Differences In Socioeconomic Status Research Articles

Associations between Socioeconomic Status and Psychological Distress: An Analysis of Disaggregated Latinx Subgroups Using Data from the National Health Interview Survey

Differences in socioeconomic status (SES), including income, education, and employment, continue to be significant contributors to health disparities in the United States (US), including disparities in mental health outcomes. Despite the size and diversity of the Latinx population, there is a lack of literature describing differences in mental health outcomes, including psychological distress, for Latinx subgroups (e.g., Dominican, Puerto Rican, Cuban). Therefore, we used pooled data from the 2014-2018 National Health Interview Survey to examine variations in psychological distress among Latinx subgroups as compared to other Latinx subgroups and non-Latinx whites. Additionally, we conducted regression analyses and tested whether race/ethnicity modified the relationship between SES indicators and psychological distress. Findings indicate that individuals categorized as Dominican and Puerto Rican were among the Latinx subgroups with the highest levels of psychological distress when compared to other Latinx subgroups and non-Latinx whites. Additionally, results demonstrate that SES indicators, such as higher levels of income and education, were not necessarily significantly associated with lower levels of psychological distress for all Latinx subgroups when compared to non-Latinx whites. Our findings discourage the practice of making broad generalizations about psychological distress or its associations with SES indicators to all Latinx subgroups using results garnered from the aggregate Latinx category.

An Epidemiological Survey of Intestinal Parasitic Infection and the Socioeconomic Status of the Ethnic Minority People of Moken and Orang Laut.

Ethnic minority groups are often subjected to exclusion, social and healthcare marginalization, and poverty. There appears to be important linkages between ethnic minority groups, poor socioeconomic status, and a high prevalence of parasitic infection. Data regarding the prevalence and health effects of IPIs are necessary in the development and implementation of targeted prevention and control strategies to eradicate intestinal parasitic infection in the high-risk population. Thus, we investigated for the first time the intestinal parasitic infection status (IPIs), the socioeconomic status, and sanitary condition in the communities of Moken and Orang Laut, the ethnic minority peoples living on the coast of southwest Thailand. A total of 691 participants participated in the present study. The information concerning socioeconomic status and sanitary condition of the study population was obtained by personal interviews using a picture questionnaire. Stool samples were collected and examined for intestinal parasitic infection using direct wet smear and formalin-ethyl acetate concentration techniques. The results revealed that 62% of the study population were infected with one or more types of intestinal parasites. The highest prevalence of intestinal parasitic infections was found in the 11-20-year-old age range group. A statistically significant difference of IPIs among the three communities were observed (p < 0.0001). There was a statistical difference concerning 44 multiple infections of soil-transmitted helminths (STHs) (p < 0.001), whereas no statistically significant difference in multiple infections of protozoa was observed (p > 0.55). The results also displayed the significant difference in socioeconomic status and sanitary condition among the Moken living in Ranong and Phang Nga and the Orang Laut living in the Satun province (p < 0.001). Our study found no direct association between parasitic infection status and ethnic/geographic features; however, socioeconomic status is the key factor associated with prevalence of intestinal parasitic infection, with the observation that the higher prevalence of IPIs is due to a low socioeconomic status, consequently leading to poor hygiene and sanitation practices. The picture questionnaire played a major role in information gathering, especially from those of low or no education. Lastly, data pertaining to the species of the parasites and the mode of transmission assisted in the identification of group-specific vulnerabilities and shortcomings that can be utilized in education and corrected to reduce the prevalence of infection in the study areas.

Parental Investment on a Socioeconomic Basis: A Comparative Study of Southeast China and Taiwan

Differences in socioeconomic status have long been one of the major contributing factors to household educational investment, which is also a key concern in related research. Utilizing Panel Study of Family Dynamics (PSFD) datasets from 2003 to 2004, in this study we examine family investment in children’s education in southeast China and Taiwan, two core economic players in east Asia, with mainland China presenting much more social inequality than Taiwan, based on Gini coefficient measures. Our findings reveal that the different levels of parental investment in education are consistent with socioeconomic disparities, which vary significantly both quantitatively and qualitatively among mainland Chinese families from diverse social class backgrounds, but this gap appears to be narrowing among households in Taiwan. Parents’ level of education and income, deemed as the main class-based indicators, continue to be the determining factors in how families obtain and construct educational access, resources and opportunities for their offspring.

Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis

Background and aimsMost patients with heart failure (HF) are diagnosed following a hospital admission. The clinical and health economic impacts of index HF diagnosis made on admission to hospital versus...

Factors Associated with Lack of Health Screening among People with Disabilities Using Andersen’s Behavioral Model

People with disabilities often have poorer health than the general population, and many do not participate in preventive care. This study aimed to identify the health screening participation rates of such individuals and investigate why they did not receive preventive medical services based on Andersen's behavioral model, using data from the Survey on Handicapped Persons with Disabilities. The non-participation health screening rate for people with disabilities was 69.1%. Many did not in health screening because they showed no symptoms and were considered healthy, in addition to poor transportation service and economic limitations. The binary logistic regression result indicates that younger age, lower level education, and unmarried as predisposing characteristics; non-economic activity as the enabling resources; and no chronic diseases, severe disability grade, and suicidal ideation as need factor variables were the strongest determinants of non-participation health screening. This indicates that health screening of people with disabilities should be promoted while takings into account the large individual differences in socioeconomic status and disability characteristics. It is particularly necessary to prioritize ways to adjust need factors such as chronic disease and mental health management, rather than focusing on uncontrollable predisposing characteristics and enabling resources among barriers to participation in health screening for people with disabilities.

Decomposition and comparative analysis of differences in depressive symptoms between urban and rural older adults: Evidence from a national survey.

The aim of this study was to investigate the factors influencing urban-rural differences in depressive symptoms among old people in China and to measure the contribution of relevant influencing factors. A cross-sectional research. The 2018 data from The Chinese Longitudinal Health Longevity Survey (CLHLS). Twenty-three provinces in China. From the 8th CLHLS, 11,245 elderly participants were selected who met the requirements of the study. We established binary logistic regression models to explore the main influencing factors of their depressive symptoms and used Fairlie models to analyze the influencing factors of the differences in depressive symptoms between the urban and rural elderly and their contribution. The percentage of depressive symptoms among Chinese older adults was 11.72%, and the results showed that rural older adults (12.41%) had higher rates of depressive symptoms than urban (10.13%). The Fairlie decomposition analysis revealed that 73.96% of the difference in depressive symptoms could be explained, which was primarily associated with differences in annual income (31.51%), education level (28.05%), sleep time ( - 25.67%), self-reported health (24.18%), instrumental activities of daily living dysfunction (20.73%), exercise (17.72%), living status ( - 8.31%), age ( - 3.84%), activities of daily living dysfunction ( - 3.29%), and social activity (2.44%). The prevalence of depressive symptoms was higher in rural than in urban older adults, which was primarily associated with differences in socioeconomic status, personal lifestyle, and health status factors between the urban and rural residents. If these factors were addressed, we could make targeted and precise intervention strategies to improve the mental health of high-risk elderly.

STROKE RISK ASSESSMENT AND DIET-RELATED RISK FACTORS – COMPARISON OF TWO CITIES FROM BOSNIA AND HERZEGOVINA

Abstract Stroke, as one of the cardiovascular diseases, is becoming more of a priority for health systems around the world, but especially in developing countries. Mortality rates had increased drastically in developing countries in comparison to developed countries. This shift is thought to be driven by multiple reasons; the ageing of population, difference in socioeconomic status, health care, just to name a few. Change in risk factors is driven by the economic development. The majority of stroke risk factors are lifestyle related which is strongly affected by the urbanization processes. For stroke, the most important risk factors are hypertension, high blood cholesterol, diabetes, obesity, lack of physical activity and poor diet. Present study aimed to calculate the stroke risk in adults from two different urban settings in one developing country. A cross-sectional observational study was conducted on 210 adults from two cities (Mostar and Sarajevo) in Bosnia and Herzegovina. Stroke risk was calculated with the “Stroke Risk Quiz” developed by the American Heart Association and the American Stroke Association. To assess the compliance of diet with the recommendations for stroke prevention we developed a short point-based questionnaire which focused on the consumption of 16 foods/food groups. Study participants from Sarajevo, capital of Bosnia and Herzegovina, have lower stroke risk compared to those from Mostar, a smaller city close to the Adriatic coast, where we expected to see the protective effect of the Mediterranean lifestyle which is traditional in the area. In Sarajevo, the dominant risk factors identified include increased body weight and blood pressure, and smoking. Only diet in Mostar reflects the Mediterranean, but family history of cardiovascular diseases, higher blood cholesterol levels and lower level of physical activity among study participants from Mostar surpass the benefit of a better diet and lower body mass.Our findings support the idea that different (urban) settings require public health systems to adapt their educational and intervention activities to improve health indicators of populations and lead to reductions in health care expenses.

