Sociodemographic Inequalities Research Articles

Temporalities of emergency: the experiences of Indigenous women with traumatic brain injury from violence waiting for healthcare and service support in Australia

ABSTRACT Globally, traumatic brain injury (TBI) has been recognised as a serious health issue not only because of the immediate impacts at the time the injury occurs but even more so due to the longstanding impacts. Even though TBI is a globally recognised condition, the research is disproportionately focused on its incidence in, and immediate and long-term effects on men. A growing body of research suggests that generally, women who experience family violence are at high risk of TBI and suffer its impacts in ways that reflect gendered differences in the patterns and frequency of violence. In Australia, the social and physical costs of TBI are multiplied for Indigenous women, whose experience of disability and access to healthcare lies at the intersection of gender and race in the historical context of settler colonialism. The present study addresses the need for research into the sociodemographic inequalities that affect access to culturally appropriate hospital care, timely response systems, and flexible, safe and engaged social services. This paper draws on data from interviews and focus groups with Indigenous women, hospital staff and community-based service providers and suggests potential pathways for further research in settler-colonial settings elsewhere in the world.

Sociodemographic inequality in children aged 0–19 years with and without parents diagnosed with heart disease: a Danish nationwide register-based study

ObjectivesThis study aimed to estimate the prevalence of children aged 0–19 years who have a parent with a history of heart disease and investigate their sociodemographic characteristics. Study designA national register-based study. MethodsFrom the Danish Fertility Register and the Danish National Patient Register information on children of parents with ischemic heart disease, arrhythmia, heart failure and heart valve disease in the period 1981–2018 were obtained. Statistical analyses including descriptive statistics, logistic and linear regression were used to illuminate associations between parental heart disease and sociodemographic characteristics. ResultsThe study population consisted of 142,480 children aged 0–19 years with at least one parent diagnosed with heart disease, corresponding to every 9th child in Denmark in 2018. The number increased from 4.5% in 2002 to 11.1% in 2018. In the study population most had a father with heart disease (57.8%) and 4.6% had two parents with heart disease. Parents with heart disease had significantly higher odds of being out of work (OR 1.68, 95% CI 1.64; 1.72), in a single-parent household (OR 1.09, 95% CI 1.07; 1.11), divorced or widowed (OR: 1.10, 95% CI 1.08; 1.12), having a lower educational level (OR 1.35, 95% CI 1.33; 1.37), and a lower family income (−42,410 DKR, 95% CI -50,306; −34,514, P < 0.0001) compared to those without heart disease. ConclusionChildren affected by parental heart disease comprise a substantial part of the Danish population. These have significantly different sociodemographic characteristics than children in families without parental heart disease, which might affect social heritage and parental capacity.

Inequalities in emergency care use across transition from paediatric to adult care: a retrospective cohort study of young people with chronic kidney disease in England.

Sociodemographic inequalities in emergency secondary care usage were evident in this cohort across the transition period, independent of age, with some variation between admissions and A&E use, and evidence of effect modification by transfer. Such inequalities likely have multifactorial origin, but importantly, could represent differential meetings of care needs. • In chronic kidney disease (CKD), transfer from paediatric to adult healthcare is associated with declining health outcomes. • Known differences in CKD outcomes by sociodemographic factors have limited prior exploration in the context of transfer. • Population-level data was used to examine the impacts of transfer and sociodemographic factors on unplanned secondary care utilisation in CKD. • Healthcare utilisation trends may not reflect known CKD pathophysiology and there may be unexplored sociodemographic inequalities in the experiences of young people across transfer.

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019.

It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level. We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group. Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index. Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years. Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.

Diabetes subgroups and sociodemographic inequalities in Mexico: a cross-sectional analysis of nationally representative surveys from 2016 to 2022

Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys. We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage. We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74). Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states. This research was supported by Instituto Nacional de Geriatría in Mexico.

Sociodemographic inequities in food allergy: Insights on food allergy from birth cohorts.

