Differences In Socioeconomic Status Research Articles

The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

Supplemental Material for Socioeconomic and job status differences in the experience of perceived unacceptable electronic performance monitoring.

Electronic performance monitoring (EPM) technologies are widely used by organizations, but research has shown that workers feel EPM is unacceptable when it violates their needs for autonomy and transparency. These negative consequences of EPM have the potential to contribute to broader issues of workplace inequality, such that more vulnerable workers are disproportionately affected. Reasoning about how worker status may affect perceived autonomy and transparency with regard to EPM led to the prediction that workers with lower socioeconomic status [SES] (education and income) and job status (job zone, job security, tenure) experience more EPM that they perceive to be unacceptable (perceived unacceptable EPM [EPM-U]). Additionally, we explored whether workers endorse justifications for EPM based on consent, transparency, and autonomy differentially based on SES and job status. Results from a sample of 267 diverse workers showed that tenure predicted EPM-U, but other indicators of SES and job status did not. Supplementary analyses examining different operationalizations of perceived EPM acceptability as outcomes also supported the effect of tenure. On average, participants endorsed the consent and transparency EPM justifications at a high rate but not the autonomy justification, and status differences did not affect these rates. Results showed that workers in general feel that EPM is only sometimes acceptable, depending on how the organization justifies it. We discuss theoretical implications for technology in the workplace, practical implications regarding how EPM should be implemented in ways that benefit all workers, and suggestions for future research.

Socioeconomic and job status differences in the experience of perceived unacceptable electronic performance monitoring.

Electronic performance monitoring (EPM) technologies are widely used by organizations, but research has shown that workers feel EPM is unacceptable when it violates their needs for autonomy and transparency. These negative consequences of EPM have the potential to contribute to broader issues of workplace inequality, such that more vulnerable workers are disproportionately affected. Reasoning about how worker status may affect perceived autonomy and transparency with regard to EPM led to the prediction that workers with lower socioeconomic status [SES] (education and income) and job status (job zone, job security, tenure) experience more EPM that they perceive to be unacceptable (perceived unacceptable EPM [EPM-U]). Additionally, we explored whether workers endorse justifications for EPM based on consent, transparency, and autonomy differentially based on SES and job status. Results from a sample of 267 diverse workers showed that tenure predicted EPM-U, but other indicators of SES and job status did not. Supplementary analyses examining different operationalizations of perceived EPM acceptability as outcomes also supported the effect of tenure. On average, participants endorsed the consent and transparency EPM justifications at a high rate but not the autonomy justification, and status differences did not affect these rates. Results showed that workers in general feel that EPM is only sometimes acceptable, depending on how the organization justifies it. We discuss theoretical implications for technology in the workplace, practical implications regarding how EPM should be implemented in ways that benefit all workers, and suggestions for future research.

Socioeconomic and geographic disparities in pediatric scoliosis surgery.

To compare the population of pediatric patients undergoing surgery for scoliosis in California by gender, race, and ethnicity and identify any underlying differences in social determinants of health as measured by the child opportunity index (COI), social deprivation index (SDI), and insurance category among them. This project extracted demographic reports including patient sex, race, zip code, insurance type, and associated diagnosis and procedure codes from the Office of Statewide Health Planning and Development (OSHPD). These data were combined with COI and SDI data, which further describe the socioeconomic environment of each patient. Census data were referenced to compare the population of patients receiving scoliosis procedures to the general population by race and ethnicity. Chi-square tests were performed for categorical data. Independent t-test and one-way analysis of variance (ANOVA) were performed for continuous data, with significance set at 0.05. Unfavorable SDI and COI scores were observed among males, Hispanics, and Black patients, and these patients were more likely to be covered by Medi-Cal. Length of stay was significantly higher among males and Medi-Cal recipients. The data demonstrate significant differences in social determinants of health as measured by race, ethnicity, gender, insurance type, COI, and SDI among patients ≤ 20years undergoing surgery for idiopathic scoliosis in California. The noted differences in socioeconomic status (SES) and insurance are known and/or expected to have an impact on access to quality health care, exposing a need for future studies to determine whether COI and SDI influence patient-reported outcomes after scoliosis surgery. IV.

