Socioeconomic Status Categories Research Articles

Video gaming and digital competence among elementary school students

ABSTRACT Engagement with video games can potentially advance student digital competence however, there is a digital skills gap by the time young people progress into adolescence. This current research explores how elementary school students’ digital self-efficacy might relate to experiences in video game environments to influence perceptions of digital competence. We examine the differential impact of sex, self-efficacy, and socioeconomic status (SES) on 7–10-year-old students’ (N = 613) perceptions of video gaming and their digital skills. Analysis revealed the unexpected finding that SES was inversely related to enjoyment for gaming and digital technology, with students in the lower-SES category responding more positively compared to students in higher SES categories. As expected, boys self-reported digital skills higher than girls across all SES categories. We argue for the use of gaming pedagogies to support learning in classrooms that accounts for nuances in students’ digital self-efficacy moderated by gender and SES.

Frailty and outcomes in lacunar stroke

BackgroundLacunar strokes (LS) are ischemic strokes of the small perforating arteries of deep gray and white matter of the brain. Frailty has been associated with greater mortality and attenuated response to treatment after stroke. However, the effect of frailty on patients with LS has not been previously described. ObjectiveTo analyze the association between frailty and outcomes in LS. MethodsPatients with LS were selected from the National Inpatient Sample (NIS) 2016-2019 using the International Classification of Disease, 10th edition (ICD-10) diagnosis codes. The 11-point modified frailty scale (mFI-11) was used to group patients into severely frail and non-severely frail cohorts. Demographics, clinical characteristics, and complications were defined. Health care resource utilization (HRU) was evaluated by comparing total hospital charges and length of stay (LOS). Other outcomes studied were discharge disposition and inpatient death. ResultsOf 48,980 patients with LS, 10,830 (22.1%) were severely frail. Severely frail patients were more likely to be older, have comorbidities, and pertain to lower socioeconomic status categories. Severely frail patients with LS had worse clinical stroke severity and increased rates of complications such as urinary tract infection (UTI) and pneumonia (PNA). Additionally, severe frailty was associated with unfavorable outcomes and increased HRU. ConclusionSevere frailty in LS patients is associated with higher rates of complications and increased HRU. Risk stratification based on frailty may allow for individualized treatments to help mitigate adverse outcomes in the setting of LS.

Impact of Victorian COVID-19 restrictions on emergency department presentations and hospital admissions for ophthalmic conditions

ABSTRACT Clinical Relevance Assessing the extent to which COVID-19 impacted hospitals can provide important learnings for future pandemics. Background This study aims to determine the impact of the 7-month duration COVID-19 pandemic-related lockdown orders on ophthalmology-related hospital admissions and emergency department (ED) presentations, during 2020 in Victoria, Australia. Methods Analysis was performed on Victorian statewide data from the Victorian Emergency Minimum Dataset (VEMD) and Victorian Admitted Episodes Dataset (VAED), between 1 January 2018 and 31 October 2020. Numbers of presentations and admissions for key ophthalmic conditions were stratified by age, socioeconomic status, location (metropolitan versus rural), and triage category. From the observations occurring in the pre-pandemic period (January 2018 to March 2020), a linear regression prediction model was built for each diagnosis which predicted what the presentation number in the COVID-19 period would have been if the pandemic had not occurred. Results Based on pre-COVID-19 trends, the largest decreases in expected admissions were for glaucoma (32.9%) and retinal breaks and detachments (21.2%). For the ED data, the most apparent changes were: an increase in presentations for foreign bodies (22.6%); a decrease in retinal detachments (35.5%); and a decrease in keratitis (18.4%) relative to predictions. Conclusions Hospital admissions decreased and patterns of ED attendances changed during lockdown. The findings suggest the need for the following: increased safety messaging to avoid eye injuries around the home; improved pathways for safe and rapid triaging of eye conditions in the community to ensure effective use of ED resources; and messaging to ensure that people do not delay care when they notice signs of sight-threatening conditions such as retinal detachment.

Stress and Alcohol Intake among Hispanic Adult Immigrants in the U.S. Midwest.