Sociodemographic factors associated with tracheostomy and mortality in bronchopulmonary dysplasia.

We sought to investigate how race, ethnicity, and socioeconomic status relate to tracheostomy insertion and post-tracheostomy mortality among infants with bronchopulmonary dysplasia (BPD). The Vizient Clinical Database/Resource Manager was queried to identify infants born ≤32 weeks with BPDadmitted to US hospitals from January 2012 to December 2020. Markers of socioeconomic status were linked to patient records from the Agency for Healthcare Research and Quality's Social Determinants of Health Database. Regression models were used to assess trends in annual tracheostomy insertion rate and odds of tracheostomy insertion and post-tracheostomy mortality, adjusting for sociodemographic and clinical factors. There were 40,021 ex-premature infants included in the study, 1614 (4.0%) of whom received a tracheostomy. Tracheostomy insertion increased from 2012 to 2017 (3.1%-4.1%), but decreased from 2018 to 2020 (3.3%-1.6%). Non-Hispanic Black infants demonstrated a 25% higher odds (aOR 1.25, 1.09-1.43) and Hispanic infants demonstrated a 20% lower odds (aOR 0.80, 0.65-0.96) of tracheostomy insertion compared withnon-Hispanic White infants. Patients receiving public insurance had increased odds of tracheostomy insertion (aOR 1.15, 1.03-1.30), but there was no relation between other metrics of socioeconomic status and tracheostomy insertion within our cohort. In-hospital mortality among the tracheostomy-dependent was 14.1% and was not associated with sociodemographic factors. Disparities in tracheostomy insertion are not accounted for by differences in socioeconomic status or the presence of additional neonatal morbidities. Post-tracheostomy mortality does not demonstrate the same relationships. Further investigation is needed to explore the source and potential mitigators of the identified disparities.

Abstract TP70: Association Between Race And Length Of Stay Among Stroke Patients: The National U.S. Emergency Departments Dataset

Background: There remain ongoing racial and ethnic disparities in care and outcomes among stroke patients treated in the US. However, length of stay (LOS) and inpatient costs warrant further evaluation. Methods: The 2019 Nationwide Emergency Department Sample (NEDS), which includes data from roughly 20% of US emergency departments, was queried for patients with cerebral infarction. Multivariable logistic regression was used to estimate the odds of prolonged length of hospital stay (&gt;75th percentile) and inpatient costs among various race/ethnic groups, including income and payor status, age, modified Charlson Comorbidity Index (mCCI), vascular risk factors, and treatment with thrombolysis and thrombectomy. Results: Of 617,946 estimated patients with acute ischemic stroke, 398,661 (65.5%) were &gt; 65y, and 386,096 (63.5%) were Medicare beneficiaries. Lower income and Medicaid or self-pay status were more commonly observed in Black and Hispanic versus White patients (p&lt;0.001). In multivariable regression, Black patients were more likely to have a prolonged LOS (Odds Ratio 1.41, 95% confidence interval 1.28-1.55) compared to Whites. Prolonged LOS was inversely related to income, but there was no significant interaction between race and income bracket (p&gt;0.05). Prolonged LOS was also associated with Medicaid (versus Medicare), higher mCCI, thrombolysis, and thrombectomy (p&lt;0.05). Race was not independently associated with higher inpatient costs. Conclusions: These results build on prior population-based studies that indicate ongoing disparities in stroke care based on differences in socioeconomic status and race, but no difference in inpatient cost.

