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Current research is beginning to explore causal links between drinking water quality and environmental justice indicators such as race/ethnicity, socioeconomic status, and other means of marginalization. What we know from [...]

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Uncontrolled GDM increases the risk of negative pregnancy outcomes for both the pregnant individual and the infant. African Americans (AAs) have higher maternal morbidity and infant mortality rates than non-Hispanic whites (NHWs). The goal of the current study was to examine racial differences in the effect of GDM on birth outcomes. The data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed with a focus on four states in the southern U.S. (Alabama, Georgia, Louisiana, and Mississippi). The results presented suggest that AAs are at lower risk of GDM than NHW individuals. Even with the lower risk of GDM, AAs are at higher risk of pre-term births. In addition, socioeconomic factors and access to prenatal care play a role in birth outcomes including moderating the effect of GDM on outcomes. A discussion of potential policy interventions that may improve pregnancy outcomes is discussed including increased use of doulas to support pregnant people., Author(s): Sharlene D. Newman [sup.1] , Chuong Bui [sup.1] , Lilanta Joy Bradley [sup.2] , Maria Hernandez-Reif [sup.3] Author Affiliations: (1) grid.411015.0, 0000 0001 0727 7545, Alabama Life Research Institute, [...]

Background: Socioeconomic status (SES) has been shown to influence the outcomes of surgical pathologies in areas with unequal access to health care. The purpose of this study was to measure the effect of SES on the urgency for inguinal hernia repair in an area with purported equitable access to health care in the context of a universal health care system. Methods: We included all adult patients who underwent surgical management of an inguinal hernia between 2012 and 2016 at 2 urban academic centres. We measured the SES using the Vancouver Area Neighbourhood Deprivation Index (VANDIX) score. Results: We included 2336 patients: 98 emergency surgery and 294 elective surgery cases. We matched patients without replacement on age, sex and American Society of Anesthesiology score, using optimized propensity score matching at a ratio of 1 case to 3 controls. We found no significant correlation between lower SES and emergency surgical management (p = 0.122). Secondary analysis assessed the impact of SES on morbidity and length of stay. We found no significant difference in the rate of complications, length of stay and recurrence by SES category. Patients from lower SES brackets had increased odds for readmission (odds ratio 1.979; 95% confidence interval 1.111-4.318). Conclusion: We found no correlation between a low SES and the need for emergency inguinal hernia repair, but found an increased rate of readmission in patients from lower SES brackets. This finding should be further scrutinized through a deeper dive into the barriers to access to nonacute care settings, such as home care. Contexte : Il a ete demontre que le statut socioeconomique (SSE) influe sur l'issue des maladies operables dans les regions ou on note un a[alpha]ces inequitable aux soins de sante. Cette etude avait pour but de mesurer l'effet du SSE sur l'urgence attachee aux reparations de hernie inguinale dans une region ou l'acces aux soins de sante est presume equitable en vertu du regime public de sante universel. Methodes : Nous avons inclus tous les patients adultes ayant subi une reparation chirurgicale de hernie inguinale entre 2012 et 2016 dans 2 centres universitaires urbains. Nous avons mesure le SSE a l'aide de l'indice VANDIX (Vancouver Area Neighbourhood Deprivation Index). Resultats : Nous avons inclus 2336 patients : 98 cas urgents et 294 cas non urgents. Nous avons procede a un appariement des patients sans remplacement selon l'age, le sexe et le score de l'American Society of Anesthesiology, par appariement optimise des coefficients de propension selon un rapport 1 cas:3 temoins. Nous n'avons observe aucune correlation significative entre un statut SSE plus defavorable et une prise en charge chirurgicale urgente (p = 0,122). L'analyse secondaire a permis d'evaluer l'impact du SSE sur la morbidite et la duree de l'hospitalisation. Nous n'avons note aucune difference significative pour ce qui est du taux de complications, de la duree du sejour et de la recurrence en fonction de la categorie de SSE. Les patients provenant de milieux plus defavorises presentaient un risque superieur de readmission (rapport des cotes 1,979; intervalle de confiance 1,111-4,318). Conclusion: Nous n'avons etabli aucune correlation entre un SSE faible et la necessite d'une reparation urgente des hernies inguinales, mais nous avons constate une hausse des taux de readmission chez les patients de milieux plus defavorises. Cette observation merite d'etre exploree plus en profondeur au plan des obstacles a l'acces aux services de soins non urgents, comme les soins a domicile., Inguinal hernias are commonly treated conditions in general surgery, with more than 20 million inguinal hernia repairs done per year worldwide. (1) Although the all-cause mortality rate of inguinal hernia [...]

