Socioeconomic Status Outcomes Research Articles

Analysing the Impact of Socioeconomic Factors on Mental Health Differences in Chinese Society: Integrating Cultural, Psychological and Technological Perspectives.

Mental health (MH) differences remain an issue in contemporary Chinese society, with various factors influencing individuals' well-being. This study investigates the complex connection between results related to psychological wellness and social issues, integrating cultural, psychological and technological perspectives. Through a quantitative research methodology, data were collected from 1000 individuals using a questionnaire survey and analysed using SPSS software. The study's findings shed light on the impact of socioeconomic status (SES) on MH stigma, help-seeking behaviour and overall well-being. The findings identify that lower SES was associated with heightened levels of MH stigma and decreased the search for assistance actions. Cultural beliefs emphasising MH stigma and societal expectations were identified as mediators in the connection involve SES and MH outcomes. Digital technology use emerged as a moderator, indicating that higher levels of technology utilisation were linked to reduced disparities in accessing MH resources. The novelty of this study lies in its comprehensive examination of the multifaceted factors influencing MH disparities within Chinese society. Additionally, psychological factors such as resilience and social support were observed to mitigate the negative lower SES's effect on MH consequences. The interaction between SES and cultural factors was found to predict MH outcomes, with lower SES exacerbating the effects of MH stigma and cultural barriers.

Abstract A042: Patient poverty burden influences the molecular biology of ER+ breast cancer

Abstract Although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and White women in the US, Black patients have significantly worse outcomes. Black women in the US have also have worse health care options, poorer educational opportunities, and face significantly higher rates of poverty burden. Collectively contributing to an overall lower socioeconomic status (SES) compared to White women. However, cancer health disparities research primarily exists in two forms: 1) The impact of socioeconomic factors on cancer outcomes, and 2) The molecular underpinnings associated with genetic ancestry on cancer biology. This siloing results in an incomplete picture of how systemic factors (i.e. racism, poverty burden) contribute to the biology of breast cancer in addition to, and along-with, ancestral genetics. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field, because ancestral genetics cannot explain the breadth of disparities that patients face. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. For instance, ER+ breast tumors in Black women have distinct signatures of defective DNA damage repair (DDR) that associate with more aggressive tumor growth. However, how factors of SES contribute to these differences in molecular biology and whether these differences alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and factors of SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations. Altogether, these data begin to define the complex interplay between factors of SES and changes in gene expression in addition to patient outcomes for women with ER+ breast cancer. Citation Format: Jerry T. DeWitt. Patient poverty burden influences the molecular biology of ER+ breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A042.

Exploring Diversity of Hispanic Health Outcomes Through Prism of Environmental Justice

In environmental economics studies US Hispanics are frequently depicted as one large homogeneous group, despite diversity in their countries’ cultural traditions, genetic background and socioeconomic status (SES). This study aimed to compare Florida’s very diverse Hispanic population of Caribbean, Mexican, Central, and South American ancestry.Twelve independent variables were selected from environmental pollution, geospatial challenges, and SES categories. Dependent variables included the relative prevalence of three major chronic diseases: asthma, diabetes, and heart disease. Analysis of pairs correlations was supplemented by multi-variable linear regression. Majority-Hispanic areas have higher than average pollution, diabetes, proximity to disadvantaged neighborhoods, and lower SES. Despite lower pollution than in urban areas, Florida’s inland rural areas had higher rates of all major diseases and lower life expectancies. Cuban and Puerto Rican populations of Miami and Orlando metro areas, respectively, have less favorable SES outcomes and higher diabetes. Columbian and Venezuelan communities have significantly higher education levels than other Hispanic cohorts, and they have the best relative outcome among US Hispanics in SES and health, although still lagging US averages. African-American community in Miami-Dade County was by far the most disadvantaged, with significantly lower SES and health outcomes than any other group in the study, including the nearby Cuban-majority community. Our results confirmed the view that Hispanics are environmentally disadvantaged in Florida, with worse outcomes than the US and Florida average in health and economic factors. Furthermore, the study highlighted significant differentiation of SES and health outcomes among various regional Hispanic cohorts.

Exploration of auditory statistical learning, socioeconomic status, and language outcomes in Bangladeshi children: A functional near-infrared spectroscopy study.

