Socioeconomic Position Disparities Research Articles

Gynaecologic and breast cancers in women living with HIV in South Africa: A record linkage study.

Breast and gynaecologic cancers account for approximately half of all cancers diagnosed amongst women in South Africa, many of whom also live with HIV. We aimed to determine the incidence of and risk factors for developing breast and gynaecologic cancers in women living with HIV (WLHIV) in South Africa. This is a longitudinal analysis of the South African HIV Cancer Match study including women aged ≥15 years with two or more HIV-related laboratory tests. We used Cox proportional hazard models to determine the association of Human Papilloma Virus (HPV)-related and hormone-related gynaecologic cancer with patient- and municipal-level characteristics. From 3 447 908 women and 10.5 million years of follow-up, we identified 11 384 incident and 7612 prevalent gynaecologic and breast cancers. The overall crude incidence rate was 108/1 00 000 person-years (pyears) (95% confidence interval [CI]: 106-110), with the highest incidence observed for cervical cancer (70/1 00 000 pyears; 95% CI: 68.5-71.7). Low CD4 cell counts and high HIV RNA viral loads increased the risk of cervical and other HPV-related cancers. Age was associated with both HPV-related and hormone-related cancers. Women accessing health facilities in high socioeconomic position (SEP) municipalities were more likely to be diagnosed with HPV-related cancers and breast cancer than women accessing care in low SEP municipalities. It is important to improve the immunologic status of WLHIV as part of cancer prevention strategies in WLHIV. Cancer prevention and early detection programmes should be tailored to the needs of women ageing with HIV. In addition, SEP disparities in cancer diagnostic services have to be addressed.

Socioeconomic disparities in growth trajectories of Chinese children and adolescents during 1991-2015

Abstract Backgrounds Socioeconomic (SEP) disparities in growth of children from low-/middle-income countries are not well understood, especially in countries experiencing rapid economic growth. We investigated how SEP disparities in child growth in China have changed over time. Methods Using the longitudinal data of 5,118 children and adolescents (7-18y) from China Health and Nutrition Survey (10 sweeps, 1991-2015), we derived four cohorts born in 1981-95, 1986-90, 1991-95, 1996-2000. We applied random-effects fractional polynomial models to estimate mean height and BMI trajectories for each gender separately, by socioeconomic position (SEP) for each cohort. SEP disparities were estimated as differences between high and low SEP groups (by community-level urbanization index, household income/capita, parental education, and occupational class). We also examined whether SEP disparities in nutritional status (stunting, thinness, overweight/obesity) have changed over time. Results Mean height and BMI increased across cohorts, with differences being greatest in adolescence. The increasing trend for height was similar in high and low SEP groups, thus positive SEP differences in mean height persisted across cohorts (e.g. for boys at 10y, were 3.8cm in the earliest and 2.9cm latest cohorts at by urbanization index, and were 3.6cm and 3.1cm by HH income). For BMI, the increasing trend was much faster in high (vs low) SEP groups, thus SEP differences in mean BMI increased across cohorts (e.g. for boys at 10y, increased from 0.5 to 0.8kg/m2 by urbanization index, and 0.4 to 1.1kg/m2 by HH income). Findings for stunting and overweight/obesity were consistent with those for height and BMI. No significant association was found between SEP and thinness. Conclusions Short stature is associated with lower SEP, whereas high BMI is associated with higher SEP among Chinese youths. Between 1991-2015 in China, inequalities in childhood BMI increased while those for height remained fairly constant. Key messages Short stature is associated with lower SEP, whereas high BMI is associated with higher SEP among Chinese youths. Between 1991-2015 in China, inequalities in childhood BMI increased while those for height remained fairly constant.

Trends and socioeconomic disparities in all-cause mortality among adults with diagnosed diabetes by race/ethnicity: a population-based cohort study - USA, 1997–2015

ObjectivesBy race/ethnicity and socioeconomic position (SEP), to estimate and examine changes over time in (1) mortality rate, (2) mortality disparities and (3) excess mortality risk attributed to diagnosed diabetes (DM).DesignPopulation-based...

