Socioeconomic Status Quartile Research Articles

Abstract 6107: Survival differences by socioeconomic status in Merkel cell carcinoma: A retrospective analysis using the National Cancer Database

Abstract Introduction: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer whose incidence and survival outcomes demonstrate disparities based on patients’ socioeconomic status (SES). This study aims to evaluate the impact of SES on MCC diagnosis age, comorbidity burden, treatment modalities, and survival outcomes using the National Cancer Database. Methods: We conducted a retrospective analysis of 9742 patients diagnosed with MCC from 2016 to 2020 in the United States. To assess how socioeconomic status influences outcomes, a composite score was created by adding income and education quartile assignments (1, 2, 3, 4), to create new composite SES quartiles of 2-3, 4-5, 6-7, and 8. Patients were stratified into quartiles based on their SES (lowest Q1 to highest Q4). Binomial test was performed for categorical variables and ANOVA was performed for continuous. Survival differences were examined with Cox proportional hazards models and Kaplan-Meier curves. Results: Patients with lower SES presented with MCC at younger ages, with the average age of patients in the lowest SES Q1 being 73.8 years (95% CI 73.15-74.35) and the highest SES Q4 being 75.0 years (95% CI 74.48-75.46). Patients in SES Q1 also had higher Charson-Deyo scores, indicating more comorbidities than patients in SES Q4 (8.41% vs 5.8%, p < 0.001). They were also more likely to have advanced stage 4 MCC (9.67% vs 7.79%, p < 0.01) compared to patients in SES Q4. When treated with surgery, patients in SES Q1 were more likely to be treated with local tumor excision (14.39% vs 10.83%, p < 0.001) whereas patients in SES Q4 were more likely treated with Mohs surgery (5.02% vs 3.56%, p < 0.01). Survival probabilities for patients SES Q1 were worse at 1 year (82.99% vs 85.81%, p<0.001), 3 years (61.18% vs 68.49%, p < 0.001) and 5 years (45.99% vs 55.09%, p < 0.001) compared to patients in SES Q4. Conclusion: This study highlights disparities in age at diagnosis, comorbidities, treatment, and survival outcomes in MCC patients based on SES. Patients in lower SES quartiles are diagnosed younger, bear higher comorbidity burdens, and have worse rates of survival. Citation Format: Rachel C. Chang, Elise K. Brunsgaard, David Reid. Survival differences by socioeconomic status in Merkel cell carcinoma: A retrospective analysis using the National Cancer Database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6107.

Abstract WMP47: Neighborhood Socio-Economic Status as a Predictor of All-Cause Long-Term Post-Stroke Mortality

Background: Previous studies have shown that neighborhood socioeconomic status may be associated with post-stroke mortality. However, these studies did not adjust for stroke severity. We aim to determine the association between neighborhood of residence on long-term mortality after stroke. Methods: Within our population of 1.3 million in the Greater Cincinnati Northern Kentucky area, incident strokes among adult residents were ascertained at all area hospitals during calendar years 2005, 2010 and 2015. Participants addresses were used to geocode and determine their census tract and then used a validated index to determine neighborhood socio-economic status. We used national death index data to determine mortality status at 5 years post stroke. Individuals who survived at least 30 days were included in the analysis. We used cox proportional hazards to determine the association between neighborhood of residence deprivation and case fatality rate after stroke. Results: Among 4514 incident ischemic strokes, there were 1719 deaths over 5 years; for an all-cause post-stroke mortality rate of 38.08% among survivors of 30 days post-stroke. Similarly, there were 552 intracerebral hemorrhages with 224 deaths over 5 years: yielding an all-cause post-stroke mortality rate of 40.58%. Individuals in the quartile of neighborhoods with lowest neighborhood socio-economic status had 1.3 times the all-cause post-stroke mortality rate (HR 1.29 95% CI 1.08-1.54); after adjustment for age sex, race, and year of study (2005, 2010 and 2015). After adjustment for age, race, sex, year of study and NIH stroke scale score, individuals living in the quartile of neighborhoods with the lowest neighborhood socio-economic status had 1.29 times the risk of dying (HR 1.29 95% CI 1.09-1.53). We found insufficient evidence of an association between neighborhood socio-economic status and 5-year case fatality rate among intracerebral hemorrhages. Conclusion: Rates of all-cause post-stroke long-term mortality were higher among patients with ischemic stroke who lived in neighborhoods with lowest quartile of socio-economic status. This effect persisted even after adjusting for stroke severity.

