Socioeconomic Status Indicators Research Articles

Association Between Socioeconomic Status and Prevalence of Hypersensitivity Diseases and Autism: A Nationwide Study of Children.

Prior research suggests that children with a low socioeconomic status (SES) background are at an increased risk for special healthcare needs. Conversely, for hypersensitivity-related diseases, many studies reported a lower risk among children with lower SES according to the hygiene hypothesis. We aimed to evaluate the association between SES and several hypersensitivity diseases and autism in a representative American sample. We used data from the 2016, 2017 and 2018 US National Survey of Children's Health. A total of 102,341 children aged 0-17 years were included. The dependent variables were doctor-diagnosed allergies, arthritis, asthma, diabetes, and autism. The main SES indicators were family poverty levels, highest education of the reported adults and difficulty in family income. Our analysis used logistic regression that accounted for the survey sampling design. The sample had a mean age of 9.4 ± 5.3 years. The weighted prevalence for allergies was 24.4%, 0.3% for arthritis, 11.9% for asthma, 0.5% for diabetes and 2.6% for autism. Children with adults reporting higher educational levels had greater odds of allergies (adjusted odds ratio and 95% CI: 1.48, 1.23-1.78) than those with lower educational levels. But for all other diseases, most findings suggested that a higher odds of disease was associated with lower SES instead of higher SES. A low SES background remains an important risk factor for hypersensitivity diseases in children. Most of our results suggested that children with low SES were associated with a higher risk of hypersensitivity diseases and autism.

Non-alcoholic fatty liver disease and socioeconomic determinants in an Iranian cohort study

BackgroundNon-alcoholic fatty liver disease (NAFLD) is widespread worldwide. On the other hand, social inequality and socioeconomic status (SES) can affect all aspects of health. Therefore, this study aimed to investigate the relationship between SES indicators and NAFLD.MethodsThis was a cross-sectional study using data from the registration phase of the Hoveyzeh Cohort Study, which included 10,009 individuals aged 35–70 years from May 2016 to August 2018. Fatty liver disease was determined based on Fatty Liver Index (FLI). The crude and adjusted odds ratios were calculated by logistic regression analysis to estimate associations between the fatty liver index and SES after controlling the potential confounders.ResultsAccording to the FLI index, there were 2,006 people with fatty liver (28%) and 5,246 people without fatty liver (72%). Several 4496 people (62%) were women. The chi-square test showed significant relationships between the educational level and skill level (P < 0.001), the wealth index (P < 0.001), and Townsend Index (P < 0.001) with fatty liver index. In multivariable analysis, after adjustment for age, sex, physical activity, smoking, type of residence, calorie intake, dyslipidemia, skill level, and diabetes, the wealth index (p < 0.001) was positively associated with the fatty liver index. Besides, a reverse and significant association was seen between the Townsend index and the fatty liver index(p < 0.001). In contrast, no significant associations were seen between gender and educational level with the fatty liver index.ConclusionsA more vulnerable SES is associated with NAFLD. Fatty liver index and socioeconomic indicators can be powerful monitoring tools to monitor health differences in diagnosing NAFLD.

Educational Attainment and Cancer Incidence in a Large Nationwide Prospective Cohort.

Educational attainment is a social determinant of health and frequently used as an indicator of socioeconomic status. Educational attainment is a predictor of cancer mortality, but associations with site-specific cancer incidence are variable. The aim of this study was to evaluate the association of educational attainment and site-specific cancer incidence adjusting for known risk factors in a large prospective cohort. Men and women enrolled in the American Cancer Society's Cancer Prevention Study-II Nutrition Cohort who were cancer free at baseline were included in this study (n = 148,965). Between 1992 and 2017, 22,810 men and 17,556 women were diagnosed with incident cancer. Cox proportional hazards regression models were used to estimate age- and multivariable-adjusted risk and 95% confidence intervals of total and site-specific cancer incidence in persons with lower versus higher educational attainment. Educational attainment was inversely associated with age-adjusted cancer incidence among men but not women. For specific cancer sites, the multivariable-adjusted risk of cancer in the least versus most educated individuals remained significant for colon, rectum, and lung cancer among men and lung and breast cancer among women. Educational attainment is associated with overall and site-specific cancer risk though adjusting for cancer risk factors attenuates the association for most cancer sites. This study provides further evidence that educational attainment is an important social determinant of cancer but that its effects are driven by associated behavioral risk factors suggesting that targeting interventions toward those with lower educational attainment is an important policy consideration.

