Socioeconomic Status Disadvantage Research Articles

Evaluating the impact of socioeconomic status on patient satisfaction in radiation oncology.

e23166 Background: Patient satisfaction (PS) is a critical indicator in evaluating healthcare quality. While the impact of socioeconomic status (SES), on healthcare outcomes is well-documented, its specific connection to PS in the context of radiation oncology remains unclear. This study aims to delineate the correlation between SES, as determined by the Area Deprivation Index (ADI), and PS within our healthcare system. Methods: In this single institution study, National Research Council (NRC) PS survey questionnaires were prospectively collected from patients who visited 4 separate outpatient academic radiation oncology sites between May 2021 and November 2023. Area Deprivation Index (ADI) data for these patients was sourced from the Neighborhood Atlas, encompassing both national percentiles and state deciles, with higher values indicating a greater level of SES disadvantage. To assess the data, univariate (UVA) and multivariable (MVA) logistic regression analyses were performed on the survey's recommendation scores, which ranged from 0 to 10, with scores of 9 or higher suggesting a greater propensity to recommend the facility or provider. Results: Our analysis included 7,501 survey responses with a cohort that was majority female (55.3%), curative intent (81.5%), and had a breast cancer diagnosis (30.4%). Most survey responses were follow-up visits (69.0%). Mean state and national ADI scores were 3.94 and 50.75, respectively. The UVA revealed curative intent (OR 1.68, p < 0.001), follow-up visits (OR 1.69, p < 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as predictors of higher likelihood to recommend the facility or the provider. Patients with a national ADI above the mean were less likely to recommend the facility (OR 0.81, p = 0.050) or the provider (OR 0.71, p = 0.002). The MVA, outlined in Table 1, showed the influence of national ADI on provider recommendations remained significant (OR 0.730, p = 0.005) but not for facility recommendations (OR 0.832, p = 0.089). All other variables remained significant on the MVA. Conclusions: Respondents experiencing greater SES disadvantage were significantly less likely to recommend their provider. These findings underscore the necessity of incorporating SES as a factor when evaluating PS. Further research is necessary to determine the root cause of the impact of SES on PS and to explore the complex dynamics of patient-provider interactions. [Table: see text]

Socioeconomic Disadvantage Moderates the Association of Systemic Inflammation With Amygdala Volume in Adolescents Over a 2-Year Interval: An Exploratory Study

BackgroundResearch has demonstrated an association between elevated systemic inflammation and changes in brain function. Affective areas of the brain involved in processing threat (e.g., amygdala) and reward (e.g., nucleus accumbens) appear to be sensitive to inflammation. Early-life stress, such as experiencing low socioeconomic status (SES), may also potentiate this association, but relevant evidence has come primarily from cross-sectional studies of brain function. It is unclear whether similar associations are present between early-life stress, inflammation, and brain structure, particularly in typically developing populations. MethodsWe recruited and assessed 50 adolescents (31 females/19 males) from the community (mean [SD] age = 15.5 [1.1] years, range = 13.1–17.5 years) and examined in exploratory analyses whether changes in C-reactive protein (ΔCRP) from blood spots predict changes in gray matter volume (ΔGMV) in the bilateral amygdala and nucleus accumbens over a 2-year period. We also investigated whether experiencing early-life stress, operationalized using a comprehensive composite score of SES disadvantage at the family and neighborhood levels, significantly moderated the association between ΔCRP and ΔGMV. ResultsWe found that ΔCRP was negatively associated with Δamygdala GMV (i.e., increasing CRP levels were associated with decreasing amygdala volume; β = −0.84, p = .012). This effect was stronger in youths who experienced greater SES disadvantage (β = −0.56, p = .025). ConclusionsThese findings suggest that increases in systemic inflammation are associated with reductions in amygdala GMV in adolescents, potentially signaling accelerated maturation, and that these neuroimmune processes are compounded in adolescents who experienced greater SES disadvantage. Our findings are consistent with theoretical frameworks of neuroimmune associations and suggest that they may influence adolescent neurodevelopment.