Rethinking “Educación Diversificada” for Afro-Descendants in Costa Rica

Costa Rica is a Central American country known for its commitment to education and environmental conservation. Educación Diversificada in Costa Rica refers to a system of education that offers a variety of options and programs, seeking to accommodate the diverse interests, needs, and abilities of students. Despite these efforts, challenges remain, including limited funding, inadequate infrastructure, and a lack of awareness among students and their families about the benefits of a diversified education. Nevertheless, there is a growing consensus that a diversified education system is crucial for the long-term development and competitiveness of Costa Rica. This paper provides an overview of the variations in educational attainment in Costa Rica and points to differences in socioeconomic status (SES) as a significant contributor to disparities in academic success. However, historically, the research suggests multiple dimensions of inequality and captures relevant but limited aspects of this phenomenon. Research is needed that will comprehensively illustrate the critical factors that impact educational success for people of African descent in Costa Rica and how these factors combine to affect the economic success of Afro-Costa Ricans. Immigration and migration history, for example, have been important predictors of the educational success of Afro-descendants in Costa Rica. Further research is needed to highlight the complex ways in which SES, race, migration, and immigration combine to affect educational success. Fully capturing the role of race in education also requires examining the conditions under which racial discrimination in education persists. The paper identifies research priorities in all these areas. Keywords: Ethnic and Racial Studies, Education, Costa Rica, Social Anthropology, Social Sciences, Afro-Descendants DOI: 10.7176/JEP/14-4-07 Publication date: February 28 th 2023

Obesity among Latinx people in the United States: A review.

Obesity is a serious, chronic disease that is associated with a range of adiposity-based comorbidities, including cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease. In the United States, obesity is a public health crisis, affecting more than 40% of the population. Obesity disproportionately affects Latinx people, who have a higher prevalence of obesity and related comorbidities (such as cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease) compared with the general population. Many factors, including genetic predisposition, environmental factors, traditional calorie-dense Latinx diets, family dynamics, and differences in socioeconomic status, contribute to the increased prevalence and complexity of treating obesity in the Latinx population. Additionally, significant heterogeneity within the Latinx population and disparities in health care access and utilization between Latinx people and the general population add to the challenge of obesity management. Culturally tailored interventions have been successful for managing obesity and related comorbidities in Latinx people. Antiobesity medications and bariatric surgery are also important options for obesity treatment in Latinx people. As highlighted in this review, when managing obesity in the Latinx population, it is critical to consider the impact of genetic, dietary, cultural, and socioeconomic factors, in order to implement an individualized treatment strategy.

Socioeconomic Factors and Pediatric Injury.

The goal of this review is to describe how socioeconomic status (SES) is evaluated in the pediatric trauma literature and further consider how differences in SES can lead to inequities in pediatric injury. Insurance status, area-level income, and indices of socioeconomic deprivation are the most common assessments of socioeconomic status. Children from socioeconomically disadvantaged backgrounds experience higher rates of firearm-related injuries, motor vehicle-related injuries, and violence-related injuries, contributing to inequities in morbidity and mortality after pediatric injury. Differences in SES may also lead to inequities in post-injury care and recovery, with higher rates of readmission, recidivism, and PTSD for children from socioeconomically disadvantaged backgrounds. Additional research looking at family-level measures of SES and more granular measures of neighborhood deprivation are needed. SES can serve as an upstream target for interventions to reduce pediatric injury and narrow the equity gap.

What Matters on Rural Left-Behind Children's Problem Behavior: Family Socioeconomic Status or Perceived Discrimination.

With the acceleration of China's industrialization and urbanization, there is a large number of left-behind children in China who are reported with more challenges in development. The study aims to analyze the differences in family socioeconomic status (SES) and discrimination perception between left-behind children and non-left-behind children and further explore whether SES or discrimination perception has a greater impact on the problem behaviors of left-behind children. We found the family SES of left-behind children was significantly lower than that of non-left-behind children; left-behind children's perceived discrimination was significantly higher than that of non-left-behind children; perceived discrimination of left-behind children had a greater impact on their problem behavior than the family SES.

Advancements in Oncoproteomics Technologies: Treading toward Translation into Clinical Practice.