Racial and Ethnic Variation in ECMO Utilization and Outcomes in Pediatric Cardiac ICU Patients

BackgroundPrevious studies have reported racial disparities in extracorporeal membrane oxygenation (ECMO) utilization in pediatric cardiac patients. ObjectivesThe objective of this study was to determine if there was racial/ethnic variation in ECMO utilization and, if so, whether mortality was mediated by differences in ECMO utilization. MethodsThis is a multicenter, retrospective cohort study of the Pediatric Cardiac Critical Care Consortium clinical registry. Analyses were stratified by hospitalization type (medical vs surgical). Logistic regression models were adjusted for confounders and evaluated the association between race/ethnicity with ECMO utilization and mortality. Secondary analyses explored interactions between race/ethnicity, insurance, and socioeconomic status with ECMO utilization and mortality. ResultsA total of 50,552 hospitalizations from 34 hospitals were studied. Across all hospitalizations, 2.9% (N = 1,467) included ECMO. In medical and surgical hospitalizations, Black race and Hispanic ethnicity were associated with severity of illness proxies. In medical hospitalizations, race/ethnicity was not associated with the odds of ECMO utilization. Hospitalizations of other race had higher odds of mortality (adjusted odds ratio [aOR]: 1.61; 95% CI: 1.22-2.12; P = 0.001). For surgical hospitalizations, Black (aOR: 1.24; 95% CI: 1.02-1.50; P = 0.03) and other race (aOR: 1.50; 95% CI: 1.17-1.93; P = 0.001) were associated with higher odds of ECMO utilization. Hospitalizations of Hispanic patients had higher odds of mortality (aOR: 1.31; 95% CI: 1.03-1.68; P = 0.03). No significant interactions were demonstrated between race/ethnicity and socioeconomic status indicators with ECMO utilization or mortality. ConclusionsBlack and other races were associated with increased ECMO utilization during surgical hospitalizations. There were racial/ethnic disparities in outcomes not explained by differences in ECMO utilization. Efforts to mitigate these important disparities should include other aspects of care.

Socioeconomic Status of the Family as a Determinant of Family-School Cooperation

Many factors on both the family and the school parts determine family-school cooperation. This paper presents the research results aimed at finding the relationship between family socioeconomic status and teacher cooperation at the primary level of education. The research findings present how parents rate their current cooperation with teachers at the primary level of education. The article also highlights whether there is a statistically significant association between parents' education, occupation, income and their satisfaction with the cooperation with the teacher. The research instrument was a questionnaire addressed to parents of children in primary education. The research findings were evaluated with mathematical-statistical methods: Pearson's chi-squared test, Kolmogorov-Smirnov test, and Kruskal-Wallis’ test. The research has shown that indicators of family socioeconomic status (education, income and occupation) do not differentially affect the evaluation of family-school cooperation, which was demonstrated by statistical analysis of research findings. Parents, regardless of their socioeconomic status (SES), expressed a positive attitude towards the class teacher, their satisfaction with cooperation, and perceived teachers' efforts to develop cooperation with the child's parents. Parent-teacher cooperation impacts the child's functioning in the institutional education setting. It is of particular importance at the primary level of education. It influences the process of adaptation of students to the school environment at the beginning and later their learning success and relationship to the school.

Racial Disparities in Survival of Patients with High-Risk LA SCCHN in the U.S.