Air pollution has emerged as a risk factor for type 2 diabetes (T2D) in numerous epidemiological studies. (1,2) However, evidence for the role that social factors may play in the [...]

Individuals with chronic low back pain (cLBP) frequently report sleep disturbances. Living in a neighborhood characterized by low-socioeconomic status (SES) is associated with a variety of negative health outcomes, including poor sleep. Whether low-neighborhood SES exacerbates sleep disturbances of people with cLBP, relative to pain-free individuals, has not previously been observed. This study compared associations between neighborhood-level SES, pain-status (cLBP vs. pain-free), and daily sleep metrics in 117 adults (cLBP = 82, pain-free = 35). Neighborhood-level SES was gathered from Neighborhood Atlas, which provides a composite measurement of overall neighborhood deprivation (e.g. area deprivation index). Individuals completed home sleep monitoring for 7-consecutive days/nights. Neighborhood SES and pain-status were tested as predictors of actigraphic sleep variables (e.g., sleep efficiency). Analyses revealed neighborhood-level SES and neighborhood-level SES*pain-status interaction significantly impacted objective sleep quality. These findings provide initial support for the negative impact of low neighborhood-level SES and chronic pain on sleep quality., Author(s): Deanna D. Rumble [sup.1] , Katherine O'Neal [sup.2] , Demario S. Overstreet [sup.1] , Terence M. Penn [sup.1] , Pamela Jackson [sup.3] , Edwin N. Aroke [sup.3] , Andrew [...]

Identify the pathway by which social determinants of health (SDoH) variables impact systolic blood pressure (SBP) in immigrants. Latent variables were used to assess the relationship between SDoH and SBP. Latent variables were identified using confirmatory factor analysis (CFA) for (1) global socioeconomic status (SES) (education, income, number of hours worked per week), (2) stressors of immigration (life-course SES, immigration stress, immigration demand), (3) adaptation to immigration (perceived discrimination, perceived stress, health literacy), and (4) burden of disease (disability, comorbidities, chronic pain). Structural equation modeling (SEM) was used to investigate the relationship between immigrant specific latent variables and SBP. The study included 181 adult immigrants. The initial model (chi2 (77, n = 181) = 302.40, p < 0.001, RMSEA = 0.086, CFI = 0.84, TLI = 0.78, CD = 0.91) showed that stressors of immigration had a direct relationship with SBP (-0.35, p = 0.033); global (SES) had a direct relationship with burden of disease (-0.70, p = 0.007) and an indirect relationship with SBP by way of burden of disease (0.24, p = 0.015). The final model (chi2 (69, n = 181) = 149.98, p < 0.001, RMSEA = 0.054, CFI = 0.94, TLI = 0.91, CD = 0.96) maintained that global SES had a direct relationship with burden of disease (-0.40, p < 0.001) and an indirect relationship with SBP by way burden of disease (0.34, p < 0.001). This study suggests a direct relationship between burden of disease and SBP, and an indirect relationship between SES and SBP. Development of interventions should take burden of disease into account as a direct driver of blood pressure in immigrants, and address factors related to SES., Author(s): Aprill Z. Dawson [sup.1] [sup.2] , Rebekah J. Walker [sup.1] [sup.2] , Chris Gregory [sup.3] , Leonard E. Egede [sup.1] [sup.2] Author Affiliations: (1) grid.30760.32, 0000 0001 2111 8460, [...]

