Socioeconomic Status Indicators Research Articles

The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change.

Socioeconomic status and parenting-related differences in preschoolers' working memory

The relations between socioeconomic status (SES), parenting-related factors, and children's cognitive ability are well-documented. However, limited research has investigated whether there are interactions between SES and parenting-related factors in their association with children's cognitive performance. In this study, we used an extensive battery of SES and parenting-related measures to examine their association with kindergarten children's working memory (WM). Children (N = 190) were recruited from five kindergartens in Bangkok, Thailand, and were administered three WM tasks. Caregivers completed a questionnaire on their SES, parenting stress, parenting behaviours, and provision of cognitive stimulation. Multiple-indicators-multiple-causes models revealed that income and cognitive stimulation were unique explanatory variables for WM and had greater explanatory power than other SES and parenting-related factors. Several SES indicators interacted with parenting-related factors. Specifically, a negative association between permissive parenting and WM and a positive association between cognitive stimulation and WM were found only among families whose mothers were less educated and among those with less prestigious occupations, respectively. A negative association between parenting stress and WM was found only among the highest-income families and among those with highly educated mothers. These findings underscore the importance of considering the interactive roles of both SES and parenting-related factors on children's cognitive capabilities. These findings provide information on the families that WM interventions should best target. Educational relevance statementThis study highlights the importance of understanding the interplay between family socioeconomic status (SES) and parenting-related factors on kindergarten children's working memory in Thailand. The findings showed that parenting-related variables do not have uniform relations with WM but vary depending on socioeconomic status. Specifically, permissive parenting and cognitive stimulation were only related to WM when mothers were less educated or had less prestigious occupational status. In contrast, parenting stress was associated with WM only among families with the highest income and whose mothers were the most educated. The results suggest that interventions should be customized according to these SES and parenting variables. Less educated parents may benefit from guidance on setting appropriate boundaries, while affluent, highly educated parents may require support in stress management.

A Comparison of Three Area-Level Indices of Neighborhood Deprivation and Socioeconomic Status and their Applicability to Breast Cancer Mortality.

Neighborhood deprivation indices are widely used in research, but the performance of these indices has rarely been directly compared in the same analysis. We examined the Area Deprivation Index, Neighborhood Deprivation Index, and Yost index, and compared their associations with breast cancer mortality. Indices were constructed for Georgia census block groups using 2011-2015 American Community Survey data. Pearson correlation coefficients and percent agreement were calculated. Associations between each index and breast cancer mortality were estimated among 36,795 women diagnosed with breast cancer using Cox proportional hazards regression. The indices were strongly correlated (absolute value of correlation coefficients > 0.77), exhibited moderate (41.4%) agreement, and were similarly associated with a 36% increase in breast cancer mortality. The similar associations with breast cancer mortality suggest the indices measure the same underlying construct, despite only moderate agreement. By understanding their correlations, agreement, and associations with health outcomes, researchers can choose the most appropriate index for analysis.

COGNITIVE AND FUNCTIONAL IMPACTS OF CHILD LABOR IN INDIA: THE MEDIATING ROLE OF EDUCATION

Abstract This study aims to examine how entry into the labor market in childhood is associated with deficits in late-life cognitive and functional health. Using the Cumulative Advantage/Disadvantage Theory, it further explores how educational attainment, an indicator of socio-economic status, mediates the associations between child labor and cognitive and functional health among older adults in India. Lastly, it investigates if the results vary by gender. We use the nationally representative World Health Organization Study on global AGEing and Health (SAGE), and select respondents aged 50 years or older (n = 6,215 for Mini-Mental State Examination (MMSE); n=6,408 for the Functional Limitation (FL)). Mediation models were performed for each dependent variable using the sgmediation2 program, bootstrapped 5,000 resamples, and percentile bootstrap confidence interval. The indirect and total effects of child labor on MMSE were significant, while the direct effect of child labor was not. For FL, the indirect effect was significant, but the direct and total effects were not. Gender difference was found in terms of the direct effect, child work was directly associated with a lower MMSE score in older women (p < .01), whereas it was not significant for older men. Findings suggest that early entry into the labor market (as a child) has a negative impact on older adults’ MMSE and FL through deprivation of educational opportunities. Providing opportunities for completing certain level of education can mitigate the negative impact of child labor on health in old age.

