Socioeconomic Status Bias Research Articles

Tracking Procedures and Criteria and the SES Bias in Teacher Track Recommendations

The allocation of students to ability tracks is often based on teacher recommendations. These recommendations tend to be biased in favor of students from higher socioeconomic status (SES) backgrounds. While tracking procedures and criteria have been proposed to play a role herein, empirical research is lacking. Using a survey experiment and information from 221 teachers in 69 Dutch schools, I find that teachers in the same school vary in their interpretation of their school’s procedure and (relatedly) their own tracking criteria. Teachers who perceive the school procedure to put more weight on students’ home environment, and/or (relatedly) put more weight on this themselves, show a stronger SES bias in track recommendations in the survey experiment.

Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review

ObjectivesResearch indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP)...

Unconscious Bias among Health Professionals: A Scoping Review.

Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

BackgroundPerson-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequitable PCMC based on SES.MethodsData are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers’ perceptions of women’s expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women’s SES characteristics and providers’ perceptions of women as ‘difficult’ or ‘good’. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression.ResultsThe average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger negative explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.71 (SD = 0.43), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education had significantly lower explicit bias scores on the low SES vignette than those with less education. Providers in private facilities had higher IAT scores than those in government hospitals.ConclusionsThe findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

Understanding disparities in person-centred maternity care: the potential role of provider implicit and explicit bias.

Studies in low-resource settings have highlighted disparities in person-centred maternity care (PCMC)-respectful and responsive care during childbirth-based on women's socioeconomic status (SES) and other characteristics. Yet few studies have explored factors that may underlie these disparities. In this study, we examined implicit and explicit SES bias in providers' perceptions of women's expectations and behaviours, as well as providers' general views regarding factors influencing differential treatment of women. We conducted a convergent mixed-methods study with 101 maternity providers in western Kenya. Implicit SES bias was measured using an adaptation of the Implicit Association Test (IAT) and explicit SES bias assessed using situationally specific vignettes. Qualitative data provided additional details on the factors contributing to disparities. Results provide evidence for the presence of both implicit and explicit bias related to SES that might influence PCMC. Differential treatment was linked to women's appearance, providers' perceptions of women's attitudes, assumptions about who is more likely to understand or be cooperative, women's ability to advocate for themselves or hold providers accountable, ability to pay for services in a timely manner, as well as situational factors related to stress and burnout. These factors interact in complex ways to produce PCMC disparities, and providing better care to certain groups does not necessarily indicate preference for those groups or a desire to provide better care to them. The findings imply the need for multilevel approaches to addressing disparities in maternity care. This should include provider training on PCMC and their biases, advocacy for women of low SES, accountability mechanisms, and structural and policy changes within health care settings.

Analysis of Students’ Ratings of Teaching Quality to Understand the Role of Gender and Socio-Economic Diversity in Higher Education

Contribution: This paper contributes to the literature by confirming the existence, in gender and socio-economic diversified higher educational environments, of differential evaluation ratings given by students to their teachers. Background: Women and low socio-economic classes have historically been under-represented, both as students and teachers. Various policies and measures are being put in place internationally to raise their standing, equity, and success as they progress in their careers. To be effective, the after effects of these policies must be investigated and understood. Research Questions: This paper addressed the question of whether gender and socio-economic differences, in both teachers and students, affect students’ opinion of their teachers in higher education, across a number of disciplines. Methodology: The research analyzed the differentials in students’ ratings of their teachers in five disciplines in the field of education. Data was drawn from student responses to the surveys conducted in a large Indian university at the end of each course unit. The survey questions elicit their perceptions of teaching quality in the disciplines of civil engineering, electrical engineering, computer science engineering, mathematics, humanities and social sciences. This paper analyzes 112 919 and 16 354 complete sets of student ratings, to study the gender and socio-economic diversity based effects respectively. Statistical multivariate and univariate general linear models were used to derive the relevant results and graphs. Findings: The study reveals the existence of socio-economic status bias, gender-typical behavior, gender-atypical behavior, and same-gender and cross-gender biases; these resulted in differential ratings in the disciplines examined.

Track recommendation bias: Gender, migration background and SES bias over a 20‐year period in the Dutch context

Bias in track recommendations is an important mechanism, which causes education inequity in a tracked educational system (streaming). If teacher biases in track recommendations change over time, inequity in society and in the education system may also change. We investigated changes in track recommendation bias over time for gender, immigration status and socioeconomic status (SES), based on a longitudinal empirical study of nine cohorts of Dutch students in their final year (grade 6) of primary education in the period 1995–2014. An overview of educational and societal trends was provided, alongside the empirical analysis, to explain the findings in variation over time in track recommendation bias. Results indicate that the level of track recommendations provided to the students gradually increased over time. For a similar performance, a higher track recommendation was awarded in 2014 compared to 1995. This development coincided with an increase in parental education level, the valuing of education and the introduction of lower‐status pre‐vocational education tracks. Track recommendation bias favouring students with a migrant background and female students decreased, which coincided with growing cultural intolerance and attention to the ‘boy problem’. Bias in track recommendations related to SES appeared stable, with only small deviations from year to year. The results of this study indicate that track recommendation bias and teacher considerations are dependent on time and context.

