Tract Socioeconomic Status Research Articles

Abstract P104: Geospatially Varying Relationships of Green and Blue Spaces With Biomarkers of Stress and Cardiometabolic Risk in Racially and Ethnically Diverse Children

Introduction: Neighborhood green (e.g., parks) and blue (e.g., lakes) spaces have been associated with reduced stress and cardiometabolic risk (CMR), but research is limited in socially vulnerable urban communities affected by structural racism and redlining. This study explored the spatial correlation between green and blue spaces and cortisol levels, BMI percentile, waist circumference (WC), pulse, and systolic (SBP) and diastolic blood (DBP) pressure in a sample of racially/ethnically diverse children. Methods: We used cross-sectional data from the Family Matters cohort study, consisting of 1307 racially/ethnically diverse families with children (age 7±1.5 yrs). Participant addresses were matched to the US 2010 Census tract attributes. We used 246 sample locations across 149 census tracts in the 7-county Twin Cities, MN, metro area. Green and blue spaces were retrieved from the Twin Cities Metropolitan Council. Hair cortisol (chronic stress biomarker), BMI, WC, pulse, SBP and DBP were objectively measured in a subsample of 246 children. We used Decision Tree and Geographically Weighted Regression (GWR) to examine the spatially varying associations of CDC’s Social Vulnerability Index (SVI) and green and blue spaces (independent variables) with biomarkers of stress and CMR (dependent variables). SVI reflects four themes: socioeconomic status, household composition and disability, racial and ethnic minority status and language, and housing type and transportation. Results: Northwest Minneapolis was identified as a hotspot for elevated cortisol, BMI, and WC, while east St. Paul was a hotspot for elevated BMI and WC. Decision trees indicated that green and blue spaces explain variation in accumulated cortisol after tract socioeconomic status and racial and ethnic minority status. GWR revealed nonuniform relationships with the highest explanatory power in high social vulnerability hotspots. GWR’s R 2 for cortisol (0.07), BMI (0.14), and WC (0.14) were driven by hotspots where local R 2 was 2-5 times stronger than areas not identified as hotspots indicating robust geographical variations in the northern areas (areas of high social vulnerability) and distance from green and blue spaces. Patterns were inconsistent for pulse, SBP, and DBP. Conclusions: The spatially varying relationships of green and blue spaces with biomarkers of stress and CMR in children were heterogeneous, possibly indicating different mechanisms across biomarkers and geographical areas. Higher cortisol levels, BMI percentile, and WC in northern Twin Cities areas may reflect the legacy of structural racism and redlining, which have resulted in inequitable use of green and blue spaces for minoritized communities. Future interventions co-developed with local communities to improve green and blue spaces’ access and use, as well as to reduce disparities in stress and CMR, are needed to advance health equity.

Neighborhood Deprivation and Neural Tube Defects.

Individual measures of socioeconomic status (SES) have been associated with an increased risk of neural tube defects (NTDs); however, the association between neighborhood SES and NTD risk is unknown. Using data from the National Birth Defects Prevention Study (NBDPS) from 1997 to 2011, we investigated the association between measures of census tract SES and NTD risk. The study population included 10,028 controls and 1829 NTD cases. We linked maternal addresses to census tract SES measures and used these measures to calculate the neighborhood deprivation index. We used generalized estimating equations to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) estimating the impact of quartiles of census tract deprivation on NTDs adjusting for maternal race-ethnicity, maternal education, and maternal age at delivery. Quartiles of higher neighborhood deprivation were associated with NTDs when compared with the least deprived quartile (Q2: aOR = 1.2; 95% CI = 1.0, 1.4; Q3: aOR = 1.3, 95% CI = 1.1, 1.5; Q4 (highest): aOR = 1.2; 95% CI = 1.0, 1.4). Results for spina bifida were similar; however, estimates for anencephaly and encephalocele were attenuated. Associations differed by maternal race-ethnicity. Our findings suggest that residing in a census tract with more socioeconomic deprivation is associated with an increased risk for NTDs, specifically spina bifida.

Racial/ethnic and socioeconomic disparities in COVID-19 infections among working-age women with precancerous cervical lesion in Louisiana: analysis of more than two years of COVID-19 data.

