Sociodemographic Disparities Research Articles

Social epidemiology of early adolescent nutrition.

This study aimed to investigate associations between sociodemographic factors and dietary intake among a diverse population of early adolescents ages 10-13 years in the United States. We examined data from the Adolescent Brain Cognitive Development (ABCD) Study in Year 2 (2018-2020, ages 10-13 years, N = 10,280). Multivariable linear regression models were conducted to estimate the adjusted associations between sociodemographic factors (age, sex, race and ethnicity, household income, parental education) and dietary intake of various food groups, measured by the Block Kids Food Screener. Older age among early adolescents was associated with slightly less fruit, whole grain, and dairy and more monounsaturated fat consumption. Male sex was associated with a lower intake of fruit, fruit juice, vegetables, whole grains, and fiber and a higher intake of meat/poultry/fish, added sugars, fat, as well as higher glycemic index and glycemic load compared to female sex. Racial and ethnic minority status, lower household income, and lower parental education were generally associated with less fruit and vegetable consumption and more added sugars. These findings can guide public health interventions to reduce diet quality disparities by targeting key populations and addressing differences according to socioeconomic status, sex, and race. Sociodemographic disparities in diet quality have been studied, but none have explored sociodemographic associations with specific food groups and components (e.g., different types of fat) in early adolescence. In this demographically diverse sample of 10-13-year-old early adolescents in the US, we found sociodemographic disparities in dietary intake across various food groups. Most notably, male sex, racial and ethnic minority status, lower household income, and lower parental education were associated with less fruit and vegetable consumption and more added sugars.

Gender and educational trends in lifetime risk, age at onset, expectancy, and survival with cardiovascular disease in Finland, 1996-2020.

Cardiovascular disease (CVD) is the leading cause of mortality globally. Examining trends in CVD burden and associated sociodemographic disparities can contribute to tailoring policies that promote cardiovascular health and narrow health disparities. However, existing studies predominantly focus only on mortality. Therefore, we provide a more comprehensive understanding of CVD trends by studying the diverse aspects of CVD burden: lifetime risk, onset age, CVD-free and CVD life expectancy, and survival with CVD. We focus on the overall Finnish population in 1996-2020, as well as gender and educational disparities. We use sociodemographic information from individual-level population registers, which are linked to hospital discharge and Death Registers, on the entire Finnish population aged 40-100 years in five five-year periods in 1996-2020 (N=2,796,732-3,273,232). We employed multistate models to derive the study metrics. Overall, CVD's lifetime risk stabilizes at 72% following a rise, with onset age and CVD-free life expectancy increased by 3 years. Although men bear a higher CVD burden, they experience a greater increase in onset age and CVD-free expectancy than women. Educational disparities in CVD-free expectancy persist, exceeding 3.5 years for men and women. Furthermore, survival with CVD has extended by 2.8 years but educational disparities widen. Despite the encouraging CVD trends in the overall population and progress in narrowing gender disparities, there remains considerable room for further improvement. Persistent educational disparities in CVD burden underscore the need for more effective interventions to address enduring inequalities.

Sociodemographic inequities in overall survival among younger and older women with cervical cancer.

Older Black women and women living in areas of low socioeconomic status (SES) diagnosed with cervical cancer (CC) have worse overall survival (OS). The objective was to investigate associations between OS and race/ethnicity and sociodemographic factors in younger (21-64years) and older women (≥ 65years) diagnosed with CC using Surveillance, Epidemiology, and End Results Program data. This retrospective, population-based cohort study included 39,000 women ≥ 21years diagnosed with CC diagnosed between 2006 and 2020. Age-group stratified Cox proportional hazards models adjusted for age, diagnosis year, and histology examined sociodemographic (rurality, SES, and persistent poverty) differences in OS. In the sample, 82.8% were < 65years. Compared to younger women, older women were more likely to be non-Latinx (NL) Black (16.0 vs 12.9%) and diagnosed with late-stage CC (67.9 vs 47.5%). Adjusted models suggested younger NL Black women had worse OS than their NL White counterparts (HR 1.45 [95% CI 1.37-1.54]), this association was not found among older NL Black women (HR 1.06 [95% CI 0.96-1.16]). Similarly, younger women in lowest SES areas had worse OS compared to women in highest SES areas (HR 1.82 [95% CI 1.69-1.96]), this association was attenuated in older women (HR 1.27 [95% CI 1.15-1.42]). Finally, younger women living in persistent poverty had worse OS compared to those who did not (HR 1.40 [95% CI 1.32-1.48]), this association was not found in older women (HR 1.10 [95% CI 0.99-1.21]). Sociodemographic disparities were found in CC OS for women < 65 that were attenuated or nonexistent in women ≥ 65years.