Approximately 50-67% of patients with squamous cell carcinomas of the head and neck (SCCHN) present with locally advanced (LA) disease. Human papillomavirus (HPV) associated SCCHN has improved survival compared to non-HPV SCCHN. Studies have analyzed racial disparities in LA SCCHN but few have adjusted for HPV status and socio-economic status (SES). Our objective was to characterize disparities in LA SCCHN. We identified high-risk patients from 2010-2017 with AJCC v8 Stage IVA/IVB SCCHN of the oral cavity, oropharynx (OP), larynx or hypopharynx, or Stage III SCCHN of the OP in the Surveillance, Epidemiology, and End Results (SEER) with HPV Status and Census Tract-level SES/Rurality Combined Database. We excluded OP patients with missing HPV data. SEER-reported treatment was used to classify initial treatment as definitive therapy (DT) categories: surgical DT, non-surgical DT or non-DT. The Kaplan Meier method was used to estimate overall survival (OS) with 95% confidence intervals (CI). Multivariable cox proportional hazard models were used for associations between covariates and hazard ratio (HR) of death, adjusted for age, sex, race, ethnicity, DT category, marital status, rurality, tumor size, cancer stage, and HPV status. We explored the impact of additionally adjusting for Yost SES index quintiles. We identified 17,818 eligible patients: 79.3% White, 14.4% Black, 5.8% Asian/Pacific Islander (A/PI), and 0.6% American Indian/Alaska Native (AI/AN). Primary tumor sites were oral cavity (36.8%), larynx (29.0%), OP (24.4%), and hypopharynx (9.9%). 10.4% were HPV-associated. Race and SES quintiles were related (chi-squared, p<0.001) and the majority (56.5%) of black patients were in the lowest SES quintile. mOS was shorter and risk of death was significantly higher for black vs white patients in both the all-site and OP-only cohorts. When we added SES to multivariable analyses, Black race was no longer associated with increased risk of death in the all-site or OP-only cohorts. (Table 1) CONCLUSION: We found that when adjusting for sociodemographic and clinical factors, Black race was independently associated with a higher risk of death compared to white patients. When we adjusted for SES in multivariable analysis the association between Black race and risk of death was no longer significant, consistent with previously published analyses and indicative of a complex relationship between race and SES. Further research is needed to identify and address the causative factors of disparities in LA HNSCC.

Very Early-Life Risk Factors for Developing Dementia: Evidence From Full Population Registers.

Very early-life conditions are recognized as critical for healthy brain development. This study assesses early-life risk factors for developing dementia. In the absence of historical medical birth records, we leverage an alternative full population approach using demographic characteristics obtained from administrative data to derive proxy indicators for birth complications and unfavorable birth outcomes. We use proxy variables to investigate the impact of early-life risk factors on dementia risk. We use administrative individual-level data for full cohorts born 1932-1950 in Sweden with multigenerational linkages. Records on hospitalization and mortality are used to identify dementia cases. We derive 3 birth risk factors based on demographic characteristics: advanced maternal age, narrow sibling spacing, and twin births, and apply survival analysis to evaluate long-term effects on dementia risk. We control for confounding using multiple indicators for socio-economic status (SES), including parental surnames, and by implementing a sibling design. As comparison exposure, we add low education from the 1970 Census. The presence of at least 1 birth risk factor increases dementia risk (HR = 1.059; 95% CI: 1.034, 1.085). The occurrence of twin births poses a particularly heightened risk (HR = 1.166; 95% CI: 1.084, 1.255). Improvements to the very early-life environment hold significant potential to mitigate dementia risk. A comparison to the influence of low education on dementia (the largest known modifiable risk factor) suggests that demographic birth characteristics are of relevant effect sizes. Our findings underscore the relevance of providing assistance for births experiencing complications and adverse health outcomes to reduce dementia cases.

Inequality in the golden years: Wealth gradients in disability-free and work-free longevity in the United States

We study the relationship of wealth with the “quality” of longevity as measured by years after age 65 containing disability or work. By comparing cohorts turning 65 in 1996 and 2006, we observe strong within-cohort gradients of wealth in which the more wealthy live more years disability-free and work more years, yet also experience more work-free years. We document that these gradients steepened over the decade we study. We explore robustness using education as an alternative indicator for socioeconomic status, and rule out certain explanations for these trends by analyzing the effect of health shocks on wealth accumulation.