A large and growing corpus of epidemiologic studies suggests that the population-level burden of pediatric FA is not equitably distributed across major sociodemographic groups, including race, ethnicity, household income, parental educational attainment, and sex. As is the case for more extensively studied allergic disease states such as asthma and atopic dermatitis epidemiologic data suggest that FA may be more prevalent among certain populations experiencing lower socioeconomic status (SES), particularly those with specific racial and ethnic minority backgrounds living in highly urbanized regions. Emerging data also indicate that these patients may also experience more severe FA-related physical health, psychosocial, and economic outcomes relating to chronic disease management. However, many studies that have identified sociodemographic inequities in FA burden are limited by cross-sectional designs that are subject to numerous biases. Compared with cross-sectional study designs or cohorts established later in life, birth cohorts offer advantages relative to other study designs when investigators seek to understand causal relationships between exposures occurring during the prenatal or postnatal period and the atopic disease status of individuals later in life. Numerous birth cohorts have been established across recent decades, which include evaluation of food allergy-related outcomes, and a subset of these also have measured sociodemographic variables that, together, have the potential to shed light on the existence and possible etiology of sociodemographic inequities in food allergy. This manuscript reports the findings of a comprehensive survey of the current state of this birth cohort literature and draws insights into what is currently known, and what further information can potentially be gleaned from thoughtful examination and further follow-up of ongoing birth cohorts across the globe.

An exploratory review of the fintech influence field

Fintech as a three-dimensional phenomenon reflects the rapidly changing technological, financial and business environment. The bibliometric analysis of scientific articles allowed us to identify the main themes and create a map of the field of fintech influences. Systematization of scientific articles revealed the influence of economic development and socio-demographic inequality on fintech development. Government regulatory policies can accelerate the digitisation of financial services and financial inclusion and help the fintech sector face geopolitical challenges. Fintech’s impact was divided into three areas: financial stability and sustainable development, the business ecosystem and human behaviour. The research we summarised allowed us to identify the mechanisms through which fintech influences various fields. A complex approach to the influence of fintech enables us to understand the phenomenon and make better decisions.

Sociodemographic inequities in COVID-19 vaccination among adults in the United States, 2022

BackgroundDespite the availability of COVID-19 vaccines since December 2020, sociodemographic inequities in vaccination and preventable COVID-related deaths persist. To inform efforts for equitable COVID-19 vaccination campaigns, a comprehensive national evaluation of existing inequities is necessary. ObjectiveTo examine sociodemographic inequities in COVID-19 vaccination receipt using data from the 2022 National Health Interview Survey (NHIS). MethodsThis secondary data analysis used cross-sectional nationally-representative data from the 2022 NHIS to assess vaccination inequities among 27,126 adults. Separate Poisson regressions adjusted for clinical factors (e.g., age, sex, high-risk health conditions) were used to evaluate vaccination inequities across sociographic factors (e.g., race/ethnicity, poverty, health insurance). ResultsIn 2022, 79.6% of adults received at ≥ 1 vaccine dose, 75.0% received ≥ 2 doses (“fully vaccinated”), 45.7% received ≥ 3 doses (≥ 1 booster), and 17.2% received ≥ 4 doses (≥ 2 boosters). Marked inequities were evident in COVID-19 vaccination across primary and booster doses, especially receipt of at least 1 booster dose (≥ 3 doses). Black (35.7%, prevalence ratio [PR] 0.78 [95% CI 0.74-0.83]) and Latinx (35.5%, PR 0.82 [CI 0.78-0.86]) adults were less likely to receive ≥ 3 doses than Asian (66.5%, PR 1.41 [CI 1.35-1.48]) and White (48.8%) adults. Poverty (31.1% [PR 0.65 {CI 0.61-0.69}] vs. 50.7%) and food insecurity (27.1% [PR 0.63 {CI 0.58-0.68}] vs. 47.3%) were negatively associated with receipt of ≥ 3 vaccine doses. Adults without usual source of care (24.9%, PR 0.61 [CI 0.57-0.65]) or health insurance (17.4%, PR 0.40 [CI 0.36-0.45]) had much lower rates of ≥ 3 doses than those with appropriate health care access (48.7% and 51.9%, respectively). ConclusionAs of 2022, 1-in-5 U.S. adults remain unvaccinated, and more than half have not received any recommended booster doses. Economically/socially marginalized populations—including Black and Latinx adults and those with structural barriers such as poverty, food insecurity, and poor health care access—were less likely to receive a booster. Addressing these vaccination inequities is crucial to achieve equitable COVID-19 protection and reduce preventable deaths among economically/socially marginalized populations.

