Birth weight and asthma in young adults of a Brazilian birth cohort.

This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association.

Association of socioeconomic position with sensory impairment among Chinese population: a nationally representative cohort and Mendelian randomization study.

Aims: To investigate the association between socioeconomic position (SEP) and sensory impairments (SIs). Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS) (2015). Logistic regressions estimated the odds ratio for associations of SEP with SIs. In addition, Mendelian randomization (MR) analysis was conducted to assess the causal relationship between them with the inverse variance weighting (IVW) estimator. MR-Egger, simple median, weighted median, maximum likelihood, and robust adjusted profile score were employed for sensitivity analyses. Results: In the observational survey, we enrolled 19,690 individuals aged 45 and above. SEP was negatively associated with SIs. Adjusted odds of vision impairment were higher for illiterate (1.50; 95%CI: 1.19, 1.91), less than elementary school diploma (1.76; 95%CI: 1.39, 2.25), middle school diploma (1.53; 95%CI: 1.21, 1.93) and lower income (all p < 0.001). The odds of hearing impairment were significantly higher for people with less than a high school diploma than those with a college degree or higher diploma, for agricultural workers than non-agricultural workers, and for people in low-income families (p < 0.01). The MR analysis also showed that occupation was associated with HI (1.04, 95%CI: 1.01, 1.09, p < 0.05) using IVW. Conclusion: We found that both observational and causal evidence supports the theory that SEP can result in SIs and that timely discovery, targeted management, and education can prevent SIs among middle-aged and older adults.

The role of bipolar disorder and family wealth in choosing creative occupations.

Research in psychology and medicine has linked mental health disorders, and particularly bipolar disorder (BD), to employment in creative professions. Little is known, however, about the mechanisms for this link, which could be due to biology (primarily through a person's genes) or environmental (through socioeconomic status). Using administrative data on mental health diagnoses and occupations for the population of Denmark, we find that people with BD are more likely to be musicians than the population, but less likely to hold other creative jobs. Yet, we also show that healthy siblings of people with BD are significantly more likely to work in creative professions. Notably, people from wealthy families are consistently more likely to work in creative professions, and access to family wealth amplifies the likelihood that siblings of people with BD pursue creative occupations. Nevertheless, family wealth explains only a small share of the correlation between BD and creative employment.

Linking Childhood Cultural Health Capital Factors with Adult Health Literacy.

Adult health outcomes are linked to childhood factors such as socioeconomic status via cultural health capital (CHC). Specifically, these factors shape opportunities for developing skills for navigating health environments via experience and the intergenerational transfer of health-related knowledge and skills. Health literacy (HL) is considered a part of and/or result of CHC. HL develops similarly to CHC via opportunities and experiences. Most research to date has ignored the effect of childhood factors on adult HL. The purpose of this study was to explore how childhood factors are related to adult HL. Data were collected from adults (N = 736, mean age = 40.65 years, standard deviation [SD] = 15.39; 52% female; 53.8% White, 31.3% Hispanic and Latino/a/e) in the United States using Qualtrics Panel. Multivariate ordinal and binary logistic regressions predicting HL (as measured by the Newest Vital Sign and Single-Item Literacy Scale) from childhood factors and accounting for demographic covariates were estimated. After accounting for covariates, such as the presence of an employed adult in a white-collar (odds ratio [OR] = 3.34) or blue-collar (OR = 3.68) occupation (versus unknown/not employed) increased the odds of being categorized as possible limited literacy and adequate literacy (versus limited literacy) as measured by the Newest Vital Sign. Similarly, having an employed adult during childhood who had a blue-collar occupation (vs. unknown/not employed) increased the odds of being categorized as adequate literacy (OR = 2.06) as measured by the Single-Item Literacy Scale. Because the adult's employment played a role in the child's adult HL after accounting for other factors and demographics, these findings support using a lifespan approach to assess and identify risk factors for lower HL. This study contributes to the growing body of evidence of how HL is interconnected with social determinants of health across the lifespan and the need to address HL skills in those with poor social determinants of health. [HLRP: Health Literacy Research and Practice. 2024;8(2):e79-e88.].

PLAIN LANGUAGE SUMMARY: Childhood conditions, such as family financial position, may be related to adult health literacy. Adults who had limited income as children were more likely to have lower health literacy than those whose family members had white-collar and blue-collar jobs. Therefore, it is important that childhood factors be considered when identifying groups that may benefit from health literacy interventions.