PRESIDENTIAL SYMPOSIUM: BUILDING BRIDGES ACROSS THE SCIENCES TO CATALYZE SLEEP DISPARITIES RESEARCH

Abstract This BSS Presidential Symposium brings together scholars from Sociology, Social and Family Dynamics, Human Development and Family Studies, Occupational Science and Medicine to highlight a multidisciplinary approach to sleep disparities research. Sleep is essential for restoration of healthy brain function, the immune system, and overall physical and emotional well-being. Conversely, sleep deficiencies are associated with a wide range of poor physical and emotional health outcomes, health behaviors and premature mortality. Strong empirical evidence indicates that sleep health is socially patterned, such that minoritized populations are generally more likely to experience sleep disruptions, disorders, and difficulties. These sleep deficiencies are also observed across indicators of socioeconomic status, such as income and educational attainment. Despite documentation of sleep disparities, studies that examine underlying health disparity causal pathways contributing to sleep health disparities are limited. This symposium is aligned with recommended strategies to address sleep health disparities from the National Institutes of Health, including: a) develop and promote integrative research on sleep health disparities, b) investigate the health and social causes and consequences of sleep health disparities, and c) develop multilevel, culturally tailored interventions to address sleep health disparities. By placing people and place at the center of their research, these scholars demonstrate their approach to addressing current research gaps, challenges and opportunities in sleep and health disparities research among middle-aged and older adults that are important to advance this emerging field.

LOWER SOCIOECONOMIC STATUS PREDICTS NEGATIVE PREFERENCES FOR PALLIATIVE CARE

Abstract With an aging US population, more people than ever live with serious illnesses. Although palliative care (PC) can improve outcomes in serious illness, there are inequities in PC utilization. People with low socioeconomic status (SES), men, and Black and Hispanic people are less likely to receive and benefit from PC services. Despite these established demographic differences in PC utilization, there is a dearth of relevant survey research on preferences for PC in the general population. To address this gap, we surveyed a random sample of 1,500 NJ adults. Respondents were given a brief definition of PC and asked to indicate how likely they would be to schedule, attend, and routinely attend PC visit(s) if they were diagnosed with a serious illness. Predictors included in logistic regression modeling were SES indicators (income, educational attainment, insurance status, employment status), gender, and race/ethnicity. Data were weighted to be representative of the population of NJ. Modeling results revealed that lower income and lower educational attainment were associated with significantly lower odds of endorsing willingness to schedule, attend, and routinely attend PC visits in the event that one would become seriously ill. Unexpectedly, there were no gender or race/ethnicity differences in preferences for PC. These findings highlight the importance of public health education for what PC is and its benefits for an aging population, especially among those with lower SES. Future research efforts are needed to understand discrepancies in reported PC preferences versus real-world PC utilization for men and Black and Hispanic individuals.

THE SOCIAL DETERMINANTS OF BRAIN HEALTH: FROM THE SEARCH FOR MECHANISMS TO RECOMMENDATIONS TO INCREASE EQUITY

Abstract Dementia risk has been established to be partly attributable to modifiable social and behavioral risk factors. However, the biological pathways behind these associations and the effects of intervening on present risk factors to reduce dementia risk have not been fully elucidated. The symposium will present latest research on the social determinants of brain health and dementia. We will explore proposed mechanisms between modifiable risk factors and risk of dementia, and present findings on the modifiability of dementia risk through addressing risk factors. Specifically, the first presentation reports analyses testing possible pathways from socioeconomic status, notably childhood and adulthood indicators such as (parental) education and occupation, to cognitive functioning in later mid-adulthood via indicators of brain damage and white matter connectivity with the Maastricht Study. The second presentation reports empirical analyses testing the possible mediating role of the gut microbiome in the relationships between social and modifiable risk factors and Mild Cognitive Impairment with data of the controls of the Luxembourg Parkinson’s Study. The third presentation reports on the associations between hearing loss as a modifiable risk factor and incident dementia in the UK Biobank and investigates the potential to modify hearing loss-associated dementia risk through the use of hearing aids. Lastly, the fourth presentation moves to recommendations for policy and government action. It gives an overview of various fields in which policy and legislation could implement cognitive impact assessments to protect individuals’ cognition, with the aim of improving population brain health and health equity. This is a Brain Interest Group Sponsored Symposium.

