Neighborhood Status Research Articles

Disparities in Genetic Profiles, Risk Stratification and Outcomes in Adults with Acute Myeloid Leukemia Comparing Patients of Hispanic and Non-Hispanic Ethnicity in Central California

Acute myeloid Leukemia (AML) is the most common type of acute leukemia in adults. Ethnic disparities due to distinct biology and socioeconomic status have been described in AML. Prior studies indicated Hispanic AML patients had a younger age at presentation, more frequent high-risk mutations, and worse survival compared with non-Hispanics. We conducted a retrospective study to investigate the differences in AML risk stratification, mutational profiles and outcomes between Hispanic and non-Hispanic AML patients treated at Community Medical Centers (CMC) in Central California. Methods: We retrospectively analyzed patients ≥ 18 years diagnosed with AML between January 2016-December 2022 and treated at CMC in Fresno, CA. Patients with Acute promyelocytic leukemia and patients without complete cytogenetic and molecular data were excluded. The clinical data including age, sex, ethnicity, race, zip code, WBC on diagnosis, cytogenetics, molecular data and treatment regimens were reviewed. Molecular profiling was performed by next generation sequencing using established myeloid panels by NeoGenomics (NeoTYPE comprising of 63 genes) or Foundation One Heme laboratory (406 genes). Risk groups were identified based on the European Leukemia Network (ELN) 2022 criteria. RedCap data collection tool was used for data collection. A comparison of patient characteristics and rate of genetic alterations between Hispanic and Non-Hispanic patients was done using the Fisher exact test or Chi-square test. Kaplan-Meier Curve with log-rank test was used for evaluation of overall survival (OS) and progression-free survival (PFS). Results: 201 patients met the study criteria, 30 of them did not receive treatment and were included for their diagnostic data only but excluded from the survival analysis. The mean age at diagnosis was 65.6. 58.5% were males and 30% were Hispanic. Hispanic patients were younger than non-Hispanics (57.6 vs 64.6 years, p=0.01). Hispanic patients were also more likely to live in the relatively low Socioeconomic status (SES) neighborhoods (i.e., living in zip codes with the 1st or 2nd quartile of median income level) p=0. 007. More Hispanic patients needed interpreter P<0.001. However, Hispanics were more likely to experience favorable risk AML (8.4 % vs 0.7%, p=0.012), while non-Hispanics had higher rate of poor risk disease (63.8 Vs 55.9%, p=0.012).). There was no significant difference between Hispanics and non-Hispanics in terms of sex, de novo versus secondary AML, WBC at time of diagnosis, Extramedullary or Central nervous system (CNS) involvement, type of induction regimen or rate of consolidative or subsequent allogeneic stem cell transplant. Median OS in Hispanics was 17.3 months compared to 10.28 months for non-Hispanics, p=0.117.and median PFS for Hispanics was 9.17months compared to non-Hispanics at 6.04 months P=0.034 (Figure 1). In univariate analysis PFS and OS were better in patients with normal cytogenetics compared to those with abnormal cytogenetics (15.3 vs 3.52 months and 20.4 vs 7.69 months respectively, p < 0.001) and in patients with favorable compared to intermediate risk and poor risk groups (84.5 vs 11.4 vs 4.1 months for PFS and Non reached vs 18.1 vs 7.8 months for OS, p< 0.001). There was no significant effect of income level in terms of OS or PFS. The most common genetic mutations in our patients were NPM1, FLT3-ITD, DNMT3A, TET2 and TP53. However, there were differences in the rates between Hispanics and non-Hispanics. 5q deletion and STAG2 were more common in non-Hispanics while KMT2C was detected more in Hispanics (table 1). Conclusion: Our study identified biologic differences between Hispanic and non-Hispanic AML patients with heterogeneity in genetic mutations. While Hispanic patients had lower income, they were younger at diagnosis and more likely to have favorable risk AML. Hispanic patients had better PFS and a trend towards improvement in OS. Further studies on larger patient population are warranted to evaluate the effect of ethnicity and SES on outcomes of AML patients.