Sociodemographic Disparities in the Use of Hospice by U.S. Nursing Home Residents: A Systematic Review.

Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. We conducted a review of English-language, peer-reviewed articles 2008 to 2023 describing this variation in NH hospice use to characterize disparities and inform educational and quality initiatives to improve EOL care in NHs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We screened 1595 records, reviewed 82 articles and included 13 articles. Eleven used pre-2009 data. Six evaluated national data and 7 used regional (n = 1), state (n = 4), or local (n = 2) data. One assessed hospice referral, 10 hospice use, and 3 length-of-stay. Twelve conducted regression analyses; 1 stratified by race, another evaluated interaction terms, and a third compared racial differences within-and between-facilities. Unadjusted and adjusted differences were evaluated by resident race-and-ethnicity (n = 6 unadjusted, n = 10 adjusted, respectively), sex (n = 5, n = 9), or payor (n = 1, n = 4), or by NH race-mix (n = 1, n = 2), ownership (n = 1, n = 7), payor-mix (n = 1, n = 5), or urban/rural location (n = 1 adjusted). Unadjusted differences showed lower hospice use by Non-White residents and varied results by sex. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use. Further study is warranted to identify targets for improving hospice access.

Applying analytics to sociodemographic disparities in mental health

Applying analytics to sociodemographic disparities in mental health

Uptake of the first to fifth doses of coronavirus disease 2019 vaccine in individuals with chronic lymphocytic leukaemia: A nationwide cohort study in Sweden.

Patients with chronic lymphocytic leukaemia (CLL) have an increased risk of severe coronavirus disease 2019 (COVID-19) as well as impaired responses to COVID-19 vaccination, which may be overcome by repeated booster vaccinations. Our objective was to explore the uptake of the COVID-19 vaccine in this population since records of this are scarce. In this nationwide cohort study, we used multiple population-based health and sociodemographic registries to study COVID-19 vaccine uptake in individuals with CLL in Sweden, from 27 December 2020 to 28 February 2023. A total of 6304 individuals were included. The cumulative incidence (95% confidence interval) at the end of the study period was 95%, 94%, 88%, 78% and 56% for the first, second, third, fourth and fifth doses, respectively. The uptake was significantly higher compared with the age-standardized nationwide uptake. However, there were large disparities, especially for the fourth and fifth doses, across different age groups, birth regions, and income quartiles. These differences were especially pronounced in intersectional analyses, where individuals born abroad in the lowest income quartile had a vaccine uptake of only 49% and 24% for the fourth and fifth doses, respectively. Even though uptake was generally high in individuals with CLL, it seems to be declining from dose three and onwards, and there are significant sociodemographic disparities in vaccine uptake.

Sociodemographic disparities in everyday discrimination among a national sample of adults in the United States, 2023.

Discrimination is a social determinant contributing to health inequities in the United States (US). This study investigated the prevalence of, and sociodemographic disparities in, perceived everyday discrimination among a national sample of US adults. We used data from the 2023 National Health Interview Survey (n=27,538) and estimated the prevalence of three perceived everyday discrimination outcomes (1) any discrimination, (2) unique components of the discrimination experience, and (3) the Everyday Discrimination Scale (EDS) (range: 0-20) overall and by age, sex assigned at birth, race and ethnicity, sexual orientation, educational attainment, income-to-poverty ratio, and urban-rural status. Over half of US adults experienced any discrimination (55.8%), and the most common form of perceived discrimination was being treated with less respect (45.2%). Adults who were younger (aged 18-44), female, non-Hispanic Black, sexual minority, some college-educated, low income, or urban-living generally reported higher discrimination. For example, among the sample, non-Hispanic Black (vs. non-Hispanic White) (OR: 1.61, 95% CI: 1.44-1.81) and sexual minority (vs. heterosexual) (OR: 2.48, 95% CI: 2.12-2.90) adults had the highest odds of any discrimination and EDS scores (β: 1.38 (95% CI: 1.17-1.59) and β: 1.65 (95% CI: 1.35-1.94), respectively). The odds of perceived discrimination varied in magnitude by specific experience; for example, sexual minority adults had the highest odds of being threatened or harassed (OR: 2.93, 95% CI: 2.52-3.42). Perceived everyday discrimination is prevalent and differentially affects adults, especially members of marginalized and underserved populations. Understanding discrimination patterns will benefit public health and medical efforts aimed at mitigating exposure and deleterious health consequences.

