Underlying Health Disparities Research Articles

Improving equity in diabetes technology use: Voices of youth and their parents.

There are marked inequities in clinical outcomes and rates of diabetes technology use among youth with type 1 diabetes (T1D). The quantitative data from our mixed methods cohort study identified significant improvements in glycaemia and quality of life in participants. We aimed to use qualitative methods to provide further insight into our quantitative findings in the setting of underlying health disparities. Fifteen publicly insured, insulin pump-naïve non-Hispanic Black youth aged 6-21 years with T1D and baseline haemoglobin A1c (HbA1c) ≥86 mmol/mol (10%) and their parents participated in a mixed methods cohort study. Semi-structured interviews were conducted separately with parents and youth after completion of 6 months of HCL use. Three topic areas were explored: (1) Experience using HCL, (2) barriers to HCL and (3) facilitators to accessing HCL. Semantic content analysis and consensus coding involving two team members were used to generate themes. Thematic saturation was achieved. Youth (Medianage 14.9 years, 67% female) and parents (92% female) were interviewed. Youth and their parents reported that access to HCL provides a new outlook on living with T1D, although managing T1D is still hard. They felt that diabetes technology is most helpful for those struggling with management. Participants experienced barriers to access including misconceptions of HCL systems, clinician bias and systemic racism. They suggested these barriers can be overcome by offering diabetes technology education for all people with T1D, increasing awareness of HCL in the community and providing resources to overcome barriers created by social determinants of health. The voices of historically minoritised youth with suboptimal T1D control and their parents provide important, previously unreported experiences and perspectives on barriers and facilitators to using HCL that will shape interventions to improve equity in access to diabetes technology.

Area Deprivation Index is associated with biomarkers of inflammation cross‐sectionally and longitudinally over a 9‐year follow‐up period

AbstractBackgroundLiving in a socioeconomically disadvantaged neighborhood has a negative impact on health outcomes, including increased risk for Alzheimer’s disease (AD). The biological mechanisms underlying this risk are poorly understood. We examined how neighborhood disadvantage relates to core AD pathology, neurodegeneration, and inflammatory biomarkers in community‐dwelling older adultsMethodVanderbilt Memory and Aging Project participants (n = 327, 73±8 years, 41% female) underwent fasting blood and cerebrospinal fluid (CSF) acquisition serially over a 9‐year follow‐up period (mean follow‐up = 5.8 years). Area Deprivation Index (ADI), representing neighborhood disadvantage, was quantified at baseline based on 17 components [e.g., housing, income, education, and household characteristics (Kind & Buckingham, 2018)]. Ordinary least squares regressions cross‐sectionally related ADI to plasma and CSF biomarkers adjusting for age, sex, race/ethnicity, education, modified Framingham Stroke Risk Profile score, apolipoprotein E‐e4 status, and cognitive status. Linear mixed‐effects regression models related baseline ADI to longitudinal biomarkers with identical baseline covariates plus follow‐up time. Outcomes included CSF chitinase‐3‐like protein 1 (YKL‐40), CSF soluble triggering receptor expressed on myeloid cells 2 (sTREM2), CSF amyloid‐b40 (Ab40), CSF amyloid‐b42 (Ab42), CSF Ab40/Ab42 ratio, CSF tau, CSF phosphorylated tau (ptau), plasma high sensitivity C‐reactive protein (CRP), and plasma and CSF neurofilament light chain (NfL).ResultOn average, the sample was from relatively less disadvantaged neighborhoods (ADI national decile = 35.4±25.0, range = 1‐98). Greater neighborhood disadvantage at study entry was cross‐sectionally associated with elevated CSF YKL‐40 (β = ‐0.733, p = 0.003), sTREM2 (β = 19.74, p = 0.04), Aβ40 (β = 35.96, p = 0.01), tau (β = 2.31, p = 0.02), and ptau (β = 0.33, p = 0.03). Greater neighborhood disadvantage at study entry related to longitudinal increases in CRP (β = 0.012, p<0.001) and decreases in plasma NfL (β = ‐0.025, p = 0.04) over the follow‐up period.ConclusionAmong community‐dwelling older adults, greater neighborhood disadvantage was associated with elevated inflammatory and AD CSF biomarkers cross‐sectionally, and longitudinal increases in a non‐specific inflammatory blood biomarker. Collectively, findings suggest that neighborhood disadvantage confers immediate risk for systemic neuroinflammation and AD and future risk for non‐specific inflammation, providing valuable evidence of a sociobiological mechanism underlying health disparities in aging adults based on geographic location. Funding. R01‐AG034962, K24‐AG046373, T32‐AG058524, P20‐AG068082

