Socioeconomically Deprived Research Articles

'Breaking the cycle': a qualitative study exploring general practitioners' views of infant mental health.

Infants living in areas of socioeconomic deprivation are more likely to have adverse childhood experiences (ACEs), which are associated with infant mental health (IMH) problems and poor physical and mental health outcomes throughout the life course. As part of the development of IMH services in Scotland, studies are being conducted to explore various stakeholders' perspectives. To understand the views and experiences of GPs working in socioeconomically deprived areas in relation to IMH. Qualitative study with GPs working in deprived urban communities in Scotland, UK. Semi-structured interviews were conducted with 12 GPs from 11 practices. Transcribed interviews were thematically analysed, following the Braun and Clarke framework, using NVivo (version 12) software. The following three overarching themes are presented: (1) Deep End GPs' inherent understanding of IMH, owing to their placement in deprived communities and their under-recognised role in current IMH provision; (2) Factors influencing how communities might perceive IMH, including the potential associations of IMH with parental blame or judgement in areas of socioeconomic deprivation; and (3) Using previous experience to visualise future IMH service delivery, particularly improving on current shortcomings of connectivity and accessibility of services, to develop successful new services. GPs in areas of socioeconomic deprivation have a deep understanding of the issues affecting IMH, although do not necessarily relate to the term 'IMH'. New community-based IMH services are much needed, particularly in deprived areas. However, the pre-existing role of primary care must be recognised, supported, and integrated into new services, alongside training to increase IMH awareness among GPs and other primary healthcare professionals (HCPs).

Geographic patterns and hotspots of pediatric tuberculosis: the role of socioeconomic determinants.

Children are an important demographic group for understanding overall tuberculosis epidemiology, and monitoring of childhood tuberculosis is essential for appropriate prevention. The present study sought to characterize the spatial distribution of childhood tuberculosis notification rates in continental Portugal; identify high-risk areas; and evaluate the association between childhood tuberculosis notification rates and socioeconomic deprivation. Using hierarchical Bayesian spatial models, we analyzed the geographic distribution of pediatric tuberculosis notification rates across 278 municipalities between 2016 and 2020 and determined high-risk and low-risk areas. We used the Portuguese version of the European Deprivation Index to estimate the association between childhood tuberculosis and area-level socioeconomic deprivation. Notification rates ranged from 1.8 to 13.15 per 100,000 children under 5 years of age. We identified seven high-risk areas, the relative risk of which was significantly above the study area average. All seven high-risk areas were located in the metropolitan area of Porto or Lisbon. There was a significant relationship between socioeconomic deprivation and pediatric tuberculosis notification rates (relative risk = 1.16; Bayesian credible interval, 1.05-1.29). Identified high-risk and socioeconomically deprived areas should constitute target areas for tuberculosis control, and these data should be integrated with other risk factors to define more precise criteria for BCG vaccination.

Association of Race and Neighborhood Socioeconomic Disadvantage with Incident Peripheral Artery Disease and Chronic Limb-threatening Ischemia

There are disparities in peripheral artery disease (PAD) outcomes according to both race and socioeconomic disadvantage separately. However, few studies have investigated the association of race and socioeconomic deprivation together with risk of PAD. We aimed to investigate the association of race and socioeconomic disadvantage with risk of incident PAD and incident chronic limb-threatening ischemia (CLTI). We included all non-Hispanic white and non-Hispanic Black adults in the Maryland Health Services Cost Review Commission from January 2013 through December 2019 without prevalent PAD or CLTI at their index visit. PAD and CLTI were defined by inpatient and outpatient diagnosis codes. Socioeconomic disadvantage was determined by the area deprivation index (ADI), a comprehensive measure of socioeconomic deprivation, using nine-digit zip codes. Patients living in neighborhoods with greater socioeconomic deprivation (ADI 3 and 4) were categorized as high ADI, while patients living in neighborhoods with lower socioeconomic deprivation (ADI 1 and 2) were categorized as low ADI. We estimated the cumulative incidence of PAD and CLTI and quantified hazard ratios (HR) using multivariable Cox proportional hazards models across four race and ADI groups after correcting for traditional demographic and cardiovascular risk factors. A total of 5,592,650 adult patients without PAD or CLTI at baseline (51.6% ≥65 years of age, 37.9% Black, 31.2% with high ADI) were followed for a median of 10.71 years (interquartile range, 5-31 years). The overall cumulative incidence of PAD and CLTI was 22% and 6%, respectively, and varied significantly by race and ADI (Figs 1 and 2). After adjusting for baseline differences between groups, the risk of incident PAD was highest for the Black-high ADI group (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.38-1.43), followed by White-high ADI (HR, 1.22; 95% CI, 1.20-1.24) and Black-low ADI (HR, 1.00; 95% CI, 0.99- 1.01) compared to White-low ADI (Table). Similarly, the risk of incident CLTI was highest for the Black-high ADI group (HR, 1.52; 95% CI, 1.48-1.57), followed by White-high ADI (HR, 1.38; 95% CI, 1.33-1.42), then Black-low ADI (HR, 1.14; 95% CI, 1.11-1.17) compared to White-low ADI. Previously reported racial differences in risk of PAD and CLTI are largely explained by socioeconomic deprivation, as characterized by ADI. Adults living in areas with higher socioeconomic deprivation are at higher risk of incident PAD and CLTI than their less socioeconomically deprived counterparts.Fig 2Cumulative Incidence Function Curves of Incident CLTI in health Services Cost Review Commission Database from 2013 through 2019 Stratified by Race and ADI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center.