Alcohol intake and Alcohol Use Disorder (AUD) among recent and very recent Hispanic immigrants are not well characterized, in particular in the context of perceived stress among such groups. The objective of the present study was to shed light on alcohol intake and AUD overall, as well as potential modifications derived from varying levels of stress and socioeconomic status (SES). The study population was immigrants with six or fewer months of having arrived in the American Midwest, and members of their peer networks who had been in the U.S. for 2+ years. We found that AUD and alcohol intake spanned from very high to a considerable proportion who abstained; perceived stress did not have an obvious impact on AUD or alcohol intake. Moreover, neither New vs. Established immigrant statuses, or SES levels, were associated with AUD or alcohol intake. Future research should examine in a more finely-grained approach the components of SES to verify if the complex circumstances of recent immigrants are in fact amenable to SES classification using standard quantification approaches-even using the functional descriptions of the SES surrogates we used.

Changes in Socioeconomic Status as Predictors of Cardiovascular Disease Incidence and Mortality: A 10-Year Follow-Up of a Polish-Population-Based HAPIEE Cohort.

Although the inverse association between socioeconomic status (SES) and cardiovascular disease (CVD) is well established, research on the effect of changes in the SES throughout life on CVD risk in populations with different social backgrounds remains scarce. This study aimed to assess the relationship between childhood SES, adulthood SES, and changes in SES over time, and CVD incidence and mortality in a Polish urban population. In addition, the predictive performance of the SES index was compared with education alone. A cohort study with a 10-year follow-up was conducted, in which a random sample of 10,728 residents in Kraków aged 45-69 years were examined. The SES was assessed at baseline using data on education, parents' education, housing standard at the age of 10 years, professional activity, household amenities, and difficulties in paying bills and buying food. SES categories (low, middle, and high) were extracted using cluster analyses. Information on new CVD cases was obtained from questionnaires in subsequent phases of the study and confirmed by reviewing clinical records. Data on deaths and causes were obtained from the residents' registry, Central Statistical Office, and the participants' families. The effect of the SES index on the risk of CVD was assessed using Cox proportional hazard models. In male and female participants, the CVD incidence and mortality were observed to be 27,703 and 32,956 person-years (384 and 175 new CVD cases) and 36,219 and 40,048 person-years (159 and 92 CVD deaths), respectively. Childhood SES was not associated with CVD incidence and mortality. A protective effect of high adulthood SES against CVD mortality was observed in men and women (HR = 0.59, 95% CI = 0.31-0.97; HR = 0.33, 95% CI = 0.14-0.75, respectively). In women, downward social mobility was related to 2.24 and 3.75 times higher CVD incidence and mortality, respectively. In men, a protective effect against mortality was observed in upward mobility (HR = 0.50, 95% CI = 0.29-0.84). Model discrimination was similar for the SES index and education alone for the association with CVD incidence. In women, the SES index was a slightly better predictor of CVD mortality than education alone (C-index = 0.759, SE = 0.0282 vs. C-index = 0.783, SE = 0.0272; p = 0.041). In conclusion, high adulthood SES, but not childhood SES, may be considered to be a protective factor against CVD in urban populations in high-CVD-risk regions. No effects of critical periods in early life were observed on CVD risk. In later life, social mobility was found to affect CVD mortality in both men and women. In men, a protective effect of upward mobility was confirmed, whereas in women, an increased CVD risk was related to downward mobility. It can be concluded that CVD prevention may be beneficial if socioeconomic potentials are strengthened in later life.

Analysis of 372 Adult Allograft Recipients Reveals Associations between Non-European Ancestry, Low Socioeconomic Status, and Receipt of HLA-Disparate Grafts