Objectives Previous studies indicated a significant association between small for gestational age (SGA) in infants and their parents' socioeconomic status (SES). Thus, this study aimed to examine if parental factors, such as maternal smoking, and the pre-pregnancy body mass index (BMI) could mediate the associations between parental SES and SGA. Methods The participants of this study were pregnant women who enrolled in an ongoing birth cohort study, the Hokkaido study, during the first trimester of their pregnancies. A total of 14,593 live singleton births were included in the statistical analysis, of which 1011 (6.9%) were SGA. Two structural equation models were employed to evaluate the associations between parental SES, parental characteristics, and SGA. Results The effect of low SES on SGA was directly mediated by maternal pre-pregnancy BMI, smoking during the third trimester, and alcohol consumption during the first trimester in the first model, which was based the assumption of independent associations between mediating factors. In the second model, which additionally considered the mediating factors from the first model, smoking during pregnancy mediated decline in parental SES, consequently increased SGA. Moreover, an increase in pregnancy smoking status increased the prevalence of lower maternal pre-pregnancy BMI and its effect on SGA. Conclusions for Practice In this study, we observed the independent mediating effect of maternal pre-pregnancy BMI, smoking, and alcohol consumption during pregnancy on low SES and, consequently, SGA, with the additional mediating pathway of SES to smoking to low BMI on SGA., Author(s): Naomi Tamura [sup.1] [sup.2] [sup.3] , Tomoyuki Hanaoka [sup.1] , Kumiko Ito [sup.1] [sup.4] , Atsuko Araki [sup.1] [sup.2] , Chihiro Miyashita [sup.1] , Sachiko Ito [sup.1] , Sumitaka [...]

BACKGROUND: Exposure to air pollution has been associated with a higher risk of type 2 diabetes (T2D), but studies investigating whether deprived groups are more susceptible to the harmful effects of air pollution are inconsistent. OBJECTIVES: We aimed to investigate whether the association between air pollution and T2D differed according to sociodemographic characteristics, comorbidity, and coexposures. METHODS: We estimated residential exposure to P[M.sub.2.5], ultrafine particles (UFP), elemental carbon, and N[O.sub.2] for all persons living in Denmark in the period 2005-2017. In total, 1.8 million persons 50-80 y of age were included for main analyses of whom 113,985 developed T2D during follow-up. We conducted additional analyses on 1.3 million persons age 35-50 y. Using Cox proportional hazards model (relative risk) and Aalens additive hazard model (absolute risk), we calculated associations between 5-y time-weighted running means of air pollution and T2D in strata of sociodemographic variables, comorbidity, population density, road traffic noise, and green space proximity. RESULTS: Air pollution was associated with T2D, especially among people age 50-80 y, with hazard ratios of 1.17 [95% confidence interval (CI): 1.13, 1.21] per 5 [micro]g/[m.sup.3] P[M.sub.2.5] and 1.16 (95% CI: 1.13, 1.19) per 10,000 UFP/[cm.sup.3]. In the age 50-80 y population, we found higher associations between air pollution and T2D among men in comparison with women, people with lower education vs. individuals with high education, people with medium income vs. those with low or high income, people cohabiting vs. those living alone, and people with comorbidities vs. those without comorbidities. We observed no marked changes according to occupation, population density, road noise, or surrounding greenness. In the age 35-50 y population, similar tendencies were observed, except in relation to sex and occupation, where we observed associations with air pollution only among women and blue-collar workers. DISCUSSION: We found stronger associations between air pollution and T2D among people with existing comorbidities and weaker associations among people with high socioeconomic status in comparison with those with lower socioeconomic status. https://doi.org/10.1289/EHP11347, Introduction The prevalence of type 2 diabetes (T2D) has increased markedly in countries of all income levels, from 108 million in 1980 to 422 million in 2014. (1) The main [...]

