Socioeconomic Disparities Research Articles

Navigating the Global Dietary Transition and Its Impact on Planetary and Human Health: The Role of Middle-Income Countries

Abstract This case study examines global dietary transitions and their impact on environmental sustainability, nutritional well-being, and socio-economic inequalities, focusing on middle-income countries (MICs) like China, India, Brazil, Turkey, and Mexico. As economic expansion, urbanization, and cultural shifts drive changes in eating habits, MICs encounter both advantages and disadvantages. The study explores how socio-economic transformation influences dietary preferences, resulting in increased consumption of processed foods and animal-based products, linked to rising non-communicable diseases and environmental impacts such as greenhouse gas emissions and resource depletion. It delves into the influence of cultural heritage and social norms on dietary practices, alongside the impact of Western dietary patterns and media. Additionally, the case study underscores the role of governmental strategies in fostering sustainable and nutritious diets through policies that support local agriculture and public health. It also investigates contributions from the private sector and emphasizes the significance of community-driven and grassroots movements in promoting sustainable dietary habits and reinforcing food security. This study aims to provide insights into the interconnection between dietary transitions, their environmental and nutritional impacts, and the socio-economic drivers and disparities within and across MICs, offering guidance for sustainable development and public health improvement. Information © The Author 2024

Neoliberalism and legal culture: The path of least resistance is what makes rivers run crooked

This article examines the relationship between neoliberalism and legal culture in South Africa, focusing on how the neoliberal paradigm influences legal interpretation and the adjudication of socio-economic rights. It explores how neoliberalism, defined as the dominance of capitalist forces over weaker oppositional interests, permeates judicial decision-making, shaping how courts address issues of inequality and social justice. The article argues that neoliberalism, in prioritizing market interests, has contributed to a conservative legal inertia that prevents transformative legal outcomes. This dynamic has entrenched existing socio-economic disparities, especially as state power continues to serve the interests of capital, reinforcing apartheid-era economic structures. Despite the transformative potential embedded in South Africa's constitutional framework, the legal system remains constrained by what Karl Klare terms as professional sensibilities, codes, and values, many of which are influenced by neoliberalism. Drawing on theoretical insights of Karl Klare, the article calls for a rethinking of legal culture and a shift towards more relational, metaphorical approaches that challenge hegemonic narratives. Only by resisting these metanarratives can meaningful transformation be achieved in the pursuit of equality and justice.

Assessing Socioeconomic Disparities and Health Outcomes among Cancer Patients in a Nigerian Teaching Hospital

Background: Cancer affects all population groups in the Nigeria, but due to social, environmental, and economic disadvantages, certain groups bear a different burden of cancer. Disparities in health among populations account for preventable morbidity and mortality. Research in this area is focused on identifying health disparities and outcomes contributing to overall wellbeing. Different groups may experience cancer disparities and these groups can be defined by age, gender, education, ethnicity, income, race, origin, and other characteristics. Health disparities can affect cancer outcomes, from diagnosis to treatment. This study evaluates the health disparities and outcomes of cancer patients in a Nigerian Teaching Hospital. Methods: This is a descriptive cross-sectional study using a structured questionnaire among patients visiting the oncology unit in the hospital. The questionnaire was interviewer- administered. Descriptive statistics was used to present respondents’ sociodemographic characteristics. Pearson correlation test was used to determine relationship between the determinant of cancer disparity (social demographics) and the outcomes (from patient perspective). Results: A total of 150 patients participated in the study. More female respondents (70%) than male respondents (45%), mostly within the age range of 62 and above (56.7%) participated in this study. The disparities examined include: age, gender, marital status, educational level, occupatina, montly income, religion and health insurance. There was a correlation between the different disparities and health outcomes. All disparities except gender were statistically significant (P = 0.05 & 0.01). Age, marital status, occupation status, religion and health insurance associated postively, while educational level and monthly income associated negatively. Gender had no associaton at all. Overall, patients (50%) were a little satisfied with the overall health outcomes.

Exploring vaccine hesitancy in digital public discourse: From tribal polarization to socio-economic disparities.