Introduction: While both race/ ethnicity & socioeconomic status (SES) impact care delivery for allograft candidates & recipients, the associations between ancestry & SES, & their interaction with donor type are not fully established. We hypothesized that low SES disproportionately impacts non-European (non-EURO) recipients of HLA-disparate grafts (cord blood, haploidentical, or 4-7/8 unrelated donor [mmURD]). Methods: We examined surrogates of SES in consecutive adults undergoing allograft 3/2020-2/2022 stratified by recipient ancestry & donor type. A 3/2020 analysis commencement was selected as Social Work (SW) philanthropic financial support for vulnerable patients increased at the onset of the COVID-19 pandemic. As household income was not collected, surrogates of low SES were defined as: 1) an area deprivation index (ADI) national percentile ≥ 60; 2) Medicaid as the primary insurance at BMT referral; &/ or 3) received SW philanthropic financial support to cover cost-of-living expenses within 6 months of transplant. We also assessed mean fold differences in the funding amount/ patient receiving philanthropic support. Results: Of 372 patients (pts, median 62 years, range 19-81; 73% myeloid malignancy), 257 (69%) had European (EURO) and 115 (31%) non-EURO ancestry (including 31 White Hispanic, 40 African, 34 Asian, 4 Middle Eastern, and 6 mixed non-EURO pts). 53 (14%) received matched sibling donor, 191 (51%) 8/8 unrelated donor, 38 (10%) cord blood, 47 (13%) haploidentical, and 43 (12%) mmURD transplants. More than half (67/115, 58%) of non-EURO ancestry pts received an HLA-disparate graft compared to 24% (61/257) of EURO pts (p < 0.001). Median ADI was 14 (range 1-100). Eighteen (5%) patients had low SES by ADI ≥ 60; 22 (6%) by Medicaid insurance; and 71 (19%) by receipt of financial support. A higher proportion of pts received financial support if they had Medicaid (13/22, 59%) compared to Medicare/ private insurance (58/350, 17%), p < 0.001, or if their ADI was ≥ 60 (7/18, 38%) compared to < 60 (64/354, 18%), p = 0.028. Conversely, only one pt with ADI ≥ 60 had Medicaid. Notably, the 3 SES classifications resulted in different pts being classified as low SES (Figure 1). Only 20 pts had low SES by two of these measures, & only 1 by all three. When analyzing by ancestry, compared to EUROs, non-EUROs had a similar ADI distribution but over double the proportion on Medicaid (12/115, 10% vs 10/257, 4%, p = 0.013). Non-EUROs also had almost twice the proportion receiving financial support (33/115, 29% vs 38/257, 15%, p = 0.002), & those who did were granted a mean of 40% more funds relative to EUROs. African ancestry pts had the highest proportions on Medicaid (5/40, 12.5%) & receiving financial support (17/40, 42.5%), with the highest mean fold increase in funds (58% more) relative to EUROs. When stratifying by both ancestry & graft source, because very few EURO HLA-disparate graft recipients had low SES, all EURO ancestry pts were combined. Relative to EUROs, non-EUROs who received HLA-disparate grafts (n = 67 including 15 White Hispanic, 31 African, 20 Asian, & 1 mixed non-EURO pts) had triple the proportion on Medicaid (8/67, 12% vs 10/257, 4%, p = 0.015) with more than double receiving financial support (22/67, 33% vs 38/257, 15%, p = 0.001). Also, those who received support were granted a mean of 50% more funds relative to EUROs (Table 1). By contrast, differences between EUROs & non-EURO HLA-matched graft recipients were not significant. African ancestry pts who received HLA-disparate grafts had the highest proportions on Medicaid (5/31, 16%) & receiving financial support (14/31, 45%) with the highest mean fold increase in funds (75% more) relative to EURO pts. Conclusions: We demonstrate an intersectionality between ancestry & SES, & an association with donor type, with the most vulnerable patients (non-EUROs with low SES, especially African ancestry pts) receiving the most complex (ie HLA-disparate) transplants. Successful extension of transplant access to minority pts will be contingent on addressing this financial hardship. Moreover, as the different SES classification systems result in different assignment of SES, interventions to advance equity will require better SES classifications or detailed recording of household income. Access to expensive post-transplant medications may be another surrogate of low SES & analysis of this is underway at our Center. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 14008: Socioeconomic Status and Prediction of Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Socioeconomic status (SES) is a potent risk factor for heart failure (HF), but current HF prediction models do not incorporate data on SES. It is not known if the performance of HF risk prediction algorithms differs by SES, and how including SES in risk models impacts risk prediction. Methods: We performed an analysis of participants without HF at Visit 1 (1987-89) of the ARIC study. SES was assessed by household income, educational attainment, Area Deprivation Index, and as a combined cumulative SES score that included all three measures. Incident hospitalizations and deaths related to HF were assessed through 12/31/2019. We compared risk discrimination (c-statistic) of the established ARIC HF risk score across SES categories, and assessed calibration within SES strata by comparing observed versus predicted risk. We examined changes in risk discrimination, net reclassification and calibration (calculating the Hosmer-Lemeshow statistic for the latter) with adding SES to the ARIC HF risk score. Results: We studied 14,468 individuals; 54% were women, 26% were Black adults and 22% had low cumulative SES. There were 3,568 HF events over 33 years of follow-up. The c-statistic of the ARIC HF risk score was lower in those with low versus high cumulative SES (0.726 vs 0.765). There were differences in the ARIC HF risk score’s calibration by SES, with lower predicted than observed HF risk in those with low SES in all quintiles of predicted risk (Figure). Calibration improved with adding SES to the risk model (change in Hosmer-Lemeshow 127.6 to 98.3), especially in those with low SES (Figure). Adding SES to the model modestly improved risk discrimination (change in c-statistic 0.767 to 0.771; p&lt;0.001) and changed net reclassification (0.05 [95% CI 0.02-0.08]). Conclusions: HF prediction algorithms underestimate HF risk in those with low SES. Systematic assessment and incorporation of SES data may enhance HF risk prediction in socioeconomically diverse populations.