Abstract 14060: Health Disparities in Exercise Performance in Tetralogy of Fallot

Introduction: Patients with tetralogy of Fallot (TOF) from disadvantaged racial and ethnic groups are reported to have worse outcomes, including worse exercise performance. The underlying mechanisms are not fully understood. Hypothesis: We hypothesize that the association of exercise performance with race is mediated by socioeconomic factors. Methods: We conducted a single center retrospective cohort study of TOF patients aged 8 - 30 years who underwent maximal exercise stress testing (EST) from 2007 - 2020. The primary outcome was percent-predicted maximum oxygen consumption (VO2). Addresses were geocoded. The Childhood Opportunity Index (COI) and its three domains represented neighborhood socioeconomic status. Generalized linear models and mediation analysis were used (Figure). Results: We included 154 subjects who underwent 273 ESTs (Table). Correcting for age at EST, sex, outflow tract repair type, and body mass index, those of non-Hispanic Black race had an 8.6% lower percent-predicted VO2 (95% CI -15.0, -2.2) than those of non-Hispanic white race. Mediation analysis showed that the COI mediates 90% of this relationship. By domain, Education is the strongest mediator and alone can account for 75% of this relationship. Conclusions: Disparities exist in exercise performance after TOF repair. Neighborhood-level factors, in particular related to Education, are significant mediators of the relationship between race and exercise performance in TOF. A detailed understanding of the driving mechanisms underlying health disparities, particularly those that are modifiable, is critical to eliminating those disparities at both the patient and societal levels.

The Health Disparities Research Industrial Complex

Research focused on health disparities—whether relating to one's race/ethnicity, gender expression, sexual orientation, citizenship status, income level, etc.—constitutes a large, generative, and highly profitable portion of scholarship in academic, clinical, and government settings. Health disparities research is expressed as a means of bringing greater attention to, and ultimately addressing via evidence-based implementation science, acts of devaluation and oppression that have continually contributed to these inequities. Philosophies underlying health disparities research's expansive and growing presence mirror the formal logic and ethos of the Military Industrial Complex and the Prison Industrial Complex. The “Health Disparities Research Industrial Complex,” operationalized in this article, represents a novel mutation and extension of these complexes, primarily being enacted through these three mechanisms: 1) The construction and maintenance of beliefs, behaviors, and policies in healthcare, and society more broadly, that create and sustain disadvantages in minority health; 2) the creation and funding of research positions that inordinately provide non-minoritized people and those without relevant lived experiences the ability to study health disparities as “health equity tourists”; and 3) the production of health disparities research that, due to factors one and two, is incapable of fully addressing the disparities. In this piece, these and other core elements of the Health Disparities Research Industrial Complex, and the research bubble that it has produced, are discussed. Additionally, strategies for reducing the footprint and impact of the Health Disparities Research Industrial Complex and better facilitating opportunities for meaningful implementation in the field are presented.

The application of clique percolation method in health disparities research.

Clique percolation, one of the joint community detection algorithms in network science, is a novel and efficient approach to detecting overlapping communities in real networks. The current study illustrated how clique percolation can help to identify overlapping communities within the complex networks underlying health disparities, particularly highlighting nodes with strong associations with more than one community. A cross-sectional study. The study used a dataset on Latinx populations (N = 1654; mean age = 43.3 years; 53.1% women) as an example to demonstrate the role of such overlapping nodes in the network of syndemic conditions and their common risk factors. Syndemic conditions in the network included HIV risk, substance abuse (smoking, heavy alcohol consumption and marijuana use) and poor mental health. Moreover, the risk factors encompassed individual (education and income) and sociostructural (adverse childhood experiences [ACEs] and access to services) factors. The network was estimated using the R-package bootnet. Clique percolation was conducted on the estimated network using the R-package CliquePercolation. A total of three communities were detected, with HIV risk and poor mental health not being assigned to any community. In general, Community 1 was comprised of ACE categories, Community 2 included education, income and access to services and Community 3 included other syndemic conditions. Of note, two nodes were assigned to two communities: 'household dysfunction' to Communities 1 and 2 and 'smoking' to Communities 2 and 3. Household dysfunction might be the key connector, among other ACEs, to individual and structural barriers. Such barriers further exposed Latinx individuals to risky behaviours, especially smoking, which further linked to marijuana use and heavy alcohol consumption. Clique percolation facilitated our understanding of the complex systems of factors shaping health disparities. The overlapping nodes are promising intervention targets for reducing health disparities in this historically marginalized population. No patient or public contribution.