Precancerous cervical lesion (PCL) is common in working-age and minority women. In Louisiana, 98% of PCL cases were diagnosed at age 18-65 with over 90% of them being human papillomavirus (HPV)-related. PCL women represent those who may be immunocompromised from the precancerous condition and thus more vulnerable to SARS-CoV-2. Most studies evaluating racial disparities for COVID-19 infection have only used data prior to vaccine availability. This study assessed disparities by race/ethnicity and socioeconomic status (SES) in COVID-19 infections among working-age PCL women for pre- and post-COVID-19 vaccine availability. Louisiana women aged 18-65 with PCL diagnosed in 2009-2021 were linked with the Louisiana statewide COVID-19 database to identify those with positive COVID-19 test. Race/ethnicity was categorized as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and others. The census tract SES quintiles were created based on American Community Survey estimates. Logistic regression was employed to assess the racial/ethnic and SES differences in COVID-19 infections. Of 14,669 eligible PCL women, 30% were tested COVID-19 positive. NHB had the highest percentage of COVID-19 infection (34.6%), followed by NHW (27.7%). The infection percentage was inversely proportional to SES, with 32.9% for women having the lowest SES and 26.8% for those with the highest SES. NHB women and those with lower SES had higher COVID-19 infection than their counterparts with an aOR of 1.37 (95% CI 1.25-1.49) and 1.21 (95% CI 1.07-1.37), respectively. In the pre-vaccine period, NHB and Hispanic women had higher odds of infection than NHW women. However, after the vaccine was implemented, the significant racial/ethnic and SES differences in COVID-19 infections still existed in PCL women residing in non-Greater New Orleans area. There are substantial variations in racial/ethnic and SES disparities in COVID-19 infections among working-age women with PCL, even after vaccine implementation. It is imperative to provide public health interventions and resources to reduce this unequal burden for this vulnerable population.

Disparities in Cutaneous T-Cell Lymphoma Incidence by Race/Ethnicity and Area-Based Socioeconomic Status.

Cutaneous T-cell lymphoma (CTCL) is a rare type of extranodal non-Hodgkin lymphoma (NHL). This study uses population-based data from the New Jersey (NJ) State Cancer Registry to examine geographic variation in CTCL incidence and evaluates whether CTCL risk varies by race/ethnicity and census tract socioeconomic status (SES). The study included 1163 cases diagnosed in NJ between 2006 and 2014. Geographic variation and possible clustering of high CTCL rates were assessed using Bayesian geo-additive models. The associations between CTCL risk and race/ethnicity and census tract SES, measured as median household income, were examined using Poisson regression. CTCL incidence varied across NJ, but there were no statistically significant geographic clusters. After adjustment for age, sex, and race/ethnicity, the relative risk (RR) of CTCL was significantly higher (RR = 1.47, 95% confidence interval: 1.22-1.78) in the highest income quartile than in the lowest. The interactions between race/ethnicity and SES indicated that the income gradients by RR were evident in all groups. Compared to non-Hispanic White individuals in low-income tracts, CTCL risk was higher among non-Hispanic White individuals in high-income tracts and among non-Hispanic Black individuals in tracts of all income levels. Our findings suggest racial disparities and a strong socioeconomic gradient with higher CTCL risk among cases living in census tracts with higher income compared to those living in lower-income tracts.

Structural and Social Barriers to Survival in Adolescent and Young Adult (AYA) Patients with Acute Myeloid Leukemia (AML)