Socioeconomic status and health disparities drive differences in accelerometer-derived physical activity in fatty liver disease and significant fibrosis.

BACKGROUND AND AIMS: The cornerstone of clinical management of patients with nonalcoholic fatty liver disease (NAFLD) are lifestyle changes such as increasing physical activity (PA) aimed at improving cardiometabolic risk. To inform NAFLD prevention and treatment guidelines we aimed to: (i) quantify the role of PA on lowering the risk for NAFLD and fibrosis; (ii) characterize NAFLD and fibrosis association with PA in the context of socioeconomic environment. METHODS: A sample of 2648 participants from the NHANES 2003-2006 was selected to develop survey weighted multivariable logistic regression models for predicting NAFLD and significant fibrosis, diagnosed non-invasively via fatty liver index (FLI) and fibrosis-4 (FIB-4) index. The PA measures were obtained from a hip-worn accelerometer. RESULTS: The predictive model for NAFLD showed AUC of 0.687 and a decrease of 43% in NAFLD risk with moderate vigorous PA (MVPA) (OR = 0.569, p < 0.001). The predictive model for fibrosis had AUC of 0.755 and there was a 48% and a 70% decrease in significant fibrosis risk with MVPA (OR = 0.518, p = 0.022) and total log activity count (TLAC) (OR = 0.296, p = 0.017), respectively. Participants with NAFLD and NAFLD with fibrosis engage in declining PA. Despite having jobs with higher level of PA and participating in more moderate-to-vigorous PA, a larger proportion of Hispanics participants had NAFLD and significant fibrosis. CONCLUSIONS: These findings demonstrate the role of PA as a protective factor against the presence of NAFLD and significant fibrosis. Protective levels of PA in NAFLD differ by races.

Health-related quality of life and impact of socioeconomic status among primary and secondary school students after the third COVID-19 wave in Berlin, Germany.

In the earlier phases of the COVID-19 pandemic, studies in Germany and elsewhere found an overall reduction in health-related quality of life (HRQoL) among students. However, there is little evidence on later pandemic stages as well as socioeconomic influencing factors. We aimed to (1) describe HRQoL in a Berlin student cohort at two time points in mid-2021, and to (2) analyze the effects of household income and education. We assessed HRQoL of students from 24 randomly selected primary and secondary schools in Berlin, Germany, with the KIDSCREEN-10 index in June and September 2021. To adjust for non-response bias, inverse probability weighting was applied. The potential effects of both household income and education (lower vs. higher) were estimated in generalized linear mixed models, based on prior assumptions presented in directed acyclic graphs. Our cohort comprised 660 students aged 7-19 years. In June 2021, 11.3% [95% CI = 9.0% - 14.0%] reported low HRQoL, whereas in September 2021, this increased to 13.7% [95% CI = 11.1% - 16.5%], with adolescent girls more frequently reporting low HRQoL at both time points (20% [95% CI = 17.1% - 23.3%] and 29% [95% CI = 25.5% - 32.5%]) compared to boys and younger children. While there was no statistically significant total effect of lower household income on HRQoL, a negative effect of lower household education was statistically significant (ß = -2.15, SE 0.95, 95% CI = -4.01 to -0.29, p = 0.024). In summary, students' HRQoL in mid-2021 was better than that documented in other studies conducted at pandemic onset using KIDSCREEN-10. Female adolescents reported low HRQoL more often, and lower household education significantly reduced children's HRQoL. Support strategies for psychosocial wellbeing should consider socioeconomically disadvantaged children as important target groups.

Associations between the objective and perceived food environment and eating behavior in relation to socioeconomic status among adults in peri-urban settings: results from the CIVISANO study in Flanders, Belgium.