Priority and prejudice: does low socioeconomic status bias waiting time for endoscopy? A blinded, randomized survey

Introduction: An unwanted socioeconomic health gap is observed in Western countries with easily accessible, government-financed health care systems. Survival rates from several malignancies differ between socioeconomic clusters and the disparities remain after adjusting for major co-morbidities and health related behavior. The possibility of biased conduct among health care workers has been proposed as a contributing factor, but evidence is sparse.Methods: A blinded, randomized online questionnaire survey was conducted among specialists in gastroenterology in Norway. Each respondent was asked to give priority for colonoscopy to three different referrals. By randomized sequence, half the referrals contained a discreet piece of information indicating low socioeconomic status (SES). The SES information given was focused on known low-status clusters in Norway, namely the morbidly obese and receivers of disability pensions.Results: There were 107 respondents giving a response rate of 67%. A lower priority was consistently given to the referrals containing information on low SES, but the difference only reached statistical significance (p = .018) for one of the referrals.Conclusion: Information on low SES may influence how referrals for endoscopy are prioritized.

Effect of Socioeconomic Status Bias on Medical Student-Patient Interactions Using an Emergency Medicine Simulation.

Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high-fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. Teams of MSs were randomly assigned to participate in a high-fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low-SES homeless man and a high-SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, six information gathering, and five clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed-effects model with a random effect for case to account for multiple observations per case. Fifty-eight teams participated in an equal number of high- and low-SES cases. MSs asked about pain control more often (p = 0.04) in patients of high SES. MSs touched the low-SES patient more frequently (p = 0.01). There were no statistically significant differences in clinical care or information gathering measures. This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size, and larger cohorts will be required to identify the factors that contribute to SES bias.

Racial, gender, and socioeconomic status bias in senior medical student clinical decision-making: a national survey.

Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. The study included senior medical students. We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p = .03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p < .001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions between patient race and gender on student recommendations.

Utility of a child abuse screening guideline in an urban pediatric emergency department

Previous studies have found racial and socioeconomic status bias in the way clinicians screen for and detect child abuse in patients presenting to the emergency department. We hypothesized that implementing a guideline for screening would attenuate this bias. An algorithm for child abuse screening in patients younger than 1 year presenting with fractures was developed for a pediatric trauma center emergency department. Data were collected 1.5 years before and after implementation of the algorithm to investigate implementation success. Data were compared before and after the implementation of the algorithm using χ and univariate logistic regression analysis. The characteristics of patients with fractures were similar before and after the algorithm implementation. Implementation of the algorithm was related to a significant increase in algorithm required screenings: skeletal survey (p < 0.001), urinalysis (p < 0.001), and transaminase levels (p < 0.001). The racial composition of those screened did not change after the implementation of the protocol. Children with government-subsidized or no insurance were more likely to be screened for child abuse via skeletal survey before the algorithm implementation compared with those with private insurance (odds ratio, 2.7; 95% confidence interval, 1.2-6.0; p = 0.017). This relationship did not exist after the algorithm implementation (odds ratio, 1.2; 95% confidence interval, 0.56-2.46; p = 0.66). Final determination of child abuse was related to insurance status both before and after the algorithm implementation. A child abuse screening algorithm was successfully implemented in an urban trauma center. After implementation, screening was no longer associated with socioeconomic status of the patient's family, although final determination of child abuse still was. Additional research is needed to determine utility of unbiased screening on patient outcomes. Therapeutic study, level IV.

Including socioeconomic status in coronary heart disease risk estimation.

Socioeconomic status (SES) predicts coronary heart disease independently of the Framingham risk-scoring factors included in cholesterol treatment guidelines, possibly resulting in undertreatment of lower SES persons. We examined whether hybrid SES measures (based on area measures of income and individual education) address this bias and derived an approach to incorporating SES information into treatment guidelines. The Atherosclerosis Risk in Communities study data (initiated in 1987 with a 10-year follow-up of 15,495 adults aged 45 to 64 years in 4 southern and midwestern communities) were used to assess the calibration bias of 4 Cox models predicting 10-year coronary heart disease risk: Framingham risk score alone, and Framingham risk score plus SES using an individual-based measure (income less than 150% federal poverty level or less then 12 years of schooling), and 2 hybrid SES measures substituting area-based income measures (block group or zip code median incomes of less than 25th national percentiles) for the individual income component. Revised cholesterol treatment thresholds based on SES risk were also derived. Use of either the block group hybrid or individual-based SES measures eliminated the significant SES bias observed using Framingham risk score alone. Cholesterol treatment guideline thresholds of 10% and 20% coronary heart disease risk (based on the Framingham risk score) were reduced to 6% and 13% for those with low SES. Using patient income based on block group and individual education minimizes the SES bias in Framingham risk scoring and suggests more aggressive cholesterol treatment thresholds for low-SES persons.