Epidemiological profile of intestinal parasites in children under five years of age in Maputo, Mozambique

Intestinal parasites are one of the most sought-after causes in pediatrics. Its occurrence is one of the indicators of socioeconomic status that may be associated with several sociodemographic factors. It is estimated that approximately 50% of the vulnerable population is parasitized with one or more types of parasites, such as children. Considering that this population is essential for human development, the goal of this work was to evaluate the epidemiological profile of intestinal parasites in children up to five years of age in Maputo, Mozambique. To this end, a cross-sectional descriptive study was done with 70 children, through the application of a questionnaire with content related to sociodemographic conditions, clinical profile and identification of the patient’s parasitosis. A stool sample was also requested for parasitological analysis by Ritchie concentration, Ziehl-Neelsen and rapid test techniques. From the 70 children, 36 (51.4%) were infected with at least one intestinal parasite, with Ascaris lumbricoides and Trichuris trichiura being the most prevalent. Furthermore, it was possible to observe a direct correlation between basic sanitation and intestinal parasites. Fever symptoms were also correlated with the presence of intestinal parasitism. Although the government of Mozambique has adopted since 2009 a policy of massive drug administration to deworm children, the high rate of intestinal parasites remains present in the population. Therefore, preventive measures must be taken to contribute to the reduction of this rate of intestinal parasites in this population. KEY WORDS: Public health; Mozambique; kids; intestinal parasites.

Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure

Medication nonadherence is common among patients with heart failure with reduced ejection fraction (HFrEF) and can lead to increased hospitalization and mortality. Patients living in socioeconomically disadvantaged areas may be at greater risk for medication nonadherence due to barriers such as lower access to transportation or pharmacies. To examine the association between neighborhood-level socioeconomic status (nSES) and medication nonadherence among patients with HFrEF and to assess the mediating roles of access to transportation, walkability, and pharmacy density. This retrospective cohort study was conducted between June 30, 2020, and December 31, 2021, at a large health system based primarily in New York City and surrounding areas. Adult patients with a diagnosis of HF, reduced EF on echocardiogram, and a prescription of at least 1 guideline-directed medical therapy (GDMT) for HFrEF were included. Patient addresses were geocoded, and nSES was calculated using the Agency for Healthcare Research and Quality SES index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value, and education, with higher values indicating higher nSES. Medication nonadherence was obtained through linkage of health record prescription data with pharmacy fill data and was defined as proportion of days covered (PDC) of less than 80% over 6 months, averaged across GDMT medications. Among 6247 patients, the mean (SD) age was 73 (14) years, and majority were male (4340 [69.5%]). There were 1011 (16.2%) Black participants, 735 (11.8%) Hispanic/Latinx participants, and 3929 (62.9%) White participants. Patients in lower nSES areas had higher rates of nonadherence, ranging from 51.7% in the lowest quartile (731 of 1086 participants) to 40.0% in the highest quartile (563 of 1086 participants) (P < .001). In adjusted analysis, patients living in the lower 2 nSES quartiles had significantly higher odds of nonadherence when compared with patients living in the highest nSES quartile (quartile 1: odds ratio [OR], 1.57 [95% CI, 1.35-1.83]; quartile 2: OR, 1.35 [95% CI, 1.16-1.56]). No mediation by access to transportation and pharmacy density was found, but a small amount of mediation by neighborhood walkability was observed. In this retrospective cohort study of patients with HFrEF, living in a lower nSES area was associated with higher rates of GDMT nonadherence. These findings highlight the importance of considering neighborhood-level disparities when developing approaches to improve medication adherence.