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

BackgroundThis study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines.MethodsA follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications.ResultsThe average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use.ConclusionsSocioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.

Long term cost outcomes among commercially insured patients undergoing bariatric surgical procedures.

Bariatric procedures have become safer in recent years, warranting new data on long-term costs. This study examined the impact of bariatric procedures on a person's long-term healthcare costs up to 10years and if it differed by socio-economic status (SES). This retrospective observational study compared the downstream health care cost of patients with obesity who had undergone bariatric surgery (BS) between 2009 and 2018 to a 1:1 matched group of members with obesity but no surgery. 167,764 individuals from administrative claims data with an obesity diagnosis were included; 83,882 in the BS group and 83,882 in the non-surgical group. In follow-up years 2-10, the BS group was associated with lower total medical healthcare cost compared to the non-surgical group (cost ratios ranged 0.85-0.93, p values<0.05). When stratifying the BS group by SES quartiles, there were no significant cost differences by SES (cost ratios ranged from 0.96 to 1.05, most p values>0.05). BS was associated with lower long-term follow-up medical cost and cost savings appeared similar among the SES quartiles in the BS group. The study results may help policy makers and employers in designing benefits and extending coverage for bariatric surgical procedures.

Socioeconomic inequalities in national transfers accounts in Ecuador 2006 and 2011: Did a new socialist government make a difference?

Latin America is the least egalitarian region in the world. A neo-socialist government in Ecuador prioritized the reduction of socioeconomic status (SES) inequalities. The generational economy is a framework to understand the economic lifecycle and to link demographic change with people's well-being. This article aims to uncover SES-driven inequalities in the generational economy of Ecuador: did public transfers modify them from 2006 to 2011? National transfer accounts (NTA) were disaggregated by SES quartiles, which were defined by the highest level of education attainment in each household. The accounts within SES quartiles were estimated using standard NTA methods. A pseudo-Gini coefficient summarized SES-driven inequalities by age and generational account. This secondary analysis was based on existing micro databases from the Ecuadorian NTA. ResultsNational averages do not represent well the generational economy of the low-SES population. The usual gradient of higher economic figures in higher SES strata shows up in almost all NTAs with the notable exceptions of reversal (progressive) gradients in conditional public cash transfers to low-SES households and public education at the elementary school level. Retirement pensions are extremely regressive public transfers, benefiting mostly high-SES strata. ConclusionsPopulation aging might worsen the high levels of inequality already existing in Ecuador and Latin America. Some progressive public policies worked well to reduce inequality in Ecuador. ContributionThis article demonstrates the importance of uncovering SES-driven inequalities existing in NTAs and their change through the lifecycle. It also identifies public policies that ameliorated inequality as well as public transfers that are regressive.

Socioeconomic status is associated with greater hazard of post-discharge mortality than race, gender, and ballistic injury mechanism in a young, healthy, orthopedic trauma population

ObjectivesTo explore the utility of legacy demographic factors and ballistic injury mechanism relative to popular markers of socioeconomic status as prognostic indicators of 10-year mortality following hospital discharge in a young, healthy patient population with isolated orthopedic trauma injuries. MethodsA retrospective cohort study was performed to evaluate patients treated at an urban Level I trauma center from January 1, 2003, through December 31, 2016. Current Procedure Terminology (CPT) codes were used to identify upper and lower extremity fracture patients undergoing operative fixation. Exclusion criteria were selected to yield a patient population of isolated extremity trauma in young, otherwise healthy individuals between the ages of 18 and 65 years. Variables collected included injury mechanism, age, race, gender, behavior risk factors, Area Deprivation Index (ADI), and insurance status. The primary outcome was post-discharge mortality, occurring at any point during the study period. ResultsWe identified 2539 patients with operatively treated isolated extremity fractures. The lowest two quartiles of socioeconomic status (SES) were associated with higher hazard of mortality than the highest SES quartile in multivariable analysis (Quartile 3 HR: 2.2, 95% CI: 1.2–4.1, p = 0.01; Quartile 4 HR: 2.2, 95% CI: 1.1–4.3, p = 0.02). Not having private insurance was associated with higher mortality hazard in multivariable analysis (HR 2.0, 95% CI: 1.3–3.2, p = 0.002). The presence of any behavioral risk factor was associated with higher mortality hazard in univariable analysis (HR: 1.8, p < 0.05), but this difference did not reach statistical significance in multivariable analysis (HR: 1.4, 95%: 0.8–2.3, p = 0.20). Injury mechanism (ballistic versus blunt), gender, and race were not associated with increased hazard of mortality (p > 0.20). ConclusionLow SES is associated with a greater hazard of long-term mortality than ballistic injury mechanism, race, gender, and medically diagnosable behavioral risk factors in a young, healthy orthopedic trauma population with isolated extremity injury.