Biologic indicators of donor socioeconomic disadvantage and recipient mortality following allogeneic hematopoietic cell transplantation.

6500 Background: Allogeneic hematopoietic cell transplantation (HCT) carries significant risks, with low socioeconomic status (SES) being predictive of increased mortality. Our team recently discovered that socioeconomic disadvantage among unrelated HCT donors results in decreased recipient overall survival (OS) and increased treatment-related mortality (TRM) within a cohort from the Center for International Blood and Marrow Transplant Research (CIBMTR). We also demonstrated that upregulation of the stress- and SES-related gene expression profile termed the ‘conserved transcriptional response to adversity’ (CTRA) is associated with low SES and worse outcomes among HCT recipients. Here, we hypothesize that donor immunologic characteristics associated with neighborhood socioeconomic disadvantage (CTRA) will confer prognostic risk to HCT recipients as indicated by inferior long-term recipient outcomes. Methods: Among a subset of the above cohort for which donor whole blood samples were available from the CIBMTR repository, we evaluated whether donor cell CTRA gene regulation was associated with inferior HCT outcomes at 3 years in recipients being treated for hematologic malignancy. Multivariable models adjusted for donor and recipient characteristics evaluated associations between donor CTRA and recipient OS, TRM, disease free survival (DFS), relapse, and acute and chronic graft versus host disease. Results were considered significant if P<0.05. Results: We identified 263 donor-recipient pairs for study inclusion. Median recipient age at hematologic malignancy diagnosis was 53 years (range 19-77), 46% were female, and 54% had acute myeloid leukemia. Donors were 35% female and median age at donation was 31 years (range 18-60). In RNA sequencing data from HCT donors, greater CTRA expression was associated with reduced OS (covariate-adjusted HR=1.94/CTRA SD, 95% CI [1.01, 3.71], p=.046) which was driven predominately by increased TRM (adjusted HR=5.04, [2.20, 11.50], p=.0001). These clinical outcomes are consistent with those observed to be associated with donor SES in our prior work. Donor cell effects on transplant outcomes derived predominately from the pro-inflammatory component of the CTRA (OS: adjusted HR=1.67, [1.20, 2.33], p = .0026; TRM: adjusted HR=2.21, [1.21, 4.06], p=.010) and emerged above and beyond the effects of the recipients’ own SES, as well as multiple other recipient disease, treatment, and demographic factors. Donor CTRA was not associated with relapse, DFS, or other transplant outcomes. Conclusions: For the first time, we show that transcriptome patterning among HCT donors, consistent with neighborhood SES disadvantage, results in adverse recipient HCT outcomes. These findings suggest that SES has a biologic impact at either the stem or immune cell level that persists even when transplanted into a new host.

PASSING ON THE SILVER SPOON: THE ROLE OF EARLY LIFE CIRCUMSTANCES ON DOWNWARD INTERGENERATIONAL FINANCIAL TRANSFERS

Abstract Childhood circumstances are known to etch an indelible influence on individual outcomes across the life course such as education, income, and health. Yet relatively little is known about how early life exposures influence family outcomes. This study aims to determine how childhood exposures are associated with inter vivos downward intergenerational financial transfers among older adults aged 51-85 with at least one surviving adult child. Using cumulative (dis)advantage theory, I hypothesized that experiences in childhood shape intergenerational transfers patterns – with early-life advantage being able to provide more transfers than their disadvantaged counterparts. I used data from the US Health and Retirement Study waves 1998 to 2018 (n=32,095 individuals, 169,316 person-years) and estimated random effects models. The index of childhood socioeconomic status was constructed by adding the following dichotomized indicators: poor to fair family socioeconomic status, mother / father having less than HS education, father working for service sector, and moved due to financial difficulty. Downward transfers were defined as whether the respondent gave money, helped pay bills, or covered certain costs to children or grandchildren worth ≥US$ 500. The unadjusted model revealed that the probability of providing downward transfers among those with 1 and 2+ childhood socioeconomic status disadvantage was 5.4% and 3.8% less than those without disadvantage. The inverse association of early life disadvantage and downward transfers were preserved when basic demographic controls and household income and wealth were controlled for, although the magnitude slightly declined (4.0% and 3.1% lower probability for those with 1 and 2+ misfortunes, respectively).

