Community Socioeconomic Status Research Articles

Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study.

Delays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability. We studied patients with ischemic stroke who arrived by emergency medical services in 2015 to 2017 from the American Heart Association Get With The Guidelines-Stroke registry. The primary outcome was time to hospital arrival after stroke (in minutes), beginning at last known well in most cases. Using Geographic Information System mapping, we displayed the geography of delay. We then used Cox proportional hazard models to study the relationship between community-level factors and arrival time (adjusted hazard ratios [aHR] <1.0 indicate delay). The primary exposure was the social vulnerability index (SVI), a metric of social vulnerability for every ZIP Code Tabulation Area ranging from 0.0 to 1.0. Of 750 336 patients, 149 145 met inclusion criteria. The mean age was 73 years, and 51% were female. The median time to hospital arrival was 140 minutes (Q1: 60 minutes, Q3: 458 minutes). The geospatial map revealed that many zones of delay overlapped with socially vulnerable areas (https://harvard-cga.maps.arcgis.com/apps/webappviewer/index.html?id=08f6e885c71b457f83cefc71013bcaa7). Cox models (aHR, 95% CI) confirmed that higher SVI, including quartiles 3 (aHR, 0.96 [95% CI, 0.93-0.98]) and 4 (aHR, 0.93 [95% CI, 0.91-0.95]), was associated with delay. Patients from SVI quartile 4 neighborhoods arrived 15.6 minutes [15-16.2] slower than patients from SVI quartile 1. Specific SVI themes associated with delay were a community's socioeconomic status (aHR, 0.80 [95% CI, 0.74-0.85]) and housing type and transportation (aHR, 0.89 [95% CI, 0.84-0.94]). This map of acute stroke presentation times shows areas with a high incidence of delay. Increased social vulnerability characterizes these areas. Such places should be systematically targeted to improve population-level stroke presentation times.

Survival benefit of autologous transplant (ASCT) for mantle cell lymphoma (MCL) in the California Cancer Registry (CCR).

e19043 Background: Extended follow up of the prospective Nordic MCL2 cohort shows ASCT in CR1 confers a median OS (mOS) of 12.7 y (Eskelund, BJH 2016). Incorporation of BTK inhibitors in 1L MCL is challenging the role of ASCT in an ongoing prospective trial (TRIANGLE, ASH 2022). The present study aims to evaluate the role of ASCT and the impact of social determinants of health (SDH) in a diverse real-world population of MCL patients. Methods: Adult MCL patients diagnosed from January 1, 2000 to December 31, 2020 in the CCR were identified with ICD-O-3 code 9673. The study was approved by UCLA IRB. OS was estimated using KM statistics, calculated from diagnosis to death/last follow-up. Univariate Cox proportional hazards modeling for lymphoma-specific survival (LSS) was performed for variables of interest; those significant at p ≤ 0.10 were incorporated in a stepwise multivariable regression excluding patients with missing data. Socioeconomic status (SES) variables were reported using census-block group data at diagnosis. Results: 5740 ethnically diverse patients were included (NH Whites, n=4038; NH Black, n=175; Hispanic, n=1057; Asian/Pacific Islanders, n=400). Median age at diagnosis was 69 y (IQR 61–68) and 71% were males. 4096 (71%) and 1346 (23%) patients received chemoimmunotherapy and were treated at an NCI/NCCN center, respectively. With a median follow-up of 33 m (IQR 9–76), mOS of the entire cohort was 4.4 y. ASCT patients (n=652, 11%) had improved mOS compared to non-ASCT (14.2 y vs 3.7 y, respectively p&lt;0.001), and 100-day TRM was 2.5%. In the univariable model for all subjects, age, Charlson Comorbidity Index (CCI), married, chemoimmunotherapy, ASCT, NCI/NCCN center, insurance, period of diagnosis, and community SES, poverty, and education were prognostic for LSS. Race, sex, and rural residence were not associated with LSS. Multivariable analysis of 4148 subjects showed significant predictors of LSS were age ≥ 70 y (HR 1.71, p&lt;0.001), ASCT (HR 0.54, p&lt;0.001), diagnosis after 2013 (HR 0.78, p&lt;0.001), CCI (Ref 0; 1-2 HR 1.22, p&lt;0.001; 3+ HR 1.94, p&lt;0.001), married (HR 0.86, p=0.003), NCI/NCCN treatment center (HR 0.77, p=0.001), higher education (top 40% with high school diploma vs. bottom 20%, HR 0.70, p&lt;0.001), higher overall SES (medium vs. low SES tertile, HR 0.81, p=0.003), and increased community poverty (middle 40% vs. bottom 20%, HR 1.14, p=0.043). Conclusions: Our data represent the largest real-world cohort describing the role of ASCT and SDH in MCL. A minority of patients received ASCT and had improved OS compared to non-ASCT patients. While follow-up of ongoing prospective studies will clarify the role of ASCT using contemporary 1L regimens, the present data suggest ASCT in select patients results in durable response with low TRM. Socially disadvantaged patients should be identified and offered supportive programs early in the disease course to mitigate inferior outcomes.