Regional disparities and correlates of alcohol use during pregnancy in India: Insights from the National Family Health Survey-5.

Alcohol use during pregnancy is a significant public health concern due to its adverse outcomes for the mother and developing fetus. This study aims to estimate the national and state-wise prevalence of alcohol use during pregnancy in India and examine associated social, demographic and health-related correlates using data from the National Family Health Survey (NFHS-5) conducted in 2019-2020. Data from NFHS-5, a large-scale, nationally representative survey, were analysed. The survey included comprehensive interviews with 724,115 women aged 15-49 years, covering all 28 states and 8 union territories of India. The main outcome was self-reported alcohol use during the respondents' current or most recent pregnancy. Explanatory variables included age, economic status, education level, tribal affiliation, urban/rural residence, planned/unplanned pregnancy, adequacy of antenatal care and tobacco use. Statistical analyses included chi-square tests for unadjusted comparisons and logistic regression for adjusted odds ratios (AOR). The prevalence of alcohol use during pregnancy was 1.26% nationally, with significant regional variations. The highest prevalence rates were in Arunachal Pradesh (13.03%), Chhattisgarh (5.77%) and Assam (5.62%). Key correlates included belonging to Scheduled Tribes (AOR 7.987, 95% CI 5.73-11.134), having no education (AOR 1.733, 95% CI 1.025-2.931) and tobacco use (AOR 3.389, 95% CI 2.647-4.338). Regional analysis showed the highest adjusted odds for the Northeast (AOR 19.753, 95% CI 4.87-80.116) region. Alcohol use during pregnancy in India shows significant regional and socio-demographic disparities. The findings highlight the need for targeted public health interventions and policies, particularly in high-risk groups and regions.

Environmental justice issues in drinking water contaminant exposure in a European context.

Previous studies have documented ethnic and sociodemographic disparities in exposure to drinking water (DW) contaminants. A majority were conducted in the U.S., with fewer studies conducted in other regions. This research aims to assess available evidence regarding environmental justice (EJ) issues in Europe, identify contaminants and potential drivers. A Scoping Review was conducted, exploring the existing European studies from 1990 to 2022. The review encompasses types of DW contaminants studied in relation to EJ, research designs, and potential drivers contributing to inequalities in exposure to specific contaminants. In addition, a case study was conducted in Ille-et-Vilaine, France, focusing on contaminants identified in the review and using a national monitoring database. Inequalities in contaminants' exposure were assessed using a composite deprivation index, FDep, at the census tract level (IRIS) applied in multilevel models and geographically weighted regression models, accounting for the rural-urban heterogeneity. Results show a limited number of primary studies focusing on EJ and DW contaminants exposure in Europe (n=16). Various chemical contaminants such as nitrates, trihalomethanes (THMs), heavy metals, fluoride and pesticides have been assessed. Case study findings suggest some association between FDep and contaminants, with a different level of correlation depending on the contaminant. THMs show a negative correlation with deprivation, while lead displays a positive correlation related to the FDep. Disparities in exposure were also found according to the spatial scale of analysis. In rural areas, higher deprivation levels were associated with higher levels of nitrate (OR: 1.47; 95%CI: 1.02, 2.15) and lower level of fluoride (OR: 0.16; 95%CI: 0.07, 0.30) or THMs (OR: 0.73; 95%CI: 0.55, 0.98) in tap water. This study emphasizes the need for comprehensive research on EJ and DW contaminants exposure on a larger scale. Understanding complex interactions between contaminant distribution, socioeconomic factors, and exposure is essential for addressing EJ in drinking water.