IntroductionAYA cancer patients (pts) face unique healthcare disparities due to their social development stage. AYA with AML and minorities continue to suffer reduced survival (Kahn, Cancer, 2016). Our group demonstrated that structural violence, specifically neighborhood socioeconomic status (SES), significantly impacts adult AML survival (Abraham, Blood, 2020). This real-world study, in a segregated metropolitan area, confirms inferior survival in the non-white (NW) AYA AML population and explores social barriers that contribute to disparities.MethodsAYA AML (non-APL) pts, age 18 to 39, diagnosed and treated between 2012- 2018 at 6 cancer centers across the Chicago area were included. Race/ethnicity was categorized as Non-Hispanic White (NHW), Hispanic, non-Hispanic Black (NHB), and Other. Census tract data was collected using the FFIEC Geocoding/Mapping System and computed tract disadvantage and affluence scores, divided into high, moderate, and low tertiles. A survival analysis was performed to generate hazard ratios (HR) for all-cause mortality between NHW and NW pts. Social determinants of health explored for AYA outcomes included caregiver responsibilities, employment, time off work, mental health, Charlson Comorbidity Index (CCI) and obesity.ResultsTable 1 shows demographic data (n=101); 46% were NHW, 17% were NHB, 30% were Hispanic, and 8% were other. Median age was 31 years. The number of pts with children was similar across all groups, while more NHW (29%) and Hispanic (21%) pts reported being caregivers to other household members compared to NHB pts (0%), despite their young age (p=0.09). Overall, 68% of pts never met with a fertility specialist, more frequently due to no counseling (77%) than patient preference (23%). Most pts were not in school during treatment. NHW pts took time off work and filed for disability more commonly than NHB and Hispanic pts. NHW (65%) and Hispanic (71%) pts both reported anxiety and/or depression during treatment more than NHB pts (33%). Yet, NHW pts (68%) were referred to psychiatry more often than Hispanic pts (54%).Payer source differed significantly. Most NHW pts had private insurance, unlike NHB and Hispanic pts (74% vs. 41% vs. 43% respectively). The largest uninsured population was Hispanic (33%) compared to NHW (4%) and NHB (6%) pts. NHB pts (76%) tended to reside in more disadvantaged areas, while Hispanics (60%) tended to live in less affluent areas.ELN classification was comparable amongst NHW and NHB pts, while the largest group of favorable risk pts were Hispanic (37%). Extramedullary disease was more frequent in NHB (25%) and Hispanic (14%) compared to NHW (7%) pts. FLT3-ITD mutations and NPM1 mutations were more prevalent in NHW pts. Molecular testing was not done on most pts.Overall, 87% achieved CR/CRi. Notably, ICU stays during or post induction were higher in NHB (41%) and Hispanic (57%) compared to in NHW (33%) pts. Transplant status differed significantly with 87% of NHW pts receiving a transplant compared to NHB (41%) and Hispanic (57%) pts. Relapse rates were similar between all groups. However, the incidence of death within 2 years of diagnosis was highest in NHB (24%) and Hispanic (30%) pts, and nearly half that in the NHW pts (17%). (Table 2)32 pts died, 22 due to leukemia. Hazard of all-cause mortality was over twice as great for NW than for NHW pts HR=2.22 (95% CI:1.06, 4.65). Statistical adjustment for tract SES accounted for 57% of the survival disparity, reducing the HR to 1.53 (95% CI:0.59, 3.87). Further adjustment for treatment center reduced the HR to 1.25 (95% CI: 0.48, 3.28); together, treatment center and tract SES accounted for 80% of the survival disparity. Adjustment for private insurance, transplant status, clinical trial enrollment, prognosis (based on ELN classification and secondary AML) and BMI/CCI did not appear to account for any of the survival disparity. (Table 3)ConclusionOur study shows that Hispanic and NHB AYA AML pts have inferior survival compared to NHW pts despite similar ELN risk groups, treatment, response and relapse rates. Census tract-level SES related to differential resources in neighborhoods explained a significant proportion of the disparity in hazard of all-cause mortality. Our work highlights social determinants of health in AYA leukemia pts must be elucidated to determine mechanisms underlying structural barriers and inform future interventions to mitigate survival disparities. [Display omitted] DisclosuresPatel: Pfizer: Research Funding; Celgene/BMS: Research Funding. Stock: Pfizer: Consultancy, Honoraria, Research Funding; amgen: Honoraria; agios: Honoraria; jazz: Honoraria; kura: Honoraria; kite: Honoraria; morphosys: Honoraria; servier: Honoraria; syndax: Consultancy, Honoraria; Pluristeem: Consultancy, Honoraria. Altman: Theradex: Consultancy; Syros: Consultancy; Kuro Oncology: Consultancy; Daiichi Sankyo: Consultancy; Astellas: Consultancy; AbbVie: Consultancy; Glycomimetics: Membership on an entity's Board of Directors or advisory committees; BioSight: Consultancy, Other: Travel fees to attend an advisory meeting (I did not accept payment for the advisory board). Dinner: Kite/Gilead: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria.

The impact of socioeconomic status on survival in stage III colon cancer patients: A retrospective cohort study using the SEER census-tract dataset.

BackgroundThe impact of socioeconomic status (SES) has been described for screening and accessing treatment for colon cancer. However, little is known about the “downstream” effect in patients who receive guideline‐concordant treatment. This study assessed the impact of SES on cancer‐specific survival (CSS) and overall survival (OS) for stage III colon cancer patients.MethodsThe SEER Census Tract‐Level SES Dataset from 2004 to 2015 was used to identify stage III colon adenocarcinoma patients who received curative‐intent surgery and adjuvant chemotherapy. The predictor variable was census tract SES. SES was analyzed as quintiles. The outcome variables were OR and CSS. Statistical analysis included chi square tests for association, Kaplan–Meier, Cox, Fine and Gray regression for survival analysis.ResultsIn total, 27,222 patients met inclusion criteria. Lower SES was associated with younger age, Black or Hispanic race/ethnicity, Medicaid/uninsured, higher T stage, and lower grade tumors. CSS at the 25th percentile was 54 months for the lowest SES quintile and 80 for the highest. Median OS was 113 months for the lowest SES quintile and not reached for highest. The 5‐year CSS rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest (p < 0.001). The 5‐year OS rate was 66.5% for the lowest SES quintile and 74.6% in the highest (p < 0.001).ConclusionThis is the first study to evaluate CSS and OS in an incidence‐based cohort of stage III colon cancer patients using a granular, standardized measure of SES. Despite receipt of guideline‐based treatment, SES was associated with disparities in CSS and OS.