Socioeconomic status and in-hospital outcomes for patients undergoing heart transplantation or ventricular assist device implantation.

Although lower socioeconomic status (SES) has been associated with worse in-hospital outcomes among patients with heart failure, the in-hospital outcomes for patients undergoing durable Left Ventricular Assist Device (LVAD) implantation or Heart Transplantation (HT) based on SES have not been well characterized. We analyzed data from the National Inpatient Sample of hospitalizations between January 2016 and December 2020 of patients aged 18 and over who underwent a HT or newly implanted LVAD. Quartile classification of the median household income of the patient's residential zip code was used to estimate SES. Multivariable analyses with logistic and linear regression were used to evaluate the effects of SES on inpatient outcomes including inpatient mortality, length of stay, and key inpatient complications. A total of 16,265 weighted hospitalizations for new LVAD implantation and 14,320 weighted hospitalizations for HT were identified. In multivariable analysis, among patients undergoing HT or LVAD implantation respectively, there were no significant differences between the lowest and highest SES quartiles among important in-hospital outcomes including length of stay (adj B-coeff .56, (-3.59)-(4.71), p=.79 and adj B-coeff 2.40, (-.21)-(5.02), p=.07) and mortality (aOR 1.02, .61-1.70, p=.94 and aOR 1.08, .72-1.62, p=.73). There were also no differences based on SES quartile in important inpatient complications including stroke and cardiac arrest. In this analysis from the National Inpatient Sample, we demonstrate that SES, evaluated by median zip code income, was not associated with important in-hospital metrics including mortality and length of stay among patients undergoing LVAD or HT.

Cancer inequalities in incidence and mortality in the State of São Paulo, Brazil 2001-17.

Cancer disparities exist between and within countries; we sought to compare cancer-specific incidence and mortality according to area-level socioeconomic status (SES) in the State of São Paulo, Brazil. Cancer cases diagnosed 2003-2017 in the Barretos region and 2001-2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age-standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES-cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.

Disproportionate increases in alcohol-associated hepatitis incidence in women and individuals of low socioeconomic status: A population-based study using the Rochester epidemiology project database.

Alcohol-associated hepatitis (AH) is among the deadliest liver diseases, but its incidence is poorly defined. The aim of our study was to define the incidence of AH meeting the National Institute on Alcohol Abuse and Alcoholism criteria and to identify risk factors for AH. We conducted a retrospective cohort study using the Rochester epidemiology project database on adult patients hospitalized with AH between January 1, 2000 and December 31, 2018. Patients were screened using ICD-9 codes and then included if they met the National Institute on Alcohol Abuse and Alcoholism criteria on manual chart review. Baseline demographics, comorbidities, access to care, liver-related complications, and outcomes were obtained. The HOUsing-based index of SocioEconomic status index was used to measure socioeconomic status. Incidence rates were calculated in cases per 100,000 person-years of follow-up. Among 204 patients, the cumulative AH incidence was 6.8 per 100,000 person-years. Between 2000-2004 and 2015-2018, AH incidence among males increased from 8.4 to 14.7 per 100,000 py, whereas AH incidence among females increased by 7-fold from 0.8 to 5.9 per 100,000 py. Such increases among females were accompanied by increases in comorbid depression and anxiety. The proportion of patients with AH in the lower socioeconomic status quartiles increased from 62.9% between 2000 and 2004 to 73.3% between 2015 and 2019. The incidence of AH is increasing rapidly, especially among females and individuals of lower socioeconomic status. There are areas of unmet need in preventative measures and treatments for comorbid psychiatric disorders in patients at high risk of AH.