Youth Outdoor Recreation Experience, Race, and Socioeconomic Status: Explaining Connection to Nature and Future Career Interest

The outdoor recreation industry faces the challenge of recruiting the next generation of professionals. This study examined factors that may influence young adults’ interest in outdoor recreation careers, including participation in organized and unorganized outdoor recreation as a youth, connection to nature (CTN), racial identity, and socioeconomic status (SES). An online questionnaire was distributed using a Qualtrics panel, and criterion sampling was used to ensure the sample included participants with approximately equal representation across racial identity and SES categories. Participation in unorganized recreation, CTN, and SES were found to be significant predictors of interest in outdoor recreation careers. Additionally, participation in organized recreation was found to be a significant negative predictor of CTN, while participation in unorganized recreation and racial identity were significant positive predictors of CTN, and CTN had a small mediating effect on the relationship between unorganized recreation participation and interest in outdoor recreation careers.

Revisiting the Social Construct of Status in India: The Modified B.G. Prasad Socio-economic Status Classification (2022)

Revisiting the Social Construct of Status in India: The Modified B.G. Prasad Socio-economic Status Classification (2022)

The Impact of the Affordable Care Act on Disparities in Utilization of Cardiovascular Preventive Services by Socioeconomic Status.

Disparities in cardiovascular outcomes are persistent in our society. The objective was to track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in utilization of cardiovascular disease (CVD) preventive services among nonelderly adults aged 18-64 years. This study used the National Health Interview Survey (2011-2017) to compare utilization of blood pressure, cholesterol, glycemic screening, and diet and smoking cessation advice over time between groups stratified by SES and race using difference-in-difference analysis. This study also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs. White, middle-high-income, and insured). The study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic White) between 2011 and 2017, translating to 194.8 million nonelderly US adults per year. Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), low-income (13.6%), and lowest income SES (18.3%). The proportion of CVD preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals. The difference in blood pressure checks, cholesterol checks, and smoking cessation advise between high- and lowest income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively, between 2011 and 2017. The findings demonstrate a trend in reduction of CVD preventive care disparities between SES groups. However, a gap still exists, and this study highlights the need for continuous improvement to eliminate SES disparities.

The Global Network Socioeconomic Status Index as a predictor of stillbirths, perinatal mortality, and neonatal mortality in rural communities in low and lower middle income country sites of the Global Network for Women's and Children's Health Research.

BackgroundGlobally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations.ObjectiveThe current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia.MethodsThe analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded Global Network for Women’s and Children’s Health Research. Generalized estimating equations models were computed for each outcome by SES level (high, moderate, or low) and controlling for site, maternal age, parity, years of schooling, body mass index, and facility birth, including sampling cluster as a random effect.ResultsWomen with low SES had significantly higher risks for stillbirth (p < 0.001), perinatal mortality (p = 0.001), and neonatal mortality (p = 0.005) than women with high SES. In addition, those with moderate SES had significantly higher risks of stillbirth (p = 0.003) and perinatal mortality (p = 0.008) in comparison to those with high SES.ConclusionThe SES categories were associated with pregnancy outcomes, supporting the validity of the index as a non–income-based measure of SES for use in studies of pregnancy outcomes in LMICs.