Neighborhood Socioeconomic Status and Identification of Patients With CKD Using Electronic Health Records

Screening for chronic kidney disease (CKD) is recommended for patients with diabetes and hypertension as stated by the respective professional societies. However, CKD, a silent disease usually detected at later stages, is associated with low socioeconomic status (SES). We assessed whether adding census tract SES status to the standard screening approach improves our ability to identify patients with CKD. Screening test analysis. Electronic health records (EHR) of 256,162 patients seen at a health care system in the 7-county Minneapolis/St. Paul area and linked census tract data. The first quartile of census tract SES (median value of owner-occupied housing units<$165,200; average household income<$35,935; percentage of residents >25 years of age with a bachelor's degree or higher<20.4%), hypertension, and diabetes. CKD (eGFR<60 mL/min/1.73 m2, or urinary albumin-creatinine ratio >30mg/g, or urinary protein-creatinine ratio >150mg/g, or urinary analysis [albuminuria] >30 mg/d). Sensitivity, specificity, and number needed to screen (NNS) to detect CKD if we screened patients who had hypertension and/or diabetes and/or who lived in low-SES tracts (belonging to the first quartile of any of the 3 measures of tract SES) versus the standard approach. CKD was prevalent in 13% of our cohort. Sensitivity, specificity, and NNS of detecting CKD after adding tract SES to the screening approach were 67% (95% CI, 66.2%-67.2%), 61% (95% CI, 61.1%-61.5%), and 5, respectively. With the standard approach, sensitivity of detecting CKD was 60% (95% CI, 59.4%-60.4%), specificity was 73% (95% CI, 72.4%-72.7%), and NNS was 4. One health care system and selection bias. Leveraging patients' addresses from the EHR and adding tract-level SES to the standard screening approach modestly increases the sensitivity of detecting patients with CKD at a cost of decreased specificity. Identifying further factors that improve CKD detection at an early stage are needed to slow the progression of CKD and prevent cardiovascular complications.

Abstract 2354: Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania

Abstract Background: Colorectal cancer (CRC) is a leading cause of mortality in the US. There are racial and socioeconomic disparities in CRC incidence and mortality, in part due to underuse of CRC screening. The goal of this cross-sectional study was to examine multilevel factors associated with CRC screening in Southeastern PA. Methods: We conducted a cross-sectional study using the Public Health Management Corporation's Community Health Database household survey (2010-2015) and American Community Survey data (2010-2014) to examine multilevel factors related to CRC screening via sigmoidoscopy and colonoscopy. We compared adults age 50+ that received CRC screening within 10 years (N=12963) to non-compliant individuals (N=4585), according to American Cancer Society guidelines. We conducted descriptive analyses to compare individual and residential census tract characteristics of the compliant and non-compliant groups. Multilevel regression models including random intercepts for census tracts (CTs) and CT-level socioeconomic status (SES) were used to examine independent associations with CRC screening compliance. P-values &amp;lt;0.05 were considered statistically significant. Results: In bivariate analysis, we observed that individuals that did not comply with CRC screening recommendations were more likely to be younger, male, non-black, unmarried, less educated, uninsured, and current smokers than those in compliance. Non-compliant individuals were also more likely to live in areas with lower SES, shorter distance to public transportation, lower educational attainment, lower median income, and higher percentages of uninsured, unemployed, poverty and households on public assistance compared to those in compliance. In multilevel regression analysis, being unmarried (OR=1.49, 95% CI=1.34-1.65), uninsured (OR=1.65, 95% CI=1.30-2.10), or living in lower SES census tracts (below the first SES quartile: OR=1.48, 95% CI=1.30-1.69 and between the 2nd and 3rd quartile: OR=1.51, 95% CI=1.29-1.75 vs. above the highest quartile) were associated with non-compliance in CRC screening recommendations. There were no interactions detected between race and census tract SES in these models. Conclusions: We identified multilevel factors (marital status, health insurance status, and residential SES) significantly associated with non-compliance to CRC screening recommendations. Individuals and CTs with low levels of compliance can be identified and targeted for tailored interventions, such as peer support and community education about CRC in future studies. Future studies might examine how the availability and location of screening facilities may relate to CRC screening recommendation compliance rates in different neighborhoods. Citation Format: Charnita M. Zeigler-Johnson, Scott Keith, Kari Moore, Russell McIntire, Preethi Selvan, Steven Melly, Ana Diez-Roux. Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2354.