Socioeconomic inequalities in health-related fitness gradient shifts between 2001 and 2022 in young Polish adults.

This study aimed to assess the importance of socioeconomic status (SES) on health-related fitness (H-RF) measurements in young adults and determine the impact of SES over 20 years of substantial social and economic changes in Poland. The study compared H-RF differences between 2001 (P1) and 2022 (P2) in 252 volunteers aged 18 to 28 years who were grouped into quartiles based on SES and gender. The variables measured included height, weight, body mass index, body fat mass, hand strength (hand grip), abdomen strength (sit-ups), flexibility (sit and reach), and leg power (standing long jump), with a synthetic motor performance index (MPSI) calculated for each participant. Health-related differences based on social inequalities included body fat mass and MPSI, and two-way analysis of variance (ANOVA) revealed an interaction between SES and period on motor performance (F = 2.73, p = 0.045). In addition, post-hoc tests revealed differences in P1 between SES quartiles one and two (p = 0.028). Over the last 20 years, physical fitness decreased and body fat increased. The regression slope showed decreased motor performance with higher amounts of body fat in P2 subjects compared to their P1 peers. The observed trends may be associated with lifestyle changes shaped by technology development, high-energy and low-quality food access, and increased physical inactivity.

Economic model of community-based falls prevention: seeking methodological solutions in evaluating the efficiency and equity of UK guideline recommendations

BackgroundFalls significantly harm geriatric health and impose substantial costs on care systems and wider society. Decision modelling can inform the commissioning of falls prevention but face methodological challenges, including: (1) capturing non-health outcomes and societal intervention costs; (2) considering heterogeneity and dynamic complexity; (3) considering theories of human behaviour and implementation; and (4) considering issues of equity. This study seeks methodological solutions in developing a credible economic model of community-based falls prevention for older persons (aged 60 +) to inform local falls prevention commissioning as recommended by UK guidelines.MethodsA framework for conceptualising public health economic models was followed. Conceptualisation was conducted in Sheffield as a representative local health economy. Model parameterisation used publicly available data including English Longitudinal Study of Ageing and UK-based falls prevention trials. Key methodological developments in operationalising a discrete individual simulation model included: (1) incorporating societal outcomes including productivity, informal caregiving cost, and private care expenditure; (2) parameterising dynamic falls-frailty feedback loop whereby falls influence long-term outcomes via frailty progression; (3) incorporating three parallel prevention pathways with unique eligibility and implementation conditions; and (4) assessing equity impacts through distributional cost-effectiveness analysis (DCEA) and individual-level lifetime outcomes (e.g., number reaching ‘fair innings’). Guideline-recommended strategy (RC) was compared against usual care (UC). Probabilistic sensitivity, subgroup, and scenario analyses were conducted.ResultsRC had 93.4% probability of being cost-effective versus UC at cost-effectiveness threshold of £20,000 per QALY gained under 40-year societal cost-utility analysis. It increased productivity and reduced private expenditure and informal caregiving cost, but productivity gain and private expenditure reduction were outstripped by increases in intervention time opportunity costs and co-payments, respectively. RC reduced inequality delineated by socioeconomic status quartile. Gains in individual-level lifetime outcomes were small. Younger geriatric age groups can cross-subsidise their older peers for whom RC is cost-ineffective. Removing the falls-frailty feedback made RC no longer efficient or equitable versus UC.ConclusionMethodological advances addressed several key challenges associated with falls prevention modelling. RC appears cost-effective and equitable versus UC. However, further analyses should confirm whether RC is optimal versus other potential strategies and investigate feasibility issues including capacity implications.

First Responder CPR and Survival Differences in Texas Minority and Lower Socioeconomic Status Neighborhoods

Introduction First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities. Methods We linked the 2014–2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata. Results We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22–0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65–0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61–0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17–0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10–0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata. Conclusion While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.