Spatial and temporal disparities in air pollution exposure at Italian schools

Air pollution poses major threats to children’s health and learning, making exposure at school particularly critical. However, some children are more exposed than others, especially depending on the socioeconomic status of their school’s neighbourhood. In this study, we explore how exposure to air pollution varies across schools, over time and by the socioeconomic characteristics of the neighbourhood using data on approximately 23 thousand schools in Italy connected with estimates on Particulate Matter 2.5 measured in µg/m3 at a 1 × 1 km resolution from 2002 to 2018 provided by the Atmospheric Composition Analysis Group (ACAG). Moreover, we create an indicator of school socioeconomic status (SES) using fine-grained information on the real estate value made available by the Italian Observatory of Real Estate Value. Results highlight three main findings. First, air quality at the location of the schools improved over time by about 35%. Secondly, SES shows an inverted U-curve with PM2.5 suggesting schools in middle SES neighbourhoods to be exposed to the highest levels of pollution. Thirdly, SES does not show a substantive association with a decrease in air pollution over time. In conclusion, air quality has improved over time in Italy, but schools still do not comply with the World Health Organization (WHO) standards and middle SES neighbourhoods remain the most exposed to air pollution.

Correlations between Educational Struggle, Toxic Sites by School District and Demographic Variables, with Geographical Information System Projections.

This correlational study associated data on children enrolled in individualized educational plans in their K-12 schools (IEP) and an algorithm-calculated score of neurotoxins at contaminated sites located in each school district. The study also mapped and projected the correlations using Geographical Information System (GIS) technology. These data were populated in ArcMap 10.5 (a GIS software) for generating maps and data to conduct geospatial analysis. A total of 1 Superfund site and 39 CERCLA sites were identified as contaminated sites for this analysis. The majority of contaminants were heavy metals such as lead, arsenic, mercury, and cadmium. The mean toxic score of all contaminated sites combined was 13.4 (SD 14.4). Correlational analysis between the IEP numbers from each school district and toxic scores from the contaminated school district sites exhibited a positive relationship (F = 23.7, p < 0.0001). Correlations were also seen among higher toxics scores, IEP numbers, and children under the age of 10 (p < 0.00052) as well as higher proportions of black students in areas with high toxics scores (p = 0.0032). Black students were also far more likely to be enrolled in an IEP (p < 0.0001). Household income and poverty percentage in contaminated areas were also correlated (p = 0.0002). Individuals without college degrees were overrepresented in high toxic score school districts (p < 0.0001). The important low socio-economic status indicator of free and reduced lunch programs also correlated with increasing toxic scores (p = 0.0012) and IEP numbers (p = 0.0416). This study emphasizes the need to account for multiple exposures to wholistically appreciate environmental factors contributing to negative health outcomes.

Functional Outcome of Uncemented Total Hip Replacement in Low Socioeconomic Group Using Modified Harris Hip Score: A Prospective Midterm Follow-Up Study.

Background Total hip replacement is a safe and effective surgery with excellent outcomes in most patients with hip arthritis. The aim of this study was to evaluate functional outcomes and complications of total hip replacement among patients with low socioeconomic status in India. Methods We assessed 50 patients whose incomes fell below the poverty line and who underwent uncemented total hip replacement. We used a modified Harris Hip Score, replacing two items (one measuring range of motion and one measuring deformity) with two new ones (one related to return to professional activity and another regarding sexual activity). Results At the final follow-up, patients' modified Harris Hip Score improved from a preoperative meanvalueof 13.28 (0-46) to a postoperative meanvalueof 88.52 (64-100), suggesting marked improvement in functional outcome (p<0.001). In total, 32 (64%) patients returned to their original profession, and 12 (24%) switched to alternate work with mild pain. All patients reported satisfaction with their sexual activity at the final follow-up. Conclusions Many patients in India whose income is below the poverty line work in manual labor professions (e.g., farmers, masons, and cobblers) that increase their risk of hip damage. Total hip replacement is beneficial for these patients, offering good personal and professional quality of life after the surgery.