Risk Factors for Reinfection with SARS-CoV-2 Omicron Variant among Previously Infected Frontline Workers.

In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.

Excess risk of chronic health conditions in Hispanic survivors of adolescent and young adult cancers.

There is a growing population of survivors of adolescent and young adult (AYA) cancers (age 15-39years at diagnosis). Studies in AYA cancer survivors have identified racial and ethnic disparities in long-term outcomes. To understand the extent to which a cancer diagnosis exacerbates pre-existent health disparities within a minoritized population, comparisons should be made to those of the same race or ethnicity without a cancer history. Self-reported data from the National Health Interview Survey (2009-2018) were used to identify Hispanic AYA cancer survivors and Hispanic age- and sex-matched controls. SES factors (marital status, income, education, insurance) and prevalence of chronic health conditions were compared between groups using chi-square tests. The log-odds of chronic conditions were modeled by survey-weighted logistic regression with relation to age at survey, sex, marital status, education, family income, and cancer group (control versus cancer), together with interactions between each variable and cancer group (survivors vs. controls). Five hundred thirty-nine survivors and 5390 controls were included. Compared with controls, survivors were less likely to be married and have family income > 45K/year, and more likely to be insured and have completed some college. Survivors had higher odds than controls of chronic health conditions (odds ratio (OR): 7.39, p < 0.001 for at least 1 and OR: 4.78, p < 0.001 for 3 or more) including cardiovascular disease, diabetes, and hypertension. Female sex, higher educational attainment, and public insurance were each associated with increased odds of chronic conditions in Hispanic AYA survivors. An AYA cancer diagnosis is associated with poor SES outcomes and increased odds of comorbidities within the Hispanic population. Cancer history can exacerbate underlying health disparities. Screening for chronic conditions is especially important in minoritized populations.

Generation of three induced pluripotent stem cell lines to model and investigate diseases affecting Hispanics

Hispanics are the fastest-growing minority group in the United States. There has been a burgeoning interest in understanding the reasons underlying health disparities among this population. To facilitate the modeling and investigation of diseases that differentially impact Hispanics, we generated three induced pluripotent stem cell (iPSC) lines from the peripheral blood mononuclear cells (PBMCs) of healthy Hispanic subjects. All three lines exhibited normal morphology and karyotypes, robust expression of pluripotency markers, and the capacity for trilineage differentiation. The derivatives of these lines will serve as valuable ethnic-appropriate cell sources for further mechanistic studies on diseases impacting Hispanics.

6.P. Skills building seminar: Children and young people: engaging the unheard stakeholder

Abstract Global shocks from the COVID 19 pandemic have disproportionately impacted children and young people (CYP) and their families. Underlying health disparities have widened as a result of disruptions to healthcare, education and economic impacts. There are compelling arguments to engage children and young people in rebuilding society and systems from emerging public health threats including the covid 19 pandemic, the climate crisis and conflicts. Children and young people like others in society have a right to be involved in decisions that impact their lives and health but are too often unheard. Engaging those affected most by health policy ensures relevance and can improve adoption of interventions. Involving children and young people in strategic decision making can also improve their citizenship skills and improve health literacy. Although many children and young people have contributed to debates and publicly demonstrated their collective views on a variety of issues such as climate change, movements including #timesup, #Blacklivesmatter and #Metoo, their voices are seldom heard in policy and decision making arenas. In 2021, EUPHA CAPH and EUPHANxt sections collaborated to host the inaugural Engaging the Unheard Stakeholder workshop, supporting 2 young people aged &amp;lt;25 to attend the EPH and lead the workshop. (links). CAPH is now committed to make this a regular feature as part of our action plan to support young voices in public health. Learning outcomes • Develop insight into innovative ways to support and engage young people in public health policy making. • Practise advocacy skills to facilitate young people's voices in research &amp; policy Activities Participants will hear from young people who are championing activism or have been involved in shaping public policy. Interactive skills building breakout session involving role play and scenarios to challenge their unconscious bias and learn skills as ‘active bystanders’ to empower young people Key messages • Despite major movements where children and young people have demonstrated their views on a variety of issues such as climate change, their voices are seldom heard in policy and decision making arenas. • Public health professionals can advocate, support and engage children and young people in public health policy making but lack awareness and skills in advocacy to do this effectively.

Structural and health system determinants of health outcomes in systemic lupus erythematosus: Understanding the mechanisms underlying health disparities.

