Socioeconomic Variation Research Articles

Socioeconomic inequalities of pregnancy termination among reproductive age women in Bangladesh: a decomposition analysis using demographic and health survey

ObjectivesUndergoing women of pregnancy termination (PT) significantly faces the problem of physical and mental health. This study aims to assess the prevalence and socioeconomic disparity factors of PT in Bangladesh. This study analyzed data from the 2017–18 Bangladesh Demographic and Health Survey. Researchers employed chi-square tests to identify relationships between categorical variables and logistic regression to pinpoint factors associated with PT. To assess the socioeconomic variation of PT, the analysis utilized concentration curves, concentration indices, and decomposition techniques.ResultsThe study found that 21.0% of reproductive-aged women in Bangladesh had ever terminated a pregnancy. Our study revealed that women from Chittagong and Sylhet regions, with wealthier backgrounds, aged 30 or older, employed in business, taking short birth intervals, and whose husband/partner was 35 or older, were more likely to have had a pregnancy termination with statistical significance (p < 0.05). Besides, concentration curves showed a higher prevalence of PT among wealthier women (CCI = 0.029, p < 0.001). Decomposition of this inequality revealed that a woman’s wealth status was the largest contributor (74.98%) to the observed disparities, followed by exposure to mass media (41.82%), place of residence (34.35%), occupation (24.81%), and preceding birth interval (6.53%). Our study recommended that, in mitigating the above disparities, we should foster open discussions about underlying factors contributing to PT in Bangladesh.

Liver Cancer Etiology: Old Issues and New Perspectives.

This review aims to synthesize the old issues and current understandings of the etiology of liver cancer, focusing on the diverse causative factors influenced by geographical, socioeconomic, and lifestyle variations across different regions. We highlight significant geographic disparities in liver cancer risk factors. While hepatitis B and C viruses, aflatoxin exposure, and alcohol consumption remain globally established contributors; metabolic dysfunction-associated steatotic liver disease and metabolic syndromes are increasingly prominent in the West. Chronic HBV and aflatoxin continue to dominate as risk factors in Asia and Africa. Dietary factors, metabolic diseases like diabetes and obesity, genetic predispositions, environmental risk factors and lifestyle choices such as smoking and alcohol use play substantial roles in specific populations. Protective factors like coffee and tea consumption, along with aspirin use, vegetables and fruits have shown potential in reducing HCC risk, although findings vary by population and dietary habits. Liver cancer etiology is influenced by various factors that differ by region. Established risk factors include hepatitis B and C, aflatoxin, and alcohol. Emerging risks, such as metabolic dysfunction-associated steatotic liver disease, are more prevalent in Western countries, while aflatoxin and HBV remains significant in Asia and Africa. Diet, metabolic conditions like diabetes and obesity, genetic predispositions, and lifestyle choices also play crucial roles. Coffee, tea, aspirin, vegetables, and fruits may reduce HCC risk, but effectiveness varies. Future research should integrate epidemiology, genetics, and nutrition, with global cooperation and data sharing essential for effective cancer control strategies.

Empirical Study on Delays in Highway Projects: A Comparative Analysis of Small and Large Projects

Delays in National Highway projects, regardless of their geographical location, have exerted a substantial impact on project performance and yielded unfavourable economic consequences. The majority of these projects in India are implemented by Public-Private Partnerships (PPPs), which use a wide range of contract types, including traditional ones such as item rate contracts and bills of quantity, in addition to more modern alternatives such as build operate transfer, engineering procurement and transfer, and recently developed hybrid models. This study examines and compares the reasons of critical delays in national highway projects in Himachal Pradesh with project characteristics. This mixed-methods study gathered comprehensive data from project participants using qualitative analysis and a survey questionnaire. Interviews and document analysis identified delay factors, which were then assessed through a structured questionnaire distributed to a representative sample of project participants. The findings highlight critical delay factors in National Highway projects in Himachal Pradesh and offer insights into the unique challenges faced by large PPP projects and small traditional projects. Despite the small sample size of 134 survey responses, the findings are significant but may have limited applicability to other infrastructure projects due to socio-economic and geographic variations. This suggests a research gap indicating that further analysis is needed to understand the challenges in EPC and PPPs for large hilly road projects, along with a focused study on organizational culture to assess highway project performance. This study contributes empirical data to the literature about the steep National Highway projects in Himachal Pradesh. Policymakers, project specialists, and stakeholders may ascertain the reasons of delays and formulate targeted actions to enhance project efficiency.