Auditory statistical learning, or the ability to detect statistical regularities in continuously presented stimuli, is thought to be one element that underlies language acquisition. Prior studies have uncovered behavioral and neural correlates of statistical learning, yet additional work is needed from low- and middle-income countries to explore whether statistical learning varies across cultures or underlies associations often found between socioeconomic status (SES) and language outcomes. In the present study, we explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to explore auditory statistical learning in Bangladesh, a lower-middle-income country. Participants were 102 2-year-old (M = 25.72 months, SD = 2.07 months) and 125 5-year-old children (M = 62.35 months, SD = 2.46 months) living in a low-income urban neighborhood of Dhaka (average family income of 28,145.13 Bangladeshi Takas or 260.06 U.S. dollars per month). We also collected measures of SES and language outcomes. Brain responses during the statistical learning paradigm could be detected with fNIRS in both two- and 5-year-olds, with 2-year-olds exhibiting a higher response to predictable sequences and 5-year-olds exhibiting higher responses to unpredictable sequences. fNIRS correlates of statistical learning were not related to language outcomes but were associated with SES in the 5-year-old cohort. This study demonstrates the utility of employing fNIRS to study the neural correlates of statistical learning in low- and middle-income countries and the feasibility of expanding the representativeness of the existing literature. These findings also highlight potential areas for inquiry into how SES may relate to individual differences in statistical learning responses. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Material deprivation is associated with liver stiffness and liver-related outcomes in people with HIV.

Socioeconomic status (SES) is a driver of health disparities and chronic diseases. People with HIV (PWH) are at risk for chronic liver diseases. We evaluated the association between low SES and hepatic outcomes in PWH. We included PWH from a prospective cohort. SES was assessed by the Pampalon material and social deprivation index to classify the cohort into quintiles of deprivation. Multivariable linear regression was used to investigate associations of material and social deprivation with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) as markers of hepatic fibrosis and steatosis, respectively. Incidence of outcomes was evaluated through survival analysis. Among the 804 PWH included, 45% and 72% were living in areas of the highest material and social deprivation, respectively. Materially deprived PWH were more frequently female and of non-white ethnicity and had higher prevalence of metabolic comorbidities. After adjustments, material deprivation correlated with increased LSM (β = 1.86, 95% CI 0.53-3.17) but not with CAP (β = 6.47, 95% CI -5.55-18.49). Patients were observed for a median follow-up of 3.8 years. Incidence of liver-related events was higher in most materially deprived compared to most privileged PWH (hazard ratio 3.03, 95% CI 1.03-8.92), while there was no difference in extrahepatic outcomes or all-cause mortality. Social deprivation showed no association with either LSM or clinical outcomes. Living in materially deprived neighbourhoods as a proxy for lower SES, is associated with LSM and liver-related events in PWH. Future strategies should explore mechanisms underlying these relationships and whether enhanced material security improves hepatic outcomes.

Associations between parental socioeconomic status and mental health in Chinese children: the mediating roles of parenting practices.

The significance of socioeconomic status (SES) in child mental health is well-established in Western populations; however, there is little evidence on this topic in Chinese populations. The possibility that Chinese families with different SES elicit different parenting practices that cause positive or negative child mental health outcomes warrants further investigation. This study examined the associations of SES, parenting practices, and child mental health among 1401 Chinese school children and their parents residing in Shanghai. SES was measured by a composed index of parental education levels, occupations, and household incomes. The Alabama parenting questionnaire (APQ; child version) and the strengths and difficulties questionnaire (SDQ; parent version) were used to assess parenting practices and child mental health. We also explored the underlying mechanisms between parental SES and the mental health of children by testing different parenting practices as mediators of the relationships. The results showed that a higher SES is positively associated with better mental health in children. Positive involvement and deficient monitoring can mediate the relationship between SES and child mental health outcomes. Negative discipline did not significantly mediate the above relationship. The results highlight the significance of positive involvement and sufficient monitoring in promoting children's mental health and provide evidence for designing effective programs to improve parenting skills.