In Germany, socioeconomically deprived citizens more often develop esophageal carcinoma, since typical risk factors follow the social gradient. Therefore, we hypothesized that socioeconomic deprivation might also be associated with advanced tumor stages and comorbidities at the time of surgery. As a consequence, socioeconomic deprivation may be related to postoperative complications and reduced overall survival. Therefore, 310 patients who had undergone esophagectomy for cancer in curative intent between 2012 and 2020 at the University Medical Center Hamburg-Eppendorf (UKE) were included in this study. Socioeconomic status (SES) was estimated using the purchasing power of patients' postal codes as a surrogate parameter. No association was found between SES and tumor stage or comorbidities at the time of surgery. Moreover, SES was neither associated with postoperative complications nor overall survival. In conclusion, socioeconomic inequalities of patients treated at a high-volume center do not affect treatment outcomes.

Effect of ethnicity and socioeconomic deprivation on uptake of renal supportive care and dialysis decision-making in older adults.

Renal supportive care has become an increasingly relevant treatment option as the renal patient population ages. Despite the prevalence of kidney disease amongst ethnic minority and socioeconomically deprived patients, evidence focused on supportive care and dialysis decision-making in these groups is limited. This retrospective study selected older patients referred to a low clearance or supportive care service between 1 January 2015 and 31 December 2019. A descriptive analysis of clinical and socioeconomic characteristics according to treatment choice was produced and multivariate logistic regression models used to identify predictive factors for choosing supportive care. Surrogate markers for the success of decision-making processes were evaluated, including time taken to reach a supportive care decision and risk of death without making a treatment decision or within 3 months of starting kidney replacement therapy (KRT). Finally, the association between ethnicity and socioeconomic status and hospital admission rates was compared between treatment groups. Amongst 1768 patients, 515 chose supportive care and 309 chose KRT. Predictive factors for choosing supportive care included age, frailty and a diagnosis of cognitive impairment. However, there was no association with ethnicity or deprivation. Similarly, these factors were not associated with time taken to make a supportive care decision or the mortality outcome. Amongst those on KRT, more socially advantaged patients had decreased rates of hospital admissions compared with those less advantaged (incident rate ratio 0.96, 95% confidence interval 0.92-0.99). Predictive factors for choosing supportive care were clinical, rather than socioeconomic. Lower socioeconomic status was associated with increased rates of hospitalization in the KRT group. This is a possible signal that these groups experienced greater morbidity on KRT versus supportive care, an association not demonstrated amongst higher socioeconomic groups.

Exploring the benefits of nature-based interventions in socio-economically deprived communities: a narrative review of the evidence to date

Socio-economic deprivation encompasses the relative disadvantage experienced by individuals or communities in relation to financial, material or social resources. Nature-based interventions (NBIs) are a public health approach that promote sustainable, healthy communities through engagement with nature and show potential to address inequalities experienced by socio-economically deprived communities. This narrative review aims to identify and evaluate the benefits of NBIs in socio-economically deprived communities. A systematic literature search of six electronic publication databases (APA PsycInfo, CENTRAL, CDSR, CINAHL, Medline and Web of Science) was conducted on 5 February 2021 and repeated on 30 August 2022. In total, 3852 records were identified and 18 experimental studies (published between 2015 and 2022) were included in this review. Interventions including therapeutic horticulture, care farming, green exercise and wilderness arts and craft were evaluated in the literature. Key benefits were observed for cost savings, diet diversity, food security, anthropometric outcomes, mental health outcomes, nature visits, physical activity and physical health. Age, gender, ethnicity, level of engagement and perception of environment safety influenced the effectiveness of the interventions. Results demonstrate there are clear benefits of NBIs on economic, environmental, health and social outcomes. Further research including qualitative analyses, more stringent experimental designs and use of standardised outcome measures is recommended.