Men's and Women's Reactions to Hypothetical Sexual Advances: The Role of Initiator Socioeconomic Status and Level of Coercion

Research on sexual coercion has revealed a beauty bias in that participants judge coercive sexual advances committed by attractive individuals as more acceptable than coercive advances committed by unattractive individuals. In this study, we examined the extent to which there exists a similar socioeconomic status bias in people's perceptions. Participants (N = 160) read 1 of 8 vignettes that depicted sexual advances and responded to several questions about the acceptability of the initiator's behavior. The coerciveness of the advance was manipulated by varying whether the touch occurred in a gentle manner with no threat or in a forceful manner with a threat of harm. Male participants always received a vignette that portrayed a woman initiating a sexual advance, and female participants always received a vignette that portrayed a man initiating a sexual advance. Socioeconomic status of the initiator was manipulated by what type of clothing he/she wore (shabby or expensive) and the car he/she drove (old or new). Results indicated that a gentle touch was more acceptable than a forceful touch, and men found sexual advances more acceptable than did women. Participants rated sexual advances by wealthy individuals as more acceptable than sexual advances by poor individuals. However, the greater acceptability of advances by wealthy individuals appeared to hold up only in the case of a gentle touch. In addition, men appeared to be more prone to the socioeconomic status bias than were women. Methodological limitations and future directions are discussed.

Using aggregate geographic data to proxy individual socioeconomic status: does size matter?

This study assessed whether aggregate-level measures of socioeconomic status (SES) are less biased as proxies for individual-level measures if the unit of geographic aggregation is small in size and population. National Health Interview Survey and census data were used to replicate analyses that identified the degree to which aggregate proxies of individual SES bias interpretations of the effects of SES on health. Ordinary least squares regressions on self-perceived health showed that the coefficients for income and education measured at the tract and block group levels were larger than those at the individual level but smaller than those estimated by Geronimus et al. at the zip code level. Researchers should be cautious about use of proxy measurement of individual SES even if proxies are calculated from small geographic units.

"Fitness" behaviors and anthropometric characters for offspring of first-cousin matings.

The purpose of this article is to describe a unique inbreeding study and to discuss the effects of first-cousin matings on polygenic, multifactorial characters. Francis Galton collected behavioral and anthropometric data on a large sample of individuals in Victorian England over 100 years ago. These data permit control of possible effects of socioeconomic status bias in inbreeding studies. The measures included variables apparently related to fitness, such as visual and auditory acuity, as well as anthropometric characters. On the average, the mean of the inbred group is one-tenth of a standard deviation lower than the mean of the control group for the behavioral as well as the anthropometric characters. These results are consistent with those of other inbreeding studies of cognitive abilities and birth characteristics. Mean differences of this magnitude are to be expected given a polygenic and multifactorial system of inheritance. Samples greater than 1000 in each group are required to detect such differences reliably at statistically significant levels. It is puzzling that characters which would be assumed to have been subjected to strong directional selection, such as visual and auditory acuity, show no greater inbreeding depression than other characters.

Evaluating socioeconomic status bias in the WISC-R

The use of intelligence tests in making special education placement decisions for children has come under repeated scrutiny in recent years. Arguments for and against the use of IQs have centered around the issue of test bias. In California a permanent moratorium on the use of intelligence tests in placing minority group children into classes for the educable retarded has been handed down by the court. One defense proposed by advocates of mental testing has been that the tests are biased against socially and economically disadvantaged groups irrespective of race. According to Clarizio (1978), if a test predicts equally well for two groups it can not legitimately be described as biased. The purpose of this investigation was to evaluate the test bias of the Verbal IQ as measured by the Wechsler Intelligence Scale for Children-Revised in relation to predictions of academic achievement in two different socioeconomic status groups. The results indicated that Verbal IQs are not biased with respect to socioeconomic status. Derived regression equations are presented along with an analysis to inspect the statistical power of the original tests.

Does Socioeconomic Status Bias the Assignment of Elementary School Students to Reading Groups?

This study examined the standardized reading test scores, family socioeconomic status (SES), and teacher-assigned reading groups of pupils in 37 midelementary classrooms from four school districts. The analysis assessed: (1) the relative relationship of SES and reading test measurements with assignments to reading groups; (2) the relative degree of socioeconomic segregation resulting from grouping based on teacher judgments and reading tests; (3) the relationship of teachers’ own SES background to the extent of socioeconomic segregation in their classrooms. Little support was found for the conjecture that either pupil or teacher social class plays a major role in reading grouping in elementary schools.

Does Socioeconomic Status Bias the Assignment of Elementary School Students to Reading Groups?

This study examined the standardized reading test scores, family socioeconomic status (SES), and teacher-assigned reading groups of pupils in 37 midelementary classrooms from four school districts. The analysis assessed: (1) the relative relationship of SES and reading test measurements with assignments to reading groups; (2) the relative degree of socioeconomic segregation resulting from grouping based on teacher judgments and reading tests; (3) the relationship of teachers’ own SES background to the extent of socioeconomic segregation in their classrooms. Little support was found for the conjecture that either pupil or teacher social class plays a major role in reading grouping in elementary schools.