Abstract PO-174: Racial and socioeconomic disparities in height and body size in adolescence and risk for breast cancer subtypes in the Young Women’s Health History Study

Abstract The etiology of breast cancer (BC) appears to vary by tumor subtypes and currently, in the United States, non-Hispanic White (NHW) women are at an increased risk for luminal A BC and non-Hispanic-Black (NHB) women are at an increased risk for triple negative (TN) BC. Adolescence is a sensitive time for breast development, and childhood overweight/obesity and short height are associated with lower risk of premenopausal BC. The role of adolescent body size on BC risk by subtype, however, has not been well-studied. Relative to NHW girls and girls with higher socioeconomic position (SEP), NHB girls and those with lower SEP are at increased risk of overweight/obesity throughout life. We examined the association between height and body size in adolescence and odds of BC subtypes and the distribution of these factors by self-reported race and SEP. Data are from the Young Women’s Health History Study, a population-based case-control (case n=1812; control n=1381) study of invasive BC among NHB and NHW women aged 20-49 years. BC was diagnosed in Metro Detroit and Los Angeles County SEER registries, 2010-2015. Tumors were classified as luminal A, luminal B, HER2-type, or TN based on estrogen, progesterone, and HER2 receptor status and tumor grade. Area-based controls were frequency matched to cases on site, race and age. During in-home interviews, participants recalled body size at age 12 years with somatotypes (6 levels), weight at age 18 years (used to calculate body mass index (BMI)), and both measured and recalled adult height (<64, 65-66, >67 inches). Data were also collected on self-reported race, adult SEP (household percent poverty (HHP)), and established BC risk factors to evaluate confounding. Adjusted weighted logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) of BC subtype (vs controls). We also examined potential interactions with race and SEP. Among controls, NHB women and women with lower SEP (<150% HHP) were more likely to report a higher age 12 somatotype (SEP X2 p=0.02; race X2 p=0.08) and age 18 BMI (SEP X2 p<0.01; race X2 p<0.01); height did not vary by race or SEP. For age 12 somatotype a trend for reduced odds with increased somatotype was observed for Luminal B BC (p=0.05) and potentially TN (p=0.08). Women with age 18 BMI >30 vs 18.5-<25 kg/m2 had lower odds of luminal A (OR=0.43, 95% CI 0.22, 0.87); women with age 18 BMI <18.5 vs 18.5-<25 kg/m2 had increased odds of HER2-type BC (OR=1.85, 95% CI 1.03, 3.32). Taller height (>67 vs 65-66 inches), was associated with increased odds of all BC subtypes, most strongly for HER2-type (OR=1.80, 95% CI: 1.07, 3.03) and TN (OR=1.42, 95% CI: 0.98, 2.07) BC. The effect of these three body size measures on BC subtype risk did not vary by race or SEP. Body size in adolescence appears to be associated with risk for some BC subtypes, perhaps through hormonal mechanisms, and may partially contribute to explanations for racial and SEP disparities. Citation Format: Lydia R. Marcus, Dorothy P. Pathak, Ann S. Hamilton, Kendra L. Schwartz, Richard Houang, Dan A. Sanfelippo, Ellen M. Velie. Racial and socioeconomic disparities in height and body size in adolescence and risk for breast cancer subtypes in the Young Women’s Health History Study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-174.

Area-level socioeconomic disparity trends in nutritional status among 5–6-year-old children in Israel

ObjectiveThis study aimed to assess area-level socioeconomic position (SEP) disparities in nutritional status, to determine whether disparities differed by sex and to assess whether nutritional status and disparities changed over...

The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence

Introduction: This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. Methods: The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25–64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. Results: Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20–35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. Discussion/Conclusion: Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.

Diabetes in Israel- do all patients receive equal care?

Abstract Background Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators. Methods The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged &amp;gt;18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses. Results DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c&amp;lt;7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level. Conclusions These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP. Key messages Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.

Socioeconomic Position Disparities in Cardiovascular Health Before and After the Examination of Mechanisms of Exercise-Induced Weight Compensation Randomized Controlled Trial.

Purpose: We examined socioeconomic position (SEP) disparities in cardiovascular health before and after an exercise intervention.Methods: Data were from the Examination of Mechanisms of Exercise-Induced Weight Compensation (E-MECHANIC) study. Cardiovascular health was measured through a composite score combining body mass index, systolic blood pressure, cholesterol, and glucose. SEP was assessed using a single measure that combined income and education.Results: At baseline, there was no significant difference in cardiovascular health between high and low SEP participants. Post-intervention, this difference reached significance.Conclusion: Although cardiovascular health improved for exercise intervention participants, SEP disparities in cardiovascular health persisted during the trial.