The Influence of Socio- economic Status on Adverse Birth Outcomes

Adverse birth outcomes are associated with infant morbidity and mortality and with an increased likelihood of type 2 diabetes, hypertension, and cardiovascular disease in adulthood. Socio- economic status (SES) is one of the most reliable predictors of health disparities, and although the association between SES and birth outcomes has been studied previously, this is, to our knowledge, the first review that encompasses several dimensions of SES and their influence on birth outcomes in a single article. Our review indicates that education, income, neighbourhood SES, and occupation all play a role at influencing birth outcomes. We contend that, because lifestyle approaches to reducing health disparities (e.g., better diet, more exercise) are in turn related to SES, public discourse and policy interventions would be better suited to focusing attention on more fundamental causes of adverse birth outcomes—particularly low SES— if we are to see major improvements in the health of our citizens. This article has been peer reviewed.

Socioeconomic Status Affects Patient-Reported Outcome Measures in Total Hip and Knee Arthroplasty: A Retrospective Dutch Registry Study

BackgroundTo determine the association between socioeconomic status (SES) and patient-reported outcome measures in a Dutch cohort who have undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA). MethodsA retrospective national registry study of all patients who underwent primary THA or TKA between 2014 and 2020 in the Netherlands was performed. Linear mixed effects regression models were used to assess the association between SES and patient-reported outcome measures for THA and TKA patients separately. The following measures were collected: numeric rating scale for pain, Oxford Hip/Knee Score, Hip/Knee disability and Osteoarthritis Outcome Score, and the EuroQol 5-Dimensions questionnaire. Sex, age, body mass index, American Society of Anesthesiologists classification, Charnley classification, and smoking status were considered as covariates in the models. ResultsTHA patients (n = 97,443) were on average 70 years old with a body mass index of 27.4 kg/m2, and TKA patients (n = 78,811) were on average 69 years old with a body mass index of 29.7 kg/m2. Preoperatively, patients with a lower SES undergoing THA or TKA reported more severe symptoms and lower health-related quality of life. At 1-year follow-up, they also reported lower scores and less improvement over time compared to patients with a higher SES. ConclusionsPatients with lower SES report worse symptoms when admitted for surgery and less improvement after surgery. Future research must address potentially mediating factors of the association between SES and symptom reporting such as access to surgery and rehabilitation, subjectivity in reporting, and patient expectation for THA and TKA outcomes.

Abstract 6161: Investigating the relationships between race and socioeconomic status on the biology of ER+ breast cancer

Abstract Black women in the US have worse health care options, poorer educational opportunities, and decreased income quality which collectively contribute to an overall lower socioeconomic status (SES) compared to white women. Furthermore, although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and white women in the US, Black patients have significantly worse outcomes. The field has traditionally focused on systemic factors such as SES to explain outcome disparities. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. However, how SES contributes to these differences in molecular biology and whether these differences in SES alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations which suggest that the ECM and TIME of ER+ breast cancer are influenced by race and factors of SES including BMI and community poverty burden. We further provide evidence that these alterations in the TME may also associate with worse patient outcomes. Citation Format: Jerry Tyler DeWitt, Elena Oropeza, Svasti Haricharan. Investigating the relationships between race and socioeconomic status on the biology of ER+ breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6161.

Abstract A077: Investigating the relationship of socioeconomic status on the molecular biology of ER+ breast cancer

Abstract Black women in the US have worse health care options, poorer educational opportunities, and decreased income quality which collectively contribute to an overall lower socioeconomic status (SES) compared to White women. Furthermore, although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and White women in the US, Black patients have significantly worse outcomes. The field has traditionally focused on systemic factors such as SES to explain outcome disparities. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. For instance, ER+ breast tumors in Black women have distinct signatures of defective DNA damage repair (DDR) that associate with more aggressive tumor growth. However, how SES contributes to these differences in molecular biology and whether these differences alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and factors of SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations. Altogether, these data begin to define the complex interplay between factors of SES and changes in gene expression in addition to patient outcomes for women with ER+ breast cancer. Citation Format: Jerry T DeWitt. Investigating the relationship of socioeconomic status on the molecular biology of ER+ breast cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A077.