Perceived barriers to sports participation among adolescent girls from low socioeconomic status neighbourhoods

This study examined perceived barriers to sports participation among adolescent girls from low socioeconomic status (SES) neighbourhoods. A total of 11 semi-structured focus groups were conducted, involving 44 adolescent girls who were not engaged in organized sports. Thematic analysis was used to generate themes, and revealed that; 1) Participants prioritized homework, household duties and socializing with friends over sports. 2) Girls refrained from participating in sport due to fear of not fitting in because of ethnic background and reluctance to participate alone. Moreover, 3) feelings of inadequacy in sporting abilities, 4) bodily discomfort, and negative body image were perceived as barriers. 5) Finally, gender stereotypes, depicting sports as unsuitable for girls, along with negative attitudes from boys, further discouraged girls’ engagement. These findings offer a nuanced understanding of the barriers faced by this underrepresented group, informing the design of future interventions aimed at promoting sports participation among adolescent girls from low SES neighbourhoods.

Abstract 17653: Neighborhood Deprivation and Cardiovascular Health in US Adolescents, National Health and Nutrition Examination Survey 2007-2018

Introduction: AHA “Life’s Essential 8” scores cardiovascular health (CVH) as good, intermediate or poor based on diet, physical activity, sleep, tobacco exposure, cholesterol, blood pressure, blood glucose, and body mass index. CVH of the US population remains suboptimal, and the relationship between neighborhood deprivation and CVH in youth has not been fully explored. Hypothesis: We hypothesize that high neighborhood deprivation is associated with intermediate/poor CVH in adolescents. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, we examined the relationship between neighborhood deprivation index (NDI) and CVH status in adolescents. NDI was created from 2010 US Census data and reflects neighborhood level income, housing, education, and poverty status. Higher NDI indicates greater neighborhood deprivation. NDI values were divided into tertiles for analysis. We used proc survey logistic to assess the odds of poor/intermediate CVH status among youth living within high and intermediate compared to low deprivation communities. The model was adjusted for age, sex, ethnicity-race, household reference education and marital status, family poverty, rural vs urban residence and Citizenship status. All analyses were conducted using SAS 9.4, p<0.05 . Results: We evaluated data from 3894 individuals, representative of 57,195,556 US adolescents 13 to 18 years of age. Most adolescents were non-Hispanic white (67%), male (51%), US Citizens (96%), mean age of 15 years, with an even distribution of youth living within low, intermediate and high deprivation neighborhoods (Table 1). We identified 31% greater odds of intermediate/poor CVH status among youth living within the most deprived communities (Table 2). Conclusions: Greater NDI associates with worse CVH in US adolescents. Public health initiatives should consider using NDI to tailor efforts in designing intervention strategies to preserve CVH status in US adolescents.

For whom do we densify? Explaining income variation across densification projects in the region of Utrecht, the Netherlands

While governments worldwide rely upon compact city policies to reduce land consumption from urban growth, recent studies have addressed the potential trade-off between densification and housing affordability. Concerns have been voiced that densification leads to a one-sided housing supply, structurally excluding low-income households. However, few studies address household income variation across densification projects, leaving us with a limited understanding of the circumstances under which exclusion occurs. To this end, we explore household incomes in densification projects between 2012 and 2020 in the Province of Utrecht, the Netherlands, where urban development is traditionally strongly regulated through active land policy. At the same time, current shifts towards a more deregulated housing market make for an interesting case. Exceptional access to detailed cadastral and census data allows us to identify densification projects and assign them a median household income each. We investigate the influence of location and transformation process on household incomes through regression analysis and conduct qualitative case studies of projects whose median income was highly mispredicted by the regression model. This allows us to integrate non-quantified factors, such as land ownership and public policy interventions, in explaining such interesting cases. For the Province of Utrecht, our study confirms that while households in densification projects earn significantly more than their neighbours, the range of incomes in densification projects is large. Project characteristics such as centrality, neighbourhood status and transformation process explain only a small share of this variance. For cases where median incomes are much lower than predicted by the model, public land ownership, in combination with inclusionary zoning, is essential in ensuring housing affordability. Our approach highlights the necessity of supplementing densification policies with measures that secure affordable housing.