Association of family characteristics with health status and needs among children with congenital heart disease.

Low socio-economic status is associated with poorer quality of life among children with congenital heart disease (CHD), but this finding is based on disparities among children remaining under cardiology follow-up. We used a population-based health survey data set to analyse the impact of socio-economic status on health and functional status among children with CHD. We used 2007-2018 National Health Interview Survey data, selecting children 2-17 years of age who had been diagnosed with CHD. Outcomes included caregiver-rated general health, presence of functional limitations, number of missed school days, need for special education, and need for special equipment related to the child's health conditions. Socio-economic status measures included maternal educational attainment, food stamp programme participation, poverty status, and insurance coverage. Based on a sample of 233 children with CHD, 10% had fair or poor health, 38% reported having any health-related limitation on their usual activities, 11% needed special equipment, and 27% received special education services. On multivariable analysis, lower maternal educational attainment was correlated with worse caregiver-rated health, and children without insurance were especially likely to experience functional limitations. Black children with CHD had significantly worse caregiver-rated health compared to White children (ordered logit odds ratio: 0.19; 95% confidence interval: 0.08, 0.45; p < 0.001). In a population-based survey of children with CHD, race and several measures of socio-economic status disadvantage were associated with worse health outcomes. Further evaluation of social determinants of health during cardiology follow-up may help improve outcomes for children with CHD in socio-economically disadvantaged families.

Similar but distinct – Effects of different socioeconomic indicators on resting state functional connectivity: Findings from the Adolescent Brain Cognitive Development (ABCD) Study®

Early socioeconomic status (SES) has consistently been associated with child health and cognitive outcomes, in addition to alterations in brain function and connectivity. The goal of the present study was to probe the effects of different facets of SES (parent education, income, and neighborhood disadvantage), that likely represent varying aspects of the environment, on resting state functional connectivity (rsFC). We investigated this question in a large sample of 9475 children (aged 9–10 years) from the Adolescent Brain Cognitive Development (ABCD) Study. Specifically, we analyzed the association between household SES (parent education, income-to-needs ratio) and neighborhood disadvantage, and system-level rsFC using within-sample split-half replication. We then tested whether the associations were unique to each SES measure, and whether household SES and neighborhood disadvantage had interactive effects on rsFC. SES measures had both common and distinct effects on rsFC, with sensory-motor systems (e.g., sensorimotor network) and cognitive networks (e.g., front-parietal network) particularly implicated. Further, the association between neighborhood disadvantage and sensorimotor network connectivity was less pronounced in the presence of high income-to-needs. Findings demonstrate that different facets of SES have distinct and interacting effects on rsFC, highlighting the importance of considering different indicators when studying the effects of SES on the brain.

Multiple pathways linking early socioeconomic circumstances and depressive symptoms in late Middle age in the U.S.

Objectives: A growing number of life course studies are examining the influence of earlier life experiences on morbidity, disability, and mortality in mid-old age. Method: Drawing from the social pathway model, this study expands the life course literature by utilizing data collected over 35 years from the National Longitudinal Survey of Youth, 1979 Cohort, spanning four life course phases (childhood, young adulthood, middle adulthood, and late-middle adulthood). Through structural equation analyses with a phantom model, we estimated depressive symptoms in late middle age as a result of pathway effects starting with childhood socio-economic status (SES) which effect young adulthood and middle adulthood. The multi-pathway life course model includes three potential mediators of middle adulthood: health risk behaviors, social activity, and negative life events. Results: We found limited support for a direct effect of childhood SES disadvantage on depressive symptoms in middle age. Instead, much of the effects of childhood SES on later-year depressive symptoms appear to be mediated by SES in young adulthood. Further, the long-term pathway is mediated through the influence of health risk behaviors and negative life events in middle adulthood. Conclusion: Our findings do not propose this chain is permanent and irreversible; rather, this study highlights the possibility that interventions focused on promoting health behaviors and improving living conditions for people from socioeconomically disadvantaged backgrounds could help reduce the instance of depression in middle age and health outcomes along the life course could be improved.