Telemedicine and Disparities in Mental Health Service Use Among Community-Dwelling Older Adults With Alzheimer Disease and Related Dementias

ObjectiveTo examine disparities in mental health (MH) service utilization, via in-person and telemedicine (ie, tele-MH), by individuals' race, ethnicity, and community socioeconomic status, among community-dwelling older adults with Alzheimer disease and related dementias (ADRD) before and after the expansion of the Centers for Medicare and Medicaid Services’ (CMS’s) telemedicine policy. DesignObservational study. Setting and ParticipantsA total of 3,003,571 community-dwelling Medicare beneficiaries with ADRD between 2019 and 2021 were included in the study. MethodsMultiple national data were linked. The unit of analysis was individual-quarter. Three outcomes were defined: any MH visits (in-person or tele-MH), in-person MH visits, and tele-MH visits per quarter. Key independent variables included individual race and ethnicity, the socioeconomic status of the community, and an indicator for the implementation of the telemedicine policy. Regression analyses with individual random effects were used. ResultsIn general, Black and Hispanic older adults with ADRD and those in socioeconomically deprived communities were less likely to have MH visits than white adults and those from less-deprived communities. In-person and tele-MH visits varied throughout the pandemic and across subpopulations. For instance, at the beginning of the pandemic, white, Black, and Hispanic older adults experienced 5.05, 3.03, and 2.87 percentage point reductions in in-person MH visits, and 3.53, 1.26, and 0.32 percentage point increases in tele-MH visits (with P < .01 for racial/ethnic differences), respectively. During the pandemic, the increasing trend in in-person MH visits and the decreasing trend in tele-MH visits varied across different subgroups. Overall, racial and ethnic differences in any MH visits were reduced, but the gap in any MH visits between deprived and less-deprived communities doubled during the pandemic (P < .01). Conclusions and ImplicationsTelemedicine may have provided an opportunity to improve access to MH services among underserved populations. However, although some disparities in MH care were reduced, others widened, underscoring the importance of equitable health care access strategies to address the unique needs of different populations.

Abstract PO1-09-08: Mammography adherence modifies the relationship between multilevel social deprivation and tumor characteristics in the Carolina Breast Cancer Study