Adverse Childhood Experiences Among U.S. Adults: National and State Estimates by Adversity Type, 2019–2020

Although adverse childhood experiences (ACEs) are associated with lifelong health harms, current surveillance data on exposures to childhood adversity among adults are either unavailable or incomplete for many states. In this study, recent data from a nationally representative survey were used to obtain the current and complete estimates of ACEs at the national and state levels. Current, complete, by-state estimates of adverse childhood experiences were obtained by applying small area estimation technique to individual-level data on adults aged ≥18 years from 2019-2020 Behavioral Risk Factor Surveillance System survey. The standardized questions about childhood adversity included in the 2019-2020 survey allowed for obtaining estimates of ACE consistent across states. All missing responses to childhood adversity questions (states did not offer such questions or offered them to only some respondents; respondents skipped questions) were predicted through multilevel mixed-effects logistic small area estimation regressions. The analyses were conducted between October 2022 and May 2023. An estimated 62.8% of U.S. adults had past exposure to ACEs (range: 54.9% in Connecticut; 72.5% in Maine). Emotional abuse (34.5%) was the most common; household member incarceration (10.6%) was the least common. Sexual abuse varied markedly between females (22.2%) and males (5.4%). Exposure to most types of adverse childhood experiences was lowest for adults who were non-Hispanic White, had the highest level of education (college degree) or income (annual income ≥$50,000), or had access to a personal healthcare provider. Current complete estimates of ACEs demonstrate high countrywide exposures and stark sociodemographic inequalities in the burden, highlighting opportunities to prevent adverse childhood experiences by focusing social, educational, medical, and public health interventions on populations disproportionately impacted.

Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-21.

The risk of suicide is complex and often a result of multiple interacting factors. Understanding which groups of the population are most at risk of suicide is important to inform the development of targeted public health interventions. We used a novel linked dataset that combined the 2011 Census with the population-level mortality data in England and Wales. We fitted generalized linear models with a Poisson link function to estimate the rates of suicide across different sociodemographic groups and to identify which characteristics are independent predictors of suicide. Overall, the highest rates of suicide were among men aged 40-50 years, individuals who reported having a disability or long-term health problem, those who were unemployed long term or never had worked, and those who were single or separated. After adjusting for other characteristics such as employment status, having a disability or long-term health problem, was still found to increase the incidence of suicide relative to those without impairment [incidence rate ratio minimally adjusted (women) = 3.5, 95% confidence interval (CI) = 3.3-3.6; fully adjusted (women) 3.1, 95% CI = 3.0-3.3]. Additionally, while the absolute rate of suicide was lower in women compared with men, the relative risk in people reporting impairments compared with those who do not was higher in women compared with men. The findings of this work provide novel population-level insights into the risk of suicide by sociodemographic characteristics in England and Wales. Our results highlight several sociodemographic groups who may benefit from more targeted suicide prevention policies and practices.