Context: Food, housing, and financial insecurities are social determinants of health that negatively affect health. Little is known about the long-term impact of these insecurities on functional capacity. Objective: To investigate the longitudinal effect of these SDHs on functional capacity. Study Design: Retrospective cohort study Setting or Dataset: Longitudinal surveys from 41 primary care clinics across 13 states (September 2017 to February 2021) Population Studied: 2,426 adult primary care patients with multiple chronic conditions. Outcome Measures: The primary outcome was metabolic equivalents (METs) calculated from the Duke Activity Status Index (DASI). Results: The median time between baseline and follow-up surveys was 636 days. Baseline data were collected pre-COVID-19 and follow-up data were collected during COVID-19. The prevalence of one or more insecurities was 27% at baseline and 23% at follow-up. The median functional capacity was 6.1 at both time points. Compared to no SDH, the presence of one or more SDH at baseline but not follow-up (n=266) was associated with a -0.58 reduction in METs (95% CI: -0.84, - 0.33). Any SDH at follow-up but not baseline (n=172) was associated with a -0.67 reduction in METs (95% CI: -0.97, -0.36 and any SDH at both baseline and follow-up (n=369) was associated with a -0.90 reduction in METs (95% CI: -1.14, 0.66). Conclusions: The presence of these insecurities at baseline, follow-up or both was associated with significantly worse functional capacity compared to never having had these insecurities. This suggests primary prevention of insecurities (food, housing, and financial) are essential. Even participants who had insecurities at baseline and resolved it by follow-up still had poorer functional capacity, suggesting the devastating long-term impacts. Future studies should investigate Primary Care as a resource to screen for and prevent these insecurities., Presenters Levi Bonnell, MPH, PhD Candidate, Benjamin Littenberg, MD, Abigail Crocker, PhD, Constance van Eeghen, DrPH, [...]

Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants' baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women's pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women., Author(s): Teresa A. Lillis [sup.1] , John Burns [sup.1] , Frances Aranda [sup.1] [sup.2] , Helen J. Burgess [sup.1] [sup.3] , Yanina A. Purim-Shem-Tov [sup.4] , Stephen Bruehl [sup.5] , [...]

Objective To characterize dietary patterns and physical activity in a diverse cohort of Midwestern reproductive-age women and to determine associations between these lifestyle factors, socioeconomic factors, and obesity. Methods In this cross-sectional study, 185 women completed validated food frequency and physical activity questionnaires. Dietary patterns were identified through principal component analysis. Sociodemographic characteristics associated with dietary pattern adherence and physical activity participation were identified through linear regression. Associations between lifestyle factors and obesity were assessed through logistic regression. Results Two dietary patterns were identified: a 'Prudent' pattern characterized by consumption of fruits, vegetables, olive oil, and nuts and a 'Western' pattern including meat, refined carbohydrates, and high-calorie drinks. African-American women and women without a college degree were more likely to adhere to the Western dietary pattern than other women. Women in areas with higher socioeconomic deprivation had lower levels of physical activity, especially leisure-time exercise. Women who completed college participated in more leisure-time exercise and had less physically demanding occupations. Obesity was associated with increasing adherence to the Western dietary pattern in a dose-dependent fashion (aOR range 2.68-4.33, 95% CI range 0.69-16.61) but was not associated with adherence to the Prudent pattern (aOR range 0.46-1.06, 95% CI range 0.13-3.41). Increased physical activity was associated with reduced odds of obesity (aOR range 0.28-0.30, 95% CI range 0.10-0.93). Conclusions for Practice This study highlights dietary and physical activity patterns associated with obesity in reproductive-age women. Lifestyle interventions focused on minimizing consumption of the Western diet and increasing physical activity may provide an opportunity to reduce obesity among reproductive-age women., Author(s): Bronwyn S. Bedrick [sup.1] , Ashley M. Eskew [sup.1] , Jorge E. Chavarro [sup.2] , Emily S. Jungheim [sup.3] Author Affiliations: (1) grid.4367.6, 0000 0001 2355 7002, Division of [...]

Objective Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. Methods Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. Results In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. Conclusions for Practice Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups., Author(s): Angelique Ludwig [sup.1] [sup.2] , Céline Miani [sup.1] , Jürgen Breckenkamp [sup.1] , Odile Sauzet [sup.1] [sup.3] , Theda Borde [sup.4] , Ina-Merle Doyle [sup.5] , Silke Brenne [sup.6] [...]