This study analyzed online public discourse on Twitter (later rebranded as X) during the COVID-19 pandemic to understand key factors associated with vaccine hesitancy by employing deep-learning techniques. Text classification analysis reveals a significant association between attitudes toward vaccination and the unique socio-economic characteristics of US states, such as education, race, income or voting behavior. However, our results indicate that attributing vaccine hesitancy solely to a single social factor is not appropriate. Furthermore, the topic modeling of online discourse identifies two distinct sets of justifications for vaccine hesitancy. The first set pertains to political concerns, including constitutional rights and conspiracy theories. The second pertains to medical concerns about vaccine safety and efficacy. However, vaccine-hesitant social media users pragmatically use broad categories of justification for their beliefs. This behavior may suggest that vaccine hesitancy is influenced by political beliefs, unconscious emotions, and gut-level instinct. Our findings have further implications for the critical role of trust in public institutions in shaping attitudes toward vaccination and the need for tailored communication strategies to restore faith in marginalized communities.

Household Consumption of Adequately Iodized Salt: A Multi-Country Analysis of Socioeconomic Disparities.

Despite global efforts to promote universal salt iodization, iodine deficiency remains a public health issue in developing countries. This study assessed the proportion and sociodemographic characteristics of households consuming adequately iodized salt in 49 low- and middle-income countries. Data from DHS surveys of 49 low- and middle-income countries (2005-2021) were used to analyze household iodized salt prevalence. R version 4.0 was employed for statistical analyses. A random-effects meta-analysis was conducted to estimate overall and regional prevalence. We found that 83.4% of households consume adequately iodized salt, although with high heterogeneity (I2 = 100.0%). The East Asia and Pacific and the Europe and Central Asia regions showed high consumption rates of 87.6% and 87.7%, respectively, while Latin America and the Caribbean presented a significantly lower proportion of 30.8%. The study highlights the need for enhanced public health strategies to increase iodized salt consumption, especially in low-income and rural households. Addressing disparities in access, education, and affordability is crucial for improving iodine intake and preventing deficiency disorders, particularly among vulnerable populations like children and pregnant women.

Women's attitudes towards intimate partner violence in Guyana: a population-based study

Intimate partner violence (IPV) against women is a global health issue and a breach of human rights. However, the literature lacks understanding of how socioeconomic and geographic disparities influence women's attitudes toward IPV in Guyana over time. This study aimed to assess trends in women's attitudes about IPV in Guyana. Data from three nationally representative surveys from 2009, 2014 to 2019 were analysed. The prevalence of women's attitudes about IPV was assessed, specifically in response to going out without telling their partners, neglecting their children, arguing with their partner, refusing sex with their partner, or burning food prepared for family meals. A series of stratified subgroup analyses were also completed. We assessed trends in IPV using the slope index of inequality (SII) and the concentration index of inequality (CIX). We used multilevel mixed-effects logistic regression to assess factors associated with women's attitudes justifying IPV. The prevalence of women's attitudes justifying IPV for any of the five reasons declined from 16.4% (95% CI: 15.1-17.8) in 2009 to 10.8% (95% CI: 9.7-12.0) in 2019. Marked geographic and socioeconomic inequalities were observed among subgroups. The SII for any of the five reasons decreased from-20.02 to-14.28, while the CIX remained constant over time. Key factors associated with women's attitudes about IPV were area of residence, sex of the household head, marital status, respondent's level of education, wealth index quintile, and the frequency of reading newspapers/magazines. From 2009 to 2019, Guyana was able to reduce women's attitudes justifying IPV against women by 34.1% and shortened subgroup inequalities. However, the prevalence remained high in 2019, with persisted inequalities among subgroups. Effective strategies, including the use of media to raise awareness, promotion of community-based approaches, and educational campaigns focusing on geographic and socioeconomic disparities, are essential for continuing to reduce the prevalence of IPV and associated inequalities. The study was funded in part by the National Institutes of Health, Fogarty International Center grant number D43TW012189.