Socio-demographic inequalities in stage at diagnosis of lung cancer: A French population-based study

BackgroundDiagnosing patients at a non-advanced stage has become a mainstay of lung cancer prevention and control strategies. Understanding socio-demographic inequalities in stage at diagnosis may improve the targeting of interventions on patients at higher risk. This study aimed to identify these socio-demographic determinants in a large-scale French population-based cancer registry. MethodsAll incident lung cancers diagnosed between 2008 and 2019 identified from the Poitou-Charentes Cancer Registry (south-west France) were included. Stage at diagnosis was categorised as advanced/non-advanced (TNM III/IV vs I/II) according to the 8th TNM edition, the objective being to ensure a consistent level of prognosis over time. Socio-demographic variables included age, sex, the French European Deprivation Index (EDI) and patient’s place of residence. Their impact on stage at diagnosis was quantified by multivariate logistic regression models with subgroup analyses by histological subtype. ResultsOut of the 15,487 included patients, 75% were diagnosed at an advanced stage (66% to 95% depending on the histological subtype), 17% at a non-advanced stage and 10% at a non-specified stage. Multivariate analysis showed different patterns according to histological subtypes. In patients with adenocarcinoma, a higher risk of advanced stage was found for younger and older patients (u-shape), those most deprived, and those living in rural areas. The same effect of age was reported for squamous cell carcinomas, while no association was found for small-cell lung carcinomas. ConclusionsThis study highlighted substantial socio-demographic inequalities in stage at diagnosis, specifically for adenocarcinoma patients. Diagnosis strategies could be refined and strengthened in the non-smoker population, in which adenocarcinomas are mainly reported.

Sociodemographic inequities in the burden of carcinogenic industrial air emissions in the United States.

Industrial facilities are not located uniformly across communities in the United States, but how the burden of exposure to carcinogenic air emissions may vary across population characteristics is unclear. We evaluated differences in carcinogenic industrial pollution among major sociodemographic groups in the United States and Puerto Rico. We evaluated cross-sectional associations of population characteristics including race and ethnicity, educational attainment, and poverty at the census tract level with point-source industrial emissions of 21 known human carcinogens using regulatory data from the US Environmental Protection Agency. Odds ratios and 95% confidence intervals comparing the highest emissions (tertile or quintile) to the referent group (zero emissions [ie, nonexposed]) for all sociodemographic characteristics were estimated using multinomial, population density-adjusted logistic regression models. In 2018, approximately 7.4 million people lived in census tracts with nearly 12 million pounds of carcinogenic air releases. The odds of tracts having the greatest burden of benzene, 1,3-butadiene, ethylene oxide, formaldehyde, trichloroethylene, and nickel emissions compared with nonexposed were 10%-20% higher for African American populations, whereas White populations were up to 18% less likely to live in tracts with the highest emissions. Among Hispanic and Latino populations, odds were 16%-21% higher for benzene, 1,3-butadiene, and ethylene oxide. Populations experiencing poverty or with less than high school education were associated with up to 51% higher burden, irrespective of race and ethnicity. Carcinogenic industrial emissions disproportionately impact African American and Hispanic and Latino populations and people with limited education or experiencing poverty thus representing a source of pollution that may contribute to observed cancer disparities.

Sociodemographic inequalities in the incidence of COVID-19 in National Household Sample Survey cohort, Brazil, 2020