Characterizing sociodemographic disparities and predictors of Gestational Diabetes Mellitus among Asian and Native Hawaiian or other Pacific Islander pregnant people: an analysis of PRAMS data, 2016–2022

BackgroundGestational Diabetes Mellitus (GDM) affects between 2 and 10% of pregnancies in the United States, with trends of increasing prevalence and a significant amount of variability across race and ethnicity, maternal age, and insurance status. Asian and Native Hawaiian or Other Pacific Islanders (NHOPI) have been documented to have a higher prevalence and risk of developing GDM compared to non-Hispanic white populations and have been under-studied in health disparities research.MethodsUsing data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016–2022 surveys, we conducted analyses for the overall PRAMS sample as well as within-group analyses among participants who identify as Asian and NHOPI to identify risk factors for GDM. Descriptive statistics were also collected in the Asian and NHOPI subsample, stratified by Asian and NHOPI ethnicity. Bivariate analyses were performed to explore the relationship between potential GDM risk factors among the overall analytic sample and within the Asian and NHOPI subsample, and multivariable logistic regression was used to investigate potential predictors of GDM.ResultsAsian and NHOPI ethnicities differed by prevalence of GDM at 17.2%, 19.56%, 10.8%, 10.71%, and 18.49% for Chinese, Filipino, Japanese, Native Hawaiian/Other Pacific Islander, and Other Asian, respectively. Compared to White individuals (reference group), the odds of GDM were higher for Asian and Native Hawaiian/Other Pacific Islander individuals in the adjusted model (adjusted odds ratio (aOR) = 2.19, 95% CI: 2.62–2.9). Native mothers also demonstrated significantly elevated odds (aOR = 1.48, 95% CI: 1.4–1.6), while Mixed-race individuals exhibited slightly increased odds (OR = 1.22, 95% CI: 1.14–1.29). The findings revealed notable variability in GDM risk factors across ANHOPI subgroups. Obesity emerged as a consistent and strong predictor of GDM across all groups, while other factors such as interpersonal violence exposure and prenatal depression demonstrated limited or subgroup specific effects.ConclusionThis analysis of 2016 to 2022 PRAMS data illustrated significant variations of GDM predictors between the general population and the Asian and NHOPI population, as well as differences between Asian and NHOPI ethnicities.

Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany.

Wearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context. This study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator. A cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use. Overall, 24% (223/932) of participants (52% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1-2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18-40: 36%; 41-64: 26%; 65+:14%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95% CI: 0.94 to 1.07 in age group 18-40; OR = 1.07, 95% CI: 1.03 to 1.12 in age group 41-64; OR = 1.11, 95% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95% CI: -0.0244 to -0.00791, p <.001). This study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.

Attainment of World Health Organization physical activity recommendations by Ecuadorian children: Analysis of social and anthropometrics factors in two distinct populations.

Daily adherence to WHO recommended physical activity guidelines has multiple health benefits in children and adolescents. Limited data from low and middle-income countries are available regarding adherence to WHO physical activity recommendations. This study aims to objectively measure physical activity intensities and explore associations with sociodemographic and anthropometric factors related to nonadherence to the WHO minimum physical activity recommendations. Two cross-sectional studies were conducted between 2014 and 2019 in two distinct populations of Ecuador in terms of poverty and residency (Cuenca: 66% live in urban areas, and 38.2% have unsatisfied basic needs; Quininde, 76.4% live in rural areas and 91% have unsatisfied basic needs). Waist-worn accelerometers were used to measure daily physical activity, standardized questionnaires were used to assess sociodemographic variables (age, sex, ethnicity, and socioeconomic status), and anthropometric (weight, height, waist circumference) measurements were taken. Multivariable regression was used to assess the relationship between sociodemographic and anthropometric factors with physical activity in each study population. The study involved 650 participants in Cuenca, with a mean age of 9.1 years (SD 2.9), and 985 children and adolescents in Quinindé, with a mean age of 8.3 years (SD 0.4). In both settings, boys were more likely than girls (Cuenca: adj. OR 3.09, 95% CI 2.17-4.39; Quinindé adj. OR 5.63, 95% CI 4.03-7.85) to achieve the WHO physical activity guidelines. More affluent participants were much less likely to meet this recommendation than their poorer counterparts in both settings. In Cuenca, a higher waist circumference was inversely associated with meeting WHO daily physical activity recommendation (adj. OR 0.96, 95% CI 0.94-0.98), whereas in Quinindé, adherence to WHO guidelines was more likely in non-Mestizo than Mestizo children (adj. OR 1.45, 95% CI 1.02-2.07). The findings suggest that anthropometric differences and sociodemographic disparities influence the attainment of WHO physical activity recommendations in Ecuadorian children.

