Socioeconomic Disadvantage Research Articles

Neighborhood Socioeconomic Disadvantage and Long-Term Outcomes After Pediatric Tracheostomy.

To determine whether long-term outcomes after pediatric tracheostomy are impacted by neighborhood socioeconomic disadvantage. A prospective cohort of children with tracheostomies was followed at an academic pediatric hospital between 2015 and 2020. Patients were grouped into low or high socioeconomic disadvantage using their neighborhood area deprivation index (ADI). Survival and logistic regression analyses determined the relationship between ADI group, decannulation, and mortality. A total of 260 children were included with a median age at tracheostomy of 6.6 months (interquartile range [IQR], 3.9-42.3). The cohort was 53% male (N = 138), 55% White race (N = 143), and 35% Black or African American (N = 90). Tracheostomy was most frequently indicated for respiratory failure (N = 189, 73%). High neighborhood socioeconomic disadvantage was noted for 66% of children (N = 172) and 61% (N = 158) had severe neurocognitive disability. ADI was not associated with time to decannulation (HR = 0.90, 95% confidence interval [95% CI]: 0.53-1.53) or time to death (HR = 0.92, 95% CI: 0.49-1.72). Neighborhood socioeconomic disadvantage was not associated with decannulation or mortality among children with a tracheostomy. These findings suggest that long-term outcomes after pediatric tracheostomy are less dependent on socioeconomic factors in an individual community. 3 Laryngoscope, 134:2415-2421, 2024.

Parental socioeconomic status weakly predicts specific cognitive and academic skills beyond general cognitive ability.

Parental socioeconomic status (SES) is a well-established predictor of children's neurocognitive development. Several theories propose that specific cognitive skills are particularly vulnerable. However, this can be challenging to test, because cognitive assessments are not pure measures of distinct neurocognitive processes, and scores across different tests are often highly correlated. Aside from one previous study by Tucker-Drob, little research has tested if associations between SES and cognition are explained by differences in general cognitive ability rather than specific cognitive skills. Using structural equation modelling (SEM), we tested if parental SES is associated with individual cognitive test scores after controlling for latent general cognitive ability. Data from three large-scale cohorts totalling over 16,360 participants from the UK and USA (ages 6-19) were used. Associations between SES and cognitive test scores are mainly (but not entirely) explained through general cognitive ability. Socioeconomic advantage was associated with particularly strong vocabulary performance, unexplained by general ability. When controlling for general cognitive ability, socioeconomic disadvantage was associated with better executive functions. Better characterizing relationships between cognition and adversity is a crucial first step toward designing interventions to narrow socioeconomic gaps. RESEARCH HIGHLIGHTS: Understanding environmental influences on cognitive development is a crucial goal for developmental science-parental socioeconomic status (SES) is one of the strongest predictors. Several theories have proposed that specific cognitive skills, such as language or certain executive functions, are particularly susceptible to socioeconomic adversity. Using structural equation modelling, we tested whether SES predicts specific cognitive and academic tests after controlling for latent general cognitive ability across three large-scale cohorts. SES moderately predicted latent general cognitive ability, but associations with specific cognitive skills were mainly small, with a few exceptions.

Unmet Needs for Ancillary Services and Associations with Clinical Outcomes Among Transgender Women with Diagnosed HIV: Medical Monitoring Project, United States, 2015-2020.

Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV.

Neighborhood Socioeconomic Disadvantage and White Matter Microstructure of the Arcuate Fasciculus and Uncinate Fasciculus in Adolescents