Serum oxytocin levels in adolescents with conduct disorder associated with callous-unemotional traits

BackgroundConduct disorder (CD) is a serious and common psychiatric disorder affecting children and adolescents. “Callous-unemotional traits” is a new specifier added to the diagnosis of CD in the DSM-5. The new specifier is thought to be associated with more severity and higher genetic load. Oxytocin is known to be related to interpersonal sympathy and social affection, and so its deficiency might be related to unemotionality. This work aims to explore the levels of serum oxytocin in adolescents with CD associated with callous-unemotional (CU) traits as compared to healthy control subjects. Twenty patients aged 12–18 years and 20 controls of the same age range were recruited. An Arabic-translated and validated version of Mini International Neuropsychiatric Interview for kids (MINI-kid) was used to confirm the diagnosis. The Youth Psychopathic Inventory-short version (YPI-short version) and the Inventory of Callous-Unemotional Traits (ICU), both parent and self-reports, were all translated into Arabic and validated by the authors and used to evaluate the sample. Evaluation of serum oxytocin level using ELISA technique was done.ResultsAfter statistical adjustment for differences in socioeconomic status, an adolescent with CD associated with CU traits showed low levels of serum oxytocin level as compared with the control group. Serum oxytocin levels were negatively correlated in a statistically significant degree with the unemotional, the callousness, and the uncaring subscores of ICU—self-report.ConclusionsLow levels of serum oxytocin might play a potential role as a biomarker for CU traits and CD severity in adolescents with CD.

Disparities in Social Determinants of Health Among Patients Receiving Liver Transplant: Analysis of the National Inpatient Sample From 2016 to 2019.

BackgroundLiver transplantation is the life-saving standard of care for those with end-stage liver disease. Unfortunately, many patients on the liver transplant list die waiting. Several studies have demonstrated significant differences based on disparities in race, gender, and multiple socioeconomic factors. We sought to evaluate recent disparities among patients receiving liver transplants using the latest available data from the National Inpatient Sample (NIS), the largest publicly available inpatient care database in the United States.MethodsWe performed an analysis of discharge data from the NIS between 2016 and 2019. We identified adult patients with chronic liver disease who underwent a liver transplant using the International Classification of Diseases, 10th revision (ICD-10) codes. Multivariate logistic regression was used to adjust for differences in race, gender, socioeconomic status, and comorbidities among those who received a liver transplant.ResultsA total of 24,595 liver transplants were performed over the study period. Female gender was independently associated with decreased transplant rates (adjusted odds ratio (AOR) 0.83, 95% confidence interval (CI), 0.78-0.89, P < 0.001). Compared to White patients, Black patients had decreased transplant rates (AOR 0.86, 95% CI, 0.75-0.99, P = 0.034), as did Native Americans (AOR 0.64; 95% CI, 0.42-0.97, P = 0.035). Hispanics and Asian Americans had increased rates of liver transplantation (AOR 1.16, 95% CI 1.02-1.32, P = 0.022, and 1.36, 95% CI 1.11-1.67, P = 0.003; respectively). The increase in income quartile was associated with an incremental increase in transplant rates. Additionally, patients with private insurance had much higher transplant rates compared to those with Medicare (AOR 2.50, 95% CI 2.31-2.70, P < 0.001) while patients without insurance had the lowest rates of transplantation (AOR 0.18, 95% CI 0.12-0.28, P < 0.001).ConclusionsOur analysis demonstrates that race, gender, and other social determinants of health have significant impacts on the likelihood of receiving a liver transplant. Our study, on a national level, confirms previously described disparities in receiving liver transplantation. Patient-level studies are needed to better understand how these variables translate into differing liver transplantation rates.