AUD Treatment Rose During Early Pandemic

AUD Treatment Rose During Early Pandemic

1538. Socioeconomic Risk Factors for Multidrug Resistance in Enterobacterales

Abstract Background Multidrug resistance (MDR) in Enterobacterales is common; the impact of socioeconomic status (SES) on MDR prevalence is unclear. Methods Data from 2014–2021 was obtained from UNC Hospitals for all cultures with Enterobacterales growth (N=90129). ZIP-code level socioeconomic data for North Carolina was sourced from the 2020 5-Year American Community Survey and combined into an SES factor score assigned to each ZIP code (N=790). Prevalence ratios from generalized linear models were used to compare the relative MDR occurrence between SES quartiles. Results A significant inverse relationship between MDR and SES was observed (16%, 16.5%, 19.5%, and 20.7% MDR in the highest, medium-high, medium-low, and lowest quartiles, respectively; Table 1). The prevalence of MDR in Enterobacterales from patients residing in lowest-quartile ZIP codes was 32% higher (Table 1) relative to those from the highest quartile. This effect was significant across all measured antibiotic classes, with the largest absolute difference in penicillins (40.1% and 50.6% in the highest and lowest quartiles, respectively), and the smallest in aminoglycosides (5.6% and 7.3%; Figure 1). Temporally, the lowest quartile had the highest prevalence of MDR in all measured years. Conclusion Our findings show that in North Carolina from 2014–2021, MDR was consistently more prevalent in Enterobacterales from patients residing in lowest-quartile ZIP codes. These data emphasize the need to address the societal causes for disparities in clinical outcomes and can inform further study of the relationship between SES and MDR. Disclosures David van Duin, MD, PhD, Achaogen: Advisor/Consultant|Actavis: Advisor/Consultant|Allergan: Advisor/Consultant|Astellas: Advisor/Consultant|Entasis: Advisor/Consultant|Karius: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Neumedicine: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|T2Biosystems: Advisor/Consultant|Tetraphase: Advisor/Consultant|Utility: Advisor/Consultant|Wellspring: Advisor/Consultant.

Socioeconomic status and post-arrest care after out-of-hospital cardiac arrest in Texas

IntroductionPost-arrest care after out-of-hospital cardiac arrest (OHCA) is critical to optimizing outcomes, but little is known about socioeconomic disparities in post-arrest care. We evaluated the association of socioeconomic status (SES) with post-arrest care and outcomes. MethodsWe included adult OHCAs surviving to hospital admission from the 2014–2020 Texas Cardiac Arrest Registry to Enhance Survival (CARES) and stratified cases into SES quartiles based on census tract data. Outcomes were targeted temperature management (TTM), percutaneous coronary intervention (PCI), survival to discharge, and survival with a Cerebral Performance Category (CPC) 1–2. We applied both a multivariable logistic regression and a mixed effects logistic regression, comparing lower quartiles to top quartile for outcomes. We modeled receiving hospital as a random intercept. ResultsWe included 9,936 OHCAs. Using multivariable logistic regression and ignoring the receiving hospital, lower income had lower TTM (Q3 aOR 0.6, 95% CI 0.5–0.7; Q4 aOR 0.5, 95% CI 0.5–0.6), lower PCI (Q4 aOR 0.6, 95% CI 0.4–0.8), and lower survival with good CPC. Lower education had lower TTM (Q2 aOR 0.7, 95% CI 0.7–0.8; Q3 aOR, 0.6 95% CI 0.5–0.7; Q4 aOR 0.6, 95% CI 0.5–0.7), lower survival, and lower survival with good CPC. Lower employment had lower TTM (Q3 aOR 0.7, 95% CI 0.6–0.9; Q4 aOR 0.7, 95% CI 0.6–0.9) and survival with good CPC. These relationships for post-arrest care were not significant on mixed model analyses though. ConclusionLower SES was linked to lower rates of post-arrest care and outcomes, but many of the associations diminished when adjusting for receiving hospital random effect. Further study is needed to evaluate for inter-hospital disparities in care.

Association between socioeconomic status and academic performance in children and adolescents with chronic kidney disease