Proteomics continues to forge significant strides in the discovery of essential biological processes, uncovering valuable information on the identity, global protein abundance, protein modifications, proteoform levels, and signal transduction pathways. Cancer is a complicated and heterogeneous disease, and the onset and progression involve multiple dysregulated proteoforms and their downstream signaling pathways. These are modulated by various factors such as molecular, genetic, tissue, cellular, ethnic/racial, socioeconomic status, environmental, and demographic differences that vary with time. The knowledge of cancer has improved the treatment and clinical management; however, the survival rates have not increased significantly, and cancer remains a major cause of mortality. Oncoproteomics studies help to develop and validate proteomics technologies for routine application in clinical laboratories for (1) diagnostic and prognostic categorization of cancer, (2) real-time monitoring of treatment, (3) assessing drug efficacy and toxicity, (4) therapeutic modulations based on the changes with prognosis and drug resistance, and (5) personalized medication. Investigation of tumor-specific proteomic profiles in conjunction with healthy controls provides crucial information in mechanistic studies on tumorigenesis, metastasis, and drug resistance. This review provides an overview of proteomics technologies that assist the discovery of novel drug targets, biomarkers for early detection, surveillance, prognosis, drug monitoring, and tailoring therapy to the cancer patient. The information gained from such technologies has drastically improved cancer research. We further provide exemplars from recent oncoproteomics applications in the discovery of biomarkers in various cancers, drug discovery, and clinical treatment. Overall, the future of oncoproteomics holds enormous potential for translating technologies from the bench to the bedside.

Intergenerational transmission of parental risky health behaviors in Chinese children: Are there socioeconomic status differences?

Risky health behaviors in childhood, including smoking, alcohol consumption, and having a poor diet, are the major sources of non-communicable diseases in adulthood. This study aimed to examine how parents affect children's risky health behaviors and whether intergenerational transmission differs based on socioeconomic status (SES). Data were extracted from the 1991-2015 China Health and Nutrition Survey (CHNS). Smoking (n = 5,946), alcohol consumption (n = 7,821), and sugar-sweetened beverages (SSBs) consumption (n = 3,537) were used as proxies for risky health behaviors in children. A binary choice model for panel data with a random-effect specification was employed to examine whether risky health behaviors can be transmitted from parents to their children. Subsequently, we conducted a seemingly unrelated estimation test (SUEST) to explore the differences in parental transmission between the different SES groups. We found strong intergenerational persistence of smoking, alcohol drinking, and SSBs drinking behaviors, except for the mothers' smoking behavior. Mothers had a greater influence on children's alcohol drinking and SSBs drinking behaviors than fathers both in urban and rural areas and in different SES groups. The intergenerational transmission of SSBs drinking behavior exhibited a decreasing trend with increasing SES for both urban and rural families. In urban areas, mothers' alcohol drinking behavior has a decreasing trend with increasing education level, occupation, and income; however, in rural areas, the influence of mothers' alcohol drinking behavior occurred in the same direction with increasing education level and occupation type. In rural areas, the influence of fathers' drinking and smoking behaviors on children appears to mostly increase with increasing SES. Meanwhile, the influence of such behaviors among urban fathers would decrease with increasing SES. Parents' behaviors and SES can influence the initiation of risky health behaviors in their offspring. Thus, to promote healthy behaviors, policymakers can introduce health education programs for parents, particularly for those living in rural areas and with a low SES.

What can parents do? The causal mediating role of parenting in explaining SES differences in children's language development

Objective: This study estimates how much of the differences by socioeconomic status (SES) in children’s language development are mediated by parenting styles, parenting practices, and parental investments. Background: There are large differences in children’s language development by parental socioeconomic status (SES). According to some studies, SES gaps in language skills among preschoolers could be reduced substantially by intervening in the parenting styles, practices, and parental investments of low-SES parents. However, the extent to which parenting mediates the effects on language skills of growing up in low-SES contexts is still unknown. Method: This paper uses data from the National Educational Panel Study starting cohort 1, a random sample of children born between 2012 and 2013 in Germany and employs interventional causal mediation analysis to estimate the mediated share of the total effect of SES on children’s language that goes through parenting, broadly understood. Results: Parenting explains around one-third of the total effect of SES on early language skills, but close to nothing of the effect on later language skills. Conclusion: Although a share of the SES effect operates through parenting, and all parenting dimensions affect children’s language skills, interventions in parenting would be limited in their ability to reduce the gap in substantial ways. Alternative pathways, through which inequality in language skills is reproduced, could potentially explain a larger share of this effect.