Community-Engaged Research on Social Capital and Older Adults’ Health: Lessons Learned

Most adults in the United States prefer to age in their own homes and communities. However, many ageing-in-place models rely on expensive external services, negatively affecting access by lower socioeconomic status (SES) and other vulnerable groups. This article documents two pilot projects conducted by a community-academic partnership that examined associations between social capital, ageing in community, and health among older adults. The first project explored the association between social capital and health across community SES levels. The second project explored one type of social capital, timebanking, and its association with health. We highlight here our lessons learned from these community-engaged research (CER) projects: (1) Our partnership needed to improve our study design and data collection by enhancing our recruitment strategies, community site partnerships, survey instrument and data matching, and research team workload allocation issues. (2) We should have validated our instruments for use with older adults who had mild cognitive and visual impairments, acknowledged how community SES differences influenced our data collection, and included more research assistant support during our community meetings. (3) We would have benefited from protocol development for recording and responding to issues raised by participants. Our projects also led us to relational insights, such as reinforcing the need to foster clear communication across team members, involving community advisory boards earlier in the CER process, seeking network input on research strategies to meet older adults’ needs, and developing plans to sustain long-term relationships. We hope these lessons learned are useful to other community-engaged researchers.

Association Between Socioeconomic and Insurance Status and Delayed Diagnosis of Gastrointestinal Cancers

IntroductionAssociation between socioeconomic status (SES) and stage at diagnosis in gastrointestinal (GI) cancers is poorly described. Relationship between low SES and stage at diagnosis as well as the mediating role of insurance status (IS) was examined. MethodsThe Surveillance, Epidemiology, and End Results database was queried for esophageal, gastric, liver, biliary, pancreatic, colon, and rectal cancers diagnosed in 2012-2016. Relationship between census-tract SES index quintiles and late diagnosis (distant disease at diagnosis) was examined. Uni and multivariable logistic regressions were performed. Mediation analyses were conducted to determine the degree to which IS (private/Medicare versus Medicaid/uninsured) mediates the relationship between SES and late diagnosis of cancer. ResultsAnalysis included 236,713 adult patients from 18 Surveillance, Epidemiology, and End Results areas. In univariable analysis, lowest SES quintile was significantly associated with late diagnosis for all cancers except gastric and biliary cancers. In multivariable analysis controlling for age, gender, marital status and race, this association remained significant for liver (odds ratio (OR) 1.41 [95% confidence interval (CI) 1.25-1.58]), pancreatic (OR 1.13 [95% CI 1.06-1.21]), and rectal (OR 1.31 [95% CI 1.20-1.42]) cancers. Further controlling for IS showed the largest effect size reduction for rectal cancer (OR 1.18 [95% CI 1.09-1.29]), with IS mediating 36.5% (P < 0.0001) of SES effect. ConclusionsLow SES is an independent risk factor for late diagnosis in liver, pancreas, and rectal cancers. Insurance is not a critical mediator of difference by SES for most GI cancers, with the exception of rectal cancer. Further research is needed to understand factors beyond IS that can account for SES differences in late diagnosis for GI cancers. Insurance related differences for rectal cancer deserves further attention.

Rural-Urban Differences in Age at Autism Diagnosis: A Multiple Model Analysis.

Objective: Early recognition of autism is important, but diagnosis age varies among children. Recent studies have aimed to identify factors affecting age of diagnosis and several studies have attempted to explore geographic variation in age at diagnosis of autism. However, there is a lack of research examining geographic variations with multiple models to find whether geographic differences can be explained by risk factors such as socioeconomic status and differences in child characteristics. This study aimed to address this gap of knowledge by comparing age at diagnosis of autism between the group of people living in the center of the province and the group of people living in the rest of the province, considering potential medical and socioeconomic confounders. Method : The study population consisted of 50 autistic children born in East Azerbaijan Province between 2004 and 2016. Initially, univariate testing by ANOVA was performed to identify family and individual factors contributing to differences in age at autism diagnosis. Following this, the association between living in the center of the province and age at diagnosis in univariate and multivariate analyses was examined. Results: Results from the initial univariate analysis indicate a significant association between living in the center of province and early diagnosis. However, inclusion of possible confounders in multiple model illustrates that these geographical disparities in age at diagnosis can be explained by differences in socioeconomic and medical status. Conclusion: Although geographic variation in age at diagnosis of autism was observed, analyses show that differences in individual and family-level factors may contribute to geographic differences. In this study, most of the observed variation was accounted for by family-level factors rather than geographic policies. Findings prove that multiple strategies are required to identify targeted interventions and strategies.