The Link between Racial, Ethnic, and Socioeconomic Disparities, Maternal Mental Health, and Birth Outcomes

This study sought to understand the link between maternal mental health and birth outcomes, exacerbated by ethnic and socioeconomic disparities among women in the U.S. It was hypothesized that minorities experienced adverse birth outcomes, specifically preterm birth and low birth weight, due to a higher risk for mental health disorders. The study used a data set consisting of 38 participants, two of whom had twins, who utilized a pregnancy and postpartum assessment application called vidaRPM, to produce 41 sets of data. Data from this application were collected and examined for potential relationships between mood alerts (moments of concern for a participant’s mental health) and preterm birth, low birth weight, and high blood pressure. The results did not indicate any significant relationships between mood alerts and any of the physical health indicators analyzed in this project, suggesting that there are more aspects to consider than just ethnicity when conducting a study of this magnitude.

Assessing the impact of street-level greenery on older adults' emotional well-being: A longitudinal study of equigenic potential and socioeconomic disparities

Assessing the impact of street-level greenery on older adults' emotional well-being: A longitudinal study of equigenic potential and socioeconomic disparities

Trends in socioeconomic disparities in urban heat exposure and adaptation options in mid-size U.S. cities

There is ample evidence that Environmental Justice communities experience high levels of extreme heat. However, it is unknown how disparities in urban heat exposure and adaptation options change over time. This study investigates socioeconomic disparities over time in urban heat exposure and adaptation options in eight mid-sized Northeastern cities. We ask: How were socioeconomic factors associated with heat exposure and adaptation options over time? We analyzed disparities at the census block group level and census block level, respectively. At the census block group level, we ran spatial regression models between socioeconomic variables, including race, income, gender, and age, and heat exposure and adaptation variables, including land surface temperature, normalized different vegetation index (NDVI), tree cover, and air conditioning ownership rate. We found that: Low median household income is always associated with high LST and low NDVI from 1990 to 2020; Low percentage of females is always associated with high LST and low NDVI from 1990 to 2020. High percentage of POC is associated with high LST in 2010 and 2020, but not in 1990 and 2000; Low median household income and low percentage of elderly are associated with lower tree cover; High percentage of POC, low percentage of elderly, and low median household income are associated with lower AC rates. In analysis at the census block level by city, we found that disparities in urban heat exposure between predominantly POC and predominantly white communities increased in most cities during 1990-2020. Predominantly POC communities consistently have lower vegetation cover over time in most cities. Disparities in vegetation cover per unit area increased in most cities, whereas disparities in vegetation cover per capita decreased in most cities. Our findings of the trends in disparities in heat exposure and adaptation are useful for forecasting disparities in the future. These findings also suggest that interventions should prioritize cities with increasing disparities in heat exposure and adaptation.

Neuropsychiatric complications in chronic kidney disease: Role of gender, clinical, and sociodemographic factors

ABSTRACT Introduction: Patients with chronic kidney disease (CKD) frequently experience neuropsychiatric conditions, such as depression, anxiety, and cognitive impairment, which not only significantly diminish their quality of life, but also contribute to longer hospitalizations, poor treatment adherence, and increased mortality. This hospital-based cross-sectional study aimed to investigate neuropsychiatric complications in CKD patients, focusing on gender differences, and clinical and other sociodemographic factors. Materials and Methods: Diagnosis of CKD was based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and patients aged 18 years or above were included. Delirium was assessed using the Confusion Assessment Method (CAM) Scale. Those without delirium underwent evaluation using the Hindi Mental Status Examination (HMSE), Brief Psychiatric Rating Scale (BPRS), and Hospital Anxiety and Depression Scale (HADS) to identify cognitive and psychiatric symptoms. Results: Among the 104 participants, 50% were male, with a predominant age group over 45 years (61.5%). A majority portion of the cohort was married (72.1%), employed (57.7%), and identified as Christian (56.7%). The majority of CKD cases were diagnosed as stage 5 (87.5%) and on dialysis treatment. Delirium was present in 19.2% of participants. In those without delirium, anxiety affected 46.3%, depression impacted 50.0%, and cognitive dysfunction was present in 11.1%. A gender-based analysis revealed no significant differences in age or illness duration; however, males exhibited a higher level of education (P < 0.02). While females tended to display more severe psychiatric symptoms (P < 0.06), males had more cognitive dysfunction (P < 0.08); however, these differences did not reach statistical significance. Socioeconomic status (SES) comparisons demonstrated that lower SES correlated with a reduced number of years of education (P < 0.00). Conclusion: Anxiety and depression were prevalent in nearly half of CKD patients, without gender or socioeconomic disparities. This underscores the imperative need for holistic, multidisciplinary interventions to effectively manage these conditions and enhance overall quality of life.