Obesity, a significant public health concern, disproportionately affects people with lower socioeconomic status (SES). Food environments have been identified as part of the causal chain of this disparity. This study investigated variations in the food environment across groups with different SES profiles residing in peri-urban municipal settings. In addition, it examined the association of the perceived and objective food environments with eating behaviour and assessed if these associations were moderated by SES. Utilizing GIS and survey data (n = 497, aged 25-65), results showed differences in the objective and perceived food environments based on SES. Respondents with higher SES perceived their food environments as better but resided farther from all food outlets compared to respondents with lower SES. However, there was no difference in outlet density or mRFEI between SES groups. SES moderated associations between the objective and perceived food environments and most eating behavior outcomes except fast food consumption frequency. For fruits and vegetables, SES moderated the association between neighborhood availability and consumption frequency (ß0.23,CI0.03;0.49). Stratified analysis revealed a positive association for both lower (ß0.15, CI0.03;0.27) and higher (ß0.37, CI 0.12;0.63) SES groups. For snack foods, SES moderated the association between healthy outlet density and consumption frequency (ß-0.60, CI-0.94; -0.23), showing statistical significance only for respondents with higher SES (ß0.36,CI 0.18;0.55). Similarly, for sugar-sweetened beverages, a statistically significant interaction was observed between unhealthy outlet density in the 1000m buffer and consumption frequency (ß 0.06, CI 0.02; 0.11). However, this association was only statistically significant for respondents with higher SES (ß-0.02,CI -0.05;-0.0002). These results emphasize the significance of SES as a crucial element in comprehending the connection between the food environment and eating behaviour. Indicating the need for policymakers to take SES into account when implementing food environment interventions, particularly when focusing on the neighborhood food environment without considering residents' SES and their perceptions.

Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study.

BACKGROUND: Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20-64 from 2009 to 2021, emphasizing disparities related to SES. METHODS: This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions. RESULTS: Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women. CONCLUSION: Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

Socioeconomic Status Transition Throughout Life and Risk of Dementia.

Importance: Socioeconomic status (SES) is associated with dementia. However, the role of SES transitions in dementia is less explored; such evidence would be useful to understand whether social mobility is associated with healthy longevity at older ages. Objective: To investigate the association of lifetime SES transition with risk of dementia. Design, Setting, and Participants: This prospective cohort study, conducted from August 2010 to December 2016, used data from the Japan Gerontological Evaluation Study for participants aged 65 years or older from 31 different areas in Japan. Individuals with missing SES values, loss of follow-up, or new dementia onset 1 year or less from baseline were excluded. Data analysis was performed from April 2022 to April 2023. Exposure: Transitions in SES across the life course. Main Outcomes and Measures: The main outcome was risk of dementia incidence and corresponding loss or gain of dementia-free periods in a lifespan. The incidence of dementia was identified with a national registry of long-term nursing care services. Results: A total of 9186 participants (4703 men [51.2%]) were included. The mean (SD) age at baseline was 74.2 (6.0) years. Six SES transitions were identified: upward, stable-high, upper-middle, lower-middle, downward, and stable-low. During the follow-up period, 800 cases of dementia were identified. Many dementia risk factors, including lifestyle behaviors, comorbidities, and social factors, were associated with SES transition patterns. Compared with lower-middle SES, the lowest risk of dementia was observed for upward transition (hazard ratio [HR], 0.66; 95% CI, 0.57-0.74) followed by stable-high (HR, 0.77; 95% CI, 0.69-0.86), downward (HR, 1.15; 95% CI, 1.09-1.23), and stable-low (HR 1.45; 95% CI, 1.31-1.61) transition (P < .001 for linearity); there was no association of upper-middle transition with risk of dementia (HR, 0.91; 95% CI, 0.79-1.03). The greatest increases in dementia-free years in the lifespan were also associated with upward SES transition (eg, 1.8 years [95% CI, 1.4-2.2 years] at age 65 years), while the downward transition was associated with the largest loss in lifetime dementia-free years at 75 years or older (eg, -1.4 years [95% CI, -2.4 to -0.4 years] at age 85 years). Conclusions and Relevance: This cohort study of Japanese older adults identified that upward and downward SES transitions were associated with risk of dementia and the length of dementia-free periods over the lifespan. The results may be useful to understand the association between social mobility and healthy longevity.

Unravelling social status in the first medieval military order of the Iberian Peninsula using isotope analysis.

Medieval Iberia witnessed the complex negotiation of religious, social, and economic identities, including the formation of religious orders that played a major role in border disputes and conflicts. While archival records provide insights into the compositions of these orders, there have been few direct dietary or osteoarchaeological studies to date. Here, we analysed 25 individuals discovered at the Zorita de los Canes Castle church cemetery, Guadalajara, Spain, where members of one of the first religious orders, the Order of Calatrava knights, were buried between the 12th to 15th centuries CE. Stable carbon (δ13C) and nitrogen (δ15N) isotope analyses of bone collagen reveal dietary patterns typical of the Medieval social elite, with the Bayesian R model, 'Simmr' suggesting a diet rich in poultry and marine fish in this inland population. Social comparisons and statistical analyses further support the idea that the order predominantly comprised the lower nobility and urban elite in agreement with historical sources. Our study suggests that while the cemetery primarily served the order's elite, the presence of individuals with diverse dietary patterns may indicate complexities of temporal use or wider social interaction of the medieval military order.