Chronic diseases are increasingly responsible for the burden of health outcomes across the world. However, there is also increasing recognition that patterns of chronic disease outcomes (e.g., mortality, quality of life, etc.) have inequities across race, gender, and socioeconomic groups that cannot be solely attributed to these determinants. There is a need for an organizing framework which centers fundamental causes of health disparities that may better guide future work in centering these mechanisms and moving beyond acknowledgment of health disparities. In this paper, we synthesize several concepts from health disparities literature into a conceptual framework for understanding the interplay of patients' lived experiences, the health care system and structural determinants. Our framework suggests that (1) structural factors influence the health care system, the patient, the health care provider, and the provider-patient relationship through process of subordination and (2) that structurally competent actions are critical to reducing health inequities. The addition of subordination to theoretical frameworks involving health equity and social determinants of health, along with engagement with concepts of structural competency suggest several systems level changes to improve health outcomes.

Sidebar: Place-based Differences in Life Expectancy.

Life expectancy is an important indicator of a population’s overall health and can vary significantly depending on underlying health disparities, demographics, and social determinants of health. Moreover, life expectancy is an easily understood indicator for policymakers and the general public

Reevaluating Gendered Language in Surgery.

Reevaluating Gendered Language in Surgery.

Racial and ethnic differences in COVID-19 outcomes: a call to action.

Racial and ethnic differences in COVID-19 outcomes: a call to action.

Food Insecurity in Digestive Diseases

The social determinants of health (SDOH), the conditions in which people are born, grow, work, live, and age, have a profound impact on health outcomes and underlie health disparities. One way that SDOH (eg, poverty, racism, and education) can affect health is through unmet social needs such as food insecurity (FI),1 which is defined by the US Department of Agriculture as the lack of consistent access to enough food for an active and healthy life. Social factors are intertwined and FI is often the downstream result of broader structural determinants of health that affect access to high-quality education and income, which can intersect with other social risk factors such as housing instability and lack of transportation.

"Using the same hand": The complex local perceptions of integrated one health based interventions in East Africa.

BackgroundNeglected Tropical Diseases (NTDs) such as soil transmitted helminths (STH) and human rabies represent a significant burden to health in East Africa. Control and elimination remains extremely challenging, particularly in remote communities. Novel approaches, such as One Health based integrated interventions, are gaining prominence, yet there is more to be learned about the ways in which social determinants affect such programmes.MethodologyIn 2015 a mixed method qualitative study was conducted in northern Tanzania to determine community perceptions towards integrated delivery of two distinct healthcare interventions: treatment of children for STH and dog vaccination for rabies. In order to assess the effectiveness of the integrated approach, villages were randomly allocated to one of three intervention arms: i) Arm A received integrated mass drug administration (MDA) for STH and mass dog rabies vaccination (MDRV); ii) Arm B received MDA only; iii) Arm C received MDRV only.Principle findingsIntegrated interventions were looked upon favourably by communities with respondents in all arms stating that they were more likely to either get their dogs vaccinated if child deworming was delivered at the same time and vice versa. Participants appreciated integrated interventions, due to time and cost savings and increased access to essential health care. Analysis of qualitative data allowed deeper exploration of responses, revealing why people appreciated these benefits as well as constraints and barriers to participation in integrated programmes.Conclusions/significanceAn interdisciplinary One Health approach that incorporates qualitative social science can provide key insights into complex local perceptions for integrated health service delivery for STH and human rabies. This includes providing insights into how interventions can be improved while acknowledging and addressing critical issues around awareness, participation and underlying health disparities in remote pastoralist communities.

A Social Gradient of Cortical Thickness in Adolescence: Relationships With Neighborhood Socioeconomic Disadvantage, Family Socioeconomic Status, and Depressive Symptoms