BackgroundNeighborhood- or area-level socioeconomic disadvantage is associated with neural alterations across the life span. However, few studies have examined the effects of neighborhood disadvantage on white matter microstructure during adolescence, an important period of development that coincides with increased risk for psychopathology. MethodsIn 200 adolescents (ages 13–20 years; 54.5% female, 4% nonbinary) recruited from 2 studies enriched for early adversity and depression, we examined whether neighborhood socioeconomic disadvantage derived from census tract data was related to white matter microstructure in several major white matter tracts. We also examined whether depressive symptoms and sex moderated these associations. ResultsGreater neighborhood socioeconomic disadvantage was associated with lower fractional anisotropy (FA) in the left arcuate fasciculus (β = −0.24, false discovery rate [FDR]–corrected p = .035) and right uncinate fasciculus (β = −0.32, FDR-corrected p = .002) above and beyond the effects of family-level socioeconomic status. Depressive symptoms significantly moderated the association between left arcuate fasciculus FA and both neighborhood (β = 0.17, FDR-corrected p = .026) and unemployment (β = 0.22, FDR-corrected p = .004) disadvantage such that these associations were only significant in adolescents who reported less severe depression. Sex did not moderate the association between socioeconomic disadvantage and FA in these tracts. ConclusionsGreater neighborhood socioeconomic disadvantage, particularly poverty and educational attainment levels, was associated with lower FA in the arcuate fasciculus and uncinate fasciculus above and beyond the effects of family-level measures of socioeconomic status. These patterns were only observed in adolescents with low levels of depression, suggesting that we must be cautious about generalizing these findings to youths who struggle with mental health difficulties.

The association of neighborhood socioeconomic characteristics with cardiovascular health: A quasi-experimental study of refugees to Denmark

Neighborhood socioeconomic disadvantage is associated with cardiovascular health, although it is unclear which specific aspects of neighborhoods matter most. We leveraged a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986–1998, creating variation in exposure to various aspects of neighborhood disadvantage. The cohort was followed through December 2018. Exposures included neighborhood-level family income, educational attainment, unemployment, and welfare transfers measured in the first neighborhood after arrival to Denmark. Outcomes included cardiovascular risk factors (hyperlipidemia, hypertension, diabetes and anxiety/depression) and cardiovascular disease (acute myocardial infarction and ischemic heart disease). Neighborhood-level income and education were most consistently associated with cardiovascular risk factors, whereas welfare transfers were most consistently associated with cardiovascular disease. Addressing these specific aspects of neighborhood disadvantage could therefore lower the risk of poor cardiovascular health among refugees. Future research is warranted to examine if results are generalizable to other immigrant groups, countries or time periods.

Equitable access to COVID-19 diagnostics: factors associated with the uptake of rapid antigen testing in Victoria, Australia, January – February 2022

BackgroundAccessible and accurate diagnostics are critical to control communicable diseases. Uptake of COVID-19 rapid antigen (RA) testing requires physical and financial access to tests, knowledge about usage, motivation, and ability to report results. We sought to understand patterns of and factors associated with RA test uptake in Victoria during a period of high caseload, RA test promotion, and difficulty accessing RA and PCR testing. We hypothesise RA test uptake is indicated by the ratio of cases diagnosed by RA test (probable) to those diagnosed using PCR (confirmed) (p:c).MethodsAnalysing case records, trends in p:c were assessed, between regions, sex, age groups, socio-economic strata and cultural diversity. Logistic regression assessed associations between case classification, and median age, postcode-level socio-economic disadvantage, and proportion overseas-born.ResultsWe included 591,789 cases. Mean p:c was lower in socio-economically disadvantaged areas (decile 1 + 2: 0.90 vs. decile 9 + 10: 1.10), and in postcodes where the overseas-born population was above the Victorian average (0.83 vs. 1.05). Conversely, p:c was higher in younger age groups; with no difference between sexes overall. In metropolitan Melbourne, odds of RA test usage increased as socio-economic disadvantage decreased (decile 9 + 10, aOR 1.40, 95%CI 1.37–1.43, vs. decile 1 + 2; p < .001), decreased for cases from areas with a higher overseas-born population (aOR 0.85, 0.83–0.86, p < .001), and with older age.ConclusionsReduced uptake of RA tests in Victoria is associated with socio-economic disadvantage, cultural diversity, and older age. Equitable access to COVID-19 diagnostics requires elimination of financial barriers, and greater engagement with culturally diverse and older groups. Inequitable RA test uptake may lead to case under-ascertainment, affecting resource allocation, effective control strategy development, in turn impacting COVID-19 morbidity and mortality, and could indicate relative engagement with response initiatives.

