scholarly journals Life Course Socioeconomic Status, Allostatic Load, and Kidney Health in Black Americans

2020 ◽  
Vol 15 (3) ◽  
pp. 341-348 ◽  
Author(s):  
Joseph Lunyera ◽  
John W. Stanifer ◽  
Clemontina A. Davenport ◽  
Dinushika Mohottige ◽  
Nrupen A. Bhavsar ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Life Course ◽  
Low Socioeconomic Status ◽  
Allostatic Load ◽  
Process Analysis ◽  
Black Americans ◽  
Heart Study ◽  
Egfr Decline ◽  
Kidney Health

Background and objectivesLow socioeconomic status confers unfavorable health, but the degree and mechanisms by which life course socioeconomic status affects kidney health is unclear.Design, setting, participants, & measurementsWe examined the association between cumulative lifetime socioeconomic status and CKD in black Americans in the Jackson Heart Study. We used conditional process analysis to evaluate allostatic load as a potential mediator of this relation. Cumulative lifetime socioeconomic status was an age-standardized z-score, which has 1-SD units by definition, and derived from self-reported childhood socioeconomic status, education, and income at baseline. Allostatic load encompassed 11 baseline biomarkers subsuming neuroendocrine, metabolic, autonomic, and immune physiologic systems. CKD outcomes included prevalent CKD at baseline and eGFR decline and incident CKD over follow-up.ResultsAmong 3421 participants at baseline (mean age 55 years [SD 13]; 63% female), cumulative lifetime socioeconomic status ranged from −3.3 to 2.3, and 673 (20%) had prevalent CKD. After multivariable adjustment, lower cumulative lifetime socioeconomic status was associated with greater prevalence of CKD both directly (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.04 to 1.33 per 1 SD and OR, 1.45; 95% CI, 1.15 to 1.83 in lowest versus highest tertile) and via higher allostatic load (OR, 1.09; 95% CI, 1.06 to 1.12 per 1 SD and OR, 1.17; 95% CI, 1.11 to 1.24 in lowest versus highest tertile). After a median follow-up of 8 years (interquartile range, 7–8 years), mean annual eGFR decline was 1 ml/min per 1.73 m2 (SD 2), and 254 out of 2043 (12%) participants developed incident CKD. Lower cumulative lifetime socioeconomic status was only indirectly associated with greater CKD incidence (OR, 1.04; 95% CI, 1.01 to 1.07 per 1 SD and OR, 1.08; 95% CI, 1.02 to 1.14 in lowest versus highest tertile) and modestly faster annual eGFR decline, in milliliters per minute (OR, 0.01; 95% CI, 0.00 to 0.02 per 1 SD and OR, 0.02; 95% CI, 0.00 to 0.04 in lowest versus highest tertile), via higher baseline allostatic load.ConclusionsLower cumulative lifetime socioeconomic status was substantially associated with CKD prevalence but modestly with CKD incidence and eGFR decline via baseline allostatic load.

scholarly journals Early Life Course Pathways of Adult Depression and Chronic Pain

2013 ◽  
Vol 54 (1) ◽  
pp. 75-91 ◽  
Author(s):  
Bridget J. Goosby
Keyword(s):  
Chronic Pain ◽  
Socioeconomic Status ◽  
Life Course ◽  
Maternal Depression ◽  
Low Socioeconomic Status ◽  
Socioeconomic Disadvantage ◽  
Physical And Mental Health ◽  
Highly Educated ◽  
Adult Depression ◽  
Cumulative Inequality

Applying cumulative inequality theory, this study examines the extent to which childhood socioeconomic disadvantage and maternal depression increase the risk of major depression and chronic pain in U.S. working-aged adults. Further, I assess whether low socioeconomic status amplifies the risk of adult depression and/or pain. Using data from the 2003 National Comorbidity Survey Replication ( N=4339), I find that socioeconomic disadvantage and maternal depression during youth increases the risk of adult depression and/or chronic pain. The probability of having chronic pain increases in magnitude over the life course for adults whose parents have lower educational attainment relative to those with more highly educated parents. Childhood socioeconomic circumstances are not completely explained by adulthood socioeconomic status indicators. These findings help illustrate the far-reaching influence of childhood context on adult physical and mental health.