Associations of current and childhood socioeconomic status and health outcomes amongst patients with knee or hip osteoarthritis in a Mexico City family-practice setting

ObjectivesTo examine the association of current and childhood socioeconomic status (SES) with patient-reported functional status, quality of life and disability in patients with knee or hip osteoarthritis (OA).MethodsCross-sectional study amongst individuals seeking care for any medical reason in a primary care family-practice clinic in Mexico City. We included individuals with self-reported doctor-diagnosed arthritis, recruited through waiting-room posters and invitations by treating family physicians. We administered a survey using validated Spanish language versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Osteoarthritis of Lower Limbs and Quality of Life (AMICAL), and the Stanford Health Assessment Questionnaire-Disability Index (HAQ-DI). To estimate current and childhood SES, we collected data on education level and occupation type for both the patient and their parents, as well as using a validated tool to estimate income quintile.ResultsWe recruited 154 patients and excluded 8 patients. There was a high correlation between outcome scores. Estimated income and education levels were correlated with WOMAC, AMICAL and HAQ-DI scores, and significant differences were found in all scores by occupation type. The associations for current SES variables and outcome scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension, and were largely explained by current income in mutually adjusted models. Childhood SES – in particular as measured through maternal education – was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES.ConclusionsCurrent Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. The WOMAC, AMICAL and HAQ-DI scores correlate with each other and are all potentially useful markers of disease severity. More research is needed to elucidate the relationships between childhood SES and OA outcomes. Awareness of life-course SES may be useful in identifying patients at risk for worse outcomes.

The Role of Sociogenomics on Chronic Wounds

Background and Objective: 
 Chronic wounds affect almost 2.5% of the United States population. Along with substantial healthcare costs, other factors like reduced employment opportunities and social isolation further complicate the patient’s quality of life. Socioeconomic status (SES) has been shown to influence gene expression that can increase susceptibility and deterioration of chronic wounds. Our study looks to identify genes that have been impacted by SES in chronic wound patients. Exploring this association can enhance understanding of the relationship between SES and chronic wound outcomes. 
 Experimental Design: 
 A cohort of 72 chronic wound patients were recruited. Patient demographics and socioeconomic backgrounds were collected. Blood DNA isolation was performed and allotted for genetic analysis by Axiom™ Precision Medicine Diversity Array (PMDA). DNA genotyping data was obtained, and single nucleotide polymorphisms (SNP) markers pertaining to wound healing were studied. P < 0.05 were used to designate significant SNP marker mutations in the cohort. 
 Results: 
 To add strength to our project, we have chosen to further study the results obtained by our group (https://doi.org/10.18060/27205), which has previously found significant SNPs associations of the vitamin D receptor (VDR) and the methylenetetrahydrofolate reductase (MTHFR) genes in chronic wound patients. Using PMDA, our analysis showed polymorphisms in CYP24A1 (p = 0.0072), a gene involved in vitamin D metabolism, and MTHFR (p = 0.00625), a gene involved in folate and homocysteine metabolism. Modifications of these genes have been associated with pathogenesis to impaired wound healing. 
 Conclusion: 
 There is a need for further investigation into health outcomes and their association with SES. Our study aims to address the knowledge gap in this field by focusing on chronic wound healing in relation to socioeconomic status. With our results, we hope to emphasize the importance of sociogenomics, and how it can be utilized to advocate for improved patient outcomes across all socioeconomic backgrounds. 
 
 Acknowledgements: 
 This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health (NIH). The presented work is also supported by NIH grants R01DK135447 and R01DK128845 to CKS. The laboratory of KS is supported by DoD grant W81XWH-22-1-0146. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Family structure, socioeconomic status, and mental health in childhood

