Socioeconomic Status Distribution Research Articles

Socioeconomic status amplifies genetic effects in middle childhood in a large German twin sample

The Scarr-Rowe hypothesis predicts that the heritability of cognitive abilities is higher in more privileged socioeconomic conditions, meaning that genetic potential can be more fully expressed in environments characterized by high socioeconomic status (SES) compared to low SES. This gene × SES interaction, however, has been replicated mostly in the United States, but not in other Western nations like the United Kingdom. In the current study, we tested the interaction between childhood SES and the heritability of cognitive ability in 3074 German twin pairs comprising three age cohorts at different developmental stages (mean ages of 11, 17, and 23 years). Higher SES was associated with significantly higher mean cognitive ability scores in the two younger cohorts, with reduced variances at higher SES levels. Results further support the Scarr-Rowe hypothesis in middle childhood, and to some degree in adolescence, but not in adulthood. This indicates that the role of family SES as a moderator of the heritability of cognitive ability changes as children grow older. Moreover, children's shared experiences appear to be explain more variance in cognitive ability at the lower end of the SES distribution in middle childhood and adolescence.

Expected widowhood duration varies with socio-economic status

ABSTRACTThis article examines the expected duration of widowhood and its variation by socio-economic status (SES). The relationship between widowhood duration (WD) and SES and how they relate to annuitization and longevity risk is relevant in the light of ongoing changes in many pension systems. Using data from Ireland, WD is estimated for older married individuals, as a function of spousal age gap and spousal longevity gap. Both of the gaps are negatively correlated with SES. Thus, WD is negatively correlated with SES. Wives in the bottom of the SES distribution have the highest degree of annuitization, protecting them against longevity risk brought about by a higher WD. The movement towards less automatic annuitization may impact future widows differently, depending on their SES.

Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status.

PurposeLocal physical and social environment has a defining influence on individual behavior and health‐related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual‐level data and assessed its independence from socioeconomic status (SES).MethodsGeoreferenced individual‐level data from the population‐based cross‐sectional Bus Santé study (n = 5002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighborhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening center was also evaluated.ResultsMammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behavior (36.5% of the initial size). The identified SES‐independent hot spots and cold spots of mammography adherence were not explained by proximity to the nearest screening center.ConclusionsSES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighborhood‐level determinants could influence mammography adherence and be the object of targeted public health interventions.

Examining access to Psychoeducational Assessments by Socioeconomic factors for children with behavioral referrals

Abstract BACKGROUND The psycho-educational assessment (PEA) is often recommended in behavioural presentations in children. The PEA assesses cognitive ability and detects any learning disabilities which may be the direct cause, or comorbidity, of a behavioral problem. This essential tool directs the child and family to appropriate treatment or intervention, and is critical for the school to design effective programming for the child. However, access to this assessment is quite variable. Some students may receive the PEA from a school psychologist if it has been established that other interventions have proven ineffective, but may experience long wait times. This study looked at a group of behavioural referrals at a local paediatric clinic to determine how many children had received a PEA, and if access seemed to be affected by their socioeconomic status (SES). OBJECTIVES • To identify how many of these behavioural referrals have also received PEAs. • To understand the SES distribution among the children receiving behavioural referrals. • To determine if children with higher SES status are more likely to have received PEAs. DESIGN/METHODS All behavioural referrals at this clinic are subject to an intake interview with a clinic nurse, who gathers a detailed medical, social and family history. This includes a list of previously accessed services and resources, including the PEA. Socioeconomic status was defined by the Quintile-Annual-Income-Per-Person-Equivalent (QAIPPE) associated with the dissemination area (DA) of the family residence. Patients were divided into these quintiles to determine the number of referrals from each quintile, and the percentage of children from each quintile that had received a PEA. RESULTS More than half of the referrals (51.2%; n=342) come from families living in DAs of the two lowest income quintiles. Of those children living in neighbourhoods in the two highest income quintiles, 27% had received the PEA prior to referral, as compared to 12.6% of those children living in the three lower income quintile neighbourhoods. CONCLUSION This demonstrates that children from low income neighbourhoods are receiving more behavioural referrals but are less likely to have received a PEA. This is a barrier to delivering timely and effective service as many children will wait over a year for their paediatric appointment only to find that they may have been better serviced elsewhere. Improving access to the PEA would improve the treatment of this population and help eliminate duplication and unnecessary service provision.