Changes in Students' Perceptions Regarding Adolescent Vaccinations through a Before-After Study Conducted during the COVID-19 Pandemic: GIRASOLE Project Study.

The COVID-19 pandemic caused a reduction in vaccination coverage for all age groups, especially in non-infant age. The main objective of the present study is to evaluate the effectiveness of an online intervention conducted among adolescents during the COVID-19 pandemic in increasing knowledge and positive attitudes toward vaccinations. The study, which took place online from March to May 2021, involved 267 students from six lower secondary schools in Palermo city (Italy); they filled out the questionnaire before and after the intervention. The questionnaire was based on the protection motivation theory (PMT), which estimates the improvement in vaccination-related knowledge and attitudes. The pre- and post-intervention comparison showed a significant increase in the perception of the disease severity: strongly agree pre-intervention n = 150 (58.6%) and post-intervention n = 173 (67.6%, p < 0.001), rated on a five-point Likert scale. In a multivariate analysis, the factor associated with the improvement in the score after the intervention was the school dropout index (low vs. very high dropout index OR 4.5; p < 0.03). The educational intervention was more effective in schools with lower early school leaving rates, an indirect index of socio-economic status. The topic of vaccination has caught the adolescents' attention, it is, therefore, important that interventions tackling teenagers are tailored to reduce their emotional tension about the perception of adverse effects and improve vaccination coverage.

Using a validated instrument to assess pregnancy planning and preconception care at antenatal booking visits: a retrospective cohort study.

To determine the completion rate for the London Measure of Unplanned Pregnancy (LMUP), a psychometrically validated measure of a woman's intention with regard to a current or recent pregnancy, during booking visits at two metropolitan antenatal care clinics; to identify socio-demographic characteristics associated with unplanned pregnancy. Retrospective cohort study; analysis of LMUP data for women attending antenatal care booking consultations as public patients in the Sydney Local Health District, 31 December 2019 - 30 November 2020. Proportions of women with LMUP scores indicating unplanned (0-9) or planned pregnancies (10-12); associations between planned pregnancy and socio-demographic characteristics, crude and adjusted for age, parity, and socio-economic status (Index of Relative Socioeconomic Disadvantage). Of 4993 women with antenatal care bookings, the LMUP was completed by 2385 (47.8%; 1142 of 3564 women at the tertiary referral hospital [32.0%], 1118 of 1160 at the secondary hospital [96.3%]). Planned pregnancies were indicated by the total LMUP scores of 1684 women (70.6%); 1290 women (59.1%) reported no health actions in preparation for pregnancy. In multivariable analyses, planned pregnancies were more likely in all age groups than for women aged 24 years or younger (30-34 years: adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.76-3.66; 35-39 years: aOR, 2.91; 95% CI, 1.95-4.33). The likelihood of planned pregnancy declined with increasing parity (v no previous births: three previous births: aOR, 0.25; 95% CI, 0.16-0.40; four or more previous births: aOR, 0.10; 95% CI, 0.05-0.19). Seven in ten women who completed the LMUP had planned their pregnancies, but fewer than half had undertaken health-related actions prior to conceiving. Higher parity was associated with unplanned pregnancy, indicating the importance of postpartum contraception advice. Overcoming barriers to implementing the LMUP more widely would enhance preconception health monitoring.

The association between material-psychological-behavioral framework of financial hardship and markers of inflammation: a cross-sectional study of the Midlife in the United States (MIDUS) Refresher cohort