The changing landscape of family structures over the last decades has led to a growing need to investigate its impact on children's well-being. This study examined differences in mental health among children from different family compositions and how these differences may be affected by familial socioeconomic status (SES). Data were collected within the LIFE Child study. Participants included 2828 children aged 3–17 years raised in traditional families, stepfamilies, or single-parent families. Mental health was measured using the Strengths and Difficulties Questionnaire (SDQ (behavioral strengths and difficulties)) and the KIDSCREEN-27 questionnaire (quality of life). Linear regression analyses were applied to examine associations between family structure, SES, and mental health outcomes. Children from single-parent families exhibited worse mental health outcomes than those from traditional families across all domains of the SDQ and the KIDSCREEN-27. Children from stepfamilies showed significantly higher Total Difficulties scores (B = 1.29 and 1.42), with 3- to 10-year-olds displaying higher scores in the Hyperactivity & Inattention (B = 0.61) and Peer Relationship Problems (B = 0.36) subscales, and 11- to 17-year-olds showing higher Conduct Problems (B = 0.31), Emotional Symptoms (B = 0.58), and a worse Parent Relationship scores (B = − 1.82) than children from traditional families (all p < 0.05). After controlling for SES, several associations between family structure and mental health lost significance, while others persisted, particularly among older children. To promote mental health in non-traditional families, interventions should address socioeconomic disparities while also investigating factors contributing to the direct impact of family structure on mental well-being.Trial registration The LIFE Child study is registered on clinicaltrials.gov (No. NCT02550236).

DIMINISHED RETURNS OF PARENTAL EDUCATION ON COGNITION: EVIDENCE FROM THREE POPULATION STUDIES IN THE US

Abstract Mounting evidence suggests that the protective effects of one’s own higher socioeconomic status (SES) on health is diminished among minoritized racial/ethnic groups in the United States (U.S.) with respect to outcomes such as mortality, hospitalization and mental health. Extending this area of research to childhood SES and later life outcomes, this study examines whether the protective effects of higher parental education on cognition is diminished among Black adults relative to their non-Hispanic White peers. Using data from the Health and Retirement Study, the Midlife in the U.S. Study, and the National Social Life, Health and Aging Project, I examine whether associations between parental education and two measures of cognition (episodic memory and global cognition) are moderated by race (non-Hispanic White or Black) using a random-effects individual participant data meta-analysis approach. I find evidence for a small, but robust, protective effect of higher parental education on both episodic memory and global cognition among White adults. Among Black adults, there was no association between parental education and neither episodic memory nor global cognition. This study provides evidence that the protective effect of higher parental education on cognition is not the same across racialized populations, consistent with the theory of Minority Diminished Returns. As scholars continue calls for life course-oriented efforts to reduce racialized cognitive disparities, it is important to consider early-life risk and protective factors in the context of structural racism.

Individual- and Community-Level Socioeconomic Status and Deceased Donor Renal Transplant Outcomes.

This study examined the relationship between socioeconomic status (SES), race, and ethnicity and clinical outcomes following deceased donor kidney transplant (DDKT) at a high-volume transplant center. This retrospective cohort study used regression models and survival analyses to examine the relationship between individual- and community-level SES, race, and ethnicity and DDKT outcomes (i.e., delayed graft function, graft failure, mortality) adjusting for potential confounders. The analytic sample included 3366 patients; 40.7% (n = 1370) were female, the mean age was 54.7 (SD = 13.3) years, 49.3% were non-Hispanic White, and the median follow-up time was 39.5 months (IQR = 24.2-68.1). Patients living in the most disadvantaged communities (using the US Census data) had a higher likelihood of delayed graft function (adjusted relative risk [RR] = 1.12, p = 0.042) and a higher hazard of mortality (adjusted hazard ratio [HR] = 1.32, p = 0.025) compared to patients living in the least disadvantaged communities. Patients without a high school diploma had a higher risk of delayed graft function compared to patients with an associate degree or more (RR = 1.37, p < 0.001). Patients with public insurance coverage had a higher risk of delayed graft function (RR = 1.24, p < 0.001) and a higher hazard of mortality (HR = 1.37, p < 0.001) and graft failure (HR = 1.71, p < 0.001) compared to patients without public insurance. There were no differences in graft failure or mortality by race and ethnicity. SES was not consistently associated with outcomes following DDKT; however, many of the predictors were associated with delayed graft function. With a large and diverse sample size, these findings further the heterogeneity of the present renal transplant research suggesting the need for further investigation to guide implementation of innovative strategies and interventions.

Socioeconomic Status and Students' Mental Health during the COVID-19 University Closure: Mediating Roles of Perceived Social Support and Self-Efficacy.