Racial, ethnic and socioeconomic disparities in diagnosis, treatment, and survival of patients with breast cancer

BackgroundThe objective of this study was to determine the influence of race/ethnicity and socioeconomic status (SES) on breast cancer outcomes. MethodsA retrospective analysis was performed of Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic patients with non-metastatic breast cancer in the SEER cancer registry between 2007 and 2016. ResultsA total of 382,975 patients were identified. On multivariate analysis, NHB (OR 1.18, 95%CI: 1.15–1.20) and Hispanic (OR 1.20, 95%CI: 1.17–1.22) patients were more likely to present with higher stage disease than NHW patients. There was an increased likelihood of not undergoing breast-reconstruction for NHB (OR 1.07, 95%CI: 1.03–1.11) and Hispanic patients (OR 1.60, 95%CI 1.54–1.66). NHB patients had increased hazard for all-cause mortality (HR: 1.13, 95%CI 1.10–1.16). All-cause mortality increased across SES categories (lower SES: HR 1.33, 95%CI 1.30–1.37, middle SES: HR 1.20, 95%CI 1.17–1.23). ConclusionsThis population-based analysis confirms worse disease presentation, access to surgical therapy, and survival across racial, ethnic, and socioeconomic factors. These disparities were compounded across worsening SES and insurance coverage.

Association of diet quality with glycemia, insulinemia, and insulin resistance in families at high risk for type 2 diabetes mellitus in Europe: Feel4 Diabetes Study

ObjectiveThe aim of the present study was to investigate the association of diet quality with fasting glycemia, insulinemia, and insulin resistance in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM) from six European countries, taking into account their socioeconomic status (SES). MethodsBaseline data from non-diabetic adults from the Feel4 Diabetes study were used and diet was assessed by the Healthy Diet Score (HDS). Insulin resistance (IR) was determined by homeostasis model assessment of IR (HOMA-IR). Sociodemographic and lifestyle characteristics were assessed through standardized questionnaires. Multiple linear regressions were adjusted for many confounders, in the total sample and by SES category. ResultsIn 1980 adults, the third tertile of diet quality was inversely associated with insulin levels (–1.48; 95% confidence interval [CI], –2.34 to 0.62), and HOMA-IR (–0.33; 95% CI, –0.57 to 0.09), yet with no statistically significant results for glucose levels. In the SES subgroup analysis, in the high SES group, both second and third diet score tertiles were inversely associated with insulin levels (–1.81; 95% CI, –2.66 to 0.95) and HOMA-IR values (–0.45; 95% CI –0.69 to 0.21), independent of age, sex, smoking and body mass index. No such associations were observed for glucose levels in the high SES group and for all indices in the low SES group. ConclusionIn adults from families at high risk for T2DM, higher diet quality was negatively associated with fasting insulin levels and IR, only in the high SES group and not in the low SES group. Future larger studies may be able to explore further this association, as well as the potential factors that mitigate its strength in the low SES groups.

Technical Skill Assessments as a Predictor or Agriculture Students' Success after High School

This study was conducted using quantitative methods to determine if a relationship exists between former Agriculture Career and Technical Education (CTE) concentrators’ Technical Skills Assessment (TSA) performance and their attaining related placement after high school. The study included data from 13,581 agriculture students who graduated during the years 2015-2019. To investigate the relationship between TSA assessment performance and attaining related placement, multiple descriptive models were run and disaggregated by gender, race/ethnicity, Individuals Education Plan (IEP) status, and Socioeconomic Status (SES). The data revealed students who pass their TSA assessment are more likely to attain related placement compared to those not passing their assessment. Agriculture students’ rates of passing the TSA assessment and attaining related placement were high. Additional analysis to determine the relationship between TSA assessment performance and attaining related placement involved multiple binary logistic regression models. The logistic regression models helped determine how passing the TSA assessment and student demographics interacted and influenced students attaining related placement. Statistically significant findings were determined for TSA assessment, Black students, and those not disadvantaged in the SES category. The findings from this study may add merit to the numerous secondary CTE agriculture education programs in the United States. Keywords: Agriculture education, technical skill assessment, CTE accountability measures, industry-recognized credential

Socioeconomic status does not influence the presentation of patients with inguinal hernia at an urban Canadian teaching hospital.