Health care service use by people diagnosed with invasive melanoma in Queensland: a benefit incidence analysis.

To quantify differences, by residential remoteness and socio-economic status, in health care service use by people diagnosed with invasive melanoma in Queensland. Benefit incidence analysis of CancerCostMod data, comprising Queensland Cancer Registry data linked with Queensland Hospital Admitted Patient Data Collection (QHAPDC), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data. Adults (18 years or older) newly diagnosed with invasive melanoma in Queensland during 1 July 2011 - 31 June 2015 and alive three years after diagnosis. Concentration curves and indices quantifying differences by residential postcode-based remoteness (Australian Statistical Geography Standard - Remoteness Area) and socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage) in hospital admissions (overall and by type) and use of MBS (overall and by type) and PBS services during the three years following diagnosis of invasive melanoma. A total of 13 145 adults diagnosed with invasive melanoma during 2011-15 were alive three years after the diagnosis. Public hospital admissions were more frequent for people living in areas of greater socio-economic disadvantage (concentration index, -0.15; 95% confidence interval [CI], -0.19 to -0.12) or outside major cities (concentration index, -0.10; 95% CI, -0.13 to -0.06); private hospital admissions (concentration index, 0.11; 95% CI, 0.07-0.15) and specialist consultations (concentration index, 0.08; 95% CI, 0.07-0.10) were more frequent in areas of lesser disadvantage and in major cities (private hospital admissions: 0.10; 95% CI, 0.06-0.13; specialist services: 0.07; 95% CI, 0.06-0.09). Differences in other melanoma health care service use by residential remoteness and socio-economic disadvantage were not statistically significant. Variation in health care service use by Queenslanders with primary diagnoses of invasive melanoma by residential socio-economic disadvantage and remoteness were generally minor. Our analysis suggests that access to health care for people with melanoma is fairly equitable in Queensland.

What Are the Psychosocial Effects of Pavlik Harness Treatment? A Prospective Study on Perceived Impact on Families and Maternal-Infant Bonding.

The Pavlik harness (PH) is the most common treatment for infants with developmental dysplasia of the hip. Although success rates are high when used appropriately, brace treatment may impact family function and parental bonding. The purpose of this study was to prospectively determine how PH treatment affected these psychosocial variables. This is a prospective, single-surgeon study at a tertiary-care, urban, academic children's hospital between November 2022 and March 2023. All patients newly treated with a Pavlik were eligible. Caregivers were administered the Postpartum Bonding Questionnaire and the Revised Impact on Family Scale (rIOFS) at the baseline visit and 2- and 6 weeks following treatment initiation. Demographic and treatment-specific information was collected through surveys and retrospective chart review. Descriptive statistics and bivariate analysis were used. A total of 55 caregiver-child dyads were included in the final analysis. Most patients were female (89%) and/or first-born (73%). Forty (73%) hips were diagnosed as having stable dysplasia. rIOFS scores steadily improved from baseline, through 2- and 6 weeks posttreatment initiation. Six-week rIOFS scores were significantly lower than both baseline ( P= 0.002) and 2 weeks ( P =0.018). Average parental bonding scores also improved steadily throughout treatment and did not surpass the threshold of clinical concern at any time. Neither full-time harness use (24h/d vs. 23h/d based upon clinical stability) nor age at treatment initiation had a statistically significant effect on parental bonding or family functioning (all P >0.05). Additional demographic variables such as birth order, parental history of anxiety/depression, and relative socioeconomic disadvantage also had no significant effect on psychosocial outcomes. PH treatment did not significantly impact maternal-fetal bonding or family dynamics. Relative to other pediatric diseases, PH treatment has an impact on family life greater than that of single-leg spica, but less than that of school-age children with chronic medical illnesses. As PH treatment is a widely used treatment for infantile developmental dysplasia of the hip, this study provides information that clinicians may use to more accurately counsel families and assuage parental concerns. Level IV-prospective uncontrolled cohort study.

Reconnecting with the Warrior Within: Australian Indigenous perspectives on the development of a social and emotional wellbeing program.