Center-Based Child Care and Differential Improvements in the Child Development Outcomes of Disadvantaged Children

BackgroundResearch finds center-based child care typically benefits children of low socio-economic status (SES) but few studies have examined if it also reduces inequalities in developmental disadvantage.ObjectiveI test if the length of time in center-based care between ages one and three years associates with child development scores at age three years, focusing on the impact for groups of children in the lower tercile of child development scores and in the lower SES tercile.MethodUsing data from 1,606 children collected in a nationally representative Chilean survey, I apply a value-added approach to measure gains in child development scores between age one and three years that are associated with length of time in center-based child care.ResultsDisadvantages at age one year were associated with lower child development scores at age three years. No benefits of additional time in center-based care were found for the non-disadvantaged group, but positive associations were found between more time in center-based care and child development outcomes for children with the SES disadvantage only. Center-based care was not associated with child development trajectories of children with lower child development scores at age one year, no matter their SES status.ConclusionsThere is evidence that Chilean center-based child care reduces SES inequality in child development scores between ages one and three years, but only if children already were not low-scorers at age one year.

Adult child socio-economic status disadvantage and cognitive decline among older parents in Mexico

There is growing interest in the contribution of offspring educational attainment to parents' health outcomes. However, less is known about the impacts of offspring socio-economic status (SES) on parents' cognitive decline or about the role of offspring SES disadvantage. We used data from the Mexican Health and Aging Study (n = 10,426) to evaluate the impact of adult child SES disadvantage on parents' verbal memory trajectories over fourteen years (2001–2015). We estimated linear mixed models and used measures of adult child SES (educational, financial, and employment) disadvantage. Our most robust finding was that having an adult child with less than secondary education was associated with faster decline in verbal memory z-scores for older women (β: −0.009 [95% CI: −0.01, −0.001]) and men (β: −0.01 [95% CI: −0.02, −0.01]). Although poor adult child financial well-being was associated with a faster decline in parents' verbal memory z-scores, this finding was less consistent across model specifications. Additional analyses also suggested some evidence of heterogeneity by parents' own educational attainment and gender. These findings highlight the potential importance of children's socio-economic status for the cognitive aging of their older parents.

Using latent class modeling to jointly characterize economic stress and multi-pollutant exposure

INTRODUCTION: Work is needed to better understand how joint exposure to environmental and economic factors influence cancer. OBJECTIVE: We hypothesize that environmental exposures vary with socioeconomic status (SES) and urban/rural locations, and that areas with minority populations coincide with high economic disadvantage and pollution. METHODS: To model joint exposure to pollution and SES, we develop a latent class mixture model (LCMM) with three latent variables (SES-Advantage, SES-Disadvantage and Air Pollution) and we compare the LCMM fit to K-means clustering. We ran an ANOVA to test for high exposure levels in non-Hispanic black populations. The analysis is at the census tract level for the entire state of North Carolina (NC). RESULTS: The LCMM was a better and more nuanced fit to the data than K-means clustering. Our LCMM had two sub-levels (low, high) within each latent class. The worst levels of exposure (high SES disadvantage, low SES advantage, high pollution) are found in 22% of the census tracts, while the best levels (low SES disadvantage, high SES advantage, low pollution) are found in 5.7%. Overall, 34.1% of the census tracts exhibit high disadvantage, 66.3% have low advantage and 59.2% have high mixtures of toxic pollutants. We found that high levels of pollution exposure exist in some rural areas. Areas with higher SES disadvantage had significantly higher non-Hispanic black population density (p&lt;0.001) and non-Hispanic black population density was higher in areas with higher pollution (p&lt;0.001). CONCLUSIONS: Joint exposure to air toxins and SES varies with rural/urban location and coincides with minority populations. Our model can be extended to provide a holistic modeling framework for estimating disparities in cancer survival.

Using Latent Class Modeling to Jointly Characterize Economic Stress and Multipollutant Exposure.