Physical Fitness, Executive Functions, and Academic Performance in Children and Youth: A Cross-Sectional Study

The aim of this cross-sectional study was to investigate the relationship between physical fitness, executive function, and academic performance in children and adolescents. A total of 131 students (49% female) aged 10–15 years from a public school in Rio de Janeiro were assessed in executive functions (hearts and flowers, Corsi’s block, and digit span tasks), academic performance (Portuguese, reading, math, and overall school grade), physical tests (touch test disc, agility, lower limb and upper limb explosive strength), and anthropometric measurements. Regression results showed that the composite of sports-related fitness measures was the best predictor of executive functions (β = 0.472; t = −6.075 p < 0.001). Decision tree classifier analysis showed that the combination of factors that discriminated better and worse executive function groups were better performance in hand–eye coordination (TTD), math, and upper limb strength (ULEST). Sports-related fitness is significantly correlated with executive function. Hand–eye motor coordination has been identified as the most important predictor of improved cognitive outcomes, surpassing even academic skills. These findings should be considered in the design of physical activity programs in school settings, which may have a positive impact on child development, reflected in the reduction of academic and socioeconomic disparities.

Disparities in Treatment for Alcohol Use Disorder Among All of Us Participants.

The authors examined racial/ethnic and socioeconomic disparities in receiving treatment for alcohol use disorder (AUD). A retrospective cohort study was conducted that included adults (≥18 years) with AUD from the All of Us Controlled Tier database v7. Outcomes were lifetime receipt of FDA-approved medications (disulfiram, acamprosate, and naltrexone), psychotherapy (individual, family, and group-based session), and combination treatment (medication and psychotherapy). The study examined treatment receipt by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), insurance (private, Medicare, Medicare and Medicaid, Medicaid, Veteran Affairs [VA], none), income (<$10K, $10-<$50K, $50-$100K, >$100K), and area deprivation index (ADI) quintiles. Multivariable logistic and multinomial logistic regressions were used to assess the association between patient characteristics and treatment receipt. The cohort consisted of 18,692 patients (mean age=57.1 years; 60.7% were male; 47.1% were non-Hispanic White). Almost 70% received no treatment, 11.4% received medication, 24.0% received psychotherapy, and 4.9% received combination treatment. In adjusted analysis, non-Hispanic Black (aOR=0.78, 95% CI=0.69-0.89) and Hispanic (aOR=0.75, 95% CI=0.64-0.88) individuals were less likely to receive medication than non-Hispanic White counterparts. There was no association between race/ethnicity and receipt of psychotherapy or combination treatment. Compared with private insurance, dual eligibility was associated with less use of medication, Medicare and Medicaid with less use of medication and combination treatment, and VA and no insurance with more use of psychotherapy and combination treatment. Higher income and lower ADI were positively associated with all treatment types. There are disparities in AUD treatment by race/ethnicity, socioeconomic status, and insurance. Systematic approaches are required to improve equitable access to effective treatment.

Tracing the educational journey of Indian women across generations: A study of multigenerational education mobility in India

This study investigates intergenerational mobility and socioeconomic disparities in women's education in India, utilizing data from the Longitudinal Ageing Study in India (LASI) Wave 1. It uniquely examines three generations of women: the second generation (G2), aged 45–75, who reported on their own education, their mother's education (G1), and their daughter's education (G3). Despite India's economic growth over the past three decades, women's educational status remains poor, influenced by enduring gender discrimination. The study constructs educational transition matrices and measures two mobility indices: M1, which represents the expected proportion of daughters transitioning from their mother's educational level, and M2, which measures the extent of transitions between educational categories. M1 is further broken down into upward and downward mobility. The findings highlight significant progress in educational mobility across generations, with notable increases in upward mobility from the grandmother-mother to the mother-daughter generations, indicating a positive trend. Urban women show significantly higher levels of educational mobility compared to their rural counterparts. However, the study also identifies a decline in multigenerational educational mobility among Muslim women. Persistent caste-based disparities in education are observed, although there is a promising trend of narrowing gaps in recent years. Additionally, the study reveals substantial progress in educational attainment among the most economically disadvantaged groups compared to previous generations.