Socioeconomic inequalities in childhood-to-adulthood BMI tracking in three British birth cohorts

BackgroundBody mass index (BMI) tracks from childhood-to-adulthood, but the extent to which this relationship varies across the distribution and according to socio-economic position (SEP) is unknown. We aimed to address this using data from three British cohort studies.MethodsWe used data from: 1946 National Survey of Health and Development (NSHD, n = 2470); 1958 National Child Development Study (NCDS, n = 7747); 1970 British Cohort Study (BCS, n = 5323). BMI tracking between 11 and 42 years was estimated using quantile regression, with estimates reflecting correlation coefficients. SEP disparities in tracking were investigated using a derived SEP variable based on parental education reported in childhood. This SEP variable was then interacted with the 11-year BMI z-score.ResultsIn each cohort and sex, tracking was stronger at the upper end of the distribution of BMI at 42 years. For example, for men in the 1946 NSHD, the tracking estimate at the 10th quantile was 0.31 (0.20, 0.41), increasing to 0.71 (0.61, 0.82) at the 90th quantile. We observed no strong evidence of SEP inequalities in tracking in men in the 1946 and 1958 cohorts. In the 1970 cohort, however, we observed tentative evidence of stronger tracking in low SEP groups, particularly in women and at the higher end of the BMI distribution. For example, women in the 1970 cohort from low SEP backgrounds had tracking coefficients at the 50th, 70th, and 90th quantiles, which were 0.05 (−0.04; 0.15), 0.19 (0.06; 0.31), and 0.22 (0.02; 0.43) units higher, respectively, than children from high SEP groups.ConclusionTracking was consistently stronger at the higher quantiles of the BMI distribution. We observed suggestive evidence for a pattern of greater BMI tracking in lower (compared to higher) SEP groups in the more recently born cohort, particularly in women and at the higher end of the BMI distribution.

Disparities in the Prevalence of Diagnosed Diabetes - United States, 1999-2002 and 2011-2014.

The prevalence of diabetes mellitus has increased rapidly in the United States since the mid-1990s. By 2014, an estimated 29.1 million persons, or 9.3% of the total population, had received a diagnosis of diabetes (1). Recent evidence indicates that the prevalence of diagnosed diabetes among non-Hispanic black (black), Hispanic, and poorly educated adults continues to increase but has leveled off among non-Hispanic whites (whites) and persons with higher education (2). During 2004-2010, CDC reported marked racial/ethnic and socioeconomic position disparities in diabetes prevalence and increases in the magnitude of these disparities over time (3). However, the magnitude and extent of temporal change in socioeconomic position disparities in diagnosed diabetes among racial/ethnic populations are unknown. CDC used data from the National Health Interview Survey (NHIS) for the periods 1999-2002 and 2011-2014 to assess the magnitude of and change in socioeconomic position disparities in the age-standardized prevalence of diagnosed diabetes in the overall population and among blacks, whites, and Hispanics. During each period, significant socioeconomic position disparities existed in the overall population and among the assessed racial/ethnic populations. Disparities in prevalence increased with increasing socioeconomic disadvantage and widened over time among Hispanics and whites but not among blacks. The persistent widening of the socioeconomic position gap in prevalence suggests that interventions to reduce the risk for diabetes might have a different impact according to socioeconomic position.

Association between community socioeconomic position and HIV diagnosis rate among adults and adolescents in the United States, 2005 to 2009.

We examined the association between socioeconomic position (SEP) and HIV diagnosis rates in the United States and whether racial/ethnic disparities in diagnosis rates persist after control for SEP. We used cases of HIV infection among persons aged 13 years and older, diagnosed 2005 through 2009 in 37 states and reported to national HIV surveillance through June 2010, and US Census data, to examine associations between county-level SEP measures and 5-year average annual HIV diagnosis rates overall and among race/ethnicity-sex groups. The HIV diagnosis rate was significantly higher for individuals in the low-SEP tertile than for those in the high-SEP tertile (rate ratios for low- vs high-SEP tertiles range = 1.68-3.38) except for White males and Hispanic females. The SEP disparities were larger for minorities than for Whites. Racial disparities persisted after we controlled for SEP, urbanicity, and percentage of population aged 20 to 50 years, and were high in the low-SEP tertile for males and in low- and high-SEP tertiles for females. Findings support continued prioritization of HIV testing, prevention, and treatment to persons in economically deprived areas, and Blacks of all SEP levels.

The association of socioeconomic disadvantage with postoperative complications after major elective cardiovascular surgery

Background:Understanding the mechanism by which both patient- and hospital level factors act in generating disparities has important implications for clinicians and policy-makers.Objective:To measure the association between socioeconomic position (SEP) and...