Long-term association between neighbourhood socioeconomic deprivation in early childhood and perceived stress in early adulthood: a multilevel cohort study

BackgroundPrevious studies have shown that neighbourhood socioeconomic deprivation is related to mental health problems, with chronic stress responses as one possible biopsychological pathway; however, less is known about the possible...

Levelling up or left behind? are GP training opportunities in northern Ireland widening or closing the gap on health inequalities?

Increasing the GP workforce will not necessarily level up healthcare provision: instead increasing GP training numbers could worsen health inequity and inequalities. This is especially true if there are fewer opportunities to learn, train and build confidence in under-served, socioeconomically deprived areas. To investigate the representation of socioeconomic deprivation in postgraduate GP training practices in Northern Ireland (NI). Socioeconomic deprivation indices and scores of GP practices in Northern Ireland were calculated. We compared the socioeconomic deprivation indices and scores of GP postgraduate training practices against general practice in NI by examining the representation of practices whose patients live in areas of blanket deprivation, higher deprivation and higher affluence. Of 319 practices in NI, 171 (54%) were registered as postgraduate training practices with a mean deprivation score of 3.02 (95% CI 2.91-3.12) compared with non-training practices' higher mean deprivation score of 3.2 (95% CI 3.01-3.33), P-value <0.05. The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented, with the current postgraduate GP training practices having more affluent populations. Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than in other areas of the UK and better than undergraduate teaching opportunities in general practice. Health inequalities will worsen if the representation of general practice training in areas of greater social economic deprivation is not increased.

Disparities in prevalence of heart failure between the genders in relation to age, multimorbidity and socioeconomic status in southern Sweden: a cross-sectional study

Objective Prior studies have reported that heart failure typically affects elderly, multimorbid and socioeconomically deprived men. Women with heart failure are generally older, have a higher EF (ejection fraction) and have more heart failure-related symptoms than men. This study explored the disparities in the prevalence of heart failure between men and women in relation to age, multimorbidity level and socioeconomic status of the population in southern Sweden. Design A register-based, cross-sectional cohort study. Setting and subjects: The inhabitants from 20 years of age onwards (N = 981,383) living in southern Sweden in 2015. Main outcome measure: Prevalence and mean probability of having heart failure in both genders. CNI (Care Need Index) percentiles depend on the socioeconomic status of their listed primary healthcare centres. Results Men had a higher OR for HF − 1.70 (95% CI 1.65–1.75) - than women. The probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity levels. At all CNI levels, the multimorbid patients had a higher prevalence of heart failure in men than in women. The disparity in the mean probability of heart failure between the most affluent and deprived CNI percentile was more apparent in women compared to men, especially from 80 years. Conclusions The prevalence of heart failure differs significantly between the genders. Men had an increasing mean probability of heart failure with advancing age and multimorbidity level compared to women. Socioeconomic deprivation was more strongly associated with heart failure in women than in men. The probability of having heart failure differs between the genders in several aspects. Key Points Independently of socioeconomic status, men had a higher prevalence of heart failure than women among the multimorbid patients. The mean probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity level. Socioeconomic status was more strongly associated with heart failure in women than in men.

Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study

Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations. Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group. MUP in Scotland was associated with a significant 13·4% reduction (95% CI -18·4 to -8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (-8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland. The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm. Scottish Government.

Deprivation and chronic kidney disease-a review of the evidence.