Attention-deficit hyperactivity disorder is associated with disordered eating in adolescents.

Attention-deficit hyperactivity disorder (ADHD) and disordered eating (DE) are both highly prevalent among adolescents, but their relationship is understudied. This study examines their possible association in a nationally representative sample of adolescents. Participants in the Israeli Youth Health and Nutrition Survey (2015-2016), a cross-sectional, school-based study, completed self-administered questionnaires, including the SCOFF questionnaire, and underwent anthropometric measurements. An affirmative reply to at least two SCOFF items was considered a DE case. Multivariable logistic regression evaluated the ADHD-DE association and the associations between ADHD and individual SCOFF items, controlling for age, sex, socioeconomic status, and body mass index. Of 4616 participants (12-18 years, 50.2% male), 654 reported an ADHD diagnosis. DE prevalence among ADHD adolescents was significantly higher than the non-ADHD group (50.2% vs. 43.9%, p = 0.003). Controlling for potential covariates, the association between ADHD and DE remained significant (OR = 1.409; 95% CI: 1.170-1.697), as did associations between ADHD and three SCOFF items. No difference in DE prevalence was found between stimulant-treated (n = 287) and untreated (n = 326) adolescents with ADHD. Adolescents with ADHD are more likely to experience DE. As DE can herald an imminent eating disorder, early identification is crucial. Further studies are needed to determine the ADHD-DE relationship's causality. Disordered eating (DE) and attention-deficit hyperactivity disorder (ADHD) are common among adolescents, and significantly affect health and well-being. This study examined the association between ADHD and DE in adolescents using the SCOFF questionnaire. Following adjustment for sociodemographic variables and BMI z-score, ADHD was associated with a 41% increased odds for DE. This study established the association between ADHD and DE, using a well-known questionnaire, in a large, nationally representative sample of adolescents. Monitoring eating behaviors and attitudes among adolescents with ADHD should be a priority, to minimize the risk of developing an eating disorder and its harmful consequences.

Social disparities in alcohol consumption among Canadian emerging adults.

Young adult drinking is a public health priority, but knowledge of socioeconomic status (SES) indicators and alcohol use among emerging adults (EAs; aged 18-29 years) is primarily informed by college samples, populations in their late teens and early twenties and non-Canadian data. We compared the association of three different SES indicators with monthly heavy episodic drinking (HED), less-than-monthly HED, no HED, and no drinking among Canadian EAs. We pooled the 2015 to 2019 waves of the Canadian Community Health Survey to include participants aged 18 to 29 years (n = 29 598). Using multinomial regression, we calculated weighted estimates of alcohol use by education, household income and area-level disadvantage, adjusting for adult roles and sociodemographic characteristics. Approximately 30% of EAs engaged in monthly HED, whereas 16% did not drink at all in the past year. Compared to those in the lowest household incomes, being in the top income quintile was significantly associated with increased relative odds of monthly HED (e.g. in combined SES model, RRR = 1.21, 95% CI: 1.04-1.39). Higher levels of education, being in higher income quintiles and living in less disadvantaged areas were significantly associated with reduced relative odds of no HED and not drinking. Adjusting for adult roles did not substantially change the associations between SES and alcohol use. Higher SES was associated with HED among EAs, although the magnitude of association was small. Universal prevention measures addressing the affordability, availability and marketing of alcohol could be complemented by interventions targeting EA populations at higher risk of HED.

Education or Socioeconomic Status: which proxy of cognitive reserve associates better with cognitive function and amyloid imaging results?