Australian Indigenous youth are at high risk of developing mental health problems. Historical determinants and socioeconomic disadvantage continue to impact their social and emotional wellbeing (SEWB) and sense of identity. Previous literature suggests connecting to culture significantly impacts SEWB in Indigenous youth. Given the diversity of Indigenous culture, collaboration and consultation with specific cultural groups is required to develop appropriate and relevant psychological treatments for SEWB. The Warrior Within Program was developed to improve SEWB in Indigenous youth by assisting them to better understand their identity through participation in group-based cultural activities. This research aimed to understand Central Queensland Indigenous Development staff perspectives around (1) the process of developing the program and (2) how group-based cultural activities contributed to staff perceived improvements in SEWB of program participants. In this qualitative study, semi-structured individual interviews of 60-90 min were conducted with four Warrior Within Program staff of Central Queensland Indigenous Development. Transcripts were thematically analysed and the subthemes identified were categorised into main themes. The process of developing the Warrior Within Program, cultural and Indigenous identity, reconnecting and knowledge emerged as the four main themes. This study makes a unique and important contribution to the Australian Indigenous literature regarding the role and nature of culture in group-based programs and the importance of collaborating with Indigenous groups to increase our understanding of their usefulness and efficacy. This study also helps to bridge the gap between Indigenous ways of knowing in program development and non-Indigenous methods of evaluation. SO WHAT?: Acknowledging Australian Indigenous methods and ways of knowing are essential to the development and delivery of culturally appropriate group problems for addressing the psychological needs of this population. The methods used in this study could be used by others seeking to legitimise cultural ways of knowing.

Influence of Socioeconomic Gender Inequality on Sex Disparities in Prevention and Outcome of Cardiovascular Disease: Data From a Nationwide Population Cohort in China.

Background Knowledge gaps remain in how gender-related socioeconomic inequality affects sex disparities in cardiovascular diseases (CVD) prevention and outcome. Methods and Results Based on a nationwide population cohort, we enrolled 3 737 036 residents aged 35 to 75 years (2014-2021). Age-standardized sex differences and the effect of gender-related socioeconomic inequality (Gender Inequality Index) on sex disparities were explored in 9 CVD prevention indicators. Compared with men, women had seemingly better primary prevention (aspirin usage: relative risk [RR], 1.24 [95% CI, 1.18-1.31] and statin usage: RR, 1.48 [95% CI, 1.39-1.57]); however, women's status became insignificant or even worse when adjusted for metabolic factors. In secondary prevention, the sex disparities in usage of aspirin (RR, 0.65 [95% CI, 0.63-0.68]) and statin (RR, 0.63 [95% CI, 0.61-0.66]) were explicitly larger than disparities in usage ofangiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR, 0.88 [95% CI, 0.84-0.91]) or β blockers (RR, 0.67 [95% CI, 0.63-0.71]). Nevertheless, women had better hypertension awareness (RR, 1.09 [95% CI, 1.09-1.10]), similar hypertension control (RR, 1.01 [95% CI, 1.00-1.02]), and lower CVD mortality (hazard ratio, 0.46 [95% CI, 0.45-0.47]). Heterogeneities of sex disparities existed across all subgroups. Significant correlations existed between regional Gender Inequality Index values and sex disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (Spearman correlation coefficient, r=-0.57, P=0.0013), hypertension control (r=-0.62, P=0.0007), and CVD mortality (r=0.45, P=0.014), which remained significant after adjusting for economic factors. Conclusions Notable sex disparities remain in CVD prevention and outcomes, with large subgroup heterogeneities. Gendered socioeconomic factors could reinforce such disparities. A sex-specific perspective factoring in socioeconomic disadvantages could facilitate more targeted prevention policy making.