Time trends in associations between neighbourhood and school characteristics and mental health problems among Dutch adolescents

We investigated trends in associations between physical and social neighbourhood and school characteristics and adolescent mental health problems between 2005 and 2017. Nationally representative, repeated cross-sectional data collected in the Netherlands among primary (N = 5,871) and secondary school students (N = 20,778) were analysed through cross-classified multilevel models. Hardly any evidence was found for over-time changes in associations between neighbourhood and school characteristics and adolescent mental health problems. Findings showed that for both groups of students, only social characteristics within the two contexts were associated with adolescent mental health problems. For secondary school students, school effects were larger than neighbourhood effects, while the opposite was true for primary school students. Specifically, primary school students residing in more socially fragmented or lower socioeconomic status (SES) neighbourhoods, and lower SES schools, reported more conduct problems and peer relationship problems. For secondary school students, only the SES of the neighbourhood and the school was associated with all four aspects of mental health problems. Remarkably, the direction of the associations between neighbourhood/ school SES and adolescent mental health problems varied across the different mental health outcomes. More research is warranted to replicate our findings.

SAT127 What’s Cookin’: Attitudes Towards A Healthy, Budget-friendly Meal Planning Tool In Patients With Type 2 Diabetes

Abstract Disclosure: R. Abramczyk: None. S. Sadiq: None. C. Vaz: None. Background: Eating home-cooked meals has been associated with reduced risk of developing type 2 diabetes (T2DM). Additionally, nutrition counseling can aid weight loss and improve glucose levels. However, these interventions may be less effective in underserved patients as food prices can be a barrier to healthy food access. We performed a preliminary assessment of a quality improvement nutritional intervention at a university-based clinic in a medically underserved area. Aim: This analysis aimed to measure patients’ perceived levels of confidence in shopping for and preparing healthy, DM-friendly meals and interest in receiving a sample grocery list with matching recipes. Methods: Patients with T2DM seen in fellows’ clinic over 3 months were offered surveys that measured confidence levels in shopping for and preparing a healthy, DM-friendly diet. Participants were subsequently offered an ADA-compliant, Supplemental Nutritional Assistance Program-friendly sample grocery list and weekly meal plan. Results: 50 patients completed surveys. 70% were >50 years and 70% identified as African American. 98% shop for food at a supermarket, with 12% also utilizing smaller grocery and corner stores. 8% were not confident in shopping for healthy, DM-friendly foods. 30% were somewhat confident, 46% were confident, and 16% were extremely confident in shopping for DM-friendly foods. 82% of participants either did their own meal prep at home or had someone else at home who cooked. 16% were not confident in cooking DM-friendly foods, whereas 26% were somewhat confident, 50% were confident, and 8% were extremely confident. 92% were interested in receiving a 1-week shopping list for healthy groceries with corresponding recipes. Conclusion: While many patients in a low socioeconomic status neighborhood reported feeling confident shopping for healthy, DM-friendly foods, fewer felt confident in preparing and cooking these foods. Most patients were interested in a budget friendly shopping list and meal planning tool to assist in both shopping for and cooking foods that will assist in achieving improved DM control. A follow up phase study will evaluate the rate of utilization and other patient behavioral factors in response to this intervention. Further research is needed to develop and evaluate the impact that tools such as this may have on changes in behavior towards shopping for and cooking healthy, DM-friendly foods at home and its effects on glycemic control. Presentation: Saturday, June 17, 2023

Survival outcomes for lung neuroendocrine tumors in California differ by sociodemographic factors.