Despite the need for urgent actions in response to the exacerbated inequalities in mental health resulting from the COVID-19 pandemic, there remains a significant gap in research into the relationships and underlying mechanisms between socioeconomic status (SES) and various mental health outcomes among students during the COVID-19 university closure. With a sample of 839 students from a university in Lanzhou, the capital city of China's Gansu Province, which was closed during the 2022 autumn semester due to the COVID-19 outbreak, this study examined the relationships between SES and both the negative and positive mental health outcomes, with a particular inquiry into the mediating roles of perceived social support and self-efficacy. The results show that SES had significant and negative total associations with psychological distress (β = -0.119, p < 0.001) and loneliness (β = -0.132, p < 0.001), while having significant and positive total associations with life satisfaction (β = 0.90, p < 0.01) and affective well-being (β = 0.108, p < 0.01). Moreover, perceived social support and self-efficacy independently and sequentially mediated the associations between SES and various mental health outcomes. Research implications for the design and improvement of university measures to reduce the socioeconomic inequalities in students' mental health are also discussed.

Socioeconomic Status and Chronic Health Conditions in Asian Survivors of Adolescent and Young Adult Cancers.

Purpose: While there are known disparities in socioeconomic status (SES) and health outcomes among racially and ethnically minoritized adolescent and young adult (AYA; ages 15-39 years at diagnosis) cancer survivors compared with White survivors, outcomes in the Asian survivor population are understudied. To better understand the association of an AYA cancer diagnosis with SES and health outcomes within a minoritized population, the current study makes comparisons between individuals of the same race or ethnicity with and without a history of AYA cancer. Methods: Non-Hispanic, Asian AYA cancer survivors and non-Hispanic, Asian age- and sex-matched controls were identified from self-reported data in the National Health Interview Survey (2009-2020). Prevalence of chronic health conditions and socioeconomic factors were compared between groups using chi-square tests. Odds of chronic conditions by SES factors were determined within and between survivors and controls using logistic regression methods. Results: One hundred and thirty-one survivors and 1310 controls were included. Survivors were less likely to be married compared with controls; however, there were no differences in other SES factors examined. Survivors had higher odds of at least one chronic condition diagnosis (odds ratio = 4.17, p < 0.001) compared with controls. Of the chronic conditions assessed, survivors had higher odds of arthritis, pulmonary disease, and hypertension compared with controls. Conclusions: Asian AYA cancer survivors are at increased risk of chronic health conditions compared with Asian individuals without a cancer history. Culturally adapted targeted interventions are needed to improve health outcomes for this population.

Excess risk of chronic health conditions in Black adolescent and young adult cancer survivors.

The US population of adolescent and young adult (age 15-39 years at diagnosis) cancer survivors is growing. Previous studies have identified racial and ethnic disparities in survival and health outcomes in racially minoritized survivors, including Black survivors, compared with White survivors. However, comparisons should be made between those of the same race or ethnicity with and without a history of AYA cancer to fully understand the association of a cancer diagnosis with socioeconomic status (SES) and health outcomes within a minoritized population. Non-Hispanic Black AYA cancer survivors and non-Hispanic Black age- and sex-matched controls were identified from self-reported data from the National Health Interview Survey (2009-2018). SES factors and chronic health conditions prevalence were compared between survivors and controls using chi-square tests. Survey-weighted logistic regression models were used to determine odds of chronic conditions by SES factors within and between survivors and controls. Interactions between each variable and cancer group were assessed. A total of 445 survivors and 4450 controls were included. Survivors were less likely than controls to be married, have family income >45K/year, have completed a bachelor's degree or higher, and have private insurance. Survivors had higher odds than controls of having at least one (odds ratio (OR): 7.02, p<0.001) and ≥3 (OR: 4.44, p<0.001) chronic conditions. Survivors had higher odds of each chronic condition assessed including cardiovascular disease, diabetes, and hypertension. Survivors had higher odds of having chronic health conditions compared with controls across all SES variables. A cancer diagnosis during adolescence and young adulthood is associated with poor SES outcomes and increased odds of comorbidities within the Black population, thus further exacerbating existing disparities. Black AYA cancer survivors have a very high risk of developing chronic health conditions after cancer treatmentand interventions are needed to improve long-term health outcomes for this population.