Disadvantaged Neighborhoods Continue to Bear the Burden of Gun Violence

IntroductionGun violence is a pervasive and dynamic public health crisis causing substantial burden on communities and healthcare systems in the United States. Risk factor and outcome analyses are crucial to develop effective interventions. The aim of this study was to assess firearm injury in a diverse community setting as it relates to neighborhood socioeconomic disadvantage and changes over time following large-scale local interventions. MethodsAll county residents with firearm injury presenting to a Level 1 Trauma Center from January 2012 to December 2021 were retrospectively reviewed. Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage based on a nine-digit zip code at patients’ home address. Injuries were also stratified by 5-year time periods, 2012-2016 and 2017-2021. Demographics and clinical data were analyzed including injury severity, hospital course, and discharge location. Data were compared by ADI quintile and between time periods using chi-squared, one-way analysis of variance, and Cochran-Armitage test. ResultsA total of 1044 injuries were evaluated. Patients were 93% male with mean age of 29 y (standard deviation 10.2) and were concentrated in the most disadvantaged neighborhoods (74% ADI Q5). Black or African American race was greater in the most disadvantaged ADI groups (76% versus 47%-66%; P <0.001). Percentage of total injuries in the most disadvantaged ADI group rose from 71% to 78% over time (P = 0.006). Mortality occurred in 154 (15%) patients overall, while most (71%) were discharged to home. Mortality declined from 18% to 11% over time (P <0.001). Medicaid utilization rose from 42% to 77% alongside a decrease in self-pay status from 44% to 4% (P <0.001). There were no clinically significant group differences in injury severity or clinical characteristics. ConclusionsFirearm injury remains concentrated in the most socioeconomically disadvantaged neighborhoods, and this disparity is increasing over time. Medicaid utilization rose and mortality decreased in this population over time. This research presents a method to inform and monitor local gun violence interventions using ADI to address public health equity.

Concurrent and prospective associations between family socioeconomic status, social support and salivary diurnal and hair cortisol in adolescence.

Exposure to socioeconomic adversity is hypothesized to impact hypothalamic-pituitary-adrenal (HPA) axis activity and cortisol secretion, but existing evidence is inconsistent. Yet, few studies have investigated this association using a developmental approach that considers potential protective contextual factors. This study examined the role of stability and changes in family socioeconomic status (SES) in the prediction of multiple cortisol indicators and tested whether social support moderated these associations. Participants were part of a population-based sample of twin pairs recruited at birth. Family SES was assessed in early childhood (ages 0-5) and mid-adolescence (age 14). Social support was assessed at ages 14 and 19. Diurnal cortisol (n = 569) was measured at age 14 at awakening, 30 min later, in the afternoon and evening over four non-consecutive days. Hair cortisol concentration (HCC, n = 704) was measured at age 19. All data were collected before the pandemic and multilevel regression models were conducted to account for the nested data structure. Youth exposed to lower family SES levels in childhood and mid-adolescence had a flatter diurnal slope and higher HCC compared with those who experienced upward socioeconomic mobility in mid-adolescence. Contrastingly, mid-adolescence SES showed no association with the diurnal slope or HCC for youth from higher-SES households in early childhood. Moreover, youth raised in higher-SES families in early childhood had a higher CAR in mid-adolescence if they reported greater social support in mid-adolescence. Social support also moderated the SES-cortisol association in mid-adolescence, with higher-SES youth showing higher awakening cortisol secretion when reporting more social support. Our findings support the hypothesis that early socioeconomic adversity sensitizes HPA axis activity to later socioeconomic disadvantage, which may bear consequences for socioemotional and behavioral functioning.

The effect of neighborhood socioeconomic disadvantage on smoking status, quit attempts, and receipt of cessation support among adults with cancer: Results from nine ECOG-ACRIN Cancer Research Group trials.