Lung neuroendocrine tumors (NETs) have few known predictors of survival. We investigated associations of sociodemographic, clinicopathologic, and treatment factors with overall survival (OS) and lung cancer-specific survival (LCSS) for incident lung NET cases (typical or atypical histology) in the California Cancer Registry (CCR) from 1992 to 2019. OS was estimated with the Kaplan-Meier method and compared by sociodemographic and disease factors univariately with the log-rank test. We used sequential Cox proportional hazards regression for multivariable OS analysis. LCSS was estimated using Fine-Gray competing risks regression. There were 6038 lung NET diagnoses (5569 typical, 469 atypical carcinoid); most were women (70%) and non-Hispanic White (73%). In our multivariable model, sociodemographic factors were independently associated with OS, with better survival for women (hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.57-0.68, P < 0.001), married (HR 0.76, 95% CI 0.70-0.84, P < 0.001), and residents of high socioeconomic status (SES) neighborhoods (HRQ5vsQ1 0.73, 95% CI 0.62-0.85, P < 0.001). Compared to cases with private insurance, OS was worse for cases with Medicare (HR 1.24, 95% CI 1.10-1.40, P < 0.001) or Medicaid/other public insurance (HR 1.45, 95% CI 1.24-1.68, P < 0.001). In our univariate model, non-Hispanic Black Californians had worse OS than other racial/ethnic groups, but differences attenuated after adjusting for stage at diagnosis. In our LCSS models, we found similar associations between sex and marital status on survival, but no differences in outcomes by SES or insurance. By race/ethnicity, American Indian cases had worse LCSS. In summary, beyond disease-related and treatment variables, sociodemographic factors were independently associated with survival in lung NETs.

Strangers in a strange land: Mapping household and neighbourhood associations with improved wellbeing outcomes in Accra, Ghana

Urban poverty is not limited to informal settlements, rather it extends throughout cities, with the poor and affluent often living in close proximity. Using a novel dataset derived from the full Ghanaian Census, we investigate how neighbourhood versus household socio-economic status (SES) relates to a set of household development outcomes (related to housing quality, energy, water and sanitation, and information technology) in Accra, Ghana. We then assess “stranger” households' outcomes within neighbourhoods: do poor households fare better in affluent neighbourhoods, and are affluent households negatively impacted by being in poor neighbourhoods? Through a simple generalized linear model we estimate the variance components associated with household and neighbourhood status for our outcome measures. Household SES is more closely associated with 13 of the 16 outcomes assessed compared to the neighbourhood average SES. For 9 outcomes poor households in affluent areas fair better, and the affluent in poor areas are worse off. For two outcomes, poor households have worse outcomes in affluent areas, and the affluent have better outcomes in poor areas, on average. For three outcomes “stranger” households do worse in strange neighbourhoods. We discuss implications for mixed development and how to direct resources through households versus location-based targets.

The impact of residential and non-residential environments on non-communicable disease in Ghanaian cities: The role of gender

Uncertainties around exposures in non-residential contexts complicate the understanding of neighborhood environments and health outcomes in low- and middle-income countries (LMICs) partly due to limited research on where people spend their day and how those spaces impact their health. The goal of this study, therefore, was to examine the relationship between time spent in/outside residential neighborhoods, length of stay in neighborhood and non-communicable diseases (NCDs) status and whether the relationship differs by gender. We used cross-sectional data from three Ghanaian cities and applied multilevel analysis. At the general level, we did not observe any significant difference between where people spend their day and NCDs status. After aggregating the data by gender, however, we found that men who spent some time outside their residential neighborhood in a typical week were about 2 times likely to be diagnosed with NCDs compared to those who spend the entire week in their residential neighborhoods. This relationship, however, was not statistically significant for women. On the other hand, longer stay in current neighborhood was associated with women's likelihood of being diagnosed with NCDs. These findings contribute to a nuanced understanding of neighborhood environments and NCD outcomes and offer directions for public health and environmental policy.