BackgroundLower socioeconomic status (SES) is associated with lower academic achievement; however, this relationship is understudied in children with chronic kidney disease (CKD). This study examined the relationship between SES and academic performance in children and adolescents with CKD.MethodsA total of 377 participants aged 6–18 years with CKD stages 1–5 (n = 199), on dialysis (n = 43) or with a kidney transplant (n = 135) were recruited. Five SES measures and a composite SES index were examined for associations with parent-rated average or above average academic performance in numeracy and literacy using multivariable logistic regression.ResultsParticipants’ median age was 12.6 years (IQR 8.9–15.5). Adjusted odds ratios (aOR) (95%CI) for better performance in numeracy and literacy, respectively, were 0.71 (0.44–1.15) and 0.75 (0.45–1.23) for children whose caregivers had lower educational attainment; 0.46 (0.26–0.80) and 0.53 (0.30–0.93) for lower household income; 0.52 (0.32–0.85) and 0.44 (0.26–0.73) for caregivers who were unemployed; 0.68 (0.41–1.12) and 0.59 (0.35–1.00) for caregivers with poor self-rated financial status; and 0.93 (0.53–1.64) and 1.00 (0.56–1.79) for caregivers who did not own their own home. Compared with the highest SES index quartile, the aORs for better performance by SES quartile in descending order were 1.24 (0.60–2.54), 0.76 (0.37–1.58), and 0.39 (0.18–0.86) for numeracy and 0.88 (0.41–1.85), 0.77 (0.35–1.66), and 0.32 (0.14–0.72) for literacy. No interactions were identified between SES and CKD stage, child age, or gender.ConclusionsAcross all CKD stages, children from lower SES families are less likely to perform well in literacy and numeracy than those from higher SES households.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

The Relationship of Preschool Attendance with Academic Achievement and Socioeconomic Status in Turkey

Preschool education plays a critical role in mitigating the opportunity gap between children through providing basic skills in early childhood. Within this scope, the G20 countries have implemented diverse policies to increase preschool attendance in their respective contexts. Turkey took solid steps to expand preschool education after 2010, leading to a significant increase in schooling rates. However, studies show that attendance in preschool education is still strongly linked with students’ socioeconomic status (SES) in Turkey. Thus, the present study aims to evaluate the relationship between preschool education attendance and students’ academic achievement in Turkey, and to determine the role of SES within this relationship. PISA and TIMSS data were used to study this relationship across age levels. Differences between schooling rates were analyzed with the z-ratio test for independent groups, and the significance of the differences between group means was analyzed through MANCOVA. The findings showed that access to preschool education increased significantly over the years, but despite these improvements, preschool attendance continued to be linked with SES. Students in higher SES quartiles demonstrated both higher schooling rates and longer participation in preschool education. The findings consistently indicated significant differences in preschool attendance between SES groups. While there were significant relationships between preschool attendance and academic achievement, these relationships were strongest for students aged 10–11. The relationship between preschool attendance and literacy for 15-year-old students was also significant, but the strength of this relationship was relatively weak. Lastly, this study revealed that the strength of the relationship between preschool education attendance and academic achievement decreases when SES is controlled. The results emphasized the importance of the recent steps taken by Turkey’s Ministry of National Education to increase access to preschool education.

Abstract EP36: Socioeconomic Status And Spontaneous Coronary Artery Dissection Outcomes

Introduction: Spontaneous coronary artery dissection (SCAD) is an emerging cause of myocardial infarction. The epidemiology of SCAD is elucidated with recent investigations and analyses. However, the association between socioeconomic status (SES) and SCAD remains to be studied. We performed this study to identify the effects of SES on SCAD. Methods: We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. Socioeconomic status was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. Results: During the study period, total 106,970,745 patients were hospitalized of which 30.17% were from 1 st (lowest), 26.26% from 2 nd , 23.76% from 3 rd and 19.82 from 4 th (highest) quartile. 0.02 % (24,560 of 106,970,745) patients were diagnosed with spontaneous coronary artery dissection. When lowest SES was compared to the highest SES quartile, the patients from the lowest SES tended to be diabetic (34.17 % v 18.39%) and younger (48.39 ± 0.01 v 50.16 ± 0.01) and less prevalence of hyperlipidemia (2.79% v 3.86%). The prevalence of hypertension (29.78% v 28.31%) and proportion of male (43.59% v 43.33%) were similar. After adjusting for age, sex and comorbid burden, the lowest SES quartile was associated with lower risk of SCAD when it was compared to highest quartile (OR 0.70; 95% CI 0.65-0.76; p&lt;0.0001). However, the lowest SES quartile was associated with higher in-hospital mortality (OR 1.51; 95%CI 1.07-2.15; p=0.02) and 30-day readmission rate (OR 1.56; 95%CI 1.39 -1.88; p&lt;0.0001) with SCAD when it compared to the highest quartile. Discussion: In this study, the lowest SES was associated with lower risk of SCAD. Individuals with low SES carry substantial burden of cardiovascular diseases. It is possible that SCAD is underdiagnosed in low SES population due to the presence of traditional cardiovascular risk factors. The unfavorable effects of low SES on SCAD can be identified with in-hospital mortality and rate of 30-day readmission. Further research is required to better understand the impact of SES on the outcomes of SCAD.