Abstract Objective: To describe associations of individual and community socioeconomic status (SES) with breast cancer tumor and treatment characteristics, and to assess potential modification by mammography receipt. Methods: The Carolina Breast Cancer Study is a population-based cohort of women diagnosed with breast cancer between 2008 and 2013. We restricted this analysis to participants with stage 1-3 cancer (n=2,841). Socio-demographic information was obtained during in-home study interviews, and tumor characteristics were obtained from medical records and pathology reports. Community characteristics were obtained from American Community Survey census-tract level data. SES subgroups were identified using latent class analysis, a method for identifying group membership based on multiple shared characteristics. This was done separately using individual data (e.g. household income) and census-tract level data (e.g. poverty rate). We reported prevalence differences (PDs) and 95% CIs for each outcome. Finally, analyses were repeated with stratification by race (Black/non-Black) and receipt of at least one mammogram every 2 years (yes/no), based on self-reported mammography history. Results: Based on the latent class models, participants were sorted into 4 groups based on their individual/community SES: “high/high”, “high/low”, “low/high”, and “low/low”. Black women made up 81% of the low/low group compared to 26% of the high/high. All high individual-SES participants were combined as one referent group because they had similar clinical characteristics regardless of community status. We found that participants with low/low SES had more aggressive tumor characteristics at diagnosis compared to the referent group, such as stage 3 cancer (PD = 5.7%, 2.4-9.0), grade 3 tumor (PD = 9.9%, 5.3-14.4), and triple negative breast cancer (PD = 5.8%, 2.4-9.1). Low/low participants were also more likely to have an interval of at least 30 days between diagnosis and treatment (PD = 4.6%, 0.2-9.0). However, none of these associations were significant for low/high women. When reported separately by race, Black women with low/low SES had greater frequency of stage 3 cancer (PD = 6.3, 1.9-10.8) and prolonged treatment length (PD = 7.5%, 1.1-13.8) compared to high-SES Black women. Race-stratified SES differences were non-significant for genomic subtype and other tumor characteristics like grade and tumor size. After stratifying by screening status, we found that associations of SES with stage and tumor size were only present among those with &amp;lt; 1 mammogram every 2 years. The low/low PDs were (7.9%, 1.5-14.3) for stage 3 and (7.8%, 2.2-13.3) for tumor size &amp;gt;5 cm. Low/low women also had greater frequency of lump detected cancer (PD = 12.6%, 4.0-21.2). In contrast, these associations were not present among women with biannual mammography. Finally, screening status did not modify PDs for genomic subtype (ER+/HER2-, ER-/HER2+, TNBC). Conclusions: Lower community-level SES is associated with less favorable tumor characteristics at diagnosis, mainly among those with low individual SES. Access to mammography may explain part of the disparity in stage and tumor size, suggesting public health benefit for targeted screening initiatives in disadvantaged communities. Still, screening and SES are only 2 mechanisms that contribute to racial disparities; our future work will explore additional intervention points. Demographic and clinical characteristics of CBCS participants by individual and community socioeconomic status (n=2,841) SES groups were derived from latent class models. P-values were assessed by chi-square tests. Participants with race classified as “other” includes all those not identifying as Black or White, including American Indian/Alaska Native, Asian, or another race not listed on the questionnaire. Urbanicity is defined at the census tract-level Citation Format: Matthew Dunn, Marc Emerson, Louise Henderson, Katherine Reeder-Hayes, Terry Hyslop, Melissa Troester. Mammography adherence modifies the relationship between multilevel social deprivation and tumor characteristics in the Carolina Breast Cancer Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-08.

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

Achievement of Goal Orientation and Academic Engagement among Adolescents in Southwestern Uganda

Enhancing academic engagement is essential for improving the educational experiences of adolescents. Guided by Social Cognitive Theory, this study explored the relationship between achievement goal orientation and academic engagement among 510 secondary school students in Southwestern Uganda. The study focused on two forms of goal orientation—mastery-approach and performance-approach goals—and examined the mediating and moderating role of academic self-efficacy. The results, derived from self-reported data, indicate that approach achievement goals (mastery and performance) positively predict academic engagement, independently. Moreover, academic self-efficacy plays a dual role: while it mediates the relationship between approach achievement goals (mastery and performance) and academic engagement, self-efficacy also moderates the relationship between performance-approach achievement goals and academic engagement. These findings underscore the importance of academic self-efficacy and achievement goal orientation in enhancing academic engagement among adolescent students, especially in low socioeconomic status communities. This research contributes to the understanding of factors like teacher-student relationship, external support offered by Compassion International program, goal setting skills training and predetermined external rewards can enrich the educational experiences of students in low resource education contexts

Community Socioeconomic Status, Acute Cardiovascular Hospitalizations, and Mortality in Medicare, 2003 to 2019.

Socioeconomically disadvantaged communities in the United States disproportionately experience poor cardiovascular outcomes. Little is known about how hospitalizations and mortality for acute cardiovascular conditions have changed among Medicare beneficiaries in socioeconomically disadvantaged and nondisadvantaged communities over the past 2 decades. Medicare files were linked with the Centers for Disease Control and Prevention's social vulnerability index to examine age-sex standardized hospitalizations for myocardial infarction, heart failure, ischemic stroke, and pulmonary embolism among Medicare fee-for-service beneficiaries ≥65 years of age residing in socioeconomically disadvantaged communities (highest social vulnerability index quintile nationally) and nondisadvantaged communities (all other quintiles) from 2003 to 2019, as well as risk-adjusted 30-day mortality among hospitalized beneficiaries. A total of 10 942 483 Medicare beneficiaries ≥65 years of age were hospitalized for myocardial infarction, heart failure, stroke, or pulmonary embolism (mean age, 79.2 [SD, 8.7] years; 53.9% female). Although age-sex standardized myocardial infarction hospitalizations declined in socioeconomically disadvantaged (990-650 per 100 000) and nondisadvantaged communities (950-570 per 100 000) from 2003 to 2019, the gap in hospitalizations between these groups significantly widened (adjusted odds ratio 2003, 1.03 [95% CI, 1.02-1.04]; adjusted odds ratio 2019, 1.14 [95% CI, 1.13-1.16]). There was a similar decline in hospitalizations for heart failure in socioeconomically disadvantaged (2063-1559 per 100 000) and nondisadvantaged communities (1767-1385 per 100 000), as well as for ischemic stroke, but the relative gap did not change for both conditions. In contrast, pulmonary embolism hospitalizations increased in both disadvantaged (146-184 per 100 000) and nondisadvantaged communities (153-184 per 100 000). By 2019, risk-adjusted 30-day mortality was similar between hospitalized beneficiaries from socioeconomically disadvantaged and nondisadvantaged communities for myocardial infarction, heart failure, and ischemic stroke but was higher for pulmonary embolism (odds ratio, 1.10 [95% CI, 1.01-1.20]). Over the past 2 decades, hospitalizations for most acute cardiovascular conditions decreased in both socioeconomically disadvantaged and nondisadvantaged communities, although significant disparities remain, while 30-day mortality is now similar across most conditions.