Prospective associations of neighborhood healthy food access and walkability with weight status in a regional pediatric health system

BackgroundMost neighborhood food and activity related environment research in children has been cross-sectional. A better understanding of prospective associations between these neighborhood environment factors and children’s weight status can provide stronger evidence for informing interventions and policy. This study examined associations of baseline and changes in neighborhood healthy food access and walkability with changes in children’s weight status over 5 years.MethodsHeight, weight, and home address were obtained for 4,493 children (> 75% were Black or Latinx) from primary care visits within a large pediatric health system. Eligible participants were those who had measures collected during two time periods (2012–2014 [Time 1] and 2017–2019 [Time 2]). Data were integrated with census tract-level healthy food access and walkability data. Children who moved residences between the time periods were considered ‘movers’ (N = 1052; 23.4%). Mixed-effects models, accounting for nesting of children within census tracts, were conducted to model associations of baseline and changes in the neighborhood environment variables with Time 2 weight status (BMIz and overweight or obese vs. healthy weight). Models adjusted for weight status and child and neighborhood sociodemographics at baseline.ResultsChildren living in a neighborhood with [ample] healthy food access at Time 1 had a lower BMIz at Time 2, regardless of mover status. A decrease in healthy food access was not significantly associated with children’s weight status at Time 2. Baseline walkability and improvements in walkability were associated with a lower BMIz at Time 2, regardless of mover status.ConclusionsFindings provide evidence that residing in a neighborhood with healthy food access and walkability may support a healthy weight trajectory in children. Findings on changes in the neighborhood environment suggested that improved walkability in the neighborhood may support children’s healthy weight. The greater and more consistent findings among movers may be due to movers experiencing greater changes in neighborhood features than the changes that typically occur within a neighborhood over a short period of time. Future research is needed to investigate more robust environmental changes to neighborhoods.

Implementation of an integrated community approach in deprived neighbourhoods: a theory-based process evaluation using the Consolidated Framework for Implementation Research (CFIR).

We investigated the implementation process of an Integrated Community Approach (ICA) applied in four low socio-economic status neighbourhoods in Maastricht, the Netherlands. The ICA is a Population Health Management initiative and aims to improve population health, quality of care, professional's satisfaction and decrease costs of care. This study addresses the facilitators and barriers for implementing the ICA from a stakeholder perspective, including steering group members, professionals and citizens. We conducted a mixed-methods study using a triangulation of methods to investigate the implementation from 1 December 2016 to 31 December 2020. The Consolidated Framework for Implementation Research guided data collection and data-analysis for evaluating the implementation process. In total, 77 interviews, 97 observations, seven focus groups, 65 collected documents and two surveys with open-ended questions were conducted. Facilitators for implementation were the use of citizen science to bring residents' needs into sharp focus, the integration of the ideology of Positive Health into the working routines of the professionals and leadership at the steering group level to overcome barriers in the ICA. The existing accounting and financial infrastructure obstructed combining budgets at neighbourhood level. Engaging citizens and professionals at an early stage is an important facilitator for implementation. The use of a shared vision on health also worked as a facilitator since it created a shared language among professionals, which is important in Population Health Management initiatives where multiple professionals are expected to collaborate. NTR 6543; registration date, 25 July 2017.

Evaluation of Tourism Ecological Security Based on Driving Force–Pressure–State–Influence–Response Framework and Analysis of Its Dynamic Evolution Characteristics and Driving Factors in Chinese Province Territory

Tourism ecological security (TES) is an important measure of the sustainable development of the tourism industry. It is also an important indicator for evaluating the balance between economic growth and the environmental load of tourism destinations. Therefore, the scientific measurement and examination of TES have important theoretical and practical value in promoting the coordinated and sustainable development of the regional tourism economy and ecological environment. From the perspective of systems theory, based on the driving force–pressure–state–influence–response model, the theoretical framework and index system of China’s provincial TES were constructed. The Technique for Order Preference by Similarity to an Ideal Solution method, spatial autocorrelation, traditional and spatial Markov chain, ordinary least squares regression, and geographically and temporally weighted regression model were used to analyze the dynamic evolution characteristics and driving factors of TES. The results indicated the following: (1) Regarding time series, the average value of TES was generally relatively stable with small fluctuations, the differences among provinces exhibited a converging trend, and a significant spatial correlation was observed between the TES of provinces. (2) In terms of dynamic evolution, the transfer of TES types exhibited “path dependence” and “self-locking” effects, meaning the probability of transfer to other types was low, and the status and transfer of TES types were closely related to their neighborhood status. (3) Regarding the driving factors, except for the negative inhibitory effect of environmental pollution on TES, all other variables had a positive promoting effect on TES; however, the effect of each variable in different provinces varied significantly. The results and methods used in this study can enrich the research on TES and provide a theoretical basis and decision-making reference for the healthy and sustainable development of the tourism industry in Chinese provinces.