BackgroundMeasures of financial hardship have been suggested to supplement traditional indicators of socioeconomic status (SES) to elucidate household economic well-being. This study formally tested the construct validity of financial hardship and examined its association with markers of inflammation.MethodsThis study utilized data from the Midlife Development in the United States Refresher Study (MIDUS-R; Age = 23-76, 53.7% female, 71% white). Participants were divided into exploratory factor analysis (EFA; completed SAQs only; N = 2,243) and confirmatory factor analysis sample (CFA; completed SAQs and biomarker assessment; N = 863). Analysis was divided into three steps. First, exploratory factor analysis (EFA) is used to examine if the three-domain factor (material, psychological, and behavioral) is the best fitting model for financial hardship measures. Second, we conducted CFA to test the hypothesized three-factor measurement model of financial hardship. Third, we tested the association between domains and the general latent factor of financial hardship and inflammation (interleukin 6/IL6, c-reactive protein/CRP, and fibrinogen).ResultsResults from EFA supported the three-domain model of financial hardship. The hypothesized three-domain measurement model fits well in a different sample within MIDUS-R. In the models adjusted for age and sex, higher material hardship was associated with elevated IL6, CRP, and fibrinogen, while higher behavioral hardship was associated with higher CRP. The association between the material domain and IL6 remained significant after adding body mass index, education, and race as additional covariates. The second-order financial hardship measurement model was associated with IL6, CRP, and fibrinogen, adjusted for age, sex, BMI, education, and race.ConclusionExplicating the socioeconomic environment to include indicators of financial hardship can help researchers better understand the pathway between SES and the inflammation process, which may help elucidate pathways between SES and age-related chronic diseases associated with inflammation.

The distribution of registered occupational therapists, physiotherapists, and podiatrists in Australia.

In Australia, the distribution of occupational therapists, physiotherapists, and podiatrists density (per 10,000 population) by measure of location/rurality, usual resident population, and area-level socioeconomic status has not been described. To describe the national as well as states-and territories-wide distribution of registered allied health workforce-occupational therapists, physiotherapists, and podiatrists-by measures of rurality and area-level socioeconomic position in Australia. A linked data study that brings together (1) the location of health practitioners' principal place of practice from the Australian Health Practitioner Regulation Agency, (2) a measure of location/rurality-Modified Monash Model (MMM), and (3) an area-level measure of socioeconomic status-Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD). The provider-to-population ratio (i.e., density) of three Australia's allied health workforce (occupational therapists, physiotherapists, and podiatrists) was calculated according to the MMM classifications (i.e., Modified Monash 1-7) and IRSAD quintiles at state and national level. Nationwide, the density of occupational therapists and physiotherapists was highest in metropolitan areas (Modified Monash 1) and decreased with the increasing levels of the MMM categories. The national density of podiatrists was highest in Modified Monash 3 areas. The density of occupational therapists, physiotherapists, and podiatrists was highest in areas with IRSAD quintile 5 (i.e., the highest socioeconomic position) and decreased with the declining levels of the IRSAD quintiles nationwide. Moreover, there were notable disparities in the density of occupational therapists, physiotherapists, and podiatrists across each state and territory in Australia when stratified by the MMM classifications and IRSAD quintiles. There was uneven distribution of registered occupational therapists, physiotherapists, and podiatrists when stratified by measures of location/rurality and area-level socioeconomic status across Australian jurisdictions. The density of these three groups of allied health workforce tended to be more concentrated in metropolitan and most advantaged areas while remote and most disadvantaged areas exhibited less allied health workforce distribution across each state and territory.

Predictors of milk cortisol in North American women.

Human milk content varies across mother-child dyads, environments, and populations. Among the hormones in milk is cortisol, a glucocorticoid; its impact on the breastfeeding child is unknown. Milk cortisol may constitute a signal to the child's developing physiology which can shape characteristics (e.g., growth, temperament) to prevailing environmental conditions. This exploratory study evaluated the maternal, breastfeeding, and infant characteristics associated with milk cortisol. We evaluated archived milk specimens for cortisol using enzyme immunoassay and employed an information-theoretic approach to assess associations between milk cortisol and participant characteristics with linear regression modeling. Because we employed secondary data, information for some variables likely to impact milk cortisol variation (e.g., time of day, socioeconomic status, maternal or infant body mass index, milk energy density) was unavailable. Participants were 48 lactating mothers from upstate New York, aged 21-40 years. Milk cortisol ranged from 0.098 to 1.007 μg/dL. Child age ranged from 1 to 26 months. In linear regression employing best fit modeling criteria, milk cortisol increased with child age (B: 0.069; p: .000; a 7.1% increase in milk cortisol for each month of child age), while child symptoms of illness (B: -0.398; p: .057; a 33% decrease) and consumption of complementary foods (B: -.525; p: .020; a 41% decrease) were associated with lower milk cortisol. We speculate that increasing milk cortisol with child age plays a role in signaling development (e.g., as increasing independence increases risk for injury and other negative health outcomes), independent of the maternal stressors we could capture.