RESUMO Objetivo: Verificar a associação entre fatores sociodemográficos e o tempo até a ocorrência de novos casos de COVID-19 e de testes positivos para Sars-CoV-2 no Brasil, durante o período de maio a novembro de 2020, com base em uma coorte dos brasileiros participantes da Pesquisa Nacional por Amostra de Domicílios COVID-19. Métodos: Foi constituída uma coorte concorrente e fechada utilizando dados mensais da Pnad COVID-19, realizada por inquérito telefônico. Um caso novo foi definido com base no relato da ocorrência de um quadro de síndrome gripal, associado à perda de olfato ou paladar; e a positividade foi definida com base no relato de um teste positivo, entre os que referiram ter sido testados. Foram aplicados modelos de regressão de Cox para verificar associações, considerando a ponderação amostral, calibrada para a distribuição etária, de sexos e de escolaridade. Resultados: A incidência acumulada de casos na coorte fixa geral foi de 2,4%, enquanto a de testes positivos na coorte fixa testada foi de 27,1%. Verificou-se maiores riscos nas regiões Centro-Oeste, Norte e Nordeste, entre mulheres, residentes em áreas urbanas, pessoas com escolaridade até o ensino médio, com a cor da pele declarada como preta e trabalhadores da área da saúde. Indivíduos com menor escolaridade e profissionais de saúde apresentaram maior frequência de novos testes positivos. Novos testes positivos ocorreram com maior frequência em indivíduos com menor escolaridade e trabalhadores da área da saúde. Conclusão: Foram observados riscos desiguais entre os estratos populacionais comparados. Destaca-se a importância da realização de inquéritos nacionais prospectivos na investigação de iniquidades em saúde.

Sociodemographic inequalities in the incidence of COVID-19 in National Household Sample Survey cohort, Brazil, 2020.

To verify the association between sociodemographic factors and the time until the occurrence of new cases of COVID-19 and positive tests for SARS-CoV-2 in Brazil, during the period from May to November 2020, based on a cohort of Brazilians participating in the COVID-19 National Household Sample Survey. A concurrent and closed cohort was created using monthly data from the PNAD COVID-19, carried out via telephone survey. A new case was defined based on the report of the occurrence of a flu-like syndrome, associated with loss of smell or taste; and positivity was defined based on the report of a positive test, among those who reported having been tested. Cox regression models were applied to verify associations. The analyzes took into account sample weighting, calibrated for age, gender and education distribution. The cumulative incidence of cases in the overall fixed cohort was 2.4%, while that of positive tests in the fixed tested cohort was 27.1%. Higher incidences were observed in the North region, in females, in residents of urban areas and in individuals with black skin color. New positive tests occurred more frequently in individuals with less education and healthcare workers. The importance of prospective national surveys is highlighted, contributing to detailed analyzes of social inequalities in reports focused on public health policies.

Disparities in preconception health indicators in U.S. women: a cross-sectional analysis of the behavioral risk factor surveillance system 2019.

Optimized preconception care improves birth outcomes and women's health. Yet, little research exists identifying inequities impacting preconception health. This study identifies age, race/ethnicity, education, urbanicity, and income inequities in preconception health. We performed a cross-sectional analysis of the Center for Disease Control and Prevention's (CDC) 2019 Behavioral Risk Factor Surveillance System (BRFSS). This study included women aged 18-49 years who (1) reported they were not using any type of contraceptive measure during their last sexual encounter (usage of condoms, birth control, etc.) and (2) reported wanting to become pregnant from the BRFSS Family Planning module. Sociodemographic variables included age, race/ethnicity, education, urbanicity, and annual household income. Preconception health indicators were subdivided into three categories of Physical/Mental Health, Healthcare Access, and Behavioral Health. Chi-squared statistical analysis was utilized to identify sociodemographic inequities in preconception health indicators. Within the Physical/Mental Health category, we found statistically significant differences among depressive disorder, obesity, high blood pressure, and diabetes. In the Healthcare Access category, we found statistically significant differences in health insurance status, having a primary care doctor, and being able to afford a medical visit. Within the Behavioral Health category, we found statistically significant differences in smoking tobacco, consuming alcohol, exercising in the past 30 days, and fruit and vegetable consumption. Maternal mortality and poor maternal health outcomes are influenced by many factors. Further research efforts to identify contributing factors will improve the implementation of targeted preventative measures in directly affected populations to alleviate the current maternal health crisis.