One Size Does Not Fit All: A Comparison of White, Latinx, and Black Student's Unadjusted and Adjusted GPAs in a College of Business and Public Administration of a Hispanic Serving Institution

Because higher education creates more informed individuals, healthier citizens, social prestige, job satisfaction, and numerous other non-economic benefits, it is important that all members of society have opportunities for successful educational achievement. Using data for undergraduate students enrolled in a business college of a large Hispanic Serving Institution (HSI), this study documents the existence of an unadjusted GPA gap between White students and ethnic minority students. This study also shows that the unadjusted GPA gaps decrease when socio-economic indicators are introduced in the analysis. The gaps continue to decrease when units-taken, transfer status, age, and student status are added to the analyses. Findings also show that although the differences between White and Latinx GPA can be explained by the covariates used in the analyses, the same cannot be concluded for Black students. Adding the same covariates reduces the gaps but does not eliminate them. Latinx students thus appear to benefit more than Black from being enrolled in a HIS. To sum up, while a significant amount of the difference between White and Latinx students can be explained by differences in socioeconomic status and other factors introduced in the regression analyses, the same cannot be said about Black students. We think that this is an important outcome that deserves substantial investigation. One size does not fit all.

Investigating value added by secondary schools in Trinidad and Tobago using multivariate ordinal hierarchical linear modelling

In this study, multivariate hierarchical ordinal linear modelling was used to compare the value-added contributions made by secondary schools in Trinidad and Tobago towards student achievement in Mathematics and English Language. Results revealed that value-added contributions by denominational or government-assisted schools to students with average or higher secondary entrance scores were indeed greater than corresponding value added estimates to government schools. However, there was some reordering in the school rankings, based on value added towards students with lower entrance scores. In addition to school type, differences in socio-economic status, sex, and age were shown to contribute significantly to explaining variations in student achievement at the respective schools.

Vertical pleiotropy explains the heritability of social science traits.

We contend that social science variables are the product of multiple partly heritable traits. Genetic associations with socioeconomic status (SES) may differ across populations, but this is a consequence of the intermediary traits associated with SES differences also varying. Furthermore, genetic data allow social scientists to make causal statements regarding the aetiology and consequences of SES.

Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer.

The purpose of this study was to assess the association of comorbidity burden with overall survival, accounting for racial/ethnic and socioeconomic differences in patients with cancer. In this retrospective cohort study, patients newly diagnosed with cancer between 2010 and 2018 were identified from a large health plan in southern California. Cancer registry data were linked with electronic health records (EHR). Comorbidity burden was defined by the Elixhauser comorbidity index (ECI). Patients were followed through December 2019 to assess all-cause mortality. Association of comorbidity burden with all-cause mortality was evaluated using Cox proportional hazards model. Crude and adjusted hazard ratio (HR, 95%CI) were determined. Of 153,270 patients included in the analysis, 29% died during the ensuing 10-year follow-up. Nearly 49% were patients of color, and 32% had an ECI > 4. After adjusting for age, sex, race/ethnicity, cancer stage, smoking status, insurance payor, medical center, year of cancer diagnosis, and cancer treatments, we observed a trend demonstrating higher mortality risk by decreasing socioeconomic status (SES) (P-trend<.05). Compared to patients in the highest SES quintile, patients in the lowest, second lowest, middle, and second highest quintiles had 25%, 21%, 18%, and 11% higher risk of mortality, respectively [(HR, 95%CI): 1.25 (1.21-1.29), 1.21 (1.18-1.25), 1.18 (1.15-1.22), and 1.11 (1.07-1.14), respectively]. When we additionally adjusted for ECI, the adjusted HRs for SES were slightly attenuated; however, the trend persisted. Patients with higher comorbidity burden had higher mortality risk compared to patients with ECI score = 0 in the adjusted model [(HR, 95%CI): 1.22 (1.17-1.28), 1.48 (1.42-1.55), 1.80 (1.72-1.89), 2.24 (2.14-2.34), and 3.39 (3.25-3.53) for ECI = 1, 2, 3, 4, and >5, respectively]. Comorbidity burden affects overall survival in cancer patients irrespective of racial/ethnic and SES differences. Reducing comorbidity burden can reduce some, but not all, of the mortality risk associated with lower SES.