Impact of Poverty on Stroke Recurrence: A Population-Based Study.

BACKGROUND AND OBJECTIVES: Poverty is associated with greater stroke incidence. The relationship between poverty and stroke recurrence is less clear. METHODS: In this population-based study, incident strokes within the Greater Cincinnati/Northern Kentucky region were ascertained during the 2015 study period and followed up for recurrence until December 31, 2018. The primary exposure was neighborhood socioeconomic status (nSES), defined by the percentage of households below the federal poverty line in each census tract in 4 categories (≤5%, >5%-10%, >10%-25%, >25%). Poisson regression models provided recurrence rate estimates per 100,000 residents using population data from the 2015 5-year American Community Survey, adjusting for age, sex, and race. In a secondary analysis, Cox models allowed for the inclusion of vascular risk factors in the assessment of recurrence risk by nSES among those with incident stroke. RESULTS: Of 2,125 patients with incident stroke, 245 had a recurrent stroke during the study period. Poorer nSES was associated with increased stroke recurrence, with rates of 12.5, 17.5, 25.4, and 29.9 per 100,000 in census tracts with ≤5%, >5%-10%, >10%-25%, and >25% below the poverty line, respectively (p < 0.01). The relative risk (95% CI) for recurrent stroke among Black vs White individuals was 2.54 (1.91-3.37) before adjusting for nSES, and 2.00 (1.47-2.74) after adjusting for nSES, a 35.1% decrease. In the secondary analysis, poorer nSES (HR 1.74, 95% CI 1.10-2.76 for lowest vs highest category) and Black race (HR 1.31, 95% CI 1.01-1.70) were both independently associated with recurrence risk, though neither retained significance after full adjustment. Age, diabetes, and left ventricular hypertrophy were associated with increased recurrence risk in fully adjusted models. DISCUSSION: Residents of poorer neighborhoods had a dose-dependent increase in stroke recurrence risk, and neighborhood poverty accounted for approximately one-third of the excess risk among Black individuals. These results highlight the importance of poverty, race, and the intersection of the 2 as potent drivers of stroke recurrence.

Relationship between socioeconomic status and hypertension incidence among adults in southwest China: a population-based cohort study.

PURPOSE: To investigate the correlation between socioeconomic status (SES) and the incidence of hypertension among adults aged 18 or above in southwest China. METHODS: A multistage proportional stratified cluster sampling method was employed to recruited 9280 adult residents from 12 counties in southwest China, with all participants in the cohort tracked from 2016 to 2020. The questionnaire survey gathered information on demographics, lifestyle habits, and household income. The physical exam recorded height, weight, and blood pressure. Biochemical tests measured cholesterol levels. The chi-square test was employed to assess the statistical differences among categorical variables, while the Cox proportional hazards regression model was applied to evaluate the association between socioeconomic status (SES) and the incidence of hypertension. RESULTS: The finally effective sample size for the cohort study was 3546 participants, after excluding 5734 people who met the exclusion criteria. Adults in the highest household income group had a significantly lower risk of hypertension compared to those in the lowest income group (HR = 0.636, 95% CI: 0.478-0.845). Besides, when compared to individuals in the illiterate population, the risk of hypertension among adults with elementary school, junior high school, senior high school and associate degree educational level decreased respectively by 34.4% (HR = 0.656, 95%CI: 0.533-0.807), 44.9% (HR = 0.551, 95%CI: 0.436-0.697), 44.9% (HR = 0.551, 95%CI: 0.405-0.750), 46.1% (HR = 0.539, 95%CI: 0. 340-0.854). After conducting a thorough analysis of socioeconomic status, compared with individuals with a score of 6 or less, the risk of hypertension in participants with scores of 8, 10, 11, 12, and greater than 12 decreased respectively by 23.9% (HR = 0.761, 95%CI: 0.598-0.969), 29.7% (HR = 0.703, 95%CI: 0.538-0.919), 34.0% (HR = 0.660, 95%CI: 0.492-0.885), 34.3% (HR = 0.657, 95%CI: 0.447-0.967), 43.9% (HR = 0.561, 95%CI: 0.409-0.769). CONCLUSION: The findings indicate a negative correlation between socioeconomic status and hypertension incidence among adults in southwest China, suggesting that individuals with higher socioeconomic status are less likely to develop hypertension.