Community Socioeconomic and Urban-Rural Disparities in Prehospital Notification of Stroke by Emergency Medical Services in North Carolina.

Notification by emergency medical services (EMS) to the destination hospital of an incoming suspected stroke patient is associated with timelier in-hospital evaluation and treatment. Current data on adherence to this evidence-based best practice are limited, however. We examined the frequency of EMS stroke prenotification in North Carolina by community socioeconomic status (SES) and rurality. Using a statewide database of EMS patient care reports, we selected 9-1-1 responses in 2019 with an EMS provider impression of stroke or documented stroke care protocol use. Eligible patients were 18 years old and older with a completed prehospital stroke screen. Incident street addresses were geocoded to North Carolina census tracts and linked to American Community Survey socioeconomic data and urban-rural commuting area codes. High, medium, and low SES tracts were defined by SES index tertiles. Tracts were classified as urban, suburban, and rural. We used multivariable logistic regression to estimate independent associations between tract-level SES and rurality with EMS prenotification, adjusting for patient age, sex, and race/ethnicity; duration of symptoms; incident day of week and time of day; 9-1-1 dispatch complaint; EMS provider primary impression; and prehospital stroke screen interpretation. The cohort of 9527 eligible incidents was mostly at least 65 years old (65%), female (55%), and non-Hispanic White (71%). EMS prenotification occurred in 2783 (29%) patients. Prenotification in low SES tracts (27%) occurred less often than in medium (30%) and high (32%) SES tracts. Rural tracts had the lowest frequency (21%) compared with suburban (28%) and urban (31%) tracts. In adjusted analyses, EMS prenotification was less likely in low SES (vs high SES; odds ratio 0.76, 95% confidence interval 0.67-0.88) and rural (vs urban; odds ratio 0.64, 95% confidence interval 0.52-0.77) tracts. Across a large, diverse population, EMS prenotification occurred in only one-third of suspected stroke patients. Furthermore, low SES and rural tracts were independently associated with a lower likelihood of prehospital notification. These findings suggest the need for education and quality improvement initiatives to increase EMS stroke prenotification, particularly in underserved communities.

Long-term exposure to summer specific humidity and cardiovascular disease hospitalizations in the US Medicare population

IntroductionMost climate-health studies focus on temperature; however, less is known about health effects of exposure to atmospheric moisture. Humid air limits sweat evaporation from the body and can in turn exert strain on the cardiovascular system. We evaluated associations of long-term exposure to summer specific humidity with cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CBV) hospitalization. MethodsWe built an open cohort consisting of ∼63 million fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US (2000–2016). We assessed zip code level summer average specific humidity and specific humidity variability, based on daily estimates from the Gridded Surface Meteorological dataset (∼4km spatial resolution). To estimate associations of summer specific humidity with first CVD, CHD, and CBV hospitalization, we used Cox-equivalent Poisson models adjusted for individual and area-level socioeconomic status indicators, temperature, and winter specific humidity. ResultsHigher summer average specific humidity was associated with an increased risk of CVD, CHD, and CBV hospitalization. We found hazard ratios (HRs) of 1.07 (95%CI: 1.07, 1.08) for CVD hospitalization, 1.08 (95%CI: 1.08, 1.09) for CHD hospitalization, and 1.07 (95%CI: 1.07, 1.08) for CBV hospitalization per IQR increase (4.0 g of water vapor/kg of dry air) in summer average specific humidity. Associations of summer average specific humidity were strongest for beneficiaries eligible for Medicaid and for beneficiaries with an unknown or other race. Higher summer specific humidity variability was also associated with increased risk of CVD, CHD, and CBV hospitalization. Associations were not affected by adjustment for temperature and regions of the US, as well as exclusion of potentially prevalent cases. ConclusionLong-term exposure to higher summer average specific humidity and specific humidity variability were positively associated with CVD hospitalization. As global warming could increase humidity levels, our findings are important to assess potential health impacts of climate change.