CT scan exposure in Spanish children and young adults by socioeconomic status: Cross-sectional analysis of cohort data.

Recent publications reported that children in disadvantaged areas undergo more CT scanning than others. The present study is aimed to assess the potential differences in CT imaging by socioeconomic status (SES) in Spanish young scanned subjects and if such differences vary with different indicators or different time point SES measurements. The associations between CT scanning and SES, and between the CT scan rate per patient and SES were investigated in the Spanish EPI-CT subcohort. Various SES indicators were studied to determine whether particular SES dimensions were more closely related to the probability of undergoing one or multiple CTs. Comparisons were made with indices based on 2001 and 2011 censuses. We found evidence of socio-economic variation among young people, mainly related to autonomous communities of residence. A slightly higher rate of scans per patient of multiple body parts in the less affluent categories was observed, possibly reflecting a higher rate of accidents and violence in these groups. The number of CT scans per patient was higher both in the most affluent and the most deprived categories and somewhat lower in the intermediate groups. This relation varied with the SES indicator used, with lower CT scans per patients in categories of high unemployment and temporary work, but not depending on categories of unskilled work or illiteracy. The relationship between these indicators and number of CTs in 2011 was different than that seen with the 2001 census, with the number of CTs increasing with higher unemployment. Overall we observed some differences in the SES distribution of scanned patients by Autonomous Community in Spain. There was, however, no major differences in the frequency of CT scans per patient by SES overall, based on the 2001 census. The use of different indicators and of SES data collected at different time points led to different relations between SES and frequency of CT scans, outlining the difficulty of adequately capturing the social and economic dimensions which may affect health and health service utilisation.

How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India.

Substantial investments have been made in clinical social franchising to improve quality of care of private facilities in low- and middle-income countries but concerns have emerged that the benefits fail to reach poorer groups. We assessed the distribution of franchise utilization and content of care by socio-economic status (SES) in three maternal healthcare social franchises in Uganda and India (Uttar Pradesh and Rajasthan). We surveyed 2179 women who had received antenatal care (ANC) and/or delivery services at franchise clinics (in Uttar Pradesh only ANC services were offered). Women were allocated to national (Uganda) or state (India) SES quintiles. Franchise users were concentrated in the higher SES quintiles in all settings. The percent in the top two quintiles was highest in Uganda (over 98% for both ANC and delivery), followed by Rajasthan (62.8% for ANC, 72.1% for delivery) and Uttar Pradesh (48.5% for ANC). The percent of clients in the lowest two quintiles was zero in Uganda, 7.1 and 3.1% for ANC and delivery, respectively, in Rajasthan and 16.3% in Uttar Pradesh. Differences in SES distribution across the programmes may reflect variation in user fees, the average SES of the national/state populations and the range of services covered. We found little variation in content of care by SES. Key factors limiting the ability of such maternal health social franchises to reach poorer groups may include the lack of suitable facilities in the poorest areas, the inability of the poorest women to afford any private sector fees and competition with free or even incentivized public sector services. Moreover, there are tensions between targeting poorer groups, and franchise objectives of improving quality and business performance and enhancing financial sustainability, meaning that middle income and poorer groups are unlikely to be reached in large numbers in the absence of additional subsidies.

Socioeconomic status indicators and common mental disorders: Evidence from a study of prenatal depression in Pakistan

There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context. Prenatal depression is an important public health concern with negative sequela for the mother and her children. We use data on assets, education, food insecurity, debt, and depression symptoms from a sample of 1154 pregnant women residing in rural Pakistan. Women who screened positive for depression participated in a cluster randomized controlled trial of a perinatal depression intervention; all women were interviewed October 2015-February 2016, prior to the start of the intervention. Cluster-specific sampling weights were used to approximate a random sample of pregnant women in the area. Findings indicate that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets is linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. A gradient was also initially observed with woman’s educational attainment, but this association was attenuated once other SES variables were included in the model. Together, the asset, food insecurity, and debt indicators explain 14% of the variance in depression symptoms, more than has been reported in high income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC.

Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): A cross-sectional reference study

Hidradenitis suppurativa (HS) is a chronic debilitating disease, whereby school attendance and employment can be disturbed. We sought to determine the socioeconomic status (SES) in patients with HS relative to other dermatologic patients, and whether specific clinical HS characteristics correlate with SES. For this multicenter cross-sectional reference study, data were collected from patients with HS and sex- and age-matched dermatologic patients in a 1:2 ratio. SES was derived from the mean household income and real estate value on a neighborhood level. The SES distribution among 1018 patients with HS was significantly lower than among 2039 age- and sex-matched dermatologic control patients (P<.001). In patients with HS a low SES was associated with axillary involvement (odds ratio 1.42, P=.04), high body mass index (odds ratio 1.03, P=.003), and lower age at inclusion (odds ratio 0.98, P=.001), but not with disease severity or age of disease onset. SES was based on postal code level and causality cannot be determined. In the general population, low SES is associated with an unhealthy lifestyle such as smoking and obesity. Therefore, low SES might be a risk factor for developing HS.

Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001\u20132013: A Distributional Analysis Using Household Asset Indicators

Understanding the distribution of socioeconomic status (SES) and its temporal dynamics within a population is critical to ensure that policies and interventions adequately and equitably contribute to the well-being and life chances of all individuals. This study assesses the dynamics of SES in a typical rural South African setting over the period 2001–2013 using data on household assets from the Agincourt Health and Demographic Surveillance System. Three SES indices, an absolute index, principal component analysis index and multiple correspondence analysis index, are constructed from the household asset indicators. Relative distribution methods are then applied to the indices to assess changes over time in the distribution of SES with special focus on location and shape shifts. Results show that the proportion of households that own assets associated with greater modern wealth has substantially increased over time. In addition, relative distributions in all three indices show that the median SES index value has shifted up and the distribution has become less polarized and is converging towards the middle. However, the convergence is larger from the upper tail than from the lower tail, which suggests that the improvement in SES has been slower for poorer households. The results also show persistent ethnic differences in SES with households of former Mozambican refugees being at a disadvantage. From a methodological perspective, the study findings demonstrate the comparability of the easy-to-compute absolute index to other SES indices constructed using more advanced statistical techniques in assessing household SES.

Local level inequalities in the use of hospital-based maternal delivery in rural South Africa.

BackgroundThere is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa.MethodsWe used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts.ResultsIn both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery.ConclusionsThe findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services.

Socioeconomic status, child enrichment factors, and cognitive performance among preschool-age children: Results from the Follow-Up of Growth and Development Experiences study

Lower cognitive performance is associated with poorer health and functioning throughout the lifespan and disproportionately affects children from lower socioeconomic status (SES) populations. Previous studies reporting positive associations between child home enrichment and cognitive performance generally had a limited distribution of SES. We evaluated the associations of SES and child enrichment with cognitive performance in a population with a wide range of SES, particularly whether enrichment attenuates associations with SES. Children were sampled from a case-control study of small-for-gestational-age (SGA) conducted in a public hospital serving a low SES population (final n=198) and a private hospital serving a middle-to-high SES population (final n=253). SES (maternal education and income) and perinatal factors (SGA, maternal smoking and drinking) were obtained from maternal birth interview. Five child home enrichment factors (e.g. books in home) and preschool attendance were obtained from follow-up interview at age 4.5 years. Cognitive performance was assessed with the Differential Ability Scales (DAS), a standardized psychometric test administered at follow-up. SES and enrichment scores were created by combining individual factors. Analyses were adjusted for perinatal factors. Children from the public birth hospital had a significantly lower mean DAS general cognitive ability (GCA) score than children born at the private birth hospital (adjusted mean difference -21.4, 95% CI: -24.0, -18.7); this was substantially attenuated by adjustment for individual SES, child enrichment factors, and preschool attendance (adjusted mean difference -5.1, 95% CI: -9.5, -0.7). Individual-level SES score was associated with DAS score, beyond the general SES effect associated with hospital of birth. Adjustment for preschool attendance and home enrichment score attenuated the association between individual SES score and adjusted mean DAS-GCA among children born at both of the hospitals. The effect of being in the lower compared to the middle tertile of SES score was reduced by approximately a quarter; the effect of being in the upper compared to the middle tertile of SES score was reduced by nearly half, but this comparison was possible only for children born at the private hospital. A child's individual SES was associated with cognitive performance within advantaged and disadvantaged populations. Child enrichment was associated with better cognitive performance and attenuated the SES influence. Health care providers should reinforce guidelines for home enrichment and refer children with delays to early intervention and education, particularly children from disadvantaged populations.