BackgroundMental and physical health are affected by family and neighborhood socioeconomic status (SES). Accelerated maturation in the context of lower SES is one mechanism that might contribute to underlying health disparities; few studies, however, have considered neighborhood SES in relation to putative markers of brain maturation in adolescents. MethodsIn 120 adolescents 13 to 18 years of age, we examined family and neighborhood SES in relation to cortical thickness adjusted for age. We also examined whether cortical thickness was related to depressive symptoms and explored regions of interest. ResultsControlling for age, neighborhood socioeconomic disadvantage was associated with a thinner cortex in the left hemisphere (standardized β = −0.20), which was related to more severe depressive symptoms (standardized β = −0.33). Family SES was not significantly associated with age-adjusted mean cortical thickness in either hemisphere after controlling for relevant covariates. In exploratory, covariate-adjusted analyses of cortical thickness at the regional level, neighborhood socioeconomic disadvantage was associated with reduced cortical thickness in the left superior frontal gyrus (standardized β = −0.27), fusiform gyrus (standardized β = −0.20), and insula (standardized β = −0.21), whereas family SES was positively associated with cortical thickness in the right lateral and right medial orbitofrontal cortex (standardized β = 0.21 and standardized β = 0.19, respectively) and left transverse temporal gyrus (standardized β = 0.22). ConclusionsOur findings provide evidence for a social gradient of cortical thickness during adolescence. Adolescents living in less advantaged community or family contexts appear to have a thinner cortex according to global and regional measures. Reduced cortical thickness in the left hemisphere may indicate increased risk for depression in adolescence.

15. The Fallacy of “Systems Literacy”; How Structural Violence in Service Provision Affects the Health of Transgender Youth Experiencing Homelessness

Clear health and mortality disparities exist both in transgender populations and for youth experiencing homelessness (YEH). Furthermore, transgender youth are overrepresented within populations of YEH. However, no peer-reviewed research has yet explored the structural factors that underlie health disparities experienced by transgender YEH. We conducted a qualitative study to better understand the mechanisms by which structural factors cause health disparities in a population of transgender YEH in the San Francisco Bay Area. Semi-structured, in-depth interviews were conducted with (1) youth ages 19-24, recruited through flyers at service provision sites and via snowball sampling, and (2) key stakeholders. Topics explored included physical and mental health, identity, causes of homelessness, survival strategies, HIV risk, violence, stigma, and service access. Interviews were audio-recorded, transcribed, and double-coded. We conducted a grounded theory analysis of our data. We completed 27 in-depth semi-structured interviews with transgender YEH (n=20) and key informants (n=7). Youth participants included 6 trans women, 3 trans men, and 11 youth who identified as genderqueer, nonbinary, agender or multiple genders. Youth’s median age was 22 years, and two-thirds were people of color or mixed. Youth described within-group differences in health and social service systems success and outcomes, tying these differences to a structurally-produced set of skills, attitudes, knowledge, and other traits that allow them to successfully access systems – a concept we are naming “systems literacy.” Systems literacy affected systems access, which ultimately impacted trans YEH health, and was itself shaped by structural factors including bias and stigma, criminalization, formal education, childhood economic class, and social ties. Youth also offered systems access-focused recommendations for health and social service provision organizations. Trans YEH face significant health disparities, mediated by social and structural determinants of health, including structurally-produced systems literacy. In coining the term systems literacy, we frame systems literacy as a structural determinant of health and a form of structural violence. In addition, we aim to draw attention to the bias inherent in systems that require subjects’ systems literacy as a prerequisite for systems success and health. Incorporating feedback from trans YEH, we point to modifiable targets for intervention in health and social service provision, toward decreasing systemic violence, decreasing risk exposure, and improving health for trans YEH and diverse marginalized populations.

Racial differences in dementia‐related pathology underlying cognitive decline: The Multi‐Ethnic Study of Atherosclerosis (MESA)

AbstractBackgroundRacial differences in dementia‐related pathology are purported to underlie health disparities in Alzheimer’s disease and related disorders. We examined the prevalence and relevance of neuroimaging biomarkers of cerebral small vessel disease (cSVD), and β‐amyloid (Aβ) deposition in cognitive decline and impairment among a diverse cohort of older adults.MethodParticipants at the Wake Forest MESA site were recruited at Exam 6 (2016‐19) to receive additional detailed cognitive testing, cognitive adjudication, and multimodal neuroimaging. Brain MRI on 3T Siemens Skyra, included T1, SWI, FLAIR and NODDI sequences. Total gray matter and white matter hyperintensities (WMH) volumes were adjusted for intracranial volume. A single neuroradiologist graded vascular lesions, including cerebral microbleeds, large and lacunar infarcts. Cognitive decline was measured by the Cognitive Abilities Screening Instrument (CASI) at Exam 5 (2010‐12) and Exam 6 (2016‐19). A subset of 157 participants completed Aβ‐PET at Exam 6 to quantify Aβ burden and positivity (PiB SUVR ≥1.21). Multivariable linear and logistic regression modeled neuroimaging parameters with change in CASI and cognitive status adjusted for age, gender, education, and APOE genotype, considering potential interactions by race.ResultThe imaging sample included 252 participants (53% African‐American and 47% White; aged 72±7 years; 58% women, Table 1). 27% of participants were adjudicated to have mild cognitive impairment (MCI) and 4% had dementia. Aβ positivity (36%) and cSVD (microbleeds in 37% and lacunes in 32%) were common and did not differ by race. Further, temporal lobe cortical thickness and WMH volumes did not differ by race. Lower total gray matter volume, higher WMH volumes, and lower temporal lobe cortical thickness were consistently associated with greater cognitive decline and impairment across racial groups (Table 2). Significant interactions between race and imaging biomarkers with cognitive decline and impairment observed for: greater NODDI Free Water only in White participants and microbleeds and Aβ only in African‐American participants.ConclusionImaging biomarkers indicative of cSVD and Aβ are common in older adults. These biomarkers were not more prevalent in African‐American than White older adults as previously reported; however, they appear to be more strongly related to cognitive decline and impairment among African‐Americans.