Background:Socioeconomic status (SES) has been shown to influence the outcomes of surgical pathologies in areas with unequal access to health care. The purpose of this study was to measure the effect of SES on the urgency for inguinal hernia repair in an area with purported equitable access to health care in the context of a universal health care system.Methods:We included all adult patients who underwent surgical management of an inguinal hernia between 2012 and 2016 at 2 urban academic centres. We measured the SES using the Vancouver Area Neighbourhood Deprivation Index (VANDIX) score.Results:We included 2336 patients: 98 emergency surgery and 294 elective surgery cases. We matched patients without replacement on age, sex and American Society of Anesthesiology score, using optimized propensity score matching at a ratio of 1 case to 3 controls. We found no significant correlation between lower SES and emergency surgical management (p = 0.122). Secondary analysis assessed the impact of SES on morbidity and length of stay. We found no significant difference in the rate of complications, length of stay and recurrence by SES category. Patients from lower SES brackets had increased odds for readmission (odds ratio 1.979; 95% confidence interval 1.111–4.318).Conclusion:We found no correlation between a low SES and the need for emergency inguinal hernia repair, but found an increased rate of readmission in patients from lower SES brackets. This finding should be further scrutinized through a deeper dive into the barriers to access to nonacute care settings, such as home care.

Comparison of household socioeconomic status classification methods and effects on risk estimation: lessons from a natural experimental study, Kisumu, Western Kenya

IntroductionLow household socioeconomic status is associated with unhealthy behaviours including poor diet and adverse health outcomes. Different methods leading to variations in SES classification has the potential to generate spurious research findings or misinform policy. In low and middle-income countries, there are additional complexities in defining household SES, a need for fieldwork to be conducted efficiently, and a dearth of information on how classification could impact estimation of disease risk.MethodsUsing cross-sectional data from 200 households in Kisumu County, Western Kenya, we compared three approaches of classifying households into low, middle, or high SES: fieldworkers (FWs), Community Health Volunteers (CHVs), and a Multiple Correspondence Analysis econometric model (MCA). We estimated the sensitivity, specificity, inter-rater reliability and misclassification of the three methods using MCA as a comparator. We applied an unadjusted generalized linear model to determine prevalence ratios to assess the association of household SES status with a self-reported diagnosis of diabetes or hypertension for one household member.ResultsCompared with MCA, FWs successfully classified 21.7% (95%CI = 14.4%-31.4%) of low SES households, 32.8% (95%CI = 23.2–44.3) of middle SES households, and no high SES households. CHVs successfully classified 22.5% (95%CI = 14.5%-33.1%) of low SES households, 32.8% (95%CI = 23.2%-44.3%) of middle SES households, and no high SES households. The level of agreement in SES classification was similar between FWs and CHVs but poor compared to MCA, particularly for high SES. None of the three methods differed in estimating the risk of hypertension or diabetes.ConclusionsFW and CHV assessments are community-driven methods for SES classification. Compared to MCA, these approaches appeared biased towards low or middle SES households and not sensitive to high household SES. The three methods did not differ in risk estimation for diabetes and hypertension. A mix of approaches and further evaluation to refine SES classification methodology is recommended.

Association of Neighborhood-Level Socioeconomic Measures With Cognition and Dementia Risk in Australian Adults