Participation in population‐based case–control studies: does the observed decline vary by socio‐economic status?

An Australian study of childhood leukaemia (Aus-ALL) previously reported that control participation was positively associated with socio-economic status (SES). A similar study of childhood brain tumours (Aus-CBT) was carried out 4 years later, and this paper compares control participation and its relationship with SES in the two studies. To assess the representativeness of controls in terms of SES, the addresses of controls were linked to Australian Bureau of Statistics Census 2006 Collection Districts (CDs), and hence to area-based indices of SES. Independent sample t-tests and chi-squared tests were used to compare the SES indices of CDs where Aus-CBT controls lived with those where Aus-ALL controls lived and with those of all CDs where Australian families lived. The overall percentage of eligible families who agreed to participate was lower in Aus-CBT (53.9%) than in Aus-ALL (70.3%). Control families in both studies were of higher SES than the general population, while the distribution of SES among recruited controls was similar in both studies. These findings provide some reassurance that the observed decline in research participation over time may not be associated with an increasingly unrepresentative participant population.

The influence of population characteristics on variation in general practice based morbidity estimations

BackgroundGeneral practice based registration networks (GPRNs) provide information on morbidity rates in the population. Morbidity rate estimates from different GPRNs, however, reveal considerable, unexplained differences. We studied the range and variation in morbidity estimates, as well as the extent to which the differences in morbidity rates between general practices and networks change if socio-demographic characteristics of the listed patient populations are taken into account.MethodsThe variation in incidence and prevalence rates of thirteen diseases among six Dutch GPRNs and the influence of age, gender, socio economic status (SES), urbanization level, and ethnicity are analyzed using multilevel logistic regression analysis. Results are expressed in median odds ratios (MOR).ResultsWe observed large differences in morbidity rate estimates both on the level of general practices as on the level of networks. The differences in SES, urbanization level and ethnicity distribution among the networks' practice populations are substantial. The variation in morbidity rate estimates among networks did not decrease after adjusting for these socio-demographic characteristics.ConclusionSocio-demographic characteristics of populations do not explain the differences in morbidity estimations among GPRNs.

History Shaped the Geographic Distribution of Genomic Admixture on the Island of Puerto Rico

Contemporary genetic variation among Latin Americans human groups reflects population migrations shaped by complex historical, social and economic factors. Consequently, admixture patterns may vary by geographic regions ranging from countries to neighborhoods. We examined the geographic variation of admixture across the island of Puerto Rico and the degree to which it could be explained by historic and social events. We analyzed a census-based sample of 642 Puerto Rican individuals that were genotyped for 93 ancestry informative markers (AIMs) to estimate African, European and Native American ancestry. Socioeconomic status (SES) data and geographic location were obtained for each individual. There was significant geographic variation of ancestry across the island. In particular, African ancestry demonstrated a decreasing East to West gradient that was partially explained by historical factors linked to the colonial sugar plantation system. SES also demonstrated a parallel decreasing cline from East to West. However, at a local level, SES and African ancestry were negatively correlated. European ancestry was strongly negatively correlated with African ancestry and therefore showed patterns complementary to African ancestry. By contrast, Native American ancestry showed little variation across the island and across individuals and appears to have played little social role historically. The observed geographic distributions of SES and genetic variation relate to historical social events and mating patterns, and have substantial implications for the design of studies in the recently admixed Puerto Rican population. More generally, our results demonstrate the importance of incorporating social and geographic data with genetics when studying contemporary admixed populations.

Equity in the use of antiretroviral treatment in the public health care system in urban South Africa

The scaling up of antiretroviral treatment (ART) for HIV-infected adults requires a sizeable investment of resources in the South African public health care system. It is important that these resources are used productively and in ways that reach those in need, irrespective of social status or personal characteristics. In this study we evaluate whether the distribution of ART services in the public system reflects the distribution of need among adults in the urban population. Data from a 2008 national survey were used to estimate the distribution of socioeconomic status (SES) and sex in HIV-positive adults in urban areas. These findings were compared to SES and sex distributions in 635 ART users within 6 urban public ART facilities. Close to 40% of those with HIV are in the lowest SES quintile, while 67% are women. The distributions in users of ART are similar to these distributions in HIV-positive people. Patterns of ART use in study settings correspond to patterns of HIV in the urban population at the national level. This suggests that the South African ART programme is on track to ensure equitable delivery of treatment services in urban settings.