Technology literacy and access to digital resources for remote assessment among adults enrolled in Alzheimer's disease research.

The SARS-CoV-2 pandemic accelerated development of innovative methods for conducting research remotely via digital technologies. However, few studies have examined participant technological literacy skills or access as key social determinants of brain health in aging populations at risk of Alzheimer's disease and other dementias. To identify associations of sociodemographic and clinical characteristics, cognitive status and geolocation with digital technology access and skill within dementia research cohorts. A self-administered questionnaire surveyed digital access and literacy skills in persons enrolled across various studies conducted at Emory Goizueta Alzheimer's Disease Research Center. We investigated cognitive and sociodemographic characteristics, and neighborhood disadvantage related to these digital attributes. Of 1860 participants (mean age: 65.3 years (SD:11.4)) surveyed, 71.6% were women, 87.1% Whites, 10.4% African Americans, and 46.9% had postgraduate-level education. Most participants had access to digital devices: desktop (53.7%), laptop (81.6%), tablet (71.6%), smartphone (94.6%), internet (82.0%), or videoconferencing (95.5%). Cognitively unimpaired participants had higher odds of digital access (OR:3.75; 95% CI:2.45-5.73) and skill (OR:1.22; 95% CI:1.14-1.30). Although Whites were likelier to have access (OR:1.36; 95% CI:1.01-1.82) than African Americans, no differences were found in skill between the two groups. Living in more disadvantaged neighborhoods was significantly associated with lower technology skills (OR:0.86; 95% CI:0.82-0.91). Cognitive impairment, race, and neighborhood socioeconomic disadvantage are significant barriers which limit digital access and skill. Improving digital knowledge, skill-building, and geographic access may encourage research participation especially in geographically remote or disadvantaged areas and help narrow sociodemographic and racial disparities existing in dementia research.

Longitudinal assessment of disparities in pancreatic cancer care: A retrospective analysis of the National Cancer Database.

The existence of sociodemographic disparities in pancreatic cancer has been well-studied but how these disparities have changed over time is unclear. The purpose of this study was to longitudinally assess patient management in the context of sociodemographic factors to identify persisting disparities in pancreatic cancer care. Using the National Cancer Database, patients diagnosed with pancreatic ductal adenocarcinoma from 2010 to 2017 were identified. The primary outcomes were surgical resection and/or receipt of chemotherapy. Outcome measures included changes in associations between sociodemographic factors (i.e., sex, age, race, comorbidity index, SES, and insurance type) and treatment-related factors (i.e., clinical stage at diagnosis, surgical resection, and receipt of chemotherapy). For each year, associations were assessed via univariate and multivariate analyses. Of 75,801 studied patients, the majority were female (51%), White (83%), and had government insurance (65%). Older age (range of OR 2010-2017 [range-OR]:0.19-0.29), Black race (range-OR: 0.61-0.78), lower SES (range-OR: 0.52-0.94), and uninsured status (range-OR: 0.46-0.71) were associated with lower odds of surgical resection (all p<0.005), with minimal fluctuations over the study period. Older age (range-OR: 0.11-0.84), lower SES (range-OR: 0.41-0.63), and uninsured status (range-OR: 0.38-0.61) were associated with largely stable lower odds of receiving chemotherapy (all p<0.005). Throughout the study period, age, SES, and insurance type were associated with stable lower odds for both surgery and chemotherapy. Black patients exhibited stable lower odds of resection underscoring the continued importance of mitigating racial disparities in surgery. Investigation of mechanisms driving sociodemographic disparities are needed to promote equitable care.