Comparing population-level humoral and cellular immunity to SARS-Cov-2 in Bangalore, India

Two types of immunity, humoral and cellular, offer protection against COVID. Humoral protection, contributed by circulating neutralizing antibodies, can provide immediate protection but decays more quickly than cellular immunity and can lose effectiveness in the face of mutation and drift in the SARS-CoV-2 spike protein. Therefore, population-level seroprevalence surveys used to estimate population-level immunity may underestimate the degree to which a population is protected against COVID. In early 2021, before India began its vaccination campaign, we tested for humoral and cellular immunity to SARS-Cov-2 in representative samples of slum and non-slum populations in Bangalore, India. We found that 29.7% of samples (unweighted) had IgG antibodies to the spike protein and 15.5% had neutralizing antibodies, but at up to 46% showed evidence of cellular immunity. We also find that prevalence of cellular immunity is significantly higher in slums than in non-slums. These findings suggest (1) that a significantly larger proportion of the population in Bangalore, India, had cellular immunity to SARS-CoV-2 than had humoral immunity, as measured by serological surveys, and (2) that low socio-economic status communities display higher frequency of cellular immunity, likely because of greater exposure to infection due to population density.

Piloting a T-Shaped Approach to Develop Primary Students’ Close Reading and Writing of Literary Texts

The study was a pilot intervention to develop Year 5–8 students’ close reading and writing of literary texts using the T-Shape Literacy Model (Wilson and Jesson in Set Res Inf Teach 1:15–22, 2019). Students analysed text sets to explore how different authors use language to engender mood and atmosphere. The study used a single-subject design logic for repeated researcher-designed and a quasi-experimental, matched control group design for repeated standardised measures of reading and writing. Nine teachers and their classes participated. The schools were part of a large school improvement programme using digital tools and pedagogy to accelerate students’ learning participated that the authors were research-practice partners in. The schools all served low socio-economic status communities and the majority of students were Māori (51%) and Pacific (28%). There was a large effect size on the overall score for the researcher-designed measure (effect size = 1.00) and for the close reading of single texts sub-score (effect size = 0.90). There was a moderate-to-high effect for students’ identification of language features (effect size = 0.75) but no significant effect on their synthesis scores. Students in the intervention significantly outperformed matched control group students in the standardised writing post-test (effect size = 0.65) but differences for the standardized reading comprehension test were not significant (effect size = 0.15). Results overall suggest the approach has promise for improving the metalinguistic knowledge, literary analysis and creative writing of younger and historically underserved groups of students.

Community credit scores and community socioeconomic deprivation in association with type 2 diabetes across an urban to rural spectrum in Pennsylvania: a case–control study

BackgroundArea-level credit scores (the mean of credit scores for persons in a community) may be a unique indicator of community-level socioeconomic conditions associated with health outcomes. We analysed community credit...

Enterobius vermicularis infection at time of appendicectomy: is it a neglected risk factor?