To Investigate the Correlation Between the Socioeconomic Status and Cardiometabolic Associated Risk Indicator Among Middle Aged Adults in Selected Sub-Counties in Kisumu County in Nyanza Region in Kenya

The prevalence of Cardio- metabolic associated risk indicators are known to vary significantly across the world (Huh et al., 2019). Study design. This was a cross-sectional quantitative study on correlation between socioeconomic and cardio metabolic associated risk indicators among Residents in selected sub counties in Kisumu county Nyanza region in Kenya. It involved the determination of five indicators of cardio metabolic disorders, which included; general obesity (BMI), central obesity (waist: hip ratio), blood pressure (SBP and DBP), dyslipidemia (Lipid profile) among the residents. Results. Our study showed a strong association between BMI, WC and hypertension in the study population. These findings are in agreement with other studies that also reported an association between hypertension and prehypertension, BMI and WC as well as diabetes (hypertension 19.4%, obesity 44%, hyperglycemia 21.8% and dyslipidemia 14.9%)

Neighborhood Disadvantage, African Genetic Ancestry, Cancer Subtype, and Mortality Among Breast Cancer Survivors.

Racial disparities in breast cancer (BC) survival arise from multilevel causes, which may exert influence at different stages of BC progression. Clarifying the importance of genetic and social factors could help prioritize interventions. To jointly examine associations between African genetic ancestry, social environment, and mortality from any cause and BC in Black BC survivors. This population-based cohort study enrolled self-identified Black women aged 20 to 75 years with histologically confirmed BC from June 2005 to May 2019 and followed them up until death or censoring in September 2021. Participants lived in 10 New Jersey counties. Data were analyzed between December 2022 and April 2023. A neighborhood socioeconomic status (nSES) index composed of census tract measures (education, income, wealth, employment status, and occupation) was linked to residential addresses at diagnosis. Percentage African ancestry was estimated using the ADMIXTURE program. Sequentially adjusted (age adjusted: age and interview year; fully adjusted: age adjusted with individual SES, lifestyle factors, and comorbidities) logistic regression models were fit to estimate associations with tumor subtypes (estrogen receptor-negative [ER-] vs estrogen receptor-positive [ER+]; triple-negative breast cancer [TNBC] vs luminal A), and Cox models were fit for associations with all-cause mortality (ACM) and breast cancer-specific mortality (BCSM). Models for BCSM were fit using Fine-Gray competing risks models, and robust standard errors were used to account for census tract-level clustering. Among 1575 participants, median (IQR) African ancestry was 85% (76%-90%), and median (IQR) age was 55 (46-63) years. A 10-percentage point increase in African ancestry was associated with higher odds of ER- vs ER+ (adjusted odds ratio [aOR], 1.08; 95% CI, 0.98-1.18) and TNBC vs luminal (aOR, 1.15; 95% CI, 1.02-1.31) tumors, but not with ACM or BCSM. A 1-IQR increase in nSES was associated with lower ACM (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.63-0.93), and the HR for BCSM was less than 1 but not statistically significant (aHR, 0.81; 95% CI, 0.62-1.04) in age-adjusted models, but associations attenuated following further adjustment for potential mediators (individual SES, lifestyles, comorbidities). In this cohort study of Black female BC survivors, higher African ancestry was associated with aggressive tumor subtypes. Compared with genetic ancestry, mediating pathways related to social environments may be more important for survival in these patients.

Despite popular intuition, positive world beliefs poorly reflect several objective indicators of privilege, including wealth, health, sex, and neighborhood safety.