Up to 40% of dementia cases are potentially preventable; therefore, it is important to identify high-risk groups to whom resources could be targeted for maximal impact in preventing late-life dementia. The association of neighborhood-level socioeconomic status (SES) with cognition and dementia risk is not well known, particularly in midlife when late-life dementia may still be preventable through established interventions, such as blood pressure management. To examine whether neighborhood-level SES is associated with differences in cognitive performance and dementia risk scores. This cross-sectional study analyzed data collected between November 17, 2016, and April 14, 2020, from 4656 participants in the longitudinal population-based Healthy Brain Project cohort. This large online cohort comprised community-dwelling individuals geographically dispersed across Australia. Participants were aged 40 to 70 years without dementia or other major neurological conditions. Neighborhood-level SES was computed by matching participants' residential addresses to the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Postcodes provided by each participant were used to derive an IRSAD score that ranked participants according to deciles of neighborhood-level SES (range, 1-10, with higher deciles indicating greater socioeconomic advantage); neighborhoods in deciles 1 to 7 were considered to have low or intermediate SES, and neighborhoods in deciles 8 to 10 were considered to have high SES. Dementia risk estimated using the dementia risk score from the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) tool (n = 4656) and cognitive composite scores for memory and attention measured by the Cogstate Brief Battery (n = 2181). Of 4656 participants (mean [SD] age, 56.1 [7.2] years; 3445 women [74.0%]), 2688 individuals (57.7%) lived in areas with high neighborhood-level SES (IRSAD decile ≥8), and 1968 (42.3%) lived in areas with low or intermediate neighborhood-level SES (IRSAD decile <8), with 1263 individuals (27.1%) residing in rural or regional areas. A total of 6 participants (0.1%) identified as African, 121 (2.6%) as Asian, 57 (1.2%) as Indigenous Australian, 24 (0.5%) as Latin American, 9 (0.2%) as Pacific Islander, 3671 (78.8%) as White or European, and 768 (16.5%) indicated other race (not specified). Each decile unit increase in neighborhood-level SES was associated with a lower CAIDE dementia risk score after adjustment for race and rurality (β [SE] = -0.070 [0.019]; P = .004). Each decile unit increase was also associated with better memory (β [SE] = 0.022 [0.006]; P = .006) but not with better attention (β [SE] = 0.009 [0.007]; P = .34), as measured by Cogstate Brief Battery composite z scores after adjustment for age, sex, race, years of education, and rurality. When comparing memory performance between individuals with IRSAD scores higher and lower than decile 8, neighborhood-level SES interacted with age (F1-2171 = 6.33; P = .02) and CAIDE dementia risk scores (F1-2173 = 4.02; P = .08). Differences in memory between neighborhood-level SES categories were larger among participants who were older and had a higher risk of dementia. In this study, higher neighborhood-level SES was associated with better memory and lower dementia risk scores. These results suggest that efforts to lower dementia risk factors in disadvantaged areas are needed to curtail the increasing burden of dementia and that inclusion of individuals living in areas with lower SES in research on dementia is warranted to improve understanding and potential interventions.

Association of Race and Family Socioeconomic Status With Pediatric Postoperative Mortality

Racial disparities in postoperative outcomes have remained difficult to eliminate. It is commonly understood that socioeconomic status (SES) is an important factor associated with excess risk of postoperative morbidity and death. To date, comparable data exploring the association of family SES with pediatric postoperative mortality are unavailable, and it is unknown whether the advantage provided by higher income status is equitable across racial groups. To assess whether increasing family SES is associated with lower pediatric postoperative mortality and, if so, whether this association is equitable among Black and White children. This retrospective cohort study used data from 51 freestanding pediatric tertiary care hospitals across the US that reported to the Children's Hospital Association Pediatric Health Information System. The study included 1 378 111 Black and White children younger than 18 years who underwent inpatient surgical procedures between January 1, 2004, and December 31, 2020. The exposures of interest were race (Black and White) and parental income quartile (used as a proxy for SES and measured by median income quartile of the zip code of residence). Race was self-reported by parents or guardians at admission or assessed by the registration team consistent with each hospital's policy and state legislation. The primary outcome was risk-adjusted in-hospital mortality rates by race and parental income quartile controlled for baseline covariates. To evaluate whether belonging to the highest income quartile modified the association between race and postoperative mortality, multiplicative and additive interactions were examined. Among 1 378 111 children (773 364 [56.1%] male; mean [SD] age, 7 [6] years) who received inpatient surgical procedures during the study period, 248 464 children (18.0%) were Black, and 1 129 647 children (82.0%) were White; 211 127 children (15.3%) were Hispanic, and 825 477 (59.9%) were non-Hispanic. Only 49 541 Black children (20.3%) belonged to the highest income quartile compared with 482 758 White children (43.0%). The overall mortality rate was 1.2%, and mortality rates decreased as income quartile increased (1.4% in quartile 1 [lowest income], 1.3% in quartile 2, 1.0% in quartile 3, and 0.9% in quartile 4 [highest income]; P < .001). Among those belonging to the 3 lowest income quartiles, Black children had 33% higher odds of postoperative death compared with White children (adjusted odds ratio, 1.33; 95% CI, 1.27-1.39; P < .001). This racial disparity gap persisted among children belonging to the highest income quartile (adjusted odds ratio, 1.39; 95% CI, 1.25-1.54; P < .001). Postoperative mortality rates among Black children in the highest income quartile (1.30%; 95% CI, 1.19%-1.42%) were comparable to those of White children in the lowest income quartile (1.20%; 95% CI, 1.16%-1.25%). The interaction between Black race and income was not statistically significant on either the multiplicative scale (β for interaction = 1.04; 95% CI, 0.93-1.17; P = .45) or the additive scale (relative excess risk due to interaction = 0.01; 95% CI, -0.11 to 0.11; P > .99), suggesting no reduction in the disparity gap across increasing income levels. In this cohort study, increasing SES was associated with lower pediatric postoperative mortality. However, postoperative mortality rates were significantly higher among Black children in the highest SES category compared with White children in the same category, and mortality rates among Black children in the highest SES category were comparable to those of White children in the lowest SES category. These findings suggest that increasing family SES did not provide equitable advantage to Black compared with White children, and interventions that target socioeconomic inequities alone may not fully address persistent racial disparities in pediatric postoperative mortality.