Obstruction of the appendiceal orifice is well established as a potential cause of appendicitis. However, it remains debated as to if appendiceal orifice obstruction secondary to Enterobius vermicularis is considered a risk factor for appendicitis or appendiceal colic. Enterobius vermicularis maintains an increased prevalence within lower socioeconomic and human development index regions. Whilst Australia has an overall high human development index it has significant variability in health literacy and socioeconomics. The purpose of this literature review is to evaluate the relationship between Enterobius vermicularis and appendicitis, to review the prevalence of Enterobius vermicularis appendicectomies in lower human development index and socioeconomic status communities, and to review the Australian based Enterobius vermicularis literature available. A comprehensive review of the literature was performed to review the prevalence of Enterobius vermicularis at time of appendicectomy. PubMed, Scopus, and Google Scholar databases were investigated for applicable studies published until December 2023. Enterobius vermicularis within the appendiceal lumen may cause irritation and lymphoid hyperplasia resulting in appendiceal colic with a similar clinical presentation to that of acute appendicitis. An increased association between Enterobius vermicularis, low human development index, and socioeconomic status is suggested. Public health interventions reduce Enterobius prevalence. A single Australian based study from 1994 was identified. Enterobius vermicularis infection is a neglected risk factor for appendiceal colic. A high index of suspicion for Enterobius vermicularis infection should be taken for clinically stable patients with normal inflammatory biochemistry and low human development index. Further research is required to assess if there is a disparity in Enterobius vermicularis in relation to human development index, socioeconomic status, and remoteness within Australian communities.

CULTIVATING FOOD JUSTICE: Redefining Harvest Sales for Sustainable Urban Agriculture in Low‐Income Cape Town post Covid‐19

AbstractIt is well established that urban community gardens (UCGs) can either challenge or reinforce neoliberal urbanism. This duality is especially evident among UCGs that sell garden harvests for income generation. In this article I therefore examine UCGs in low‐income areas of Cape Town, South Africa, to understand how they might sell their harvests while countering the neoliberal food system in cities of the global South. I draw on qualitative fieldwork, including observations and semi‐structured interviews with UCG representatives and civil society actors. Most harvests are currently sold to high‐end venues through intermediary actors in civil society organizations (CSOs) and non‐governmental organizations (NGOs). However, this approach disregards the local community's socioeconomic conditions and undermines community gardens’ nutritional objectives. Yet, under specific scenarios, the sale of garden harvests could mitigate the persistent food injustice in Cape Town's low‐income areas. In this article I introduce a model for harvest sales that advances sustainable urban agriculture and fosters food justice in neoliberal cities in the global South.

SPATIAL FEATURES AND SOCIO-ECONOMIC PROBLEMS OF FORCED INTERNAL DISPLACEMENT IN THE ODESA REGION

Problem Statement and Purpose. In today's context, migration is becoming one of the most important issues for Ukraine. The socio-economic disparities in each region of the country are largely influenced by large-scale forced internal migration, which has both positive and negative aspects. Timely identification of problems and development of solutions to them makes it possible to bring the situation under control. Odesa region is a leader among the southern regions of the country in terms of the number of registered internally displaced persons (IDPs). The relevance of the study of this type of migration is due to its impact on the socio-economic status of communities and the level of integration of IDPs in the region. The article presents a structural, dynamic and regional analysis of the movement of internally displaced persons in Odesa region. In the course of the study, the trends in the distribution of internal migrants and the factors that influence it were identified. The positive and negative factors of this type of migration on the socio-economic status of the region's communities are analyzed. Ways to solve these problems were proposed. Data &amp; Methods. The study of the processes of forced internal migration of the population was based on a documentary analysis of the legislative framework and policy on migration processes in Ukraine. For the statistical analysis, data from the official websites of the relevant executive authorities of the country, the administration of Odesa region and the International Organization for Migration in Ukraine were used. To achieve this goal, the following methods were used: dialectical, empirical, modeling, and comparison. Results. The study of the movement of forced internal migration in Odesa region found that the rapid growth of new population is affecting the economic, environmental, and socio-cultural spheres of the region. The analysis of migrants' settlement in the region showed that the settlement is uneven. The leader in terms of the number of registered migrants among the seven districts of the region is Odesa district with the regional center of Odesa, with 93524 people registered as of January 2023, which is 67% of the total number of registered IDPs. This indicates that IDPs choose settlements with developed infrastructure, high economic and social standards of living of the local population, and a larger number of support programs from local governments aimed at solving problems and supporting IDPs. The overwhelming majority of migrants come from Mykolaiv and Kherson regions, due to the territorial proximity of these southern regions. The study identified the factors of influence of forced internal migration on the socio-economic situation in Odesa region. Among the main positive factors are: increased production and attraction of new investments in the communities of the region. The following negative factors were identified: unregulated control of registered migrants, burden on the economic, educational and medical funds of the region, and increased anthropogenic impact on the environment. As a result of the analysis of the identified problems and needs, ways to solve them were proposed, namely: to increase investments to improve infrastructure in each district of the region, which will allow developing programs for the uniform resettlement of the population, improving the system of social and financial programs for different groups of migrants, and increasing the level of patriotic education among the local population. All this will help internally displaced persons to adapt better in new communities, and the local population will improve their living standards and reduce discrimination in the region.