AbstractBackgroundCognitive reserve (CR) is partially responsible for inter‐individual differences in developing dementia due to Alzheimer’s disease (AD). However, education years, as the primary proxy of CR, does not capture various life experiences, vocational background, and resources available to those who did not have an opportunity to complete formal education. We compared education years against Hollingshead Four‐Factor Index of Socioeconomic Status (SES‐Adults) to examine the latter’s utility as a better proxy of cognitive reserve. The SES‐Adults is a survey collecting information on marital status, retired/employed status, educational attainment, and occupational prestige for participants and their partners. The survey results are then converted into one of the 5 social class categories including low, working, middle, upper‐middle, and upper socioeconomic status.MethodA cross‐sectional study was conducted on a cohort of adults and older adults (n = 264) with mean age of 67.96 years. Participants were recruited from a longitudinal study investigating neuropsychological and biological correlates of dementia, namely the Western Australian Memory Study (WAMS). We examined the relationships between education years and the SES‐Adults scores, with cognitive function and amyloid load while controlling for age, gender (male/female), and APOE ε4 carriage. Amyloid load was measured using 18F‐NAV‐469 tracer.ResultThe cohort included 190 females and 74 males with 80 APOE ε4 carriers (available genotyped individuals = 203). Linear regression results showed education years was significantly correlated with both general cognitive function (MoCA) and amyloid load (R2 = 0.2935, Adjusted‐R2 = 0.2513; p&lt;0.026) while controlling for the effects of age, gender, and APOE ε4 carriage. The SES‐Adults was not significantly related to cognition or amyloid load (p = .914). When SES was included in regression model, the relationships between education years and outcome measures turned non‐significant.ConclusionWe found education years to be significantly related to both cognition and amyloid load. However, no significant results was noted for the SES‐Adults. This cross‐sectional study showed that education is a reliable CR proxy as compared to a comprehensive measure of socioeconomic status(SES‐ Adults) .

Branching out: Feasibility of examining the effects of greenspace on mental health after traumatic brain injury.

This pilot study's aim was to determine the feasibility of examining the effects of an environmental variable (i.e., tree canopy coverage) on mental health after sustaining a brain injury. A secondary data analysis was conducted leveraging existing information on mental health after moderate to severe traumatic brain injury (TBI) from the TBI Model System. Mental health was measured using PHQ-9 (depression) and GAD-7 (anxiety) scores. The data were compared with data on tree canopy coverage in the state of Texas that was obtained from the Multi-Resolution Land Characteristics (MRLC) Consortium using GIS analysis. Tree canopy coverage as an indicator of neighborhood socioeconomic status was also examined using the Neighborhood SES Index. Tree canopy coverage had weak and non-significant correlations with anxiety and depression scores, as well as neighborhood socioeconomic status. Data analysis was limited by small sample size. However, there is a higher percentage (18.8%) of participants who reported moderate to severe depression symptoms in areas with less than 30% tree canopy coverage, compared with 6.6% of participants who endorsed moderate to severe depression symptoms and live in areas with more than 30% tree canopy coverage (there was no difference in anxiety scores). Our work confirms the feasibility of measuring the effects of tree canopy coverage on mental health after brain injury and warrants further investigation into examining tree canopy coverage and depression after TBI. Future work will include nationwide analyses to potentially detect significant relationships, as well as examine differences in geographic location.

Abstract B085: Associations of African genetic ancestry and neighborhood social environment with cancer-specific mortality in the Multiethnic Cohort