Background/Objectives Previous studies about obesity and its associated factors in low- and middle-income countries have been based mostly on women of reproductive age. Furthermore, disproportionally changing BMI distributions have been a challenge for its appropriate modeling. In this context, we assessed the magnitude and rate of change in BMI distribution by socioeconomic and geographic factors in both sexes in Latin American countries, modeling the shape of BMI distributions. Subjects/Methods We used data from national surveys conducted in Mexico, Colombia, and Peru at two time points between 2005 and 2013 (N = 57,414, 13,5403, and 30,811, respectively). We estimated shapes of BMI distributions for 2005 and 2010, and assessed their changes, using the generalized additive model for location, scale, and shape (GAMLSS), in which BMI was assumed to follow a Box-Cox Power Exponential (BCPE) distribution. Results In all the three countries, higher education was negatively associated with BMI in women but somewhat positive in men; and household wealth was positively associated in men but not in women. Lower household wealth was associated with higher rates of change in BMI distributions in women. Conclusion Education and household wealth were associated with BMI distributions and their change over time. Observed sex differences in these associations have implications for designing relevant policies and programs to approach target populations effectively. The BCPE-GAMLSS method can provide a useful visual assessment of time-varying measures., Author(s): Goro Yamada [sup.1] [sup.2] , Jessica C. Jones-Smith [sup.1] [sup.3] , Carlos Castillo-Salgado [sup.2] , Lawrence H. Moulton [sup.1] Author Affiliations: (1) Department of International Health, Johns Hopkins Bloomberg [...]

Background We examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study. Methods and findings In a cohort of 9,127,673 persons enrolled in the United States Veterans Affairs (VA) healthcare system, we evaluated the independent associations of sociodemographic and clinical characteristics with SARS-CoV-2 infection (n = 216,046), SARS-CoV-2-related mortality (n = 10,230), and case fatality at monthly intervals between February 1, 2020 and March 31, 2021. VA enrollees had a mean age of 61 years (SD 17.7) and were predominantly male (90.9%) and White (64.5%), with 14.6% of Black race and 6.3% of Hispanic ethnicity. Black (versus White) race was strongly associated with SARS-CoV-2 infection (adjusted odds ratio [AOR] 5.10, [95% CI 4.65 to 5.59], p-value Conclusions In this study, we found that strongly positive associations of Black and AI/AN (versus White) race and urban (versus rural) residence with SARS-CoV-2 infection, mortality, and case fatality observed early in the pandemic were ameliorated or reversed by March 2021., Author(s): George N. Ioannou 1,2,*, Jacqueline M. Ferguson 3, Ann M. O'Hare 4, Amy S. B. Bohnert 5, Lisa I. Backus 6, Edward J. Boyko 7, Thomas F. Osborne 8, [...]

Background: Despite a vast air pollution epidemiology literature to date and the recognition that lower-socioeconomic status (SES) populations are often disproportionately exposed to pollution, there is little research identifying optimal means of adjusting for confounding by SES in air pollution epidemiology, nor is there a strong understanding of biases that may result from improper adjustment. Objective: We aim to provide a conceptualization of SES and a review of approaches to its measurement in the U.S. context and discuss pathways by which SES may influence health and confound effects of air pollution. We explore bias related to measurement and operationalization and identify statistical approaches to reduce bias and confounding. Discussion: Drawing on the social epidemiology, health geography, and economic literatures, we describe how SES, a multifaceted construct operating through myriad pathways, may be conceptualized and operationalized in air pollution epidemiology studies. SES varies across individuals within the contexts of place, time, and culture. Although no single variable or index can fully capture SES, many studies rely on only a single measure. We recommend examining multiple facets of SES appropriate to the study design. Furthermore, investigators should carefully consider the multiple mechanisms by which SES might be operating to identify those SES indicators that may be most appropriate for a given context or study design and assess the impact of improper adjustment on air pollution effect estimates. Last, exploring model contraction and expansion methods may enrich adjustment, whereas statistical approaches, such as quantitative bias analysis, may be used to evaluate residual confounding. https://doi.org/10.1289/EHP7980, Introduction Studies in the United States and elsewhere have reported that long-term exposures to air pollution (AP) are associated with increased risk of all-cause (Dockery et al. 1993; Laden et [...]