Association of neighborhood-level socioeconomic status and urban heat in China: Evidence from Hangzhou

The escalating contradiction between global urban development and thermal environments has become increasingly apparent, underscoring the imperative to address social inequality in heat exposure and advocate for environmental justice (EJ) in the pursuit of sustainable urban development. To bridge the research gap in this domain, a comprehensive study was conducted to examine the correlation mechanism linking the thermal environment with the socioeconomic status (SES) of Chinese cities, employing Hangzhou as a representative case—a pivotal city among China's "four fire stoves". The investigation involved analyzing the spatial distribution pattern of diurnal Land Surface Temperature (LST) during the summer months spanning 2016 to 2018 (July to September). For SES characterization, a holistic indicator was established. Community-level LST variables were derived from LST surfaces obtained through the Terra and Aqua satellite MODIS sensors, with the community serving as the fundamental unit of analysis. The relationship between SES and LST was explored using random forest regression (RF), eXtreme Gradient Boosting (XGBoost), and support vector regression (SVR) to assess socioeconomic inequality in urban heat. The findings reveal that (1) RF exhibits the highest fitting accuracy and adeptly elucidates the nonlinear relationship and marginal effects between LST variables and SES. (2) Community SES in the Hangzhou metropolitan area exhibits spatial clustering. (3) Residents of low and middle SES communities experience heightened heat inequality. (4) A complex nonlinear relationship exists between daytime and nighttime LST and SES, with significant social disparities in urban heat within specific temperature thresholds. When deciding on measures to advance thermal environmental justice, it is crucial to prioritize both relatively disadvantaged groups and specific temperature intervals. This study departs from conventional approaches, exploring the nonlinear relationship between SES and urban heat at a fine scale, thereby assisting urban planners in developing effective strategies.

Analysis and Optimal Control Measures of a Typhoid Fever Mathematical Model for Two Socio-Economic Populations

Typhoid fever is an infectious disease that affects humanity worldwide; it is particularly dangerous in areas with communities of a lower socio-economic status, where many individuals are exposed to a dirty environment and unclean food. A mathematical model is formulated to analyze the impact of control measures such as vaccination of susceptible humans, treatment of infected humans and sanitation in different socio-economic communities. The model assumed that the population comprises of two socio-economic classes. The essential dynamical system analysis of our model was appropriately carried out. The impact of the control measures was analyzed, and the optimal control theory was applied on the control model to explore the impact of the different control measures. Numerical simulation of the models and the optimal controls were carried out and the obtained results indicate that the overall combination of the control measures eradicates typhoid fever in the population, but the controls are more optimal in higher socio-economic status communities.

Abstract 18709: Disparities in Socioeconomic Metrics Associated With Adverse Outcomes Among Medicare Beneficiaries Undergoing Peripheral Endovascular Intervention

Background Low socioeconomic status (SES) is associated with an increased incidence of peripheral artery disease, however there is a lack of granularity in the specific metrics that contribute to this discrepancy. We examine the association of community-level economic distress with adverse outcomes in patients undergoing peripheral endovascular intervention (PVI). Hypothesis: Socioeconomically distressed communities have non-healthcare-related, structural disparities that contribute to incident PVI and adverse outcomes. Methods: Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine the incidence of femoropopliteal PVI. The Distressed Community Index (DCI) was used to categorize adults as distressed (DCI ≥80) or not distressed (DCI &lt;80). Composite outcome of death and major amputation within 1 year of PVI were examined by level of distress using individual community-level metrics. Results: Socioeconomically distressed adults underwent 158 PVIs per 100000 distressed beneficiaries compared with 109 PVIs per 100000 non-distressed beneficiaries (risk ratio, 1.45 [95% CI, 1.42-1.48]; P&lt;0.001). Distressed adults who underwent PVI were more likely to be female (45.5% versus 43.1%; P&lt;0.001) and Black race (21.9% versus 10.1%; P&lt;0.001) (Table I). There was a strong association between distress and the composite outcome at 1 year (incidence rate ratio, 1.11 [95% CI 1.07-1.16; P=0.0001]). Distressed adults lacked high school diplomas (11.88% versus 11.15%; P&lt;0.001), had higher rates of unemployment (24.11% versus 22.76%; P&lt;0.001), and greater housing vacancy rates (9.74% versus 9.31%; P&lt;0.001). Conclusion: Socioeconomic distress is associated with higher rates of PVI-incidence and post-PVI adverse outcomes. This may be driven by structural inadequacies inherent to low SES communities that need to be addressed in order to narrow the gap in care among distressed adults undergoing PVI.