Abstract Importance: Evaluating contributions of both genetic and social environmental factors to cancer mortality in Black populations is necessary for prioritizing interventions to reduce racial disparities and inequities. We examined multilevel associations of African genetic ancestry (AGA) and the neighborhood social environment with cancer-specific mortality in Black participants in the Multiethnic Cohort Study. Methods: From 1993 through 1996, participants who self-identified as Black as their primary race, and were aged 45-75 years residing in Los Angeles County completed baseline demographic, clinical, and lifestyle questionnaires to enroll into the Multiethnic Cohort Study. Residential addresses were collected and geocoded to the nearest parcel, and deaths were ascertained over follow-up through December 31, 2019. For this prospective study, we analyzed data on participants with genetic ancestry data and geocoded addresses (n=10,722). Global African and European genetic ancestry was estimated using approximately 21,000 ancestry specific markers, from which AGA was estimated for each participant against the 1000 Genomes referent panel (K=2). A neighborhood socioeconomic status (nSES) index and the Index of Concentration at Extremes (ICE) capturing spatial social polarization based on income and racial composition were computed from the 1990 decennial Census and linked to residential census tracts at baseline. Cancer-specific mortality was assigned based on ICD-09 and ICD-10 codes. We estimated subdistribution hazard ratios (SHR) from Fine-Gray competing risks models adjusted for birth cohort, sex, smoking, marital status, education, body mass index (BMI), BMI at age 21, history of hypertension, physical activity, diet quality, and nSES or African ancestry. Results: There were 1,715 cancer deaths over 226,327 person-years of follow-up. Mean age was 61.1 (SD=8.9) years, mean AGA was 76% (SD=15%). Most participants identified as Black (94%) while others reported mixed (White, Hispanic, or Asian) heritage. Higher AGA was associated with lower individual education and nSES (Both P&amp;lt;0.001). AGA was not associated with cancer mortality (SHR for 10% increase: 1.02, 95% CI: 0.99-1.06). Comparing quintile 5 to 1, there were inverse but not statistically significant associations of nSES (SHR: 0.88, 95% CI: 0.71-1.09, P trend=0.34), ICE Income (SHR: 0.92, 95% CI: 0.73-1.16, P trend=0.36), and racialized income ICE (SHR: 0.81, 0.58-1.13, P trend=0.033) with cancer mortality. Associations of AGA and nSES with cancer mortality did not vary across strata of the other exposure. Conclusions and Relevance: In this large prospective study of Black participants, after accounting for sociodemographic, lifestyle, and comorbidity-related factors, there were few associations between either genetic factors or social environment with cancer mortality. Additional studies in cohorts of Black adults residing in other geographic contexts, with additional measures of social determinants of health such as health care access, are needed to further evaluate these findings. Citation Format: Hari S. Iyer, Scarlett L. Gomez, Chidinma Opara, Nur Zeinomar, Loic LeMarchand, Christopher Haiman, Lynne Wilkens, Salma Shariff-Marco, David V. Conti, Iona Cheng, Timothy R. Rebbeck. Associations of African genetic ancestry and neighborhood social environment with cancer-specific mortality in the Multiethnic Cohort [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B085.

Evaluating the Association Between Sociodemographic and Health Variables With Baseline Concussion Testing in Young Athletes

Background:Baseline concussion testing can be helpful to perform when providing concussion care for young athletes. To appropriately interpret these data, it is important to understand how certain factors may affect concussion testing.Purpose:To examine the relationship of sociodemographic and health variables with baseline concussion testing in young athletes.Study Design:Cross-sectional study; Level of evidence, 3.Methods:High school and middle school athletes competing in sports or positions at high risk for concussion (football, soccer, ice hockey, wrestling, lacrosse, and pitchers/catchers in baseball/softball) during the 2020-2021 or 2021-2022 academic years completed annual baseline concussion testing and were included in the study. Baseline data included self-reported demographic and medical information, a graded symptom checklist, the Standardized Assessment of Concussion, and the King-Devick test. A validated measure, HOUSES (HOUsing-based index of SocioEconomic Status), was used to determine participants’ socioeconomic status (SES) by linking personal address information to publicly available property data. Multivariable linear regression models were fit to analyze the relationship of concussion baseline testing to sociodemographic and health variables.Results:Among the eligible 2747 athletes (mean age, 15.4 ± 1.5 years; 73.6% male), the mean Standardized Assessment of Concussion score was 26.7 ± 2.0 and the mean best King-Devick test time was 50.3 ± 10.1 seconds. Higher baseline symptom severity scores were related to lower SES ( P = .002). A lower (ie, poorer) mean Standardized Assessment of Concussion score was significantly associated with the following in the multivariable model: male sex ( P &lt; .001), younger age ( P &lt; .001), Black/African American race ( P = .029), Hispanic ethnicity ( P = .016), previous diagnosis of learning disorder or attention-deficit hyperactivity disorder ( P &lt; .001), and lower SES ( P = .003). A higher (ie, poorer) mean King-Devick test time was related to younger age, previous diagnosis of a learning disorder or attention-deficit hyperactivity disorder, and lower SES (all P &lt; .001).Conclusion:Baseline concussion testing was found to be associated with certain sociodemographic variables and underlying health conditions in high school and middle school athletes.