Periodontal Inflamed Surface Area Is Associated With Increased Gestational Blood Pressure and Uric Acid Levels Among Pregnant Women From Rural North China

BackgroundPeriodontal disease has been associated with gestational complications and both conditions have a high prevalence in rural populations from developing regions. A cross-sectional study was carried out to explore the relationship between periodontal inflamed surface area (PISA), blood pressure (BP), and, serum uric acid levels (UA) in a group of rural North Chinese pregnant women in the third trimester of pregnancy.MethodsThree hundred and thirty-five rural women aged 20–34 years, with normal body mass index (BMI) were examined in a cross-sectional study during their third trimester of gestation. Exclusion criteria were history of pregnancy complications, multiple pregnancy, smoking habits, diabetes, hypertension or any known infectious disease. Socio-demographic variables, including age and socioeconomic status (SES), systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings, serum UA levels, and PISA values were recorded. A structural equation model was implemented with two constructed latent variables including “Dem” (comprising of age and SES category to represent unobserved demographic variables) and, “BP” (comprising of SBP and DBP to account for measurement error and lack of multiple BP readings). The model accounted for co-variance of BP and UA, and implemented simultaneous regressions for BP and UA as outcomes, upon Dem and PISA values as exogenous variables.ResultsThe median PISA score was 1,081.7 (IQR = 835.01), reflecting high levels of periodontal inflammation in the sample. SEM showed a significant association of PISA with BP (estimate = 0.011, 95% CI = 0.009–0.012 p < 0.001) and UA (estimate = 0.001, 95% CI = 0.001–0.001, p < 0.001).ConclusionHigher PISA values were significantly associated with higher blood pressure and uric acid levels among rural pregnant women in a cross-sectional sample from a center in North China after accounting for a latent demographic construct derived from age and SES.

Racial and demographic disparities in emergency department utilization for mental health concerns before and during the COVID-19 pandemic

This study investigated whether emergency department (ED) visits for mental health concerns increased during the COVID-19 pandemic, taking a health disparities lens. ED encounters from the only academic medical center in Mississippi were extracted from March-December 2019 and 2020, totaling 2,842 pediatric (ages 4–17) and 17,887 adult (ages 18–89) patients. Visits were coded based on primary ED diagnosis. For adults, there were fewer depression/anxiety ED visits during the pandemic, not moderated by any demographic factor, but no differences for serious mental illness or alcohol/substance use. For youth, there were significantly fewer ED visits for behavior problems during the pandemic among children in the lower socioeconomic status (SES) category; there were no differences for depression/anxiety. Regardless of year, adults in the lower SES category were more likely to visit the ED for mental health, Black adults were less likely to visit the ED for depression/anxiety or alcohol/substance use, and Black children were less likely to visit the ED for behavioral concerns. Results suggest that access to outpatient and telehealth services remains critical for mental health care during the pandemic and underline the importance of race- and SES-related factors in use of the ED for mental health concerns beyond the pandemic.