Implications of socio-economic status on the dietary fatty acid intakes in Turkish women

To investigate the effects of socio-economic status (SES) on the dietary intakes of fatty acids in a group of Turkish women. Materials and methods: Five hundred and sixty three women were randomly enrolled into the study. They were classified into 3 SES groups: group 1 high (n = 186), group 2 medium (n = 186), and group 3 low (n = 191). The groups were determined by the SES distribution of Ankara as determined by the 2000 census. Each participant was investigated with a questionnaire consisting of demographic characteristics, physical activity level (24-h record), and dietary intake (24-h recall) by dietetics interns. Body weight, height, waist, and hip measurements were taken. Results: Dietary protein, fat and carbohydrate intakes and their respective percentages of total energy were significantly different among the SES groups (P < 0.05). Based on the detailed dietary fat analysis, saturated and monounsaturated fatty acid intakes were highest in group 1, polyunsaturated fatty acids intake and ω-6:ω-3 ratio was highest in group 3 (P < 0.05). Body mass index, waist to hip ratio, and physical activity expenditure differed significantly between groups (P < 0.05). Conclusion: SES seems to be associated with dietary fat, fatty acid intake, and ω-6:ω-3 ratio. Thus, to maintain proper dietary balances, SES should be also verified in conjunction with the dietary modifications.

Clinical and socio-demographic profile of an Australian multi-institutional prostate cancer cohort

Aims: To describe the clinical and socio-demographic data from a South Australian prostate cancer cohort (PCCOD). Methods: Clinical data for 2329 prostate cancer patients treated at three South Australian teaching hospitals between 1998 and 2007 were analyzed by place of residence, time of diagnosis and socioeconomic status (SES). χ2 tests were used to investigate differences in stage, grade and prostate-specific antigen (PSA) at diagnosis, among subgroups and over time. Logistic regression was used to examine predictors of treatment modalities. Five-year survival was assessed using Kaplan–Meier methods. Results: The distributions of age, SES and place of residence of PCCOD patients closely reflected those of the state-based prostate cancer population, with rural patients slightly underrepresented. Lower SES or rural residence was not associated with higher stage, grade, PSA level or disease-specific survival. Treatment modalities varied with SES (for radical prostatectomy), rural residence (radical prostatectomy, radiotherapy and androgen ablation), age and clinical characteristics. There was a trend over time towards a younger age at diagnosis and more favorable clinical profiles, consistent with earlier diagnosis. However, the current risk profile for this cohort is similar to that reported approximately a decade earlier in a US series. Conclusion: PCCOD patients have a broadly similar socio-demographic profile to prostate cancer patients statewide. Socioeconomic status is not associated with clinical characteristics at diagnosis, but does predict treatment type. The clinical characteristics of the cohort are consistent with a much later stage presentation than reported in current US case series.

Transfer Access from Community Colleges and the Distribution of Elite Higher Education