Work is needed to better understand how joint exposure to environmental and economic factors influence cancer. We hypothesize that environmental exposures vary with socioeconomic status (SES) and urban/rural locations, and areas with minority populations coincide with high economic disadvantage and pollution. To model joint exposure to pollution and SES, we develop a latent class mixture model (LCMM) with three latent variables (SES Advantage, SES Disadvantage, and Air Pollution) and compare the LCMM fit with K-means clustering. We ran an ANOVA to test for high exposure levels in non-Hispanic black populations. The analysis is at the census tract level for the state of North Carolina. The LCMM was a better and more nuanced fit to the data than K-means clustering. Our LCMM had two sublevels (low, high) within each latent class. The worst levels of exposure (high SES disadvantage, low SES advantage, high pollution) are found in 22% of census tracts, while the best levels (low SES disadvantage, high SES advantage, low pollution) are found in 5.7%. Overall, 34.1% of the census tracts exhibit high disadvantage, 66.3% have low advantage, and 59.2% have high mixtures of toxic pollutants. Areas with higher SES disadvantage had significantly higher non-Hispanic black population density (NHBPD; P < 0.001), and NHBPD was higher in areas with higher pollution (P < 0.001). Joint exposure to air toxins and SES varies with rural/urban location and coincides with minority populations. Our model can be extended to provide a holistic modeling framework for estimating disparities in cancer survival.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

Service deserts and service oases: Utilizing geographic information systems to evaluate service availability for individuals with autism spectrum disorder.

Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers' availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.

Childhood socioeconomic status and inflammation: Psychological moderators among Black and White Americans.

The current study examined race differences in how childhood socioeconomic status (SES) predicted midlife inflammation. It also tested psychological resources (purpose in life, optimism, and conscientiousness) as moderators of the association between childhood SES and inflammation among Black and White adults. Data came from the biomarker subsamples of the Midlife in the United States Core and Refresher studies (n = 1,578 White and n = 395 Black participants). Childhood SES was operationalized as a composite of parental education, perceived financial status, and welfare status. Outcomes included circulating IL-6 and CRP. Childhood SES did not predict IL-6 or CRP among Black or White adults in fully adjusted models. Among Black adults with low optimism, lower childhood SES predicted higher IL-6 and CRP. Among Black adults with low purpose in life, lower childhood SES predicted higher CRP (but not IL-6). Conscientiousness did not moderate childhood SES-inflammation associations among Black adults. Among White adults with low conscientiousness or low optimism, lower childhood SES predicted higher IL-6 (but not CRP). Purpose in life did not moderate associations among White adults. Effect sizes were small (≤1% variance explained) and comparable to effects of clinical risk factors in this sample (e.g., age, chronic conditions). Race differences in the childhood SES and inflammation association were not apparent. Childhood SES was linked to inflammation more strongly among those with fewer psychological resources across both racial groups. Psychological resources may be important moderators of inflammation in the context of early life SES disadvantage. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstract A007: Using latent class modeling to characterize exposome impacts on health disparities

Abstract Recent work suggests that air pollutants, toxic chemicals, and other environmental exposures negatively impact health in a synergistic way. We hypothesize that these environmental exposures will vary with socioeconomic status (SES), and urban versus rural location, and contribute to health disparities. In order to measure and understand this phenomenon, we propose a latent class mixture model of multi-pollutant exposures and SES. This builds on our previous development of an SES mixture model, which includes 13 indicators of socioeconomic advantage (eg profession, education) and disadvantage (eg unemployment, single-parent households, etc). Our model identifies levels of joint exposure to three classes of toxic pollutants: volatile organic compounds (VOC), particulate matter (PM) and heavy metals (HM). We use publicly available data from the American Community Survey and the EPA, including the National Air Toxics Assessment (NATA), for the 2,174 census tracts in North Carolina (NC). Model results indicate that mixtures of 2 levels of pollutants, 2 levels of socioeconomic advantage and 2 levels of socioeconomic disadvantage best fit data for NC. We present estimated class-membership for the state of NC, where 34.1% of the census tracts exhibit high disadvantage, 66.3% have low advantage, and 59.2% of census tracts have high mixtures of toxic pollutants. While frequently observed in urban or regional city/suburban areas, our model shows that rural areas are detected at the highest levels of pollution as well. Areas of high advantage are focused on urban/suburban and coastal areas, while disadvantage dominates the eastern half of the state as well as many urban areas. Areas with higher SES disadvantage had significantly higher black population density (p&amp;lt;0.001). Similarly, black population density was higher in areas with higher pollution (p&amp;lt;0.001). Our next focus is to incorporate spatial correlations into our models to better characterize the interactive nature of multi-pollutant and economic exposures, and apply to specific cohorts with cancer outcomes. Taken together, these extensions will be incorporated into a holistic, exposome modelling framework for estimating disparities in cancer survival. Citation Format: Alexandra Larsen, Viktoria Kolpacoff, Victoria Seewaldt, Terry Hyslop. Using latent class modeling to characterize exposome impacts on health disparities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A007.

Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in low- and middle-income countries

BackgroundLow- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). The decomposition of the educational inequalities in SAM across individual, household and neighbourhood characteristics in LMIC has not been explored. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities.MethodsWe pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers was the main exposure variable. The explanatory variables cut across the individual-, household- and neighbourhood-level factors of the mother-child pair. Oaxaca-Blinder decomposition method was used at p = 0.05.ResultsThe proportion of children whose mothers were not educated ranged from 0.1% in Armenia and Kyrgyz Republic to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated, this varied within each country. Fourteen countries (Cameroon(p < 0.001), Chad(p < 0.001), Comoro(p = 0.047), Burkina Faso(p < 0.001), Ethiopia(p < 0.001), India(p < 0.001), Kenya(p < 0.001), Mozambique(p = 0.012), Namibia(p = 0.001), Nigeria(p < 0.001), Pakistan(p < 0.001), Senegal(p = 0.003), Togo(p = 0.013), and Timor Leste(p < 0.001) had statistically significant pro-illiterate inequality while no country showed statistically significant pro-literate inequality. We found significant differences in SAM prevalence across child’s age (p < 0.001), child’s sex(p < 0.001), maternal age(p = 0.001), household wealth quintile(p = 0.001), mother’s access to media(p = 0.001), birth weight(p < 0.001) and neighbourhood socioeconomic status disadvantage(p < 0.001). On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.ConclusionsSAM is prevalent in most LMIC with wide educational inequalities explained by individual, household and community-level factors. Promotion of women education should be strengthened as better education among women will close the gaps and reduce the burden of SAM generally. We recommend further studies of other determinate causes of inequalities in severe acute malnutrition in LMIC.

Self-Rated Health and Structural Racism Indicated by County-Level Racial Inequalities in Socioeconomic Status: The Role of Urban-Rural Classification.

Recent attention to the interrelationship between racism, socioeconomic status (SES) and health has led to a small, but growing literature of empirical work on the role of structural racism in population health. Area-level racial inequities in SES are an indicator of structural racism, and the associations between structural racism indicators and self-rated health are unknown. Further, because urban-rural differences have been observed in population health and are associated with different manifestations of structural racism, explicating the role of urban-rural classification is warranted. This study examined the associations between racial inequities in SES and self-rated health by county urban-rural classification. Using data from County Health Rankings and American Communities Surveys, black-white ratios of SES were regressed on rates of fair/poor health in U.S. counties. Racial inequities in homeownership were negatively associated with fair/poor health (β = -0.87, s.e. = 0.18), but racial inequities in unemployment were positively associated with fair/poor health (β = 0.03, s.e. = 0.01). The associations between structural racism and fair/poor health varied by county urban-rural classification. Potential mechanisms include the concentration of resources in racially segregated counties with high racial inequities that lead to better health outcomes, but are associated with extreme black SES disadvantage. Racial inequities in SES are a social justice imperative with implications for population health that can be targeted by urban-rural classification and other social contextual characteristics.

Person-Environment Fit Approach to Trajectories of Cognitive Function Among Older Adults Who Live Alone: Intersection of Life-Course SES Disadvantage and Senior Housing.