Socioeconomic status differences in psychological responses to unfair treatments: Behavioral evidence of a vicious cycle.

Two studies investigated whether lower socioeconomic status (SES) would be associated with greater tolerance for unfair treatments. Specifically, we hypothesized that individuals with lower SES would be less likely to perceive apparent injustice as unfair than those with higher SES, and furthermore, such differences in perception would lead to the corresponding differences in ensuing psychological responses. In support of the hypotheses, we found that (Study 1, N = 326; Study 2, N = 130), compared with higher SES participants, lower SES participants perceived one-sidedly disadvantageous distribution during the dictator game as less unfair. Moreover, a behavioral experiment in Study 2 showed that such tolerance for unfair treatments were associated with subsequent passive reactions in the ultimatum game. Taken together, the results imply a vicious cycle whereby the SES differences in a tendency to accept unfair treatments lead to psychological responses that may maintain or even strengthen the existing social disparities.

Nucleus Accumbens Fractional Anisotropy and Children’s Body Mass Index: Moderating Role of Race and Family Income

Background and aims: The nucleus accumbens (NAcc) functional and morphometric features mayinfluence children’s body mass index (BMI). Recent evidence, however, suggests that the functionand structure of the NAcc may have different predictive abilities for the BMI for the sub-groups ofchildren from different racial and socioeconomic status (SES) backgrounds. Using the AdolescentBrain Cognitive Development data, this study investigated racial and SES differences in the associationbetween NAcc microstructure (i.e., fractional anisotropy) and childhood BMI. Methods: This cross-sectional study included 9497 children aged 9 and 10. Data were collected from21 sites across 15 states in the United States. Then, the mixed-effects regression model was appliedfor data analysis. The predictor variable of interest was NAcc fractional anisotropy measured usingdiffusion magnetic resonance imaging (dMRI). The main outcome of interest was children’s BMI values,which were treated as a continuous variable. Covariates included gender, age, and family structure.Race (White, Black, Asian, and Other/mixed) and family income (&lt;USD 50,000, USD 50,000-100,000,and USD100,000+) were the effect modifiers (moderators). Results: Higher average NAcc fractional anisotropy in dMRI was predictive of lower levels of theBMI, and net of covariates. However, this inverse association between the average intensity of thenormalized T2-weighted image and the BMI was stronger in children from Hispanic, low income, andlow-educated backgrounds compared to non-Hispanic, high-income, and high-educated backgrounds. Conclusion: Our findings suggested that although NAcc fractional anisotropy is linked to children’sBMI, this link is not invariant across racial and SES groups. The issue of whether or not obesogenicenvironments alter the implications of NAcc for childhood BMI needs further investigation. For diversegroups, NAcc microstructures may have different magnitudes of associations with childhood BMI.

Socioeconomic factors and regional differences in mental disorder-based disability pensioning in Finland