admissions practices of the most highly selective colleges and universities of the United States are under scrutiny for their failure to enroll poor and working-class students (Douthat, 2005; Karabel, 2005; Klein, 2005). This negative attention has been spearheaded by findings reported in two important books examining the shortage of low-income students at the pinnacle of American higher education, Equity and Excellence in Higher Education by William Bowen, Martin Kurzweil, and Eugene Tobin (2005) and America's Untapped Resource: Low-Income Students in Higher Education, edited by Richard Kahlenberg (2004), as well as by research articles (e.g. Winston & Hill, 2005). In a chapter in the Kahlenberg text, for example, Carnevale andRose reported that only 3% of freshmen entering 146 highly selective institutions in 1992 came from the lowest quartile of a socioeconomic status (SES) index and about 10% came from the entire bottom half of the SES distribution (2004, p. 106). Demonstrating a highly skewed distribution of access, nearly three fourths (74%) of students enrolled at these institutions come from the highest SES quartile. Contributing further attention to the lack of socioeconomic diversity at elites, Thomas Mortenson of the Pell Institute for the Study of Opportunity in Higher Education began ranking prestigious schools according to their success or failure in enrolling financially needy students, as indicated by the proportion of the student body receiving federal Pell grants (Fischer, 2006a). findings of these studies have been widely reported (see, for example, Fischer, 2006a; Gose, 2005; Hong, 2005; Selingo & Brainard, 2006), inspiring headlines such as The chorus grows louder for class-based affirmative action (Gose, 2005). controversy raises substantial questions about the way in which valuable educational resources are distributed and the definitions of merit that prevail when elite institutions choose among numerous qualified candidates. Family affluence clearly affects what type of college a student attends or whether they go to college at all. This is shown, for example, by differences in college participation by high-and low-income students with medium-high preparedness--in other words, those who are not at the top of their class but are well qualified for college. Only 3% of wellqualified students from high-income families did not attend college, in comparison to 13% of those from low-income families. Well-qualified students from high-income families were also much more likely to attend a high-priced college than were their low-income peers (52% vs. 20%) (Hoxby, 2000, cited in Bowen et al., 2005, p. 87). Socioeconomic inequalities in college enrollments raise troubling issues for education in a democratic society. Providing students with the opportunity to enroll at a college appropriate for their level of academic ability, regardless of family circumstances, is a cornerstone of higher education policy (Bowen et al., 2005; Kahlenberg, 2004; St. John, 2003). Maintaining this commitment has become more challenging as per capita government funding for college operating subsidies and low-income student aid has declined (Archibald & Feldman, 2006; Trends in Student Aid, 2006; Weerts & Ronca, 2006). As the returns to a college degree have increased, so has demand (Education Pays, 2006), particularly for spots at highly selective colleges, whose graduates enjoy an even higher earnings premium than others (Eide, Brewer, & Ehrenberg, 1998). Students at elite colleges enjoy additional benefits as well, including a greater likelihood of degree completion and greater access tograduate and professional study (Carnevale & Rose, 2004). These benefits have spawned intense competition for enrollment at highly selective colleges, and the recent increases in socioeconomic inequities in access (Astin & Oseguera, 2004) suggest that upper-income students have successfully utilized their numerous advantages to win this competition. …

The Impact of Race and Socioeconomic Status (SES) on Survival in Non-Hodgkin's Lymphoma (NHL): A Population-Based Study from the California Cancer Registry (CCR).

Background: Despite the existence of well-established clinical prognostic indices for diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), the 2 most common subtypes of NHL, significant heterogeneity in survival remains even within prognostic groups. SES has not previously been evaluated as a prognostic factor for NHL, particularly using an unselected patient population. We therefore used the large multiethnic CCR to examine NHL survival according to histology, race/ethnicity and neighborhood SES.Methods: NHL pts were identified from the CCR for the period 1988–97 using standardized ICD-0-3 classifications (morphology codes 9690–99 for FL & 9680–84 for DLBCL). Patients with evidence of HIV/AIDS were excluded. Neighborhood SES was assigned based on the address of residence at diagnosis, according to 1990 US Census Bureau census block group (each block contains about 1500 residents), and is based upon principal components of 7 indicator variables of SES (education level, proportion with blue collar job, proportion unemployed, median household income, proportion below 200% of poverty line, median rent & median home value). Using this index, we assigned each patient into an SES quintile (SES-1 lowest, SES-5 highest) based on the statewide distribution of neighborhood SES. We computed 5-year relative survival ± standard error (SE) with SEER*Stat software using customized race and SES-specific life tables based on US Census Bureau estimates for California residents.Results: Unselected DLBCL pts [n=13,604; comprising 73% non-Hispanic White (W), 4% Black (B), 14% Hispanic (H), 8% Asian/Pacific Islander (A)] & FL pts (n=7372; 82% W, 3% B, 11% H, 4% A) were identified. The overall 5 yr relative survival for DLBCL was 45.5% (SE 0.5) and for FL was 71.1% (SE 0.6); females had a better survival than males for DLBCL [F 48.3% (SE 0.7) vs. M 42.3% (SE 0.6)] but not for FL. Lower SES was associated with inferior survival for both DLBCL & FL (Table 1). Within SES groups there were not significant racial/ethnic differences in survival. However, in DLBCL, B (34%) and H (33%) pts were proportionally more likely to be in SES-1 than W (9%) or A pts (15%), and less likely to be in SES-5 (9% B, 10% H) than W (27%) or A (22%) pts. Similarly, in FL, B (39%) & H (26%) pts were also more likely than W (8%) & A (10%) pts to be in SES-1 and less likely to be in SES-5 (W-29%, A-32%, B-10%, H-11%).Conclusion: SES predicts survival in DLBCL and FL. Race/ethnicity differences in SES distribution are apparent in NHL patients, but when stratified by SES, race/ethnicity does not appear to predict for significant differences in NHL survival.5 Year Relative Survival in DLBCL & FL by SES & RaceSES-1 (%)SE (%)nSES-5 (%)SE (%)nDLBCL40.61.3190549.41.03192W38.41.991549.41.12701A44.04.216848.23.5244B45.04.218554.37.351H41.62.163748.94.0196FL66.42.182376.61.21959W66.32.750277.11.21753A65.410.03072.05.093B69.16.58576.110.022H65.93.820671.85.491W-non-Hispanic White; A-Asian/Pacific Islander; B-Black; H-Hispanic