Measuring Socioeconomic and Stress Disparities in Infant Declarative Memory Using the Visual Paired Comparison Task.

Research suggests that socioeconomic circumstances and stress predict memory skills in adults and older children, yet few studies have addressed this question in infancy. The current study used the visual-paired comparison paradigm to examine whether socioeconomic circumstances, maternal perceived stress, and/or maternal physiological stress, all measured prenatally, predict memory performance among 6-month-old infants. We found no significant associations between infant memory and any measure of socioeconomic circumstance or stress. Potential explanations for these null findings are discussed.

Neighborhood Opportunity is Associated with Completion of Hepatocellular Carcinoma Surveillance Prior to the Diagnosis of Hepatocellular Carcinoma in Patients with Cirrhosis

BackgroundThe Ohio Opportunity Index (OOI) is a multidimensional index used to quantify neighborhood-level resources to access a wide array of factors that influence health. This study examined the relationship between neighborhood opportunity and completion of guideline-concordant hepatocellular carcinoma (HCC) screening in patients with cirrhosis. MethodsThis retrospective study included patients with cirrhosis and HCC who received care at The Ohio State University Wexner Medical Center between 1/1/2015 and 12/31/2021. High opportunity was defined as a score greater than the third quartile of the study cohort. Modified Poisson regression models with robust variance examined the association, on the prevalence ratio (aPR) scale, between guideline-concordant HCC screening and high neighborhood opportunity status. ResultsThis study included 157 cirrhosis patients newly diagnosed with HCC. Only 25.5% of the patients completed HCC surveillance within 6 months prior to diagnosis. The OOI was a significant predictor of adherence in all models. For every ten-percentile increase in OOI score, there was a consistent increase in the prevalence ratio (PR) of pre-diagnosis HCC surveillance (PR=1.37, 95% CI 1.10-1.71). This effect remained significant after controlling for sociodemographic, clinical, and cirrhosis-related variables (adjusted PR=1.38, 95% CI 1.02-1.85. Compared to those with high OOI (i.e.,≥Q3), patients in the lowest opportunity quartile had a 64% lower prevalence of HCC screening (PR=0.36, 95% CI 0.26-0.50). ConclusionNeighborhood opportunity status has a dose-dependent effect on HCC surveillance adherence in patients with cirrhosis. Future studies should identify neighborhood-level interventions to reduce socioeconomic disparities in HCC diagnosis and outcomes.

Trends in All-cause Mortality among U.S. Veterans with Sarcoidosis, 2004–2022

BACKGROUNDSarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in U.S. Veterans is lacking. RESEARCH QUESTIONSWhat are the trends in all-cause mortality among U.S. Veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs. White racial disparities, and geographic variability in relation to mortality? STUDY DESIGN AND METHODSUsing Veterans Health Administration (VHA) electronic health records (EHR), we conducted a population-based, retrospective cohort study of adjusted all-cause mortality 2004–2022 among Veterans diagnosed with sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015–2022), we considered the impact of neighborhood-level socioeconomic disparities using the area deprivation index (ADI). RESULTSIn all, 23,745 Veterans were diagnosed with sarcoidosis between 2004 and 2019 and followed through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P<0.0001) and was 6.4% higher in Black than White Veterans (mortality rate ratio=1.064, P=0.02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, and Northeast residence, and lower risk with “Other” service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged. INTERPRETATIONMortality among Veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal healthcare access in achieving equitable outcomes.