BIOSOCIAL PATHWAYS AFFECTING HEALTH AND AGING IN THE HEALTH AND RETIREMENT STUDY

Abstract Representative population studies, like the Health and Retirement Study (HRS), are gathering large amounts of biomarker and multi-omic data. This presents a unique opportunity to investigate how population-level aging effects is driven by social inequality. This research has the capacity to uncover targets for intervention that could result in extending longevity and healthy life span and reducing inequalities in aging. There has been substantial research and progress in identifying biological processes underlying age-related decline, morbidity, and mortality (the so-called biological hallmarks of aging); however, despite this progress, demographic, social, and psychological factors (the so-called social hallmarks of aging) are substantially associated with cognitive aging and ADRD above-and-beyond genetic and biological factors There is, therefore, a need for research that carefully integrates the social and biological hallmarks of the human aging processes. This symposium highlights research that investigates interactions between biological and social processes that lead to inequalities in health and aging among older adults utilizing recently released data from the HRS Venous Blood Study (a nationally representative sample of US adults over age 55). Included are papers investigating the role of timing of childhood adversity in affecting adult DNA methylation patterns, how childhood parental loss is associated with accelerated epigenetic aging, how socioeconomic status patterns expression of genes related to inflammation and cellular senescence, and how sets of age-related biomarkers can explain sociodemographic inequalities in mortality. These studies contribute to an emerging literature integrating social and biological sciences to better understand inequalities in the aging process.

Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study.

Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia. Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities. Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common. Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.

Abstract B086: Sociodemographic inequities in carcinogenic industrial air pollution exposures among women in a U.S. cohort

Abstract Purpose: In the U.S. industrial pollution disproportionately burdens under-resourced communities, but little is known about the amount of potential exposure to carcinogenic industrial air pollutants and their associations with cancer risk, especially for female cancers with known racial disparities. We assessed exposures to airborne carcinogenic emissions by race/ethnicity, education, and neighborhood deprivation. Methods: We used a U.S. Environmental Protection Agency nationwide database of regulated chemical emissions from industrial facilities to estimate historical exposures (1987-1995) to 21 known and 30 probable carcinogens for participants in the NIH-AARP Diet and Health Study. This prospective cohort includes 177,806 women enrolled in 1995-1996. We estimated chemical emissions from facilities within 2km of the enrollment residence, adjusted for distance from the home and wind direction. We compared exposure prevalence by race/ethnicity, educational attainment, and a study-specific census tract-level neighborhood deprivation index derived from 20 measures of socioeconomic status (SES) by calculating proportions exposed from each population group. We included these variables in the same ordinal logistic regression model to estimate odds ratios (ORs) and 95% confidence intervals (CIs) comparing the highest category of emissions (highest tertile (T3) or &amp;gt;90th percentile) to the referent group (zero emissions) for all sociodemographic characteristics, additionally adjusted for urbanicity and state of residence. Results: The majority identified as non-Hispanic White (89%), followed by non-Hispanic Black (6%), Hispanic/Latina (2%) and Asian (1%). Despite comprising a smaller proportion of the cohort, Black women were nearly twice as likely (20%) as White women (11%) to live within 2km of an exposure source, whereas proportions among Hispanic/Latina (13%) and Asian women (12%) were similar to those among White women. Similar patterns were observed with low educational attainment (≤high school vs. college educated) and living in areas with high (T3) compared to low (T1) deprivation. In mutually adjusted models, compared to White women, Asian (OR=1.4, CI 1.2-1.5), Black (OR=1.4, CI 1.3-1.5), and Hispanic/Latina (OR=1.5, CI 1.4-1.6) women had 1.4-1.6 times greater exposure burden to any known or probable carcinogen, with similar estimates for benzene, cadmium, dichloromethane, lead, perchlorate, and styrene. Low educational attainment and high neighborhood deprivation were associated with up to 2-fold higher odds of being heavily exposed. Conclusions: We demonstrated notable disparities in environmental exposure to airborne carcinogens by race/ethnicity and individual and neighborhood-level measures of SES. Existing etiologic and mechanistic evidence supports the role of some of these chemicals as carcinogens for sites with known disparities. Future efforts to evaluate associations of these exposures with cancer risk are warranted, particularly in populations with sufficient power to evaluate risk separately by race/ethnicity and SES. Citation Format: Jessica M. Madrigal, Jared Fisher, Barry Graubard, Mary Ward, Rena Jones. Sociodemographic inequities in carcinogenic industrial air pollution exposures among women in a U.S. cohort [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B086.