Global Trend of MASH-associated Liver Cancer: A Systematic Analysis From the Global Burden of Disease 2021.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are the leading causes of liver disease and are emerging as the main risk factors for primary liver cancer (PLC). However, updated global data on MASH remain scarce. This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from MASH-associated PLC, stratified by geographical region, sociodemographic index, age, and sex. There were 42,290 incident cases, 40,920 deaths, and 995,470 DALYs from PLC globally. Global incidence (+98%), death (+93%), and DALYs (+76%) from MASH-associated PLC increased steeply over the study period. Among different etiologies, only MASH-associated PLC had increased mortality rates (annual percent change [APC],+0.46; 95% confidence interval [CI], 0.33%-0.59%). Africa and low sociodemographic index countries exhibited the highest age-standardized incidence, death, and DALYs from MASH-associated PLC. DALYs increased in females (APC, 0.24%; 95% CI, 0.06%-0.42%), whereas they remained stable in males. Americas experienced the highest percentage increase in age-standardized incidence rate (APC, 2.09%; 95% CI, 2.02%-2.16%), age-standardized death rate (APC, 1.96%; 95% CI, 1.69%-2.23%), and age-standardized DALYs (APC, 1.96%; 95% CI, 1.63%-2.30%) from MASH-associated PLC. Over the past 2 decades, the burden of MASH-associated PLC has risen, though there are sociodemographic and geographic disparities. This necessitates urgent strategies across the globe to mitigate the epidemic of MASH-associated PLC as well as its metabolic drivers.

Socioeconomic and Demographic Disparities in Keratoconus Treatment

ObjectiveTo investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (collagen cross-linking (CXL) and keratoplasty), as well as comorbidities associated with KCN. DesignRetrospective clinical cohort study. Subjects3224 patients from the UI-Health database from 2020 to 2024, including 1612 patients with an ICD-10 diagnosis of KCN and 1612 ophthalmology patients as a control group. MethodsMultivariable and univariable logistic regression were performed to evaluate association between sociodemographic traits and rates of CXL and keratoplasty. Sociodemographic traits included age, sex, race/ethnicity, insurance status, and neighborhood social vulnerability. Best corrected visual acuity (BCVA) and manifest cylinder were used as indicators of disease impact. Comorbid disease rates were compared to a 1:1 distance-matched control group. Main Outcome MeasuresOdds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions. ResultsFemales received less keratoplasty than males (OR=0.55, P<0.001). Black individuals received less CXL than White individuals (OR=0.68, P<0.05), as did those with Medicaid (OR=0.27, P<0.0001) or no insurance (OR=0.41, P<0.001) compared to those with commercial insurance. Socially vulnerable neighborhoods received less CXL (OR=0.56, P<0.01) and keratoplasty (OR=0.66, P<0.05). Black females were the most vulnerable, undergoing fewer procedures than White females (OR=0.58, P<0.01) and Black males (OR=0.65, P<0.05). Black and Hispanic/Latin-X individuals presented with more severe disease (P<0.01, P<0.0001). Down Syndrome was more common (P<0.01), and diabetes was less common (P<0.0001) in KCN patients. ConclusionsSignificant sociodemographic disparities exist in the treatment of KCN. While further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.

Drink like a man? Modified Poisson analysis of adolescent binge drinking in the US, 1976–2022

This study estimates temporal trajectories and sociodemographic disparities in underage adolescent binge drinking in the United States over the past four decades. By compiling 47 waves of national representative data from the Monitoring the Future (MTF) study between 1976 and 2022, we analyzed two types of adolescent binge drinking behaviors, past-two-week excessive drinking and drunkenness in the past 30 days, using the innovative modified Poisson (mixture) approach to grouped and right-censored counts (GRC). The overall decrease in incidence rates was attributable to substantial reductions in the risks of excessive drinking (45.77% in 1980 and 12.62% in 2022) and drunkenness (35.12% in 1998 and 14.81% in 2022). However, at-risk adolescents only showed mild reductions in incidence rates over time. While males consistently drank more often and were at a higher risk of binge drinking and drunkenness than females, the sex disparities tended to converge over time. The modified Poisson approach is a useful tool to estimate incidence, risk, and at-risk incidence in epidemiological studies with GRC counts. The alarming high incidence rates of at-risk adolescents, especially males, warrant further investigation.

Disparities in Palliative Treatment Utilization in Metastatic Colorectal Cancer Patients.