Energy transition policy and rural revitalization of Chinese ethnic regions

This study addresses socio-economic disparities and environmental challenges in China's ethnic regions by examining the impact of energy transition policies on rural revitalization, with a particular focus on the mediating effects of population quality, economic growth, and industrial upgrading. Using data from 46 Chinese ethnic regions spanning 2003 to 2022, the analysis reveals that industrial upgrading significantly enhances the effectiveness of these policies, while educational attainment, as a measure of population quality, further amplifies their benefits. Although economic growth also contributes positively to rural revitalization, its mediating role is less pronounced. These findings highlight the need for a comprehensive strategy that integrates energy transition with socio-economic development to promote sustainable rural progress. The study underscores the critical role of incorporating energy transition into broader development policies, particularly through industrial and educational improvements, to achieve sustainable development in China's ethnic regions, and offers valuable policy recommendations.

Associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in populations from China and from England

BackgroundWe investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations. MethodsWe used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011–2015) and four in ELSA (2001−2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength. FindingsLower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline. InterpretationLower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities.

Socioeconomic mobility, metabolic health, and diet: mediation via subjective socioeconomic status.

Socioeconomic mobility, i.e., changing socioeconomic status (SES) between adolescence and adulthood, may impact health through changing resources, social status, and health-related behaviors. This analysis examined whether subjective SES contributes to associations of mobility with metabolic health (BMIand metabolic syndrome) and unhealthy diets (fast-food consumptionand sugar-sweetened beverage [SSB] consumption). National Longitudinal Study of Adolescent to Adult Health data were used (n = 4132). Mobility was defined as the difference between adolescent (collected 1994-1995, ages 11-19 years) and adult (collected 2016-2018, ages 33-43 years) SES. Linear and logistic regressions examined associations of mobility with metabolic and dietary outcomes and mediation by subjective SES. Substantial upward mobility was associated with lower risk of high SSB consumption compared with stable disadvantaged SES (risk difference: -0.10 [95% CI: -0.16 to -0.041]). Subjective SES mediated associations of upward, but not downward, mobility with risks of developing metabolic syndrome, high fast-food consumption, and high SSB consumption; upward mobility was associated with higher subjective SES and lower risks of poor metabolic and dietary outcomes. The finding that subjective SES contributed to associations between upward mobility and better health may inform development of interventions designed to promote healthier diets and reduce socioeconomic disparities in metabolic health.

The Impact of Socioeconomic Factors on 90-day Postoperative Readmissions and Cost in Shoulder Arthroplasty Patients

Understanding the impact of Social Drivers of Health (SDOH) on shoulder arthroplasty is pivotal for the development of equitable value-based payment models that enhance the quality of patient care. This investigation aims to understand the influence of Area Deprivation Index (ADI) on hospital admissions, readmissions, and associated costs post-shoulder arthroplasty. We conducted an analysis using US Medicare claims data from 2019 to 2021, identifying patients who received shoulder arthroplasty in either an inpatient or outpatient setting using Current Procedural Terminology (CPT) codes. Our primary outcomes were 90-day unplanned readmissions and post-procedure 90-day care costs. The ADI was our primary exposure variable, calculated at the census block level. Our analysis adjusted for multiple factors using a stepwise modeling approach including patient demographics, 29 Elixhauser comorbid conditions, Medicaid-dual eligibility, and end-stage renal disease status using logistic regression models. A total of 145,435 patients were included in our study. The average age of patients in our cohort was 74.5 years old, with 59.5% being female. Patients in the high ADI group had a higher readmission rate than the lowest ADI group (8.5% vs. 6.0%, p<0.001).When controlling for confounding factors, there was an indepdentent association between high ADI and readmission (OR: 1.28 [95% CI 1.12, 1.46]). Overall, we saw a dose-dependent relationship between ADI and readmission, with the association growing stronger as ADI increased. Conversely, we found a negative association with ADI and high-costs. (High ADI Group OR: 0.80 [95% CI 0.70, 0.91]). Patients in the high SES group had higher healthcare contact days during the 90-day follow-up period, with a median of 16 visits (IQR 8, 23), compared to 13 visits (IQR 6, 22) in the middle SES group and 10 visits (IQR 5, 20) in the low SES group (p<0.001). Socioeconomic disparities significantly influence the outcomes of primary shoulder arthroplasty, as indicated by higher readmission rates for low SES patients. Notably, our analysis shows a strong, independent association between ADI and readmission. Moreover, patients with higher SES incurred greater costs within a 90-day period potentially due to increased resource utilization.