Abstract C155: Differential colorectal cancer mortality across racial and ethnic groups: Impact of socioeconomic status, clinicopathology, and treatment-related factors

Abstract Introduction: Non-Hispanic Black colorectal cancer (CRC) patients have a higher risk of mortality compared to most other racial/ethnic groups. Limited studies examine the contribution of socioeconomic (SES), clinicopathologic, or treatment variations toward mortality disparities. This retrospective cohort investigation examined the extent to which SES, clinicopathologic, and treatment factors explain racial/ethnic differences in CRC mortality. Methods: We studied 146,515 individuals ,18+ years old, with a confirmed diagnosis of CRC within 2010-2017 identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed Cox regression analyses to examine the association of race/ethnicity, surgery type, and tumor site with all-cause mortality and CRC-specific mortality. We then performed mediation analysis to quantify the extent to which mortality differences were mediated by SES, clinicopathologic, and treatment factors. Results: Non-Hispanic Black patients had a significantly higher hazard of all-cause mortality than non-Hispanic White patients. The non- Hispanic White versus non-Hispanic Black patients’ comparison demonstrated that variations in SES and clinicopathologic factors significantly explained 46.63% (indirect effect HR: 0.92, 95% CI 0.91-0.93) and 10.87% (indirect effect HR: 0.98, 95% CI 0.97-99) of the excess all-cause mortality among non-Hispanic Black patients, respectively. The Hispanic vs. non-Hispanic Black comparisons identified SES as the most influential mediator, explaining 19.68% of the excess all-cause mortality. The proportions mediating for CRC-specific mortality showed comparable outcomes to all-cause mortality. Conclusions Non-Hispanic Black patients had greater risk for all-cause mortality and CRC-specific mortality attributed to SES and clinicopathologic variations compared to other racial/ethnic groups. Future studies should investigate equity in healthcare through interventions addressing SES-related disparities. Citation Format: Pierre Fwelo, Toluwani E. Adekunle, Tiwaladeoluwa B. Adekunle, Ella R. Garza, Emily S. Huang, Wayne R. Lawrence, Aldenise P. Ewing. Differential colorectal cancer mortality across racial and ethnic groups: Impact of socioeconomic status, clinicopathology, and treatment-related factors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C155.

Racial disparities in access to liver transplantation in patients with early-stage hepatocellular carcinoma