51 Cognitive Functioning in Neurofibromatosis Type 1: The Role of Community Socioeconomic Status

Objective:Neurofibromatosis type 1 (NF1) is a neurogenetic disorder associated with increased risk of neuropsychological challenges. While research has evidenced associations between environmental factors and neurocognitive development, few studies have examined the role that socioeconomic status (SES) plays on neuropsychological development in NF1. The aim of this study is to examine the relationship between community SES and cognitive/psychosocial outcomes in a neuropsychology clinic sample of pediatric NF1 patients.Participants and Methods:The sample consisted of 47 youth with NF1 (M age=11.91, SD=3.69). The sample was 51.1% female, 72.3% White, 19.1% Black/African American, and 4.3% Hispanic. All participants had completed neuropsychological assessments for clinical purposes at an outpatient clinic in an urban, midwestern medical center. Data from neuropsychological measures and demographic information were pulled from records and entered into a de-identified dataset. The Wechsler Intelligence Scales, California Verbal Learning Test (CVLT), Woodcock Johnson Test of Achievement, and parent- and teacher-report versions of the Behavior Assessment System for Children (BASC) and the Behavior Rating Inventory of Executive Function (BRIEF) were used to examine broad neuropsychological functioning. The Area Deprivation Index (ADI) measures SES at the community level, as opposed to the individual level. It is composed of 17 factors related to education, poverty, employment, and housing. This information is used to assign index scores by zip code, with scores on a scale of 110 and 10 indicating the highest level of socioeconomic disadvantage. Mean ADI for this sample was 4.02 (SD=1.93).Results:Mean neurocognitive scores were consistently in the low average to average range. Parent and teacher scores on the BASC were in the average range. Mean scores on the BRIEF indicated Global Executive Composite scores in the mildly and moderately elevated range for parents and teachers, respectively. Correlational analyses revealed significant associations between ADI scores and immediate recall performance on the CVLT (Trials 1-5; r=.37; p=.03) and the BRIEF Planning and Organization subscale (r=.35; p=.02). Both remained significant after controlling for FSIQ (CVLT: rFSIQ=.49, p=.003; BRIEF: rFSIQ=.38; p=.02).Conclusions:Mean cognitive scores for the sample are consistent with existing literature demonstrating that individuals with NF1 are at risk of reduced functioning in several domains. Sample mean ADI of 4 indicates a relatively low level of disadvantage in this sample., ADI was significantly associated with two variables, and greater deprivation was associated with better list learning performance. This suggests that the role of community SES is likely nuanced in how it impacts neurocognitive development. Results provide mild evidence of an association between ADI and learning and planning/organization. However, limitations to the current study, including a small sample size, and the retrospective nature, likely limits a more detailed understanding of the true relationship between community resources and cognitive and psychosocial outcomes among children with NF1. Future research comparing larger low and high ADI samples is necessary to fully examine the relationship between these factors. With better understanding of how community SES may limit or support neurocognitive and psychological growth in this population, more effective interventions can be designed for this group whose members are at notable risk for cognitive and psychological challenges.

Racial, Ethnic, and Socioeconomic Disparities in Prehospital Encounters for Children with Asthma