Multiple socioeconomic risks and cognitive impairment among older men and women in India.

Socioeconomic status (SES) is negatively associated with innumerable health outcomes, including cognitive functioning. Yet much remains undiscovered about SES patterns in later-life cognition in low-and middle-income countries (LMICs). The purpose of this study was to examine the association between separate and combined socioconomic risks and cognitive impairment among older adults in India. Further, given gender disparities in later life cognitive functioning and SES, the study examines the associations between socioeconomic risks and cognitive impairment separately, for older men and women. Data come from the 2017-18, first wave of the Longitudinal Aging Study in India (LASI), with 31,464 older adults aged 60years and above. Cognitive impairment was assessed using multiple broad measures of memory, orientation, arithmetic function, and visuo-spatial construction skills. We present descriptive statistics along with cross-tabulation of the outcome variable. Additionally, binary logistic regression analysis was used to test the association between outcome and explanatory variables. SES is measured using education, paid work status, and household wealth measured using monthly per-capita consumption expenditure (MPCE). A proportion of 7.14% of the older men and 20.03% of older women reported cognitive impairment. The odds of cognitive impairment were higher among uneducated older men and women, and older men and women in lowest wealth quintile. Surprisingly, older women without current or prior work history report lower odds of cognitive impairment compared to their peers in labor force. While odds of cognitive impairment are higher among non-working older men, this association is not statistically significant. In older men, the odds of cognitive impairment were 5.34, 7.14, and 13.05 times higher with one, two, and three risk factors, respectively, compared with those with no risk exposure. A similar trend was observed for women but with comparatively lower odds. Our findings underscore the need to distinguish between varying elements of SES to construct "upstream" health policies and programs that redistribute resources. In particular, the findings support the use of multiple SES indicators in identifying older adults most susceptible to cognitive deficits, and planning gender-based interventions to improve cognitive health in late life.

Race- and Gender-Specific Associations between Neighborhood-Level Socioeconomic Status and Body Mass Index: Evidence from the Southern Community Cohort Study.

Obesity and a low socioeconomic status (SES), measured at the neighborhood level, are more common among Americans of Black race and with a low individual-level SES. We examined the association between the neighborhood SES and body mass index (BMI) using data from 80,970 participants in the Southern Community Cohort Study, a cohort that oversamples Black and low-SES participants. BMI (kg/m2) was examined both continuously and categorically using cut points defined by the CDC. Neighborhood SES was measured using a neighborhood deprivation index composed of census-tract variables in the domains of education, employment, occupation, housing, and poverty. Generally, the participants in lower-SES neighborhoods were more likely to have a higher BMI and to be considered obese. We found effect modification by race and sex, where the neighborhood-BMI association was most apparent in White female participants in all the quintiles of the neighborhood SES (ORQ2 = 1.55, 95%CI = 1.34, 1.78; ORQ3 = 1.71, 95%CI = 1.48, 1.98; ORQ4 = 1.76, 95%CI = 1.52, 2.03; ORQ5 = 1.64, 95%SE = 1.39, 1.93). Conversely, the neighborhood-BMI association was mostly null in Black male participants (ORQ2 = 0.91, 95%CI = 0.72, 1.15; ORQ3 = 1.05, 95%CI = 0.84, 1.31; βQ4 = 1.00, 95%CI = 0.81, 1.23; ORQ5 = 0.76, 95%CI = 0.63, 0.93). Within all the subgroups, the associations were attenuated or null in participants residing in the lowest-SES neighborhoods. These findings suggest that the associations between the neighborhood SES and BMI vary, and that other factors aside from the neighborhood SES may better predict the BMI in Black and low-SES groups.