BackgroundOrthotopic liver transplantation is the recommended treatment option for patients with early-stage hepatocellular carcinoma and concomitant cirrhosis. Waitlist candidacy can be affected by social determinants of health that vary across races and ethnicities. Our study sought to evaluate whether racial/ethnic disparities exist in access to orthotopic liver transplantation in patients with hepatocellular carcinoma. MethodsThe National Cancer Database participant use file was used to analyze data between 2004 and 2020. Patients 18–70 years of age with TNM clinical stage I and II hepatocellular carcinoma who received either orthotopic liver transplantation or liver directed/nonsurgical therapies were included. Baseline demographic variables and treatment modalities were collected. Patients were assigned fixed categories on the basis of race and ethnicity. Descriptive statistics, multivariable logistical regressions, effects modification analysis, and propensity matching were used. ResultsThere were 23,313 non-Hispanic White, 5,215 non-Hispanic Black, 5,581 Hispanic, and 2,768 other patients included in this analysis. Significant socioeconomic variation was observed across races. Non-Hispanic White patients were more likely to undergo orthotopic liver transplantation than non-Hispanic Black patients. The proportion of patients insured by Medicare was the same between non-Hispanic White and non-Hispanic Black patients. There was a graeter proportion of non-Hispanic Black patients with Medicaid compared with non-Hispanic White patients, whereas a lower proportion of non-Hispanic Black patients were insured via private insurance compared with non-Hispanic White patients. Effect modification analysis showed the non-Hispanic Black patients were less likely to undergo orthotopic liver transplantation for those with private and Medicare coverage compared with non-Hispanic White patients. Propensity matching showed a significantly decreased rate of orthotopic liver transplantation in non-Hispanic Black patients compared with non-Hispanic White patients. ConclusionNon-Hispanic Black patients were less likely to undergo orthotopic liver transplantation for early-stage hepatocellular carcinoma, despite adjusting for cancer stage and socioeconomic factors, compared with non-Hispanic White patients. Social determinants of health were associated with the probability of undergoing orthotopic liver transplantation. Understanding disparities related to social determinants of health will help guide health policy changes and improved access to care.

Socioeconomic determinants of child malnutrition: Evidence from Ethiopia

In this research, I examined the role of socioeconomic variations in the prevalence of stunting and underweight among children in Ethiopia. The study aimed to identify key health factors contributing to these disparities in child malnutrition by utilizing concentration indices, concentration curves, and regression-based decomposition analysis. Despite a notable decline in the average rates of stunting and underweight prevalence, the relative and absolute gaps between different demographic and socioeconomic groups have widened in Ethiopia. The empirical analysis revealed that higher levels of maternal education and household wealth significantly benefited children from better socioeconomic backgrounds, making them less likely to experience malnutrition. The disparity in socioeconomic status is the primary driver of inequalities in child malnutrition. The findings suggest that to reduce these disparities, national health policies should focus on promoting maternal literacy and targeting interventions for underprivileged groups.

Age-Related Blood Pressure Gradients Are Associated With Blood Pressure Control and Global Population Outcomes.

The strong relationship between blood pressure (BP) and age is well known. Limited evidence suggests that a steeper age-BP slope may be associated with an increased risk of adverse outcomes. The May Measurement Month campaign enables an investigation of geographic, socioeconomic, and sex differences in age-related BP gradients and their association with public-health outcomes. Cross-sectional, annual global BP May Measurement Month screening data were analyzed. Average systolic BP and age-related BP slopes across different age groups were calculated to assess regional, socioeconomic, and sex-stratified variations. The association of BP slopes derived from adjusted linear regression models with country-level health metrics was investigated. Age-related systolic BP gradients differed distinctly across global geographic regions, income levels, and between sexes. The steepest age gradients of BP were observed in populations from Africa and Europe. Women had lower BP levels than men at younger ages (20s and 30s) but subsequently experienced more pronounced age-related BP gradients. Geographically divergent age-related BP gradients were significantly associated with major national public health indicators. Globally, steeper age-related BP slopes were associated with poor BP control, increased disability-adjusted life years, and death rates. A steeper population age-BP slope of 1 mm Hg per 10 years was associated with a decrease in life expectancy of 3.3 years in this population (95% CI, -5.1 to -1.4; P=0.0007). Age-related BP gradients vary considerably across global populations and are associated with variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of adverse BP gradients to improve health outcomes.

Understanding the cataract treatment disparities among older adults in India.