Drawing from life course and environmental perspectives, we examined the trajectory of cognitive function and how senior housing moderates the effects of life-course socioeconomic status (SES) disadvantage among older people living alone over time. Six waves of the Health and Retirement Study (HRS) were used with multilevel growth modeling to analyze developmental patterns of cognitive function over time and how various forms of life-course SES disadvantage affect cognitive function depending on senior housing residency status. At baseline, we found a positive role of senior housing in four subgroups: SES disadvantage in childhood only, unstable mobility pattern (disadvantage in childhood and old age only), downward mobility (no disadvantage in childhood, but in later two life stages), and cumulative disadvantage (all three life stages). Over time, the positive role of senior housing for the unstable and the most vulnerable group persisted. Our findings provide a much-needed practical and theoretical underpinning for environmental policy-making efforts regarding vulnerable elders who live alone.

Contributions of early adversity to pro-inflammatory phenotype in infancy: the buffer provided by attachment security

ABSTRACTAdversity early in life is associated with systemic inflammation by adolescence and beyond. At present, few studies have investigated the associations between different forms of adversity and inflammation during infancy, making it difficult to specify the origins of disease vulnerability. This study examined the association between multiple forms of early adversity – socioeconomic status disadvantage, familial stress, maternal depression, and security of attachment – and individual differences in a composite measure of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, and tumor necrosis factor-alpha) and the inflammatory protein C-reactive protein that were collected via saliva when (n = 49) children were 17 months old. In addition to gauging the direct effects of adversity, we also tested the hypothesis that infants’ attachment relationship with their mother might buffer infants against the immunologic effects of early adversity. Results show that familial stress, maternal depression, and security of attachment were directly associated with infant salivary inflammation and that attachment status moderated the effect of maternal depression. The findings suggest that exposure to certain forms of adversity very early in life may engender a pro-inflammatory phenotype with possible life-long implications for health.

Heterogeneous Trajectories of Depressive Symptoms in Late Middle Age: Critical Period, Accumulation, and Social Mobility Life Course Perspectives.

This study investigated patterns of depressive symptoms and whether socioeconomic status (SES) across the life course affects these trajectories using the critical period, accumulation, and social mobility models. This study uses data from 8,532 adults, age 51 to 64, collected over 12 years from the Health and Retirement Study (observations = 25,887). A latent class analysis was performed to examine distinct depressive symptom trajectories; life course models were studied with multinomial logistic regression. Four heterogeneous latent classes were identified for depression: Declining, Low, Increasing, and High and Increasing. The High and Increasing group was associated with a disadvantaged childhood SES, accumulated exposure to socioeconomic risks, and persistent SES disadvantage supporting the three life course models. There was evidence of distinct profiles of depressive symptoms in late middle age and of interrelated life course mechanisms underlying the influences of childhood SES on later life depression.

Socioeconomic status and bone mineral density in adults by race/ethnicity and gender: the Louisiana osteoporosis study.

The evidence is limited regarding the relationship between socioeconomic status (SES) and bone mineral density (BMD) for minority populations in the USA, as well as the relationship between SES and BMD for men. This study explored and examined the relationship between SES and BMD by race/ethnicity and gender. Data (n=6568) from the Louisiana Osteoporosis Study (LOS) was examined, including data for non-Hispanic whites (n=4153), non-Hispanic blacks (n=1907), and non-Hispanic Asians (n=508). General linear models were used to estimate the relationship of SES and BMD (total hip and lumbar spine) stratified by race/ethnicity and gender. Adjustments were made for physiological and behavioral factors. After adjusting for covariates, men with education levels below high school graduate experienced relatively low hip BMD than their counterparts with college or graduate education (p<0.05). In addition, women reporting a personal annual income under $20,000 had relatively low hip and spine BMD than their counterparts with higher income level(s) (p<0.05). Establishing a conclusive positive or negative association between BMD and SES proved to be difficult. However, individuals who are at an extreme SES disadvantage are the most vulnerable to have relatively low BMD in the study population. Efforts to promote bone health may benefit from focusing on men with low education levels and women with low individual income.