but substantial increases in exposure to 2 polyaromatic hydrocarbons among reproductive-age women. Among pregnant women, trends were similar, with declines in exposures to dioxins, organochlorides, PFAS, and phthalate metabolites; whereas exposure to 3 Polyaromatic hydrocarbons, 1 personal care product chemical, nitrates, and thiocyanates increased. Linear regression indicated a significant positive association between socioeconomic status and the levels of dioxin and PFAS in both reproductive-age and pregnant women, and a negative association between socioeconomic status and perchlorate and polyaromatic hydrocarbons in the participants. Conclusion: The past two decades have witnessed a general decline in the levels of most thyroidal EDCs in U.S. reproductive-age and pregnant women; however, some, particularly polyaromatic hydrocarbons, exposures have increased, especially among women with lower socioeconomic status. This has the potential to worsen disparities in health outcomes. These findings highlight the necessity for targeted public health interventions to reduce the impact of EDCs on thyroid health and address socioeconomic health disparities. Presentation: 6/3/2024

Exploring cervical cancer mortality in Brazil: an ecological study on socioeconomic and healthcare factors

ObjectiveTo evaluate the correlation between socioeconomic and healthcare factors and cervical cancer mortality rates, as well as the accessibility to prevention and treatment across Brazilian states and macroregions. The aim...

Spatiotemporal modeling of COVID-19 spread: unveiling socioeconomic disparities and patterns, across social classes in the urban population of Kermanshah, Iran.

Presenting ongoing outbreaks and the potential for their spread to nearby neighborhoods and social classes may offer a deeper understanding, enable a more efficient reaction to outbreaks, and enable a comprehensive understanding of intricate details for strategic response planning. Hence, this study explored the spatiotemporal spread of COVID-19 outbreaks and prioritization of the risk areas among social classes in the Kermanshah metropolis. In this cross-sectional study, the data of 58.951 COVID-19-infected patients were analyzed. In 2020, out of 24.849 infected patients, 10.423 were females, 14,426 were males, and in 2021, 15.714 were females, and 18,388 were males. To categorize social classes (working, middle, and upper), we utilized economic, social, cultural, and physical indicators. Our analysis utilized Arc/GIS 10.6 software along with statistical tests, including standard distance (SD), mean center (MC), standard deviational ellipse (SDE), and Moran's I. The results revealed that the average epicenter of the disease shifted from the city center in 2020-2021 to the eastern part of the city in 2021. The results related to the SD of the disease showed that more than 70% of the patients were concentrated in this area of the city. The SD of COVID-19 in 2020 compared to 2021 also indicated an increased spread throughout the city. Moran's I test and the hotspot test results showed the emergence of a clustered pattern of the disease. In the Kermanshah metropolis, 58,951 COVID-19 cases were recorded, with 55.76% males and 44.24% females. Social class distribution showed 28.86% upper class, 55.95% middle class, and 15.19% working class. A higher disease prevalence among both males and females in the upper class compared to others. Our study designed a spatiotemporal disease spread model, specifically tailored for a densely populated urban area. This model allows for the observation of how COVID-19 propagates both spatially and temporally, offering a deeper understanding of outbreak dynamics in different neighborhoods and social classes of the city.