High Socioeconomic Status (SES) Is Associated with Superior Survival in Patients with Acute Myeloid Leukemia (AML) and Multiple Myeloma (MM). A Population-Based Study.

Introduction The association between SES and survival in MM and AML has not been studied in detail and the limited results are inconclusive. In the present study the impact of SES on survival was analyzed in a large population-based cohort of MM and AML patients.Patients and Methods From the Swedish Cancer Register we identified all individuals diagnosed with MM and AML between 1973 and 2003. We used type of occupation, combined into seven groups (blue-collar worker, farmer, lower white-collar worker, higher white-collar worker, self-employed, retired, and unknown), from the Swedish National Census Databases as a proxy for SES. The relative risk of death (any cause) in relation to type of occupation and calendar period was estimated using Cox's proportional hazards regression adjusted for age, sex, calendar period and area of residence. We also conducted analyses stratified by calendar period (1973–1979, 1980–1989, 1990–1999, and 2000–2003).Results A total of 14,200 and 8,831 patients were diagnosed with MM and AML, respectively. The median age at diagnosis was 71.8 years in patients with MM and 69.1 years in AML. The SES distribution was similar between the two diseases. The majority of patients were blue-collar (38.0; 39.5%) and white-collar workers (36.4; 37%), with lower white-collar workers dominating the latter group. Women had a significantly lower mortality than men both among MM (p<0.001) and AML (p<0.05) patients. The mortality among patients diagnosed in more recent calendar periods was lower than among patients diagnosed earlier (p<0.001) Overall, higher white-collar workers had a significantly lower mortality compared to blue-collar workers for both MM (p<0.001) and AML (p<0.001). No significant differences were found between the other SES groups. In MM, analyses stratified by calendar period revealed that the mortality did not differ between the SES groups in the first two calendar periods, but in the third calendar period, 1990–1999, both higher and lower white-collar workers had a significantly lower mortality compared to blue collar workers, hazard ratios (HR) 0.85 (95% CI, 0.75–0.96) and 0.91 (95% CI 0.85–0.98), respectively. In the fourth period the mortality followed the same pattern as in the third period with lower mortality among both higher [HR 0.66 (95% CI, 0.50–0.88)] and lower [HR 0.82 (95% CI, 0.69–0.96)] white-collar workers. In AML patients no difference in mortality in relation to SES was found during the first calendar period. During the last three periods, however, a lower mortality was observed in higher white-collar workers compared to blue-collar workers, HR: 0.79 (0.66–0.95), 0.79 (0.67–0.93) and 0.74 (0.57–0.96) in the periods 1980–1989, 1990–1999 and 2000–2003, respectively.Conclusion SES, here defined as occupational profession, was significantly associated with prognosis in both MM and AML. Most conspicuously, a lower mortality was recorded in white-collar workers during more recent calendar periods. Differences in time to diagnosis (lead-time bias) and treatment strategies may be important factors contributing to this finding. Future studies may identify the relative impact of these and potentially other factors.