IntroductionPrior literature has indicated low socioeconomic status (SES) and regional differences as epidemiological risk factors for disability pension (DP) due to mental disorders.ObjectivesOur studies aimed to examine these associations and differences in greater detail, with separate consideration of the risk factors for mood disorders (F30–39) and non-affective psychotic disorder (F20–29) DP.MethodsSubjects (N = 36 879) were all those granted DP due to a mental disorder for the first time between 2010 and 2015 in Finland. All the subjects were matched with three controls. Education, income and occupational status were used as measures of SES. Conditional logistic regression models were used to study SES differences. Negative binomial regression analysis was used to study the levels of DP risk in the Finnish hospital districts.Results DP recipients had low educational and income levels and often lived alone. The risk of DP was greater in white-collar occupational groups compared with blue-collar workers. Students had the greatest risk of DP for all mental and mood disorders. Significant differences in the regional mental disorder DP risks did not appear to follow the traditional Finnish health differences.ConclusionsWe found evidence of SES factors and regional variation associating with mental disorder-related severe loss of working and studying ability in a disorder-specific way. The increased risk of white-collar worker DP could be related to the psychosocially demanding contemporary working life. Regional variation in DP may at least partly relate to differences in regional mental health service systems.DisclosureNo significant relationships.

The reorganisation of emergency general surgery services during the COVID-19 pandemic in the UK: outcomes of delayed presentation, socio-economic deprivation and Black, Asian and Minority Ethnic patients.

The COVID-19 pandemic is a global public health emergency. Lockdown restrictions and the reconfiguration of healthcare systems to accommodate an increase in critical care capacity have had an impact on 'non-COVID' specialties. This study characterises the utilisation of emergency general surgery (EGS) services during the UK lockdown period at a university teaching hospital with a catchment population that represents one of the most deprived and ethnically diverse areas in the UK. EGS admissions during the UK lockdown period (March to May 2020) were compared with the same period in 2019. Patient demographics were recorded together with clinical presentation, hospital stay and treatment outcomes, and readmission data. The study included 645 patients, comprising 223 in the COVID-19 period and 422 in the non-COVID-19 period. There was no difference in age, sex, comorbidity or socio-economic status. A lower proportion of patients of Black, Asian and Minority Ethnicity (BAME) were admitted during the pandemic (20.6% vs 35.4%, p<0.05). The duration of symptoms prior to presentation was longer, and admission clinical parameters and serum inflammatory markers. More patients presented with an acute kidney injury (9.9% vs 4.7%, p=0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p=0.023). The reorganisation of EGS to a senior-led model has been successful in terms of outcomes and access to treatment despite a more unwell population. There was a significantly lower proportion of BAME admissions suggesting additional barriers to healthcare access under pandemic lockdown conditions.

Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation.

Poverty, racial bias, and disparities are linked to adverse health outcomes for children in the United States. The social vulnerability and child opportunity indices are composite measures of the social, economic, education, health, and environmental qualities that affect human health for every U.S. census tract. Composite measures of social vulnerability and child opportunity were compared for neighborhood hot spots, where PICU admissions for acute respiratory failure requiring invasive mechanical ventilation were at the 90th percentile or greater per 1,000 children, versus non-hot spots. Population-based ecological study. Two urban free-standing children's hospital PICUs consisting of a 36-bed quaternary academic and a 56-bed tertiary community center, in Atlanta, GA. Mechanically ventilated children who were 17 years of age or younger with a geocodable Georgia residential address admitted to a PICU for at least 1 day. None. Residential addresses were geocoded and spatially joined to census tracts. Composite measures of social vulnerability and childhood opportunity, PICU readmission rates, and hospital length of stay were compared between neighborhood hot spots versus non-hot spots. There were 340 of 3,514 children (9.7%) who lived within a hot spot. Hot spots were associated with a higher (worse) composite social vulnerability index ranking, reflecting differences in socioeconomic status, household composition and disability, and housing type and transportation. Hot spots also had a lower (worse) composite childhood opportunity index percentile ranking, reflecting differences in the education, health and environment, and social and economic domains. Higher social vulnerability and lower childhood opportunity were not associated with readmission rates but were associated with longer total median duration of hospital days per 1,000 children in a census tract. Social determinants of health identified by geospatial analyses are associated with acute respiratory failure requiring invasive mechanical ventilation in critically ill children. Interventions addressing the neighborhood social vulnerability and child opportunity are needed to decrease disparities in intensive care admissions for acute respiratory failure requiring mechanical ventilation.