The relationship between socioeconomic deprivation and health is inequitable. Chronic kidney disease (CKD) is an archetypal disease of inequality, being more common amongst those living in deprivation. The prevalence of CKD is rising driven by an increase in lifestyle-related conditions. This narrative review describes deprivation and its association with adverse outcomes in adults with non-dialysis-dependent CKD including disease progression, end-stage kidney disease, cardiovascular disease and all-cause mortality. We explore the social determinants of health and individual lifestyle factors to address whether patients with CKD who are socioeconomically deprived have poorer outcomes than those of higher socioeconomic status. We describe whether observed differences in outcomes are associated with income, employment, educational attainment, health literacy, access to healthcare, housing, air pollution, cigarette smoking, alcohol use or aerobic exercise. The impact of socioeconomic deprivation in adults with non-dialysis-dependent CKD is complex, multi-faceted and frequently under-explored within the literature. There is evidence that patients with CKD who are socioeconomically deprived have faster disease progression, higher risk of cardiovascular disease and premature mortality. This appears to be the result of both socioeconomic and individual lifestyle factors. However, there is a paucity of studies and methodological limitations. Extrapolation of findings to different societies and healthcare systems is challenging, however, the disproportionate effect of deprivation in patients with CKD necessitates a call to action. Further empirical study is warranted to establish the true cost of deprivation in CKD to patients and societies.

Kratom Retail Availability in Fort Worth, Texas

ABSTRACT Kratom use is associated with cannabis use, so retail availability may also be related. Kratom and Delta-8 THC (a psychoactive cannabis product) are federally unregulated, marketed as “natural,” and often used for pain relief and/or relaxation. Kratom may have greater retail availability in more socioeconomically deprived areas because harmful substances are frequently marketed to lower-income communities. This study examined kratom retail availability in Fort Worth, Texas. Locations with alcohol, tobacco, and/or CBD licenses were called in July 2022: 1,025/1,223 (84%) answered the phone. T-tests examined potential differences in socioeconomic deprivation scores surrounding outlets by whether they sold kratom. Cross-tabulations examined overlap in kratom and Delta-8 THC availability. Kratom was available in 6% of locations. Most kratom retailers had a tobacco license (92%). However, most stores with a tobacco license did not sell kratom (14%), whereas most stores with a CBD license did (55%). Kratom availability was not associated with area deprivation scores. Most kratom retailers (95%) sold Delta-8 THC and two-thirds (65%) of Delta-8 THC retailers sold kratom. This study was the first to examine retail availability of kratom. Findings indicate the presence of niche stores specializing in the retail of federally unregulated substances.

Environmental justice promotion in the Italian contaminated sites through the national epidemiological surveillance system SENTIERI

Conceptual and operational aspects of studying and promoting environmental justice and the results from assessments on environmental justice carried out within the epidemiological surveillance SENTIERI focused on communities living close to main Italian contaminated sites are here summarized. The communities under SENTIERI surveillance often have environmental injustice conditions associated with the cumulative impact of environmental pressures due to contamination and a high socioeconomic deprivation and mortality risk. In Italy, a North-South divide gradient is present, with the worst conditions in the South&Island, where most communities affected by contaminated sites are socioeconomically deprived. The main mechanisms of development and maintenance of distributive injustice in contaminated sites are attributable to procedural injustice conditions, with marginalization and misrecognition of disadvantaged communities or subgroups in decisional processes regarding both the location and permanence of polluting industrial plants and the interventions on remediation and reduction of hazardous exposures and health-related impacts. Within SENTIERI, strategies have been developed to produce participative territorial communication plans and to strengthen the environmental health literacy of local institutional and social actors. SENTIERI contributes in promoting environmental justice through the empowerment of social capacities of local communities.

DOES SOCIOECONOMIC DEPRIVATION INFLUENCE PATIENT OUTCOMES AFTER PERIACETABULAR OSTEOTOMY?

Higher levels of socioeconomic deprivation have been associated with worse health outcomes. The influence of socioeconomic deprivation on patients undergoing periacetabular osteotomy (PAO) has not previously been investigated.A total of 217 patients (171 female, 46 male; median age 23.4 years) who underwent PAO by a single surgeon were identified. Patients were categorised into three groups according to their New Zealand Deprivation (NZDep) Index: minimal deprivation (NZDep Index 1–3, n=89), moderate deprivation (NZDep Index 4-6, n=94), and maximal deprivation (NZDep Index 7-10, n=34). The three groups were compared with respect to baseline variables, surgical details, complications, and pre-operative and two-year post-operative functional scores (including International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, and University of California Los Angeles (UCLA) activity score). Multivariate regression was undertaken to assess for the effect of NZDep Index on patient outcomes.Patients in the maximal deprivation group were more likely to be Māori (p&lt;0.001) and have surgery in a public rather than a private hospital (p=0.004), while the minimal deprivation group demonstrated a lower BMI (p=0.005). There were otherwise no other significant differences in baseline variables, surgical details, complications, nor pre-operative or two-year post-operative functional scores between the three groups (all p&gt;0.05). Multivariate analysis identified a higher NZDep Index to be independently predictive of a lower pre-operative UCLA activity score (p=0.014) and a higher two-year iHOT-12 score (p&lt;0.001).Our results demonstrate an inequality in access to PAO, with patients exposed to higher levels of socioeconomic deprivation under-represented in our study population. When provided access to PAO, these vulnerable patients achieve significant functional improvement at least as great as patients with less socioeconomic deprivation. Initiatives to improve access to hip preservation care in socioeconomically deprived populations appear warranted.