Dietary patterns, socioeconomic disparities, and risk of type 2 diabetes in the Sister Study

AimsWe investigated the role of socioeconomic disparities in the association between diet and risk of type 2 diabetes (T2D). MethodsWe used prospective data from 40,243 Sister Study participants aged 35 to 74 years who were enrolled in 2003–2009. Scores for healthy eating indices (alternate Mediterranean diet, Dietary Approaches to Stop Hypertension, alternative Healthy Eating Index, and Healthy Eating Index 2015 (HEI-2015)) were calculated using data from a 110-item food frequency questionnaire completed at enrollment. Incident T2D was defined based on self-reported physician’s diagnosis or use of anti-diabetic medications. Multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. ResultsWe observed inverse associations between all four dietary indices and incident T2D after multivariable adjustment. These associations were most pronounced among women with higher educational attainment, higher income, and lower area deprivation index (ADI) (e.g., for the HEI-2015: low ADI, aHRQ4vsQ1: 0.44, 95% CI: 0.35, 0.56 vs high ADI, aHRQ4vsQ1: 0.75, 95% CI: 0.63, 0.90; pinteraction: 0.0007). ConclusionsWeaker associations among women with lower socioeconomic status and higher neighborhood deprivation suggests that other factors play a larger role in T2D incidence than diet quality among individuals with low SES.

O.6.3-3 Gender, ethnicity, and socioeconomic status: intersectoral factors influencing adolescent girls’ participation in sport

Abstract Purpose Adolescent girls’ sports participation are low, particularly among females living in low socioeconomic status (SES) neighbourhoods. Inequalities accumulate at the intersection of gender, ethnicity, and socioeconomic status. Understanding this inequity is essential to support better female opportunities in sports participation to reduce inequalities in health. Therefore, the aim of the current study was to investigate how gender, ethnicity, and socioeconomic status influence girls’ participation in sport. Methods Eleven focus groups were conducted from July-October 2021 with in total 44 adolescent girls living in low SES neighbourhoods. Ten had Danish ethnic origin and 34 had other ethnic minority background of whom 18 were born in Denmark with parents born in non-western countries. 21 of the girls were wearing veil as a symbol of their religious background. The inclusion criteria were non-participation in organised sport in their leisure time. The girls were recruited through purposive sampling via schools placed in five different low SES neighbourhoods. Drawing on an intersectoral framework as a tool to understand the complex interaction between gender, ethnicity, and socioeconomic status, a deductive thematic analysis was conducted from verbatim transcripts using NVivo. Results Capturing the girls’ own voices, the analyses identified three overarching themes; 1) The little voice inside, 2) Sports are not for girls, 3) Can you do sport with veil? Findings revealed that the barriers for this group of girls had more complex intertwined layers, where gender, ethnicity and socioeconomic status were accumulated. The analyse indicates that gendered societal expectations and stereotypes about femininity, along with cultural and religious norms and socioeconomic factors, act as a barrier for girls to participate in sport. Conclusions The results provide insight into intersectional factors that influence sports participation among adolescent girls living in low SES neighbourhoods. The findings among this underrepresented group indicate that gender, ethnicity, and socioeconomic status should be considered to ensure equal opportunities to sports participation. The findings will be useful to shed light on how interventions should be designed to promote sports participation among adolescent girls in low SES neighbourhoods and thus help promote equity.