Abstract C063: Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women

Abstract Background: Compared to White women, African American/Black women are more likely to develop triple-negative breast cancer (TNBC), an aggressive breast cancer subtype. While many studies have examined individual-level socioeconomic status (SES) as a major social determinant of more aggressive breast tumor phenotypes, the impact of neighborhood-level SES (nSES) on breast cancer is not well understood, particularly among Blacks. Objective: To evaluate the impact of nSES on breast cancer subtypes among Black women with breast cancer. Methods: We evaluated the association of interest among 1,220 Black women with invasive breast cancer from 2006 to 2018 enrolled from 10 counties of New Jersey in the Women’s Circle of Health Study (WCHS). Residential address at diagnosis was geocoded to the census tract-level. Neighborhood SES was measured using the NCI’s census tract-level SES index, a time-dependent score constructed by a factor analysis of seven variables measuring different aspects of census tract SES (education index, percent unemployed, percent working class, median household income, percent below 150% of poverty line, median house value, and median rent). In a case-only analysis, we used multilevel multinomial logistic regressions to estimate nSES in relation to breast cancer subtype (TNBC, HER2-enriched, Luminal B vs. Luminal A). Models were adjusted for individual-level SES variables, body mass index and reproductive factors, and census tract-level percentage of Black residents. We tested whether the associations were modified by percentage of Black residents and participant’s education. Results: Higher nSES was found to predict a lower risk of TNBC. Compared to tertile 1 (lowest nSES score), the odds ratio (OR) was 0.91 (95% CI: 0.65, 1.29) for tertile 2 and 0.52 (95% CI: 0.34, 0.79) for tertile 3 (highest nSES score; p-trend: 0.001). Higher nSES was borderline significantly associated with a lower risk of Luminal B (OR: 0.61 comparing highest vs. lowest nSES tertile; 95% CI: 0.36, 1.03; p-trend: 0.055). The inverse association between nSES and TNBC was observed only among Black women living in census tracts with lower proportion of Black residents (p-for-interaction=0.08). Compared to the lowest nSES tertile, OR was 0.38 (95% CI: 0.21, 0.68) for the highest tertile (p-trend: &amp;lt;0.001). There was a suggestion that the inverse relationship of nSES with TNBC was also more pronounced among women who had relatively lower levels of education. Conclusion: Neighborhood socioeconomic environment may influence the development of TNBC among Black women, which might be buffered by some contextual factors in areas with more Black residents. Further investigation to elucidate these factors is needed. Citation Format: Bo Qin, Adana A.M. Llanos, Riddhi Babel, Jesse J. Plascak, Karen Pawlish, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C063.

4476 Association between socioeconomic status and comorbid conditions in a population of diabetes patients

OBJECTIVES/GOALS: To reduce hospitalizations, health care systems are studying ways of improving social determinants of health (SDoH) in patients with chronic disease such as diabetes (DM). Our goal was to better characterize the SDoH of a cohort of DM patients by using socio-economic information from census data. METHODS/STUDY POPULATION: Our study population included DM patients seen in primary care practices of a large health care system in 2013-2017. We integrated socio-economic status (SES) information from the American Factfinder to data extracted from the electronic health record (EHR). Addresses for the cohort were geocoded using ArcMap to obtain the census tract information for median income, poverty status, educational level, and supplemental food benefits using American Community Survey 5-Year estimates. We used multivariable logistic regression to calculate odds ratio (OR) and 95% confidence intervals [], with 3+ comorbidities as the dependent variable and demographic and SES variables as independent variables. RESULTS/ANTICIPATED RESULTS: Our study population included 13,782 patients: 53% were female, 65% white, 28% Black, 27% were on Medicare, 3% on Medicaid, median age was 60, 53% had 3+ comorbidities. Median income was $66,243, poverty level 6%, receiving food benefits 8%, no high school degree 8%, and bachelor’s degree or higher 30%. After evaluating collinearity, our multivariable analysis showed that patients with 3+ comorbidities were more likely to have income &lt; $52,000 (lower quartile) versus $84,001 (upper quartile), OR = 1.2 [1.0-1.4]; be female, OR = 1.6 [1.4-1.7]; divorced or widowed versus married, OR = 1.5 [1.3-1.7], 1.4 [1.3-1.6]; and be on Medicare, Medicaid or both, OR = 2.4 [2.2-2.6], 2.2 [1.8-2.6], 6.0 [4.5-8.3]. DISCUSSION/SIGNIFICANCE OF IMPACT: Census tract-based SES could provide invaluable information to health care providers when associated to the EHR. We found that median income, which is not collected in the EHR, was significantly associated with a higher burden of disease. Census tract SES could serve as a proxy for evaluating SDoH.