Cognitive aging with dementia, mild cognitive impairment (MCI), or no impairment: A comparison of same‐ and other‐sex couples

AbstractBackgroundChronic stress has harmful effects on cognition, and minority stress is thought to underlie health disparities experienced by lesbian, gay, bisexual, and transgender (LGBT+) older adults. Few studies have compared cognitive trajectories between individuals in same‐ (SSR) versus other‐sex relationships (OSR). We expand on this work by comprehensively examining differences in neuropsychological measurements for individuals in SSR and OSR. We explored whether: 1) SSR have poorer overall cognitive performance at baseline compared to OSR older adults, 2) SSR have steeper cognitive decline relative to OSR, and 3) differences in verbal and visuospatial memory among SSR versus OSR.MethodData were obtained from the National Alzheimer’s Coordinating Center (NACC). Eligibility criteria included 2+ visits in NACC’s Uniform Data Set (UDS) and age 55+ years at baseline. Participants were assigned to normal (N), MCI, or dementia (D) groups based on clinician assessment and CDR® global score. Given neuropsychological tests changed between versions of the UDS, we ran analyses separately using both versions (C1, C2). Multivariable linear mixed‐effects models accounted for center clustering and repeated measures by individual. Models were stratified by baseline cognition and adjusted for baseline age, sex, education, and APOE ɛ4 carrier status.ResultOSR and SSR individuals showed significant decline in CDR® sum of boxes (CDR‐SB) regardless of baseline cognition. Among C1 participants, OSR declined significantly in all cognitive domains regardless of baseline cognition. SSR‐N declined in the attention, executive, and language/semantic memory (SM) domains; SSR‐MCI showed declines in global, attention, and language/SM domains; similar to OSR‐D, SSR‐D declined in all domains. Unexpectedly, SSR‐D declined more slowly than OSR‐D in attention and language/SM domains. Among C2 participants, OSR exhibited greater levels of decline in global cognition relative to SSR.ConclusionWe sought to compare the cognitive changes of older adults in SSR or OSR. SSR declined in attention, language, and semantic memory. OSR had steeper, more global declines. Our results contrast with a recent population‐wide study of SSR versus OSR, suggesting that in our sample, SSR may be resilient to the effects of chronic minority stress on cognition. Additional research regarding LGBT+ related resiliency is necessary.

The Contribution of Material, Behavioral, Psychological, and Social-Relational Factors to Income-Related Disparities in Cardiovascular Risk Among Older Adults.

Understanding the factors underlying health disparities is vital to developing strategies to improve health equity in old age. Such efforts should be encouraged in Korea. This study explored how material, behavioral, psychological, and social-relational factors contribute to income-related disparities in cardiovascular risk among Korean adults 65 years and older. This was a secondary analysis of Korean National Health and Nutrition Examination Survey data (2013-2017), targeting 7347 older adults (≥65 years). Socioeconomic position, defined as income, was the primary indicator. The outcome was binary for predicted cardiovascular risk (<90 vs ≥90 percentile). Disparities were measured using relative index of inequality (RII). The contributions of material, behavioral, psychological, and social-relational factors were estimated by calculating percentage reduction in RII when adjusted for these factors. Among men aged 65 to 74 years and women 75 years or older, the largest reductions in RII were achieved after adjusting for social-relational factors. Among men 75 years or older and women aged 65 to 74 years, adjusting for material factors resulted in the largest reductions in RII. Adjustments for behavioral factors also reduced RII for both genders aged 65 to 74 years. Improving the social, material, and behavioral circumstances of lower-income older adults may help address income-related disparities in cardiovascular risk in old age.