Influences of Gender and Socioeconomic Status on Children’s Use of Robotics in Early Childhood Education: A Systematic Review

ABSTRACT Research Findings: This review focuses on the use of robotics in early childhood education (ECE), addressing gender and socioeconomic status (SES) differences in young children’s robotics learning. This review systematically evaluates, synthesizes, and displays the research designs, robotic toys, data collection instruments, research methods, and research findings of 15 studies related to this critical issue published from 1984 to 2021. The findings of the review indicate that children’s robotics-based learning is impacted by gender and their socioeconomic and cultural backgrounds. Boys had a considerably higher level of enjoyment in interacting with robotics than girls. Furthermore, low-income families and low parental education resulted in poor robotics-based learning experiences and outcomes for children. Practice or Policy: It is significant to devote attention to developing effective and inclusive robotics education programs for girls and children from less advantaged backgrounds. More robotics education interventions should be conducted in broader contexts to benefit a wider range of children, especially those from a lower-SES background.

Differences in the Association Between Oral Glucocorticoids and Risk of Preterm Birth by Data Source: Reconciling the Results.

To investigate causes of discrepancies in the association between early pregnancy oral glucocorticoid (OGC) use and preterm birth risk among women with rheumatoid arthritis (RA) in health care utilization data from California Medicaid (Medi-Cal) and the prospective cohort MotherToBaby Pregnancy Studies. Separately, we estimated risk ratios (RRs) between OGC exposure before gestational day 140 and preterm birth risk in data from Medi-Cal (2007-2013; n = 844) and MotherToBaby (2003-2014; n = 528). We explored differences in socioeconomic status, OGC dose distribution, exposure misclassification, and confounding by RA severity across the data sources. Preterm birth risk in women without OGC was 17.3% in Medi-Cal and was 9.7% in MotherToBaby. There was no association between OGC and preterm birth in Medi-Cal (adjusted RR 1.00 [95% confidence interval (95% CI) 0.71, 1.42]), and a 1.85-fold (95% CI 1.20, 2.84) increased preterm birth risk in MotherToBaby. When restricting each sample to women with a high-school diploma or less, preterm birth risk following no OGC exposure was 15.9% in Medi-Cal and 16.7% in MotherToBaby; adjusted RRs were 1.16 (95% CI 0.74, 1.80) in Medi-Cal and 0.81 (95% CI 0.25, 2.64) in MotherToBaby. Cumulative OGC dose was higher in MotherToBaby (median 684 mg) than in Medi-Cal (median 300 mg). An OGC dose of ≤300 mg was not associated with increased preterm birth risk. Exposure misclassification and confounding by RA severity were unlikely explanations of differences. Higher baseline preterm birth risk and lower OGC dose distribution in Medi-Cal may explain the discrepancies. Studies are needed to understand the effects of autoimmune disease severity and undertreatment on preterm birth risk in low-income populations.

Associations among socioeconomic status and preschool-aged children’s, number skills, and spatial skills: The role of executive function

Extensive literature has documented socioeconomic status (SES) disparities in young children’s standardized math achievement, which primarily reflect differences in basic number and arithmetic skills. In addition, growing evidence indicates that direct assessments of executive function (EF) both predict standardized math achievement and mediate SES differences in standardized math tests. However, early spatial skills and children’s approximate number system (ANS) acuity, critical components of later math competence, have been largely absent in this past research. The current study examined SES associations with multiple direct assessments of early ANS, cardinality, and spatial skills, as well as standardized math achievement, in a socioeconomically diverse sample of 4-year-old children (N = 149). Structural equation modeling revealed SES effect sizes of .21 for geometric sensitivity skills, .23 for ANS acuity, .39 for cardinality skills, and .28 for standardized math achievement. Furthermore, relations between SES and children’s spatial skills, ANS acuity, cardinality, and standardized math skills were mediated by a composite measure of children’s EF skills. Implications of pervasive SES disparities across multiple domains of early math development, as well as the mitigating role of EF, are discussed.

Human brain anatomy reflects separable genetic and environmental components of socioeconomic status.