Percepção das desordens de bairro e pressão arterial em adultos: um estudo multinível de base populacional

The aim of this study was to verify whether the perception of neighborhood physical and social disorder is associated with increased systolic (SBP) and diastolic blood pressure (DBP), as well as to examine the influence of the residential census tract's socioeconomic status on this association. This was a cross-sectional study that included a representative sample of 1,720 adults 20 to 59 years of age living in Florianópolis, Santa Catarina State, Brazil. Two blood pressure measurements were taken, and information was collected on the perception of neighborhood disorder. The contextual variable was the mean head-of-household's years of schooling in the selected census tracts. Statistical analysis included multilevel models with the first level represented by individuals and the second by census tracts. Interaction terms were examined between schooling tertiles in the census tract and tertiles of perception of neighborhood disorder on blood pressure. No statistically significant overall associations were identified between neighborhood disorder and SBP or DBP. However, the study showed a mean increase in SBP of 7.88mmHg (95%CI: 1.38; 14.40) in subjects that perceived more neighborhood disorder and lived in census tracts with less schooling, when compared to the reference category. Public policies aimed at lowering or that have an impact on SBP and DBP in the population should also address the characteristics of the context where the population lives, specifically in contexts marked by lower levels of schooling.

Association of Individual and Neighborhood Factors with Home Food Availability: Evidence from the National Health and Nutrition Examination Survey

BackgroundAccumulating evidence suggests the important role of the home food environment in an individual’s dietary intake. ObjectiveThis study examined the associations of individual and neighborhood-level factors with the availability of healthy and unhealthy foods in the home using a nationally representative sample from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Surveys (NHANES). DesignA cross-sectional study design was used with NHANES merged with the 2000 census data. Food availability was measured through self-report questionnaire regarding the frequency of foods or drinks available in the home. ParticipantsThe analysis included 8,975 participants aged 19 to 65 years. Statistical analyses performedAssociations of individual and neighborhood factors with home food availability (always or most of the time available) were assessed using logistic regression modeling accounting for NHANES’ complex survey design and weights. Individual-level and neighborhood-level factors were simultaneously included in the analysis. ResultsFamily income-to-needs ratio was positively associated with the availability of dark green vegetables (odds ratio [OR]=1.07; 95% CI=1.00 to 1.13), fat-free or low-fat milk (OR=1.16; 95% CI=1.07 to 1.25), and salty snacks (OR=1.12; 95% CI=1.04 to 1.20) in the home. College graduates were more likely to have fruits (OR=1.96, 95% CI=1.48 to 2.60), vegetables (OR=1.48; 95% CI=1.16 to 1.88), and fat-free or low-fat milk (OR=1.81; 95% CI=1.55 to 2.12) and less likely to have salty snacks (OR=0.77; 95% CI=0.63 to 0.95) and sugary drinks (OR=0.46, 95% CI=0.37 to 0.57) available compared with non-college graduates. Tract socioeconomic status (SES) scores were positively associated with fruit (OR=1.15; 95% CI=1.02 to 1.29), vegetable (OR=1.14; 95% CI=1.03 to 1.26), and fat-free or low-fat milk (OR=1.25; 95% CI=1.10 to 1.42) availability. Urban residents were associated with greater availability of fruits (OR=1.47; 95% CI=1.05 to 2.08) and fat-free or low-fat milk (OR=1.33; 95% CI=1.02 to 1.73) in the home compared with rural residents. Food desert status was not associated with home food availability. ConclusionsThe results show that SES at both individual (education, income) and neighborhood level was linked to home food availability, suggesting a need to improve the home food environment for socioeconomically disadvantaged individuals and neighborhoods.

Association of individual and neighborhood factors with home food availability: Evidence from the National Health and Nutrition Examination Survey (NHANES)