Robust Leaderless Time-Varying Formation Control for Nonlinear Unmanned Aerial Vehicle Swarm System With Communication Delays.

This article investigates the tracking-oriented robust leaderless time-varying formation (TVF) control problem for unmanned aerial vehicle swarm systems (UAVSSs) with Lipschitz nonlinear dynamics under directed topology, where external disturbances are random and bounded, and communication delays (CDs) are bounded. In this article, a state-feedback control approach is adopted to make sure that a UAVSS forms a desired TVF and follows a specified trajectory when CDs and external disturbances occur. First, a novel PD-like formation control protocol with several unknown parameters and CDs is designed. The protocol contains the information of the local neighborhood status and its differential quantities. Second, the tracking-oriented robust leaderless TVF control problem with Lipschitz dynamics, external disturbances, and CDs is transformed into a problem about asymptotic stability of a lower dimensional closed-loop control system through a special matrix decomposition. Third, a theorem is proposed to determine the unknown parameters of the control protocol and the upper bound of CDs. In the theorem, sufficient conditions for a UAVSS to attain the anticipated TVF and trajectory tracking are obtained. A Lyapunov-Krasovskii (LK) functional is constructed to verify that the error among the practical flight state of UAVs, the anticipant TVF configuration, and tracking trajectory can asymptotically converge to 0. Finally, with the presentation of a simulation case, the effectiveness of the theoretical results is illustrated.

Socioeconomic status and inequities in treatment initiation and survival among patients with cancer, 2011-2022.

Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers. This retrospective cohort study used electronic health record-derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type. This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020). To reduce inequities in cancer outcomes, efforts that target marginalized, low-socioeconomic status neighborhoods are necessary.

Health disparities in the detection and prevalence of pediatric obstructive sleep apnea

IntroductionPediatric Obstructive Sleep Apnea (OSA) is associated with negative health outcomes, behavior problems, and poor academic performance when left untreated. Prior research has shown that children from racial and ethnic minority backgrounds and those living in lower socioeconomic status (SES) homes or neighborhoods have higher prevalence of OSA but lower likelihood of receiving evidence-based care for OSA. Disparities in pediatric OSA detection (e.g., timely assessment and diagnosis) likely contribute to this observed inequity in receiving treatment. A polysomnogram (PSG) is the gold standard for diagnosing OSA but completing PSG can be challenging. Study aims were to examine racial, ethnic, and SES differences in (1) OSA prevalence and severity and (2) OSA detection, specifically PSG completion rates, timing since referral, and age of diagnosis.MethodsChildren (aged 1–18, N = 1,860, 56% male) were referred for PSG during a 6-month period. Participants' racial/ethnic background were as follows: 64.8% White non-Hispanic, 23.5% Black non-Hispanic, 9.4% White Hispanic, and 2.4% other. Children predominantly had Medicaid insurance (64.5%). SES was measured by insurance type and neighborhood SES using the Distressed Communities Index (DCI) for each participant's zip code (Economic Innovations Group; https://eig.org/dc). Covariates included child age and sex, BMI, premature birth status, and smoke exposure in the home.ResultsWe replicated previous research by showing that children from minority racial/ethnic backgrounds and lower SES backgrounds had higher prevalence rates of OSA and worse disease severity. Across racial, ethnic, and socioeconomic backgrounds, only 31.6% of the children referred successfully completed PSG. Insurance coverage (Medicaid or private vs. self-pay), was an important factor in predicting earlier timing and better completion rates of PSG, which is essential for successful diagnosis and treatment of pediatric OSA.