We tested whether generalized beliefs that the world is safe, abundant, pleasurable, and progressing (termed "primal world beliefs") are associated with several objective measures of privilege. Three studies (N = 16,547) tested multiple relationships between indicators of privilege-including socioeconomic status, health, sex, and neighborhood safety-and relevant world beliefs, as well as researchers and laypeople's expectations of these relationships. Samples were mostly from the USA and included general population samples (Study 2) as well as focused samples of academic researchers (Study 1) and people who had experienced serious illness or trauma (Study 3). Studies 1-2 found mostly negligible relationships between world beliefs and indicators of privilege, which were invariably lower than researcher predictions (e.g., instead of the expected r = 0.33, neighborhood affluence correlated with Abundant world belief at r = 0.01). Study 3 found that people who had experienced serious illness (cancer, cystic fibrosis) only showed modest differences in beliefs from controls. While results do not preclude that some individuals' beliefs were meaningfully affected by life events, they imply that such changes are smaller or less uniform than widely believed and that knowing a person's demographic background may tell us relatively little about their beliefs (and vice versa).

Socioeconomic status and cecal adenocarcinoma mortality risk: an American population-based analysis

To explore the relationship between socioeconomic status (SES) and disease mortality in patients with cecal adenocarcinoma in America through the Surveillance, Epidemiology, and End results (SEER) database. The SEER database was queried for patients with cecal adenocarcinoma in America diagnosed from 2011 to 2015. Factor analysis, cluster analysis, and univariate and multivariate Cox proportional hazard models were used for data analysis. Five social security factors were identified: factor 1, economic and educational disadvantage; factor 2, characteristics related to immigration (language isolation and foreign birth); factor 3, high relocation rate in the county; factor 4, high intra-state relocation rate; and factor 5, high domestic relocation rate. Five clusters defined by SES were identified. The number of all-cause deaths among 17 185 patients was 5948, and the number of survivors was 11, 237. In the multivariate Cox regression analysis, with cluster 1 (low poverty rate and high education level) as the reference, the hazard ratio (HR) of cluster 3 (high intra-county mobility rate) was 1.13 (95% CI: 1.04-1.21, P < 0.05), and the risk was 13% higher than that of cluster 1. The HR of cluster 4 (low language isolation, foreign birth, housing overcrowding, and intra-country mobility rates) was 1.15 (95% CI: 1.07- 1.24, P < 0.001) with a 15% higher risk than cluster 1. The HR of cluster 5 (economic and educational disadvantages, immigration-related characteristics, and low intra-country mobility) was 1.11 (95% CI: 1.03-1.20, P < 0.01) with a 11% higher risk. The factors related to SES indicators were based on the mortality of patients with cecal adenocarcinoma, indicating that low economic and education levels are risk factors for cecal adenocarcinoma. Low socioeconomic status is associated with an increased risk of death in patients with cecal adenocarcinoma in the United States and show different distribution patterns based on population. Improving health insurance policies and strengthening psychotherapy can provide guidance for improving prognosis f cecal adenocarcinoma patients.

Association Between Neighborhood Deprivation and Child Cognition in Clinically Referred Youth.

When socioeconomic status is measured at the individual and/or family level, it has long been associated with cognition in children. However, the association between neighborhood deprivation, an index of community-level socioeconomic status, and child cognition is not fully understood. The goal of this study was to investigate (1) the relationship between neighborhood deprivation and child cognitive functioning and (2) whether child age moderates the relationship between cognitive functioning and neighborhood deprivation. This study included 9878 children, ages 3 through 17 years (M = 10.4 yrs, SD = 3.4 yrs). Data were gathered from children referred for and evaluated at an urban, outpatient neuropsychology assessment clinic between 2006 and 2022, located in the Mid-Atlantic region of the United States. Neighborhood socioeconomic status was measured at the census block level using the Area Deprivation Index composite. There was a 20-point median difference in overall intelligence between the neighborhoods with the lowest and highest levels of deprivation. Overall intelligence and verbal comprehension, compared with working memory, fluid reasoning, and processing speed, demonstrated the strongest negative association with neighborhood deprivation (all p < 0.05). Older children had lower overall intelligence scores compared with younger children in neighborhoods with high levels of deprivation ( p < 0.01), suggesting a cumulative influence of poverty exposure. This study demonstrates the stark disparities in child cognitive functioning across levels of neighborhood deprivation. Findings support the importance of access to early interventions and services that promote intellectual growth and verbal capacity among children who live in neighborhoods with great deprivation.