Impact of Socioeconomic Status on Mechanical Circulatory Device Utilization and Outcomes in Cardiogenic Shock

<h2>Abstract</h2><h3>Objectives</h3> This study evaluates the impact of socioeconomic status (SES) on utilization of mechanical circulatory support (MCS) devices and outcomes in cardiogenic shock (CS). <h3>Background</h3> CS is associated with significant mortality. There is increasing use of temporary MCS devices in CS, and its impact on outcomes is currently under investigation. There is a lack of data on the effect of SES on the utilization of MCS devices in CS. <h3>Methods</h3> CS hospitalizations were obtained from the State Inpatient Databases in 2016 from 9 states representing various regions in the United States. The study had exempt institutional review board status as the database includes deidentified data. Hospitalizations were separated into SES cohorts based on the median household income of the patient residence zip code. Utilization of MCS devices and revascularization procedures along with clinical outcomes with CS were compared across the quartiles. <h3>Results</h3> There were 38,520 hospitalizations identified with CS, 42.6% of which were secondary to acute myocardial infarction. Patients from higher SES areas were significantly older but had lower burden of comorbidities. Utilization of temporary MCS devices was higher for hospitalizations from higher SES regions (frequency from the lowest SES quartile to the highest SES quartile: 21.3%, 21.5%, 23.5, and 24.1%, <i>P</i> < .01), though revascularization rates were similar. However, there was no significant difference in overall mortality from CS among the 4 quartiles. Patients from regions of higher SES experienced increased hospital costs. <h3>Conclusions</h3> Higher SES regions had increased use of temporary MCS. There was no difference in mortality between SES cohorts.

Abstract WP233: Socioeconomic Status And Comorbidity Variance In Ischemic Stroke

Introduction: Socioeconomic status (SES) is an upstream determinant of cerebrovascular disease comorbidities and subsequently ischemic stroke. Here we examined the association of SES and modifiable ischemic stroke risk factors. Methods: Hospitalized ischemic stroke patient data from 10/1/2015 - 12/31/2018 was obtained via the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Demographic characteristics of age, sex, race, US region, SES (defined as median household income range by zip code) and ischemic stroke risk factors of atrial fibrillation/flutter (AF), type II diabetes (DM), hypertension (HTN), hyperlipidemia (HLD), tobacco use, and obesity were identified using published ICD-10 codes. Multivariable logistic regression was used to assess each condition individually and identify which comorbidities were associated with specific socioeconomic quartiles (Q1, Q4) when adjusted for the abovementioned demographics. Results: Of the 382,734 adult ischemic stroke patients identified, mean age was 70 ±14.2 years and 50.3% were female. Socioeconomic status quartiles ranged from &lt;$43,749 (Q1) to &gt;$73,000 (Q4); 30.9% of ischemic stroke patients were in SES Q1 (vs 19.1% in SES Q4). Patients in Q1 experienced ischemic stroke at a younger age (67.9 ±14.1) as compared to patients in Q4 (72.4 ±14), p&lt;0.001. In adjusted models with Q4 as reference, Q1 patients had increased odds for DM [OR 1.27, p&lt;0.001, 95% CI 1.24 - 1.29], obesity [OR 1.05, p&lt;0.004, CI 1.02 - 1.08], and tobacco use [OR 1.66, p&lt;0.001, CI 1.51 - 1.83]. Conversely, Q1 patients had decreased odds of AF [OR 0.91, p&lt;0.001, CI 0.89 - 0.93] and HLD [OR 0.81, p&lt;0.001, CI 0.79 - 0.82]. There was no significant association between SES quartile and HTN. Conclusion: Lower SES was associated with higher odds of specific ischemic stroke risk factors. While the etiology of the risk factor variance is beyond the scope of current data analysis, the cause is likely multifactorial and influenced by underlying detection bias, income inequity, and level of education/health literacy. Further research and subgroup analysis is warranted as it may impact future preventative measures and treatment protocols.