Environmental attitude and affective-motivational beliefs towards sustainability of secondary school children in Germany and their associations with gender, age, school type, socio-economic status and time spent in nature.

There are warnings that human actions will lead to irreversible environmental damage if they continue at their current pace and scale. With regard to individual aspects, a pro-environmental attitude and positive affective-motivational beliefs towards sustainability represent fundamentals for a more sustainable future. However, there is little data regarding these constructs and relevant explanatory factors, especially with regard to young people. We examined environmental attitude (two-dimensional: utilization and preservation) and affective-motivational beliefs towards sustainability with regard to gender, age, socio-economic status, school type and time spent in nature in 484 adolescents (11-14 years) living in German cities by means of univariate and multiple regression analyses. Mean values were high in preservation and affective-motivational beliefs towards sustainability, and relatively low in utilization. Female adolescents had higher values compared to male students in affective-motivational beliefs towards sustainability. Age did not play a substantial role. Although being strongly correlated with each other, school type and socio-economic status each exhibited positive associations to environmental attitude and affective-motivational beliefs towards sustainability. Furthermore, multiple regression analyses identified time spent in nature as a significant predictor of incremental value, suggesting a tentative recommendation to spend at least half an hour per week in nature in order to promote positive attitudes towards the environment and sustainability. In sum, special needs for topic-related education seem to exist for male students, students with lower formal level of education, students with a lower socio-economic status and students who spend little time in nature.

Metacognition as a mediator of the relation between family SES and language and mathematical abilities in preschoolers.

The effect of family socioeconomic status (SES) on academic achievement in literacy and numeracy has been extensively studied with educational inequalities already witnessed in preschoolers. This is presumably explained by the effect of family SES on cognitive and socioemotional abilities associated with academic achievement. Metacognition which refers to knowledge and regulation skills involving reflexivity about one's own cognitive processes is one of these abilities. However, most of the studies investigating the association between metacognition and academic achievement have focused on school-aged students and studies with younger students are only emerging. Meanwhile, the association between family SES and metacognition abilities has surprisingly received little attention regardless of participants' age. The aim of this study was to explore the associations between family SES, metacognition, language and mathematical abilities in preschoolers aged 5 to 6. We provide the first evidence that the effect of family SES on preschoolers' language and mathematical abilities is mediated by the effect of family SES on their metacognitive abilities. The implications for future research, education and policies aiming at reducing educational inequalities are discussed.

Association of patient socioeconomic status with outcomes after palliative treatment for disseminated cancer.

BACKGROUND: Palliative treatment has been associated with improved quality of life and survival for a wide variety of metastatic cancers. However, it is unclear whether the benefits of palliative treatment are uniformly experienced across the US cancer population. We evaluated patterns and outcomes of palliative treatment based on socioeconomic, sociodemographic and treating facility characteristics. METHODS: Patients diagnosed between 2008 and 2019 with Stage IV primary cancer of nine organ sites were analyzed in the National Cancer Database. The association between identified variables, and outcomes concerning the administration of palliative treatment were analyzed with multivariable logistic regression and Cox proportional hazard models. RESULTS: Overall 238,995 (23.6%) of Stage IV patients received palliative treatment, which increased over time for all cancers (from 20.7% in 2008 to 25.6% in 2019). Palliative treatment utilization differed significantly by region (West less than Northeast, OR: 0.55 [0.54-0.56], p < 0.001) and insurance payer status (uninsured greater than private insurance, OR: 1.35 [1.32-1.39], p < 0.001). Black race and Hispanic ethnicity were also associated with lower rates of palliative treatment compared to White and non-Hispanics respectively (OR for Blacks: 0.91 [0.90-0.93], p < 0.001 and OR for Hispanics: 0.79 [0.77-0.81] p < 0.001). CONCLUSIONS: There are important differences in the utilization of palliative treatment across different populations in the United States. A better understanding of variability in palliative treatment use and outcomes may identify opportunities to improve informed decision making and optimize quality of care at the end-of-life.