Tobacco use is associated with adverse outcomes among patients diagnosed with cancer. Socioeconomic determinants influence access and utilization of tobacco treatment; little is known about the relationship between neighborhood socioeconomic disadvantage (NSD) and tobacco assessment, assistance, and cessation among patients diagnosed with cancer. A modified Cancer Patient Tobacco Use Questionnaire (C-TUQ) was administered to patients enrolled in nine ECOG-ACRIN clinical trials. We examined associations of NSD with (1) smoking status, (2) receiving tobacco cessation assessment and support, and (3) cessation behaviors. NSD was classified by tertiles of the Area Deprivation Index. Associations between NSD and tobacco variables were evaluated using logistic regression. A total of 740 patients completing the C-TUQ were 70% male, 94% White, 3% Hispanic, mean age 58.8years. Cancer diagnoses included leukemia 263 (36%), lymphoma 141 (19%), prostate 131 (18%), breast 79 (11%), melanoma 69 (9%), myeloma 53 (7%), and head and neck 4 (0.5%). A total of 402 (54%) never smoked, 257 (35%) had formerly smoked, and 81 (11%) were currently smoking. Patients in high disadvantaged neighborhoods were approximately four times more likely to report current smoking (odds ratio [OR],3.57; 95% CI, 1.69-7.54; p=.0009), and more likely to report being asked about smoking (OR,4.24; 95% CI, 1.64-10.98; p=.0029), but less likely to report receiving counseling (OR,0.11; 95% CI, 0.02-0.58; p=.0086) versus those in the least disadvantaged neighborhoods. Greater neighborhood socioeconomic disadvantage was associated with smoking but less cessation support. Increased cessation support in cancer care is needed, particularly for patients from disadvantaged neighborhoods.

THU321 Indirect Effects Of COVID-19 On The Risk Of Gestational Diabetes And Factors Mediating Increased Risk

Abstract Disclosure: Y.J. Rhou: None. J. Elhindi: None. S.J. Melov: None. N. Cheung: None. D. Pasupathy: None. Aim: COVID-19 has had indirect effects on pregnancy outcomes. This study aimed to assess the risk of gestational diabetes (GDM) in distinct COVID-19 exposure periods and determine the potential factors contributing to increased risk of GDM in a multiethnic population. Methods: Multicentre, retrospective cohort study of singleton pregnancies at three hospitals two years pre-COVID-19 (January 2018 - January 2020), 1st year of COVID-19 with low COVID-19 pandemic burden and limited restrictions (February 2020 - January 2021), and 2nd year of COVID-19 with increased pandemic burden and stringent restrictions (February 2021 - January 2022). Baseline maternal characteristics, gestational weight gain (GWG) and pregnancy outcome data were compared between time periods. The primary outcome of GDM was assessed using univariate and multivariate generalized estimating equations models. Results: Of 28,207 pregnancies, 14,663 occurred in the two years pre-COVID-19, 6,890 in COVID-19 Year 1 and 6,654 in COVID-19 Year 2. The study population was diverse, comprising 82.5% of non-Caucasian ethnicity and 22.7% in the quintile of greatest socioeconomic disadvantage. Maternal age increased across exposure periods (30.7 ± 5.0 years pre-COVID-19 vs 31.0 ± 5.0 years COVID-19 Year 1 vs 31.3 ± 5 years COVID-19 Year 2; p&amp;lt;0.001). There were increases in prepregnancy BMI (25.5 ± 5.7 kg/m2 vs 25.7 ± 5.6 kg/m2 vs 26.1 ± 5.7 kg/m2; p&amp;lt;0.001), proportion who were obese (17.5% vs 18.1% vs 20.7%; p&amp;lt;0.001) and proportion with other traditional risk factors for GDM including South Asian ethnicity and prior history of GDM. Weekly rate of GWG and proportion exceeding recommended GWG increased across pandemic exposure periods (64.3% vs 66.0% vs 66.6%; p=0.009). GDM diagnosis increased across exposure periods (21.2% vs 22.9% vs 24.8%; p&amp;lt;0.001). Both COVID-19 Year 1 and Year 2 were associated with increased risk of GDM on univariate analysis, only COVID-19 Year 2 remaining significantly associated after adjusting for maternal baseline characteristics and GWG (OR 1.17 [1.06, 1.28], p=0.01). Conclusion: Diagnosis of GDM increased with pandemic exposure. Progressive sociodemographic changes and greater GWG may have contributed to increased risk. However, exposure to the 2nd year of COVID-19 remained independently associated with GDM after adjusting for shifts in baseline maternal characteristics and GWG. Presentation: Thursday, June 15, 2023

Rent affordability after hurricanes: Longitudinal evidence from US coastal states.