Patients with metastatic colorectal cancer (mCRC) often require multidisciplinary interventions due to the diversity of symptoms. Palliative treatment offers benefits including improved quality of life, yet sociodemographic disparities influence its utilization. This study aims to characterize these disparities in palliative treatment use among mCRC patients. Utilizing data from the National Cancer Database, we identified patients diagnosed with mCRC between 2016 and 2020. Patients were categorized by metastatic site: peritoneal, liver, lung, or bone/brain/lymph node. Palliative treatment rates were compared across metastatic sites as well as patient and hospital factors. A total of 106,241 patients were identified as having mCRC, with 19,208 (18.08%) receiving palliative treatment; 24.0% of patients with multiple metastatic disease and 14.0% of those with solely peritoneal metastases (PM) utilized palliative treatment (p<0.001). Furthermore, patients over 75 years of age had a significantly decreased likelihood of receiving palliative treatment compared with younger patients (p=0.0002). Hispanic patients did not differ significantly from non-Hispanic White populations (p=0.47). Those in the highest education quartile demonstrated a higher degree of palliative treatment use compared with the lowest education quartile (p=0.0081). Among patients with mCRC, those with multiple sites of metastatic disease tend to receive higher rates of palliative treatment compared with those with oligometastatic disease. Patients with PM had the lowest rate of receiving palliative treatment. Other determinates of utilizing palliative treatment include younger age groups and higher education. Further research is warranted to understand the patterns of disparities in palliative treatment use among mCRC patients.

Sociodemographic Disparities in Access, Timing, and Outcomes of Cleft Palate Repair in the United States

Purpose: The timing of cleft palate (CP) repair has been refined based on decades of study to optimize feeding, speech, and quality of life outcomes. However, sociodemographic disparities may impact accessibility of cleft care, surgical timing, and outcomes. This study reviews published data on sociodemographic disparities impacting primary CP repair access, timing, and outcomes in the United States. Methods: A systematic review was performed following PRISMA guidelines in the Pubmed, Embase, and Medline/OVID databases. Included studies focused on sociodemographic disparities in access to, timing, and outcomes after CP surgery. Studies performed outside the United States or published before 2000 were excluded. Results: Twenty-three studies were included in the review focusing on access to care (n = 8), financial cost (n = 1), surgical timing (n = 12), and surgical outcomes (n = 9). Access is most challenging for non-White patients and those with public insurance. Financial disparities are poorly studied and understood. Non-White, particularly Asian patients, those with public insurance, or geographically remote patients receive delayed care. The same populations struggle with obtaining quality outcomes. Government health policies or the provision of a cleft navigator can resolve disparities in surgical timing and potentially outcomes. Conclusions: Disparities in CP repair access and outcomes affect minority, particularly Asian, publicly insured, and geographically remote patients. The presence of a cleft navigator to help guide patients through the healthcare system can be effective. Future studies should aim to further investigate financial disparities and design initiatives that improve coordination of care for CP surgery in underserved populations.

Sociodemographic Disparities in the Prevalence of Metabolic Syndrome in Rural South Africa: An Analysis of Gender, Age, and Marital, Employment, and Educational Status

Sociodemographic factors affect how metabolic syndrome (MetS) manifests and progresses. This study aimed to investigate the prevalence between MetS and sociodemographic factors among adult participants in the Dikgale HDSS. This was a comprehensive retrospective study where the records of 575 participants were meticulously evaluated. MetS was defined using a joint interim statement (JIS). The data were analyzed using the Statistical Package for SPSS, version 25. A chi-square test was used to compare proportions between groups, with Cramer’s V used to assess the strength of association. Logistic regression was used to determine the association between MetS and sociodemographic profiles. A p-value of less than 0.05 was considered statistically significant. The prevalence of MetS was 28.2% (females 33.3% vs. males 15.6%, p ≤ 0.001). In addition, logistic regression showed males to have lower odds of MetS as compared to females (OR = 0.36, 95% CI: 0.2–0.6, and AOR = 0.4, 95% CI: 0.2–0.6). The 55–60 age group had the highest proportion of affected individuals, and MetS was also more common among individuals with low educational attainment. In addition, on regression, the same association was observed. This study found sociodemographic disparities in MetS among rural adults, especially females, who had an increased risk of MetS, and participants with low educational attainment.