Socioeconomic Status, Knee Pain, and Epigenetic Aging in Community-Dwelling Middle-to-Older Age Adults

Chronic musculoskeletal pain is often associated with lower socioeconomic status (SES). SES correlates with psychological and environmental conditions that could contribute to the disproportionate burden of chronic stress. Chronic stress can induce changes in global DNA methylation and gene expression, which increases risk of chronic pain. We aimed to explore the association of epigenetic aging and SES in middle-to-older age individuals with varying degrees of knee pain. Participants completed self-reported pain, a blood draw, and answered demographic questions pertaining to SES. We used an epigenetic clock previously associated with knee pain (DNAmGrimAge) and the subsequent difference of predicted epigenetic age (DNAmGrimAge-Diff). Overall, the mean DNAmGrimAge was 60.3 (±7.6), and the average DNAmGrimAge-diff was 2.4 years (±5.6 years). Those experiencing high-impact pain earned less income and had lower education levels compared to both low-impact and no pain groups. Differences in DNAmGrimAge-diff across pain groups were found, whereby individuals with high-impact pain had accelerated epigenetic aging (∼5 years) compared to low-impact pain and no pain control groups (both ∼1 year). Our main finding was that epigenetic aging mediated the associations of income and education with pain impact, as such the relationship between SES and pain outcomes may occur through potential interactions with the epigenome reflective of accelerated cellular aging. PerspectiveSocioeconomic status (SES) has previously been implicated in the pain experience. The present manuscript aims to present a potential social–biological link between SES and pain via accelerated epigenetic aging.

Biologic indicators of donor socioeconomic disadvantage and recipient mortality following allogeneic hematopoietic cell transplantation.

6500 Background: Allogeneic hematopoietic cell transplantation (HCT) carries significant risks, with low socioeconomic status (SES) being predictive of increased mortality. Our team recently discovered that socioeconomic disadvantage among unrelated HCT donors results in decreased recipient overall survival (OS) and increased treatment-related mortality (TRM) within a cohort from the Center for International Blood and Marrow Transplant Research (CIBMTR). We also demonstrated that upregulation of the stress- and SES-related gene expression profile termed the ‘conserved transcriptional response to adversity’ (CTRA) is associated with low SES and worse outcomes among HCT recipients. Here, we hypothesize that donor immunologic characteristics associated with neighborhood socioeconomic disadvantage (CTRA) will confer prognostic risk to HCT recipients as indicated by inferior long-term recipient outcomes. Methods: Among a subset of the above cohort for which donor whole blood samples were available from the CIBMTR repository, we evaluated whether donor cell CTRA gene regulation was associated with inferior HCT outcomes at 3 years in recipients being treated for hematologic malignancy. Multivariable models adjusted for donor and recipient characteristics evaluated associations between donor CTRA and recipient OS, TRM, disease free survival (DFS), relapse, and acute and chronic graft versus host disease. Results were considered significant if P&lt;0.05. Results: We identified 263 donor-recipient pairs for study inclusion. Median recipient age at hematologic malignancy diagnosis was 53 years (range 19-77), 46% were female, and 54% had acute myeloid leukemia. Donors were 35% female and median age at donation was 31 years (range 18-60). In RNA sequencing data from HCT donors, greater CTRA expression was associated with reduced OS (covariate-adjusted HR=1.94/CTRA SD, 95% CI [1.01, 3.71], p=.046) which was driven predominately by increased TRM (adjusted HR=5.04, [2.20, 11.50], p=.0001). These clinical outcomes are consistent with those observed to be associated with donor SES in our prior work. Donor cell effects on transplant outcomes derived predominately from the pro-inflammatory component of the CTRA (OS: adjusted HR=1.67, [1.20, 2.33], p = .0026; TRM: adjusted HR=2.21, [1.21, 4.06], p=.010) and emerged above and beyond the effects of the recipients’ own SES, as well as multiple other recipient disease, treatment, and demographic factors. Donor CTRA was not associated with relapse, DFS, or other transplant outcomes. Conclusions: For the first time, we show that transcriptome patterning among HCT donors, consistent with neighborhood SES disadvantage, results in adverse recipient HCT outcomes. These findings suggest that SES has a biologic impact at either the stem or immune cell level that persists even when transplanted into a new host.