Climate change is expected to increase the frequency and intensity of natural hazards such as hurricanes. With a severe shortage of affordable housing in the United States, renters may be uniquely vulnerable to disaster-related housing disruptions due to increased hazard exposure, physical vulnerability of structures, and socioeconomic disadvantage. In this work, we construct a panel dataset consisting of housing, socioeconomic, and hurricane disaster data from counties in 19 states across the East and Gulf Coasts of the United States from 2009 to 2018 to investigate how the frequency and intensity of a hurricane correspond to changes in median rent and housing affordability (the interaction between rent prices and income) over time. Using a two-stage least square random-effects regression model, we find that more intense prior-year hurricanes correspond to increases in median rents via declines in housing availability. The relationship between hurricanes and rent affordability is more complex, though the occurrence of a hurricane in a given year or the previous year reduces affordable rental housing, especially for counties with higher percentages of renters and people of color. Our results highlight the multiple challenges that renters are likely to face following a hurricane, and we emphasize that disaster recovery in short- and medium-term should focus on providing safe, stable, and affordable rental housing assistance.

Australian strategic planning and socio-spatial vulnerability: the case of metropolitan Adelaide

ABSTRACT This article explores the correlation between contemporary strategic planning and socio-spatial disadvantage, utilizing data from five censuses conducted within the Adelaide metropolitan region. To assess how these two dynamics manifest across Australian cities, we introduce a vulnerability assessment methodology. Taking a historical perspective, the study delves into how ongoing socio-spatial transformations have impacted the Index of Relative Socio-economic Disadvantage (IRSD) over several decades. Employing mixed methods, we analyse the temporal progression of the IRSD from 1991 to 2021 and interpret the implications in the context of contemporary strategic plans. The research findings reveal that strategic plans in metropolitan Adelaide have become linked to the establishment of five interconnected/consolidated regional centres, as well as the relocation of areas of disadvantage from the traditional inner cities to the middle and outer suburbs. This has led to residents experiencing enduring socio-spatial vulnerability for several decades. The investigation illustrates the evolving nature of urban disadvantage in post-industrial Australian cities. This article introduces an innovative method for evaluating strategic plans, specifically monitoring progress in achieving their objectives. This could guide future plans to uplift disadvantaged suburbs from a state of permanent vulnerability.

Inequality in behavioural heat adaptation: an empirical study with mobility data from the transport system in New York City, NY, USA

Heat exposure, which can negatively affect human health and wellbeing, is heterogeneous within US cities. However, little is known about who can avoid heat stress by adjusting their everyday behaviour. We aimed to analyse the effect of ambient temperature on mobility, specifically subway (ie, the underground railway system) use, in New York City, NY, USA, during 2014-19. For this empirical study, subway use across New York City was measured with turnstile data from the New York City Metropolitan Transportation Authority between Jan 1, 2014, and Dec 31, 2019. Passenger numbers were then aggregated to the zip code tabulation area (ZCTA) level. Daily observational climate data were obtained from the US National Weather Service between Jan 1, 2014, and Dec 31, 2019. Socioeconomic data at the ZCTA level originated from the American Community Survey 2019. We extracted data on population age, ethnicity, commuting, employment, median household income, rent, and health-insurance coverage. We used a fixed-effects panel-regression model to assess the influence of temperature on subway use in New York City, which was the main outcome of our study. We obtained data for 438 subway stations across New York City. After data cleaning and preprocessing, the final aggregated data sample consisted of 238 508 instances of subway use in 1955 days across 6 years for 122 ZCTAs, with 168 days missing in the raw data and 67 days removed as outliers. The results of the fixed-effects panel-regression analysis showed a strong, non-linear effect of daily maximum temperature on subway use. Subway use was highest at 11·5°C and substantially decreased for temperatures that were colder and warmer than that, with reductions reaching 6·5% (95% CI 2·5-10·5) for the coldest temperature (ie, -6·5°C) and 10·5% (6·0-14·0) for the hottest temperature (ie, 34·5°C). Reductions differed between weekdays and weekends, when residents generally had more freedom to adjust their behaviour. Neighbourhoods that were at a socioeconomic disadvantage experienced smaller or no reductions in mobility in heat; mobility increased in neighbourhoods with beach access. Our study showed that temperature had a strong, non-linear effect on subway use, but the magnitude of the effect on subway use was heterogeneous across areas of the city on warm days. Weaker avoidance of heat stress correlated with less privilege, indicating compounding health risks. Everyday behavioural adaptation to heat is therefore an effect pathway that contributes to unequal heat effects and should be explored in future research. The Volkswagen Foundation and the Werner Siemens Foundation.