Sociodemographic Inequities in Telemedicine Use Among US Patients Initiating Treatment in Community Cancer Centers During the Ongoing COVID-19 Pandemic, 2020-2022.

Although telemedicine was seen as a way to improve cancer care during the coronavirus disease (COVID-19) pandemic, there is limited information regarding inequities in its uptake. This study assessed sociodemographic factors associated with telemedicine use among patients initiating treatment for 20 common cancers. This retrospective cohort study used deidentified electronic health record-derived patient data from a nationwide network of community cancer practices, linked to area-level Census information. We included adults (age 18 years and older) who initiated first-line systemic cancer treatment between March 2020 and December 2022 (follow-up through March 2023). Exposures include race/ethnicity, insurance status, and area-level social determinants of health (eg, block group socioeconomic status [SES]). The outcome was telemedicine use within 90 days after treatment initiation. Associations were examined using logistic regression models adjusted for age, sex, performance status, stage, and cancer type. This study included 36,993 patients (48.6% women; median age, 69 years), of whom 15.1% used telemedicine services. Black (12.2%; odds ratio [OR], 0.78 [95% CI, 0.70 to 0.88]) and uninsured (9.2%; OR, 0.59 [95% CI, 0.48 to 0.73]) patients were less likely to use telemedicine services than their White and well-insured counterparts (14.5% and 15.0%, respectively). Patients in rural (9.7%; OR, 0.54 [95% CI, 0.46 to 0.57]), suburban (11.8%; OR, 0.67 [95% CI, 0.61 to 0.74]), and low SES areas (9.9%; OR, 0.39 [95% CI, 0.35 to 0.43]) were less also likely to use telemedicine than their counterparts in urban (16.6%) or high SES (21.6%) areas. Nearly one sixth of patients initiating cancer treatment during the pandemic used telemedicine, but there were substantial inequities. The proliferation of telemedicine may perpetuate cancer care inequities if marginalized populations do not have equitable access.

Sociodemographic inequalities in long-term exposure to air pollution, road traffic noise, and greenness: A population-based cohort study of women.

Recent evidence suggests environmental health inequalities both within and between European countries and socially deprived groups may be more susceptible to pollution. However, evidence is still inconclusive and additional studies are warranted. This study aims to investigate sociodemographic inequalities in long-term residential exposure to air pollution, road traffic noise, and greenness, taking lifestyle and degree of urbanization into account. In total 20,407 women, born 1914-48 residing in Uppsala County, Sweden, were followed between 1997 and 2017. Time-varying sociodemographic variables were obtained from registers, and questionnaires provided lifestyle information. Generalized estimating equations were used to compute beta-coefficients (β) and 95% confidence intervals (95% CI) for associations between sociodemographic and lifestyle variables and spatial-temporal modeled particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), road traffic noise and greenness. All models were additionally stratified by urbanization type. Urban area residency was the most important predictor of high exposure to air pollution and noise, and to low greenness. For instance, β for NO2 was -2.92 (95% CI = -3.00, -2.83) and -3.10 (95% CI = -3.18, -3.01) µg/m3 in suburban and rural areas, respectively, compared with urban areas. For greenness, the opposite held true with corresponding β of 0.059 (95% CI = 0.056, 0.062) and 0.095 (95% CI = 0.092, 0.098). Within urban areas, elderly, unmarried and well-educated women had the highest environmental burden. However, less pronounced, and even reversed associations were found in suburban and rural areas. This study provides evidence of a mixed pattern of environmental health inequalities across sociodemographic groups in urban areas.