Patterns of Healthcare Resource Utilisation of Critical Care Survivors between 2006 and 2017 in Wales: A Population-Based Study.

In this retrospective cohort study, we used the Secure Anonymised Information Linkage (SAIL) Databank to characterise and identify predictors of the one-year post-discharge healthcare resource utilisation (HRU) of adults who were admitted to critical care units in Wales between 1 April 2006 and 31 December 2017. We modelled one-year post-critical-care HRU using negative binomial models and used linear models for the difference from one-year pre-critical-care HRU. We estimated the association between critical illness and post-hospitalisation HRU using multilevel negative binomial models among people hospitalised in 2015. We studied 55,151 patients. Post-critical-care HRU was 11-87% greater than pre-critical-care levels, whereas emergency department (ED) attendances decreased by 30%. Age ≥50 years was generally associated with greater post-critical-care HRU; those over 80 had three times longer hospital readmissions than those younger than 50 (incidence rate ratio (IRR): 2.96, 95% CI: 2.84, 3.09). However, ED attendances were higher in those younger than 50. High comorbidity was associated with 22-62% greater post-critical-care HRU than no or low comorbidity. The most socioeconomically deprived quintile was associated with 24% more ED attendances (IRR: 1.24 [1.16, 1.32]) and 13% longer hospital stays (IRR: 1.13 [1.09, 1.17]) than the least deprived quintile. Critical care survivors had greater 1-year post-discharge HRU than non-critical inpatients, including 68% longer hospital stays (IRR: 1.68 [1.63, 1.74]). Critical care survivors, particularly those with older ages, high comorbidity, and socioeconomic deprivation, used significantly more primary and secondary care resources after discharge compared with their baseline and non-critical inpatients. Interventions are needed to ensure that key subgroups are identified and adequately supported.

Variation in Testing for and Incidence of Celiac Autoimmunity in Canada: A Population-Based Study

The incidence of biopsy-confirmed celiac disease has increased. However, few studies have explored the incidence of celiac autoimmunity based on positive serology results. A population-based cohort study assessed testing of tissue transglutaminase antibodies (tTG-IgA) in Alberta from 2012 to 2020. After excluding prevalent cases, incident celiac autoimmunity was defined as the first positive tTG-IgA result between 2015 and 2020. Testing and incidence rates for celiac autoimmunity were calculated per 1000 and 100,000 person-years, respectively. Incidence rate ratios (IRRs) were calculated to identify differences by demographic and regional factors. Average annual percent changes (AAPCs) assessed trends over time. The testing rate of tTG-IgA was 20.2 per 1000 person-years and remained stable from 2012 to 2020 (AAPC, 1.2%; 95% confidence interval [CI], -0.5 to 2.9). Testing was higher in female patients (IRR, 1.66; 95% CI, 1.65-1.66), those living in metropolitan areas (IRR, 1.39; 95% CI, 1.38-1.40), and in areas of lower socioeconomic deprivation (lowest compared to highest IRR, 1.24; 95% CI, 1.23-1.25). Incidence of celiac autoimmunity was 33.8 per 100,000 person-years and increased from 2015 to 2020 (AAPC, 6.2%; 95% CI, 3.1-9.5). Among those with tTG-IgA results ≥10 times the upper limit of normal, the incidence was 12.9 per 100,000 person-years. The incidence of celiac autoimmunity was higher in metropolitan settings (IRR, 1.28; 95% CI, 1.21-1.35) and in the least socioeconomically deprived areas compared to the highest (IRR, 1.22; 95% CI, 1.14-1.32). Incidence of celiac autoimmunity is high and increasing, despite stable testing rates. Variation in testing patterns may lead to underreporting the incidence of celiac autoimmunity in nonmetropolitan areas and more socioeconomically deprived neighborhoods.