Cataract is a leading cause of global blindness, affecting around 33% of blind individuals worldwide. It significantly impacts individuals' well-being, independence, and quality of life, posing a substantial economic burden. India's rapidly ageing population necessitates an examination of cataract prevalence and treatment disparities. No attempts have been made to address socioeconomic variation in treatment disparities of effective cataract treatment coverage among older adults in India. This study utilises data from the Longitudinal Ageing Study of India (LASI) conducted in 2017-18, that covered, 73,396 individuals aged 45 and above. Logistic regression, univariate, and bivariate analyses were employed to understand the variation of cataract and their associations with various demographic factors. Visual acuity tests and self-reported cataract data were used. The prevalence of cataract among older adults in India was 14.25%, with higher rates among females and the older adult. Socioeconomic disparities werelarge, with lower prevalence among those with higher education and urban residence. Despite the effectiveness of cataract surgery, disparities in treatment access and effective coverage persisted. Approximately 27.52% of older adults did not receive cataract treatment, and those who received out of them 28% did not receive effective treatment. The effective treatment was lower among female, less educated, and poor. Cataract remains a significant public health concern in India, particularly among older adults. The study highlights the importance of addressing socioeconomic disparities in cataract treatment access and quality of care. Targeted interventions are needed to bridge these gaps, ultimately improving visual health outcomes and well-being among older adults in India.

Level of education, but not occupation, is differentially associated with asthma phenotypes in adults.

Education, but not occupation, was differentially associated with adult asthma phenotypes in the general population. Further research into socioeconomic status variation in various asthma phenotypes is warranted.

Socioeconomic variations in walking rates in the United States: Recent evidence from the 2022 National Household Travel Survey

IntroductionWe use the 2022 National Household Travel Survey for the USA—the first since the peaking of the COVID-19 pandemic—to examine variations in walking rates related to differences in socioeconomic characteristics. Our analysis provides the most recent national estimates of socioeconomic variation in walking, by far the most important form of daily physical activity in the USA. MethodsWe used graphical bivariate analysis and multiple regressions to explore the relationship between each of the socioeconomic variables and the following daily walk rates: the number of walk trips, time walked, and distance walked. We also analyzed three binary variables indicating whether a person made at least one walk trip during the travel day, achieved the equivalent of 150 min of walking per week, and walked on five or more days during the previous 30 days. ResultsHigher education levels, not owning a car, not having a driver's license, not working, working from home, and high density are strongly related to higher levels of walking. We found no significant differences or mixed results for gender, age, race, and income. Because the 2022 NHTS incorporated significant changes in methodology, sample size, survey questions, and variable definitions, its estimated trip rates cannot be compared directly to the 2017 NHTS—the last survey prior to COVID. Moreover, the 2022 NHTS greatly underestimated walk trips because—unlike previous NHTS surveys—it omitted the trip diary as well as multiple prompts to remember short trips, especially walk trips. ConclusionsThe relationships we estimated between various walk rates and the nine socioeconomic variables for 2022 were generally consistent with the results of previous studies, including those examining the 2001, 2009, and 2017 NHTS. That suggests that these relationships have remained stable over time—even if absolute rates of walking have changed, as indicated by other studies.

Parental education and children’s depression, anxiety, and ADHD traits, a within-family study in MoBa

Children born to parents with fewer years of education are more likely to have depression, anxiety, and attention-deficit hyperactivity disorder (ADHD), but it is unclear to what extent these associations are causal. We estimated the effect of parents’ educational attainment on children’s depressive, anxiety, and ADHD traits at age 8 years, in a sample of 40,879 Norwegian children born in 1998–2009 and their parents. We used within-family Mendelian randomization, which employs genetic variants as instrumental variables, and controlled for direct genetic effects by adjusting for children’s polygenic indexes. We found little evidence that mothers’ or fathers’ educational attainment independently affected children’s depressive, anxiety, or ADHD traits. However, children’s own polygenic scores for educational attainment were independently and negatively associated with these traits. Results suggest that differences in these traits according to parents’ education may reflect direct genetic effects more than genetic nurture. Consequences of social disadvantage for children’s mental health may however be more visible in samples with more socioeconomic variation, or contexts with larger socioeconomic disparities than present-day Norway. Further research is required in populations with more educational and economic inequality and in other age groups.