Uptake of a Universal Sports Subsidy Program for School-Aged Children: A Population Data Analysis.

Around 40% of Australian children do not participate in sport. Cost is a major barrier to participation, particularly for children from low socioeconomic backgrounds. This study aimed to evaluate the uptake of a population-level children's sports subsidy scheme, including sociodemographic differences in uptake. A state-wide cross-sectional analysis comparing sports voucher claimants (primary school-aged children with a valid Medicare or Australian visa number) from the 2019 financial year with population census data from South Australia. Chi-square was used to examine whether the percentage of eligible children who claimed a voucher differed based on age, sex, socioeconomic status (SES), and geographical remoteness. Subgroup analyses were conducted for the lowest 2 socioeconomic disadvantage deciles, split by gender. Scatterplots were used to compare sports between high and low SES children. A total of 74,668 children claimed sports vouchers (45.5% of eligible children). Children who were relatively younger, female, from low socioeconomic backgrounds, and from major cities were least likely to claim the voucher. The 5 most common sports were Australian rules football (30.2%), netball (13.6%), soccer (13.1%), gymnastics (10.4%), and basketball (5.7%), with the popular sports similar for high and low SES children. Future work is needed to understand how Sports Voucher, and sport participation rates have changed over time, and to improve voucher uptake among girls, city dwellers, and low SES children.

A Window of Opportunity: Understanding Pediatric Falls Using Area Deprivation Index

IntroductionThe purpose of our study is to assess neighborhood socioeconomic disadvantage (NSD) as a risk factor for window falls (WF) in children. MethodsA single institution retrospective review was performed of patients ≤18 years old with fall injuries treated at a Level I trauma center between 2018 and 2021. Demographic, injury, and NSD characteristics which were collected from a trauma registry were analyzed and compared between WF versus non-window falls. Area Deprivation Index (ADI) was used to measure NSD levels based on patients' home address 9-digit zip code, with greater NSD being defined as ADI quintiles 4 and 5. Property type was used to compare falls that took place at single-family homes versus apartment buildings. ResultsAmong 1545 pediatric fall injuries, 194 were WF, of which 60 % were male and 46 % were Hispanic. WF patients were younger than NWF patients (median age WF 3.2 vs. age 4.3, p<0.047). WF patients were more likely to have a depressed Glasgow Coma Scale (GCS score ≤12, WF 9 % vs. 3 %) and sustain greater head/neck injuries (median AIS 3vs. AIS 2, p<0.001) when compared to NWF. WF patients had longer hospital and ICU lengths of stay than NWF patients (p<0.001 and p<0.001, respectively). WF patients were more likely to live in areas of greater NSD than NWF patients (53 % vs. 35 %, p<0.001), and 73 % of all WF patients lived in apartments or condominiums. ConclusionsWindow fall injuries were associated with lower GCS, greater severity of head/neck injuries, and longer hospital and ICU length of stay than non-window falls. ADI research can provide meaningful data for targeted injury prevention programs in areas where children are at higher risk of window falls. Study TypeRetrospective review. Level of EvidenceIII.

S1439 Evaluation of Disease Surveillance and Outcomes for Patients With Primary Sclerosing Cholangitis and Inflammatory Bowel Disease Stratified by Index of Neighborhoods Experiencing Socioeconomic Disadvantage

S1439 Evaluation of Disease Surveillance and Outcomes for Patients With Primary Sclerosing Cholangitis and Inflammatory Bowel Disease Stratified by Index of Neighborhoods Experiencing Socioeconomic Disadvantage