ObjectiveTo examine the association of the availability of home healthy and unhealthy foods and drinks (fruits, dark green vegetables, soft drink, salty snack and fat‐free/low‐fat milk) with individual and neighborhood factors using a nationally representative sample from 2001–2006 National Health and Nutrition Examination Survey (NHANES).MethodsData from the 2001–2006 waves of the continuous NHANES was merged with the 2000 census and other neighborhood data sources constructed using geographic information system (GIS). Associations of individual and neighborhood factors and home food availabilities were assessed using multilevel random‐intercept logistic regression models taking study design, weights, and covariates into account.ResultsThe analysis included 4353 adult participants aged 19–65 years who had home food availability data. Both family income‐to‐needs ratio and neighborhood tract socioeconomic status (SES) scores were positively associated with home fruit, dark green vegetable and fat‐free/low‐fat milk availabilities (Ps&lt;0.05). Participants having a college degree or above were more likely to have home fruits (P=0.0007) and fat‐free/low‐fat milk (P&lt;0.0001) available and less likely to have home salty snack (P=0.017) and soft drinks (P&lt;0.0001) available relative to those without a college degree. Soft drink availability was not associated with family income‐to‐needs ratio and neighborhood tract SES scores. BMI was positively associated with fat‐free/low‐fat milk availability in the home (P=0.005) but was not associated with the availabilities of other examined foods or drinks.ConclusionsThe availabilities of home healthy and unhealthy foods and drinks are mainly associated with SES at individual and neighborhood level.Support or Funding InformationThis research was supported by the National Institute of General Medical Sciences of the National Institutes of Health (NIH) Grant R01CA140319– 01A1

Do US thyroid cancer incidence rates increase with socioeconomic status among people with health insurance? An observational study using SEER population-based data

ObjectivesThe US thyroid cancer incidence rates are rising while mortality remains stable. Trends are driven by papillary thyroid cancer (PTC), the predominant cancer subtype which has a very good prognosis....

Socioeconomic status and incidence of breast cancer by hormone receptor subtype.

Recent developments in genetics and molecular biology have classified breast cancer into subtypes based on tumor markers of estrogen (ER), progesterone (PR) and human epidermal growth Factor-2 receptors (Her-2), with the basal-like (ER−, PR−, Her2−) subtype commonly referred to as “triple negative” breast cancer (TNBC) being the most aggressive. Prior studies have provided evidence that higher socio-economic status (SES) is associated with increased breast cancer risk, likely due to hormone related risk factors such as parity and hormonal contraceptive use. However, it is unclear if the relationship between SES and overall breast cancer incidence exists within each subtype, and if this association varies by race/ethnicity. Analysis was based on data obtained from the SEER database linked to 2008–2012 American Community Survey data, and restricted to women diagnosed with breast cancer in 2010. The NCI SES census tract SES index based on measures of income, poverty, unemployment, occupational class, education and house value, was examined and categorized into quintiles. Age-adjusted incidence rate ratios were calculated comparing the lowest to the highest SES groups by subtype, separately for each race/ethnic group. We identified 47,586 women with breast cancer diagnosed in 2010. The majority was diagnosed with Her2−/HR+ tumors (73 %), while 12 % had triple negative tumors (TNBC). There was a significant trend of higher incidence with increasing SES for Her2−/HR+ (IRR Highest vs. Lowest SES: 1.32, 95 % CI 1.27–1.39; p value trend: 0.01) and Her2+/HR+ tumors (IRR Highest vs. Lowest SES: 1.46, 95 % CI 1.27–1.68; p value trend: 0.01) among White cases. There was no association between SES and incidence of HR− subtypes (Her2+/HR− or TNBC). Similar associations were observed among Black, Hispanic and Asian or Pacific Islander cases. The positive association between SES and breast cancer incidence is primarily driven by hormone receptor positive tumors. To the extent that neighborhood SES is a proxy for individual SES, future studies are still needed to identify etiologic risk factors for other breast cancer subtypes.

Racial and ethnic disparities in cancer survival by neighborhood socioeconomic status in Surveillance, Epidemiology, and End Results (SEER) Registries.

Reducing cancer disparities is a major public health objective. Disparities often are discussed in terms of either race and ethnicity or socioeconomic status (SES), without examining interactions between these variables. Surveillance, Epidemiology, and End Results (SEER)-18 data, excluding Alaska Native and Louisiana registries, from 2002 to 2008, were used to estimate five-year, cause-specific survival by race/ethnicity and census tract SES. Differences in survival between groups were used to assess absolute disparities. Hazard ratios were examined as a measure of relative disparity. Interactions between race/ethnicity and neighborhood SES were evaluated using proportional hazard models. Survival increased with higher SES for all racial/ethnic groups and generally was higher among non-Hispanic white and Asian/Pacific Islander (API) than non-Hispanic black and Hispanic cases. Absolute disparity in breast cancer survival among non-Hispanic black vs non-Hispanic white cases was slightly larger in low-SES areas than in high-SES areas (7.1% and 6.8%, respectively). In contrast, after adjusting for stage, age, and treatment, risk of mortality among non-Hispanic black cases compared with non-Hispanic white cases was 21% higher in low-SES areas and 64% higher in high-SES areas. Similarly, patterns of absolute and relative disparity compared with non-Hispanic whites differed by SES for Hispanic breast cancer, non-Hispanic black colorectal cancer, and prostate cancer cases. Statistically significant interactions existed between race/ethnicity and SES for colorectal and female breast cancers. In health disparities research, both relative and absolute measures provide context. A better understanding of the interactions between race/ethnicity and SES may be useful in directing screening and treatment resources toward at-risk populations.