Multiscale dimensions of the foreign working citizens participation to the Italian labour market: intra-regional heterogeneities across the North–South divide

This article delves into the distinctive intra- and interregional geographical heterogeneity of Italy, emphasizing demographic and socio-economic variations and the role of foreign employment, considering the labour market as a fundamental driver for migration and local inclusion. The article identifies a gap in understanding the employed foreign population as a multiscale process in Lombardy and Campania, representative regions as case studies from the North and South divide using a MGWR approach. The results reveal contrasting effects of the Italian labour force’s unemployment rate (URI). In Lombardy, a positive effect suggests working competition between labour force components while, in Campania, the relation is less clear. The analysis underscores significant local heterogeneity, emphasizing the importance and urgency of employing local scale analysis for accurate statistics. The study emphasizes the multiscale nature of the analysed process, demonstrating variable effects across different regional contexts. While the study is limited to two regions and cross-sectional data, it marks the first attempt in Italy to address the foreign presence as a multiscale process, highlighting the need for localized and multiscale approaches in understanding spatial processes related to demography and population issues.

Socioeconomic and regional variations in repair modality for ruptured abdominal aortic aneurysms

BackgroundPrevious studies report that patients of racial/ethnic minorities more frequently present with ruptured abdominal aortic aneurysms (rAAAs) than their counterparts. The distribution of rAAA treatment modality, whether open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR), by race/ethnicity classification remains uncertain. This study aims to investigate disparities, as represented by race/ethnic classification, median income, and insurance status, in the management of rAAA in a national cohort. MethodsWe conducted a retrospective analysis of patients admitted with rAAA managed with either OAR or EVAR from 2002 to 2020 using the National Inpatient Sample, comparing repair type by race/ethnicity group. Multilevel mixed effects logistic regression models, adjusted for patient- and system-level factors, were used to calculate difference in use of OAR or EVAR dependent on race/ethnicity classification. ResultsWe identified 10,788 admissions for rAAA repairs, of which 9506 (88.1%) were White, 605 (5.6%) were Black, 424 (3.9%) were Hispanic, and 253 (2.4%) were Asian/Native American. Asians/Native Americans underwent the highest frequency of OAR as compared with EVAR (61.7% vs 38.3%). In the adjusted model, there was no statistically significant difference in the use of OAR vs EVAR by race/ethnicity classification. In total, primary payer and median income were also not statistically significant predictors of AAA treatment modality. ConclusionsOur study found no statistical evidence of disparities with respect to race, insurance, or median income and use of OAR or EVAR for the management of rAAA.

Famine and Childhood: Ottoman Children’s Experiences during the Famine of 1873-1875

This article explores the unique experiences of children who lived in a famine-affected region of Central Anatolia between 1873 and 1875. The deplorable conditions forced some children to consume inappropriate foods, be traded for bread, be abandoned during migration, or be subjected to exploitation and domestic servitude. The article emphasizes the contrast between child-rearing practices and the concept of childhood in the Central Anatolian region and urban areas of the period. This challenges the prevailing emphasis in previous studies that have primarily examined urban children during the period of peace. Emphasizing the famine of 1873–1875, the research underscores that the concept of childhood and the material culture developed and adopted by urban families of the period under the effect of modernization were not observed in Central Anatolia. Thus, it is suggested that examining childhood in the Ottoman Empire necessitates a periodical and regional methodology that considers the socioeconomic and cultural variations that influenced the experiences of children in various regions and eras. In addition, the article delves into the Ottoman government’s response to the famine. The article addresses these issues by comprehensively examining Ottoman archival sources, periodicals and gazettes, together with contemporary accounts and reports from the famine period.