Objective Asthma represents one of the most common medical conditions among children encountered by emergency medical services (EMS). While care disparities for children with asthma have been observed in other healthcare settings, limited data exist characterizing disparities in prehospital care. We sought to characterize differences in prehospital treatment and transport of children with suspected asthma exacerbations by race and ethnicity, within the context of community socioeconomic status. Methods We conducted a multi-agency retrospective study of EMS encounters in 2019 for children (2–17 years) with asthma and wheezing using a national prehospital database. Our primary outcomes included EMS transport and prehospital bronchodilator or systemic corticosteroid administration. Scene socioeconomic status was evaluated using the social vulnerability index. We used generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for prehospital bronchodilator use or steroid use by race and ethnicity, adjusting for age, presence of abnormal vital signs, community size, bronchodilator use prior to EMS arrival, and transport disposition. Results We analyzed 5,266 EMS encounters (median age 8 years). Approximately half (53%) were Black non-Hispanic and 34% were White non-Hispanic. Overall, 77% were transported by EMS. In an adjusted model, Black non-Hispanic children were 25% less likely to be transported compared to White non-Hispanic children (aOR: 0.75, 95%CI: 0.58–0.96). EMS administered at least one bronchodilator to 81% of Black non-Hispanic patients, 73% of Hispanic patients, and 68% of White, non-Hispanic patients. Relative to White non-Hispanic children, EMS bronchodilator administration was greater for Black non-Hispanic children, (aOR: 1.55, 95%CI: 1.25–1.93), after controlling for scene socioeconomic status and potential confounding variables. Systemic corticosteroids were administered in 3% of all encounters. Odds of prehospital systemic corticosteroid administration did not differ significantly by race and ethnicity. Conclusion Black non-Hispanic children comprised a larger proportion of EMS encounters for asthma and were more likely to receive a bronchodilator in adjusted analyses accounting for community socioeconomic status. However, these children were less likely to be transported by EMS. These findings may reflect disease severity not manifested by abnormal vital signs, management, and other social factors that warrant further investigation.

Extracurricular activity participation, school belonging, and depressed mood: a test of the compensation hypothesis during adolescence

Feelings of acceptance within school communities can promote positive psychological outcomes. Despite occurring outside of the classroom, youth who engage in extracurricular activities typically report greater school belonging. Accordingly, we examined the longitudinal effect of extracurricular activities on school belonging and depressed mood in a nationally representative, Australian sample of adolescents (N = 3,850, Mage = 12.41) followed for four years. A random-intercept cross-lagged panel model revealed extracurricular activity participation at Time 1 predicted higher school belonging two years later. In turn, higher school belonging reinforced positive mental health outcomes, by predicting within-person decreases in depressed mood. Further, the direct and indirect effect of extracurricular activities were moderated by community-level socioeconomic status. Participants residing in low socioeconomic status communities garnered the greatest benefit from participating in activities, despite having the lowest levels of participation. Our data highlight how structured leisure time pursuits can promote wellbeing, especially within more disadvantaged communities.

S12-4 Feasibility evaluation of the Move Well, Feel Good movement behaviours intervention

Abstract Purpose Improving children’s motor competence through school-based physical activity interventions may be a mechanism for promoting positive mental health through psychosocial factors. Move Well, Feel Good (MWFG) is a such an intervention that was co-designed with children, class teachers, physical education (PE) teachers, and school leaders. This presentation describes the feasibility evaluation of MWFG. Methods Five primary schools were recruited from a low socioeconomic status community in northwest England. A 10-week intervention was co-designed which aimed to enhance children’s mental health through motor competence and psychosocial development. The core delivery of the programme involved one PE lesson per week devoted to development of locomotor, object control, and stability skills. This was supplemented by optional recess and home activities, and by non-PE curricular activities. Teachers were asked to record details of each MWFG session taught, and feasibility was evaluated against pre-defined criteria using surveys, interviews (teachers), and participatory focus groups (children). Pre- and post-intervention assessments of motor competence, mental health, wellbeing, psychosocial factors, and 24-hour movement behaviours were also completed. Results The 5 schools represented 83% of the target number of schools and 108 children consented (43% of target). PE and class teachers were recruited in all schools (100% of target). Intervention dose was reflected by 76% of scheduled PE lessons being delivered. Adherence was strong with &amp;gt;85% of children attending ≥75% of lessons. Positive indicators of acceptability were provided by 86% of children, 83% of PE teachers, and 90% of class teachers. Teachers commented on the children’s positive engagement irrespective of ability, the quality of resources provided, and the challenges of competing demands for curriculum time and spaces to deliver MWFG. The data collection methods were deemed acceptable by 91% of children and 80% of class teachers, and children spoke positively about participating in the data collection. Secondary outcome data collection was completed by 87%-100% of children, with a 0%-6% attrition rate at post-intervention. Descriptive analysis revealed favourable changes in motor competence and mental health. Conclusions MWFG was deemed to be feasible to develop further into a pilot trial, with improved school and child recruitment strategies warranted.