Socioeconomic status (SES) correlates with brain structure, a relation of interest given the long-observed relations of SES to cognitive abilities and health. Yet, major questions remain open, in particular, the pattern of causality that underlies this relation. In an unprecedently large study, here, we assess genetic and environmental contributions to SES differences in neuroanatomy. We first establish robust SES–gray matter relations across a number of brain regions, cortical and subcortical. These regional correlates are parsed into predominantly genetic factors and those potentially due to the environment. We show that genetic effects are stronger in some areas (prefrontal cortex, insula) than others. In areas showing less genetic effect (cerebellum, lateral temporal), environmental factors are likely to be influential. Our results imply a complex interplay of genetic and environmental factors that influence the SES-brain relation and may eventually provide insights relevant to policy.

Predictors of treatment initiation and mapping the cancer diagnostic pathway: A retrospective observational cohort study of patients with metastatic non-small cell lung cancer

BackgroundHealth-care providers in the US revealed that a substantial proportion of mNSCLC patients do not receive any first-line therapy and the biggest gaps in care are time inefficiencies in the diagnostic process. The goal of this study was to determine whether such gaps are found in Israel where healthcare is universal and participation in a medical insurance plan is free and compulsory. MethodsWe conducted a retrospective, observational cohort study using the computerized data of Maccabi Healthcare Services, a 2.5 million-member state-mandated health-service. Patients with mNSCLC diagnosed between 2017 and 2018 were followed until December 2019. ResultsAmong 434 patients (62% male, mean age 68 y, 74% adenocarcinoma), 345 (79%) initiated first-line treatment. Compared to treated, untreated patients (n = 89) were more likely to be older (mean [SD]=71 years [10] vs. 67 [10], p < 0.001), have a higher co-morbidity index (5.6 ([4.4] vs. 4.0 [3.4], p < 0.001), smokers (84% vs. 66%, p = 0.001), and require hospitalization in the year prior to diagnosis (80% vs 61%, p = 0.002). There was no difference in socioeconomic status. Time from first symptom to imaging was longer for untreated than treated patients (6.51 months [4.24, 7.33] vs 3.48 months [2.76, 4.34] respectively, p = 0.22). Predictors of treatment initiation included age< 70 years, non-smokers, EGFR testing performed, ECOG performance status 0–1 and shorter wait from first symptom to imaging. Median time from first symptom to initiation of 1 L, was 7.76 months (6.51–8.75). ConclusionThe proportion of untreated mNSCLC patients are comparable to those reported in the US; we did not find health disparities between socioeconomic levels. Our data suggest that the main barrier to effective diagnostic process is the wait between symptom complaint and imaging.

Are Distressed Black Women Also Depressed? Implications for a Mental Health Paradox

PurposeRecent research suggests the determinants of and links between psychological distress and psychiatric disorder are distinct among Black Americans. Yet, these associations have not been explored among Black women, despite the unique social experiences, risks, and mental health patterns they face. The present study assessed the sociodemographic and psychosocial determinants of distress and disorder and evaluated the distress–disorder association, including whether it was conditional on sociodemographic and psychosocial characteristics among Black women.MethodsData were from 328 Black women in the Nashville Stress and Health Study, a cross-sectional community epidemiologic survey of Blacks and Whites in Nashville, Tennessee, and was used to assess the correlates of distress (CES-D depressive symptoms scale) and major depressive disorder (MDD; based on the CIDI). Multinomial logistic regression models estimated the extent to which greater distress was associated with higher risk of “chronic” or “resolved MDD”.ResultsStress exposure and marital status were associated with greater distress, while stress exposure and childhood SES were associated with elevated disorder risk. Although increased distress was associated with greater disorder risk, significant interactions indicated these associations depend on differences in age and adult socioeconomic status within this population.ConclusionsThis study identifies distinct correlates of distress and disorder and shows that the distress–disorder association varies among subgroups of Black women. Results have important implications for public health research and practice, as they highlight the factors that matter most for the mental health outcomes of Black women.