Examining the Period-Based Changes in the Effect of Socioeconomic Status in Maternal Healthcare Utilization Across Regional and Residential Contexts in Postcolonial Tanzania (1991–2016)

ABSTRACT Applying dependency theory, this manuscript uses data from the six cross-sectional Tanzania Demographic Health Surveys from 1991 to 2016 (n = 30,028) to explore temporal variations in the effect of socioeconomic status (SES) on maternal healthcare (MHC) utilization across different residences and regions. Research in this area is nonexistent in Tanzania. The results suggest a notable gap in using Tanzanian MHC based on SES and location (i.e. residence, regions). Results suggest that women from underserved groups, such as those living in rural areas or all-other (i.e. unprivileged) regions with lower SES, may have less access to MHC in the underdeveloped world. There were statistically significant socioeconomic variations in MHC use observed between residencies and regions, with stronger differences seen between residencies than regions. These findings further highlight the idea that lower use of MHC in the Global South is inseparable from economic dependency on metropolitan and Global North countries. This research calls for policymakers to recognize the roles of interactions between location and socioeconomic inequalities as factors exacerbated by higher dependency when crafting policies to modify healthcare utilization among women in underdeveloped countries.

Making ends meet: spatial and socio-economic variations during the 2020-2021 COVID-19 lockdown in South Africa

ABSTRACT To mitigate the ravages of COVID-19, governments across the world imposed limitations on human movement from early 2020 onwards. Such limitations were framed as aiming to achieve a balance between saving lives and livelihoods. One way to test the impact on livelihoods is to look at socio-economic metrics, and their spatial patterns over time. We draw on data from the UJ-HSRC national COVID-19 Democracy Survey, a nationally representative sample (n = 38 785), collected from April 2020 to July 2021. Changes in socio-economic and psycho-social conditions experienced by the adult population in South Africa are assessed. Whereas infection rates during this peak period of the pandemic reached about 5% of the population, with provincial variation between 2% and 7%, the experience of hunger and/or fear affected more than one-third. Feelings of fear were dominant in those areas where livelihoods were most affected by the pandemic. In terms of economic distress, results in successive survey rounds indicated decreases in the large metropolitan areas, but increases in other parts of the country. We claim that heavy-handed government-mandated prohibitions could have been mitigated by nuanced, differential mitigatory regulations that factored in the diverse socio-economic conditions in a country such as South Africa.

Geographic and socioeconomic variation in treatment of elderly prostate cancer patients in Norway – a national register-based study

PurposeThe aim of this study was to examine geographic and socioeconomic variation in curative treatment and choice of treatment modality among elderly prostate cancer (PCa) patients.MethodsThis register-based cohort study included all Norwegian men ≥ 70 years when diagnosed with non-metastatic, high-risk PCa in 2011–2020 (n = 10 807). Individual data were obtained from the Cancer Registry of Norway, the Norwegian Prostate Cancer Registry, and Statistics Norway. Multilevel logistic regression analysis was used to model variation across hospital referral areas (HRAs), incorporating clinical, demographic and socioeconomic factors.ResultsOverall, 5186 (48%) patients received curative treatment (radical prostatectomy (RP) (n = 1560) or radiotherapy (n = 3626)). Geographic variation was found for both curative treatment (odds ratio 0.39–2.19) and choice of treatment modality (odds ratio 0.10–2.45). Odds of curative treatment increased with increasing income and education, and decreased for patients living alone, and with increasing age and frailty. Patients with higher income had higher odds of receiving RP compared to radiotherapy.ConclusionsThis study showed geographic and socioeconomic variation in treatment of elderly patients with non-metastatic, high-risk PCa, both in relation to overall curative treatment and choice of treatment modality. Further research is needed to explore clinical practices, the shared decision process and how socioeconomic factors influence the treatment of elderly patients with high-risk PCa.