Understanding the Association Between Social Determinants of Health and Receipt of Immunotherapy for Melanoma.

PURPOSE: In this review article, we sought to elucidate how the social determinants of health, including socioeconomic status, education, neighborhood or physical environment, access to healthcare, and race/ethnicity, affect the likelihood of receiving immunotherapy, a novel and expensive treatment for melanoma.  Methods: The PubMed database was queried up to May 2023, for studies pertaining to health disparities in melanoma, including studies examining the utilization of immunotherapy agents for the treatment of melanoma across various social determinants of health. RESULTS: Disparities in the utilization of immunotherapy exist across various social determinants. A total of 10 studies were found to report on disparities in receipt of immunotherapy. These studies reported an association between insurance status, education level, socioeconomic status, as well as proximity to a cancer research center, and a lower likelihood of receiving immunotherapy. CONCLUSION: As the number of novel immunotherapy drugs grows, it is important to understand the various disparities affecting the delivery of immunotherapy across social determinants. The findings from this study can help to drive public health policy aimed at addressing inequities in the treatment of melanoma as well as other cancers.    J Drugs Dermatol. 2024;23(5):311-315. doi:10.36849/JDD.7803.

Propensity score analysis for health care disparities: a deweighting approach.

BACKGROUND: Propensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM's definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables. METHODS: The present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions. RESULTS: The procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES. CONCLUSIONS: Deweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.

Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register.

BACKGROUND AND PURPOSE: We aimed to examine the association between socioeconomic status (SES) markers and opioid use after primary total hip arthroplasty (THA) due to osteoarthritis, and whether sex, age, or comorbidities modify any association. METHODS: Using Danish databases, we included 80,038 patients undergoing primary THA (2001-2018). We calculated prevalences and prevalence ratios (PRs with 95% confidence intervals [CIs]) of immediate post-THA opioid use (≥ 1 prescription within 1 month) and continued opioid use (≥ 1 prescription in 1-12 months) among immediate opioid users. Exposures were individual-based education, cohabitation, and wealth. RESULTS: The prevalence of immediate opioid use was ~45% in preoperative non-users and ~60% in preoperative users (≥ 1 opioid 0-6 months before THA). Among non-users, the prevalences and PRs of continued opioid use were: 28% for low vs. 21% for high education (PR 1.28, CI 1.20-1.37), 27% for living alone vs. 23% for cohabiting (PR 1.09, CI 1.04-1.15), and 30% for low vs. 20% for high wealth (PR 1.43, CI 1.35-1.51). Among users, prevalences were 67% for low vs. 55% for high education (1.22, CI 1.17-1.27), 68% for living alone vs. 60% for cohabiting (PR 1.10, CI 1.07-1.12), and 73% for low wealth vs. 54% for high wealth (PR 1.32, CI 1.28-1.36). Based on testing for interaction, sex, age, and comorbidity did not statistically significant modify the associations. Nevertheless, associations were stronger in younger patients for all SES markers (mainly for non-users). CONCLUSION: Markers of low SES were associated with a higher prevalence of continued post-THA opioid use. Age modified the magnitude of the associations, but it was not statistically significant.

Effect of out-of-school visual art activities on academic performance. The mediating role of socioeconomic status.

The application of visual art and other extracurricular activities to children's sustainable development is predominantly discussed in Western countries. Consequently, non-Western society could not cherish the benefit of visual art on their children's cognitive and non-cognitive skill development due to a lack of evidence that would revive the community, educators, and policy-makers' impressions about visual art activities, in addition to its amusement use. Thus, the present study adopted a cross-sectional study comprised of a large-scale survey (N = 1624) taken from the southwest part of China to assess the impact of out-of-school visual art activities on children's academic attainment across economically advantaged and disadvantaged children. Astonishingly, the study's findings shed light on current Chinese parents' dedication to purchasing out-of-school activities regardless of their social class difference; notwithstanding, lower-class parents ought to learn that spending time with their children during their activities is more beneficial. The study's implication calls for curriculum policy reform involving aesthetic education and expanding community youth centers for different extracurricular activities.

Socioeconomic and gender inequalities in mental disorders among adolescents and young adults.

BACKGROUND: Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. MATERIALS AND METHODS: We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. RESULTS: Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). CONCLUSIONS: Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.