GEOGRAPHIC AVAILABILITY OF SUBSIDIZED SENIOR HOUSING AND NEIGHBORHOOD DISPARITIES IN MISSOURI

Abstract Subsidized senior housing (SSH) provides an affordable option to low-income older adults for economic stability and aging-in-place. To date, limited attention has been given to the geographic availability of SSH and its relation to neighborhood characteristics (e.g., socioeconomic characteristics and availability of supportive services). The current study aims to describe (1) the availability of government-subsidized senior housing (SSH-availability) in Missouri and examine (2) to what extent the housing availability is associated with county-level neighborhood characteristics. First, SSH-availability in each county was measured with the number of subsidized units for older adults divided by the eligible population (i.e., aged 65 or over, income below poverty level, and spending 30% or more of income on housing). The Geographic Information System (GIS) was used to examine the distribution of SSH in Missouri. Second, based on existing literature, we used principal component analysis with multiple indicators to create two neighborhood characteristics (i.e., socioeconomic deprivation and health and social service indices). Non-parametric bivariate analyses (Kruskal-Wallis tests) were conducted with the availability quartiles and each index. Our findings showed that in 66 counties (57% of entire counties in Missouri), SSH-availability was below 20%. Bivariate analyses showed SSH-availability was significantly associated with both neighborhood characteristics: counties with higher SSH-availability were more likely to be socioeconomically deprived and face a lack of health and social services. The current study suggests the government should address the geographic disparities in SSH for low-income older adults. Also, more supportive services are needed around SSH to facilitate aging-in-place of vulnerable older adults.

HPB P13 Does Socioeconomic deprivation affect outcomes in patients undergoing liver resection for Colorectal Liver metastases?

Abstract Background It is well documented that socioeconomic deprivation (SED) has an overall negative impact on health outcomes. Many studies have shown this in primary cancers. The effect of SED on outcomes in patients undergoing liver resection for colorectal liver metastases (CRLM) is not well documented. As these patients are already under follow up, it is likely that the impact of SED on outcomes will be diminished. It was our aim to evaluate the effect of SED on overall survival (OS) in patients undergoing liver resection for CRLM. Methods The STROCSS guideline for observational studies was followed to conduct a single-centre retrospective cohort study. The tertiary centre treats patients over a wide geographical area with a population of 2.2 million. All consecutive patients undergoing liver resection for CRLM between January 2013 and December 2020 were eligible for inclusion. Demographics, prognostic variables for CRLM, operative variables, pathological variables and overall survival was recorded. Data was censored at 31 December 2021. Follow up was complete and checked with the Clinical Portal electronic database and by contacting General practitioners. The Multiple Deprivation score, that is nationally recorded was used to determine socioeconomic deprivation status of each patient. Prognostic significance of socioeconomic deprivation was determined by Kaplan–Meier survival statistics and stepwise Cox proportional-hazards regression model. Results A total of 455 patients were eligible for inclusion; 237 patients were classed as least socioeconomically deprived and 218 patients as most socioeconomically deprived. Both cohorts were comparable in terms of baseline characteristics except for age (69 most deprived vs 72 Least deprived, P=0.004). Kaplan–Meier survival statistics showed that socioeconomic deprivation was associated with significantly lower probability of overall survival (HR: 1.55, 95% CI 1.23–1.95; Logrank test: P=0.0001). The stepwise Cox proportional-hazards regression analysis identified socioeconomic deprivation as predictor of OS (HR: 1.56, 95% CI 1.23–1.98, P=0.0003) alongside the following variables: ASA status 1 (HR: 0.43, 95% CI 0.19–0.94, P=0.0349), presence of extrahepatic disease (HR: 1.51, 95% CI 1.12–2.03, P=0.0075), number of tumours (HR: 1.07, 95% CI 1.01–1.13, P=0.0221), size of largest tumour (HR: 1.01, 95% CI 1.00–1.01, P=0.0003), extended hemihepatectomy (HR: 3.24, 95% CI 1.56–6.76, P=0.0018), and absence of recurrence (HR: 0.55, 95% CI 0.43–0.70, P&amp;lt;0.0001). Conclusions Socioeconomic deprivation reduces the probability of OS following liver resection for CRLM. This should be taken into account at different levels of health care planning for management of patients with CRLM including preoperative risk assessment, health care need assessment, and allocation of resources. Our study shows that the deleterious effects of SED extends to patients who are already in the healthcare system and therefore factors other than access to healthcare need further exploration.