Geographic variation in sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist use in people with type 2 diabetes in New South Wales, Australia.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve glycaemic control and cardio-renal outcomes for people with type 2 diabetes (T2D). However, geographic and socio-economic variation in use is not well understood. We identified 367 829 New South Wales residents aged ≥40 years who dispensed metformin in 2020 as a proxy for T2D. We estimated the prevalence of use of other glucose-lowering medicines among people with T2D and the prevalence of SGLT2i and GLP-1RA use among people using concomitant T2D therapy (i.e. metformin + another glucose-lowering medicine). We measured the prevalence by small-level geography, stratified by age group, and characterized by remoteness and socio-economic status. The prevalence of SGLT2i (29.7%) and GLP-1RA (8.3%) use in people with T2D aged 40-64 increased with geographic remoteness and in areas of greater socio-economic disadvantage, similar to other glucose-lowering medicines. The prevalence of SGLT2i (55.4%) and GLP-1RA (15.4%) among people using concomitant T2D therapy varied across geographic areas, with lower SGLT2i use in more disadvantaged areas and localized areas of high GLP-1RA use (2.5 times the median). Compared with people aged 40-64 years, the prevalence of SGLT2i and GLP-1RA use was lower in older age groups, but with similar patterns of variation across geographic areas. The prevalence of SGLT2i and GLP-1RA use varied by geography, probably reflecting a combination of system- and prescriber-level factors. Socio-economic variation in GLP-1RA use was overshadowed by localized patterns of prescribing. Continued monitoring of variation can help shape interventions to optimize use among people who would benefit the most.

Social Deprivation Index Affects Time to MRI after knee injury in pediatric patients and is predicted by patient demographics

ABSTRACT Objectives This study aims to characterize the association between the timing of MRI ordering and completion for pediatric knee injuries and Social Deprivation Index (SDI), which is a comprehensive, validated, county-level, measure of socioeconomic variation in health outcomes based upon combining geography, income, education, employment, housing, household characteristics, and access to transportation. Methods A retrospective chart review was completed of patients 21 years old and younger from our institution with a history of knee sports injury (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) evaluated with MRI between 5/26/2017 and 12/28/2020. Patients were from three states and attended to by physicians associated with an urban academic institution. Patients were assigned SDI scores based on their ZIP code. Excluded from the study were patients with a non-knee related diagnosis (hip, foot, or ankle), patients from ZIP codes with unknown SDI, and non-sports medicine diagnoses (tumor, infection, fracture). Results In a multivariate regression analysis of 355 patients, increased SDI was independently associated with increased time from clinic visit to MRI order (p = 0.044) and from clinic visit to MRI completion (p = 0.047). Each 10-point increase in SDI (0-100) was associated with a delay of 7.2 days on average. SDI itself was found to be associated with a patient’s race (p < 0.001), ethnicity (p < 0.001), and insurance category (p < 0.001). Conclusion Increased SDI is independently associated with longer time from clinic visit to knee MRI order and longer time from clinic visit to knee MRI completion in our pediatric population. Recognizing potential barriers to orthopedic care can help create the change necessary to provide the best possible care for all individual patients.

Sense of neighborhood belonging and health: geographic, racial, and socioeconomic variation in Wisconsin.

Individuals' sense of belonging (SoB) to their neighborhood is an understudied psychosocial factor that may influence the association between neighborhood characteristics, health, and disparities across socio-demographic groups. Using 2014-2016 data from the Survey of the Health of Wisconsin (SHOW, N = 1,706), we conduct a detailed analysis of SoB and health in an American context. We construct OLS and logistic regressions estimating belonging's association with general, physical, and mental health. We explore geographic, racial, and socioeconomic variation to understand both the differential distribution of SoB and its heterogeneous relationship with health. A higher SoB is positively associated with better physical, mental, and general health. White participants report higher SoB than Black participants, yet the association between SoB and mental health is strongest among participants of color and urban residents. Sense of belonging to neighborhood significantly predicts many facets of health, with place and individual characteristics appearing to moderate this relationship. Racial, geographic, and socioeconomic disparities in belonging-health associations raise important questions about who benefits from the social, economic, and physical aspects of local communities.