Influenza‐related hospitalization of adults associated with low census tract socioeconomic status and female sex in New Haven County, Connecticut, 2007‐2011

ObjectivesTo help guide universal influenza vaccination efforts in the United States, it is important to know which demographic groups are currently at highest risk of costly complications of influenza infection. Few studies have examined the relationship between hospitalization with influenza and either socioeconomic status (SES) or sex. We examined associations between census tract-level SES and sex and incidence of influenza-related hospitalizations among adults.DesignDescriptive analysis of data collected by active population-based surveillance for persons >18 years old hospitalized with laboratory confirmed influenza during the 2007–2008 through 2010–2011 influenza seasons. Case residential addresses were geocoded and linked to data from the 2006–2010 American Community Survey to obtain census-tract level (neighborhood) SES measures. Census-tract level SES variables included measures of poverty, education, crowding, primary language, and median income. Four levels were created for each.SettingNew Haven, County, Connecticut.SampleEntire New Haven County population >18 years old.Main Outcome MeasuresAge-adjusted incidence of influenza hospitalizations and relative risk by sex and by each of five SES measures.ResultsCrude and age-adjusted incidence progressively increased with decreasing neighborhood SES for each measure both overall and for each influenza season. Female incidence was higher than male for each age group, and female age-adjusted incidence was higher for each SES level and influenza season.ConclusionsFemale sex and lower neighborhood SES were independently and consistently associated with higher incidence of hospitalization of adults with influenza. If this is more broadly the case, these findings have implications for future influenza vaccination efforts. Analysis using census tract SES measures can provide additional perspective on health disparities.

Effect of Vaccination Coordinators on Socioeconomic Disparities in Immunization Among the 2006 Connecticut Birth Cohort

We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan-funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months. We examined predictors of underimmunization among the 2006 birth cohort (n = 34,568) in the state's Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses. Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization. SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities.

Child obesity associated with social disadvantage of children’s neighborhoods

Evidence suggests variability in adult obesity risk at a small-scale geographic area is associated with differences in neighborhood socioeconomic status (SES). However, the extent to which geographic variability in child obesity is associated with neighborhood SES is unknown. The objective of this paper was to estimate risk of child obesity associated with multiple census tract SES measures and race within a large urban U.S. county. Height, weight, age, sex, medical insurance type and census tract residence were obtained for 6-18 year old children (n=8616) who received medical care at a health plan in King County, Washington, in 2006. Spatial analyses examined the individual risk of obesity (BMI > or = 95th percentile) with 2000 US census tract measures of median household income, home ownership, adult female education level, single parent households, and race as predictors. Conditional autoregressive regression models that incorporated adjacent census tracts (spatial autocorrelation) were applied to each census tract variable, adjusting for individual variables. We found that in adjusted spatial models, child obesity risk was significantly associated with each census tract variable in the expected direction: lower household income, lower home ownership, and for each 10% increase in less educated women, and single parent households, as well as non-white residents. In a spatial model including all variables, the SES/race variables explained approximately 24% of geographic variability in child obesity. Results indicated that living in census tracts with social disadvantage defined by multiple different measures was associated with child obesity among insured children in a large U.S. urban county. These results contribute new information on relationships between broader social and economic context and child obesity risk using robust spatial analyses.

You Are Where You Shop: Grocery Store Locations, Weight, and Neighborhoods

Residents in poor neighborhoods have higher body mass index (BMI) and eat less healthfully. One possible reason might be the quality of available foods in their area. Location of grocery stores where individuals shop and its association with BMI were examined. The 2000 U.S. Census data were linked with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 2620 adults sampled from 65 neighborhoods in Los Angeles County between 2000 and 2002. In 2005, multilevel linear regressions were used to estimate the associations between BMI and socioeconomic characteristics of grocery store locations after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods. Individuals have higher BMI if they reside in disadvantaged areas and in areas where the average person frequents grocery stores located in more disadvantaged neighborhoods. Those who own cars and travel farther to their grocery stores also have higher BMI. When controlling for grocery store census tract socioeconomic status (SES), the association between residential census tract SES and BMI becomes stronger. Where people shop for groceries and distance traveled to grocery stores are independently associated with BMI. Exposure to grocery store mediates and suppresses the association of residential neighborhoods with BMI and could explain why previous studies may not have found robust associations between residential neighborhood predictors and BMI.