‘It is an unfair game’: the role of capital in framing the relationships between kindergarten teachers and parents

ABSTRACT The article discusses the role of the different forms of capital within the patterns of relationships between kindergarten teachers (KTs) and parents in kindergartens located in one medium-high socioeconomic status neighborhood in Israel. The qualitative analysis conducted reveals how the parents’ cultural capital serves as a resource to advance the kindergarten in functioning and marketing, and for the KTs, to improve trust, cope with solitude, and receive parents’ feedback. The benefits for parents include furthering their children’s educational progress and enhancing their well-being, dealing with the municipal bureaucracy, and controlling the kindergarten’s operation. At the same time, it was found that capital resources may generate costs. For KTs, these may stem from parents’ interfering, crossing boundaries, and bullying, and cause KTs to placate the parents; for the parents, the costs may come in the form of anxiety about their children’s well-being.

Disparities in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre-vaccine and Post-Vaccine Availability.

The COVID-19 pandemic has led to significant disruptions in medical care, resulting in an estimated 40% of US adults avoiding care. However, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. We sought to analyze the visit volume and demographics of pediatric orthopedic patients at 3 timepoints: prepandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021), to determine the impact of COVID-19 restrictions on our single-center, multisite institution. We performed a retrospective cohort study of 6318 patients seeking treatment at our institution from May through August in 2019, 2020, and 2021. Patient age, sex, address, encounter date, and ICD-10 codes were obtained. Diagnoses were classified into fractures and dislocations, non-fracture-related trauma, sports, elective, and other categories. Geospatial analysis comparing incidence and geospatial distribution of diagnoses across the time periods was performed and compared with the Centers for Disease Control (CDC) social vulnerability index (SVI). The total number of pediatric orthopedic visits decreased by 22.2% during the pandemic ( P <0.001) and remained 11.6% lower post-vaccine availability compared with prepandemic numbers ( P <0.001). There was no significant difference in age ( P =0.097) or sex ( P =0.248) of the patients across all 3 timepoints; however, patients seen during the pandemic were more often White race (67.7% vs. 59.3%, P <0.001). Post-vaccine availability, trauma visits increased by 18.2% ( P <0.001) and total fractures remained 13.4% lower than prepandemic volume ( P <0.001). Sports volume decreased during the pandemic but returned to prepandemic volume in the post-vaccine availability period ( P =0.298). Elective visits did not recover to prepandemic volume and remained 13.0% lower compared with baseline ( P <0.001). Geospatial analysis of patient distribution illustrated neighborhood trends in access to care during the COVID-19 pandemic, with fewer patients from high SVI and low socioeconomic status neighborhoods seeking fracture care during the pandemic than prepandemic. Post-vaccine availability, fracture population distribution resembled prepandemic levels, suggesting a return to baseline health care utilization. Pediatric orthopedic surgery visit volume broadly decreased during the COVID-19 pandemic and did not return to prepandemic levels. All categories increased in the post-vaccine availability time point except elective visits. Geospatial analysis revealed that neighborhoods with a high social vulnerability index (SVI) were associated with decreased fracture visits during the pandemic, whereas low SVI neighborhoods did not experience as much of a decline. Future research is needed to study these neighborhood trends and more completely characterize factors preventing equitable access to care in the pediatric orthopedic population. Retrospective Study, Level III.

Deprivation and segregation in ovarian cancer survival among African American women: a mediation analysis

PurposeDeprivation and segregation indices are often examined as possible explanations for observed health disparities in population-based studies. In this study, we assessed the role of recognized deprivation and segregation indices specifically as they affect survival in a cohort of self-identified Black women diagnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study. MethodsMediation analysis was used to examine the direct and indirect effects between deprivation or segregation and overall survival via a Bayesian structural equation model with Gibbs variable selection. ResultsThe results suggest that high socioeconomic status-related indices have an association with increased survival, ranging from 25% to 56%. In contrast, index of concentration at the extremes-race does not have a significant impact on overall survival. In many cases, the indirect effects have very wide credible intervals; consequently, the total effect is not well estimated despite the estimation of the direct effect. ConclusionsOur results show that Black women living in higher socioeconomic status neighborhoods are associated with increased survival with ovarian cancer using area-level economic indices such as Yost or index of concentration at the extremes-income. In addition, the Kolak urbanization index has a similar impact and highlights the importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.