Socioeconomic Deprivation, Genetics and Risk of Dementia

AbstractBackgroundThe risk of Alzheimer’s disease and other subtypes of dementia is determined by multiple pathways including genetic, environmental and lifestyle factors. With higher risk in socioeconomically deprived individuals, it remains unclear whether associations of genetic risk with dementia incidence may be modified by individual‐ or area‐level socioeconomic deprivation.MethodParticipants of the UK Biobank study attended baseline assessments at 22 assessment centers between 2006 and 2010 and were followed‐up until 2016 or 2017. Cox proportional‐hazards regressions with area‐level socioeconomic deprivation based on the Townsend Deprivation Index and individual‐level socioeconomic deprivation based on car and home ownership, housing type, and income were run. A comprehensive polygenic risk score was employed and potential mediation through lifestyle and depressive symptoms was assessed. In an imaging substudy, associations of socioeconomic deprivation with six imaging‐derived phenotypes including white matter hyperintensities were examined.Result196,368 participants (mean [standard deviation] age, 64.1 [2.9] years, 52.7% female) aged 60 years and older, of European ancestry, without dementia diagnosis or cognitive impairment at baseline were followed‐up for 1,545,316 person‐years (median [interquartile range] follow‐up, 8.0 [7.4‐8.6] years). In high genetic risk and high area‐level deprivation 1.71% (95% confidence interval, 1.44% to 2.01%) developed dementia compared to 0.56% (95% confidence interval, 0.48% to 0.65%) in low genetic risk and low‐to‐moderate area‐level deprivation (hazard ratio, 2.31; 95% confidence interval, 1.84 to 2.91). In high genetic risk and high individual‐level deprivation 1.78% (95% confidence interval, 1.50% to 2.09%) developed dementia compared to 0.31% (95% confidence interval, 0.20% to 0.45%) in low genetic risk and low individual‐level deprivation (hazard ratio, 4.06; 95% confidence interval, 2.63 to 6.26). There was no significant interaction between genetic risk and area‐level (P =.77) or individual‐level (P =.07) deprivation. An imaging substudy including 11,083 participants found greater burden of white matter hyperintensities associated with higher socioeconomic deprivation.ConclusionIn older adults without dementia area‐level and individual‐level socioeconomic deprivation and genetic risk were significantly and independently associated with a higher risk of dementia. Dementia prevention interventions may be particularly effective if targeted to people living in deprived households and areas, regardless of genetic vulnerability.

Changing patterns of SARS-CoV-2 infection through Delta and Omicron waves by vaccination status, previous infection and neighbourhood deprivation: a cohort analysis of 2.7 M people

BackgroundOur study examines if SARS-CoV-2 infections varied by vaccination status, if an individual had previously tested positive and by neighbourhood socioeconomic deprivation across the Delta and Omicron epidemic waves of SARS-CoV-2.MethodsPopulation cohort study using electronic health records for 2.7 M residents in Cheshire and Merseyside, England (3rd June 2021 to 1st March 2022). Our outcome variable was registered positive test for SARS-CoV-2. Explanatory variables were vaccination status, previous registered positive test and neighbourhood socioeconomic deprivation. Cox regression models were used to analyse associations.ResultsOriginally higher SARS-CoV-2 rates in the most socioeconomically deprived neighbourhoods changed to being higher in the least deprived neighbourhoods from the 1st September 2021, and were inconsistent during the Omicron wave. Individuals who were fully vaccinated (two doses) were associated with fewer registered positive tests (e.g., individuals engaged in testing between 1st September and 27th November 2021—Hazards Ratio (HR) = 0.48, 95% Confidence Intervals (CIs) = 0.47–0.50. Individuals with a previous registered positive test were also less likely to have a registered positive test (e.g., individuals engaged in testing between 1st September and 27th November 2021—HR = 0.16, 95% CIs = 0.15–0.18. However, the Omicron period saw smaller effect sizes for both vaccination status and previous registered positive test.ConclusionsChanging patterns of SARS-CoV-2 infections during the Delta and Omicron waves reveals a dynamic pandemic that continues to affect diverse communities in sometimes unexpected ways.