Abstract 027: Life-course Cardiovascular Risk Mobility in the International Childhood Cardiovascular Cohort (i3C) Consortium

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Benjamin D Pollock ◽  
Tian Hu ◽  
Olli T Raitakari ◽  
Trudy L Burns ◽  
Alan R Sinaiko ◽  
...  
Keyword(s):  
Risk Factor ◽  
Life Course ◽  
Adult Child ◽  
High Mobility ◽  
Heart Study ◽  
Risk Stratum ◽  
Z Scores ◽  
Inverse Probability Weighted ◽  
Risk Factor Burden

Background: We previously adapted a methodology from literature on socioeconomic mobility (the “American Dream”) to develop an analogous concept of Cardiovascular (CV) Risk Mobility (CRM: movement across CV risk rankings during aging) in the Bogalusa Heart Study (BHS). We found high mobility, such that childhood CV risk burden tracks into adulthood, but not so strongly that a low CV-risk stratum in adulthood is unreachable. Because geopolitical, ethnic, and healthcare differences may affect mobility in life course CV health, we sought to further test CRM using an international consortium. Methods: We used prospective data from n=20,685 children followed into adulthood (inverse probability weighted, n=6,029 with adult follow-up) from the 1970s-2010s in three of the i3C Consortium cohorts: BHS, the Young Finns Study (YFS), and the Muscatine Study. During childhood (age 5-18 yr), participants were percentile-ranked by their CV risk factor burden using an age- and sex-adjusted sum of z-scores from total cholesterol, systolic blood pressure, BMI, and triglycerides. During adult follow-up (age 40-55 yr), participants were percentile-ranked using the Framingham score. The rank-rank slope (β) from the regression of adult/child percentile rankings forms the measure of CRM. Results: Patterns of CRM were similar to BHS in both YFS [β=.15 (95% CI: .12, .18) at age 10] and Muscatine [β=.14 (95% CI: .09, .19) at age 10]. Pooled results of age/rank interaction were significant ( p =0.005), indicating a pattern of lower CRM (more tracking) earlier in childhood. The pooled β=.15 (95% CI: .14, .16)], meaning that a child ranked 10 percentiles better was only 1.5 percentiles better as an adult. Conclusions: Populations in the developed world track, yet exhibit large mobility in CV risk. Children are readily able to move from both high to low and low to high CV risk strata over the life course. The earlier children develop a high CV risk factor burden relative to their peers, the lower their mobility, or opportunity to “catch up,” into adulthood.

Poor person and areal socioeconomic status is associated with increased diabetic retinopathy and visual impairment incidence and progression

2020 ◽  
pp. bjophthalmol-2020-316430
Author(s):  
Jin Rong Low ◽  
Alfred Tau Liang Gan ◽  
Eva K Fenwick ◽  
Preeti Gupta ◽  
Tien Y Wong ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Diabetic Retinopathy ◽  
Visual Impairment ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Vision Loss ◽  
Population Based ◽  
Housing Type ◽  
Incidence Risk

BackgroundTo investigate the longitudinal associations between person-level and area-level socioeconomic status (PLSES and ALSES, respectively) with diabetic retinopathy (DR) and visual impairment (VI) in Asians with diabetes mellitus (DM).MethodsIn this population-based cohort study, we included 468 (39.4%) Malays and 721 (60.6%) Indians with DM, with a mean age (SD) of 58.9 (9.1) years; 50.6% were female and the mean follow-up duration was 6.2 (0.9) years. Individual PLSES parameters (education, monthly income and housing type) were quantified using questionnaires. ALSES was assessed using the Socioeconomic Disadvantage Index derived from Singapore’s 2010 areal census (higher scores indicate greater disadvantage). Incident DR and VI were defined as absent at baseline but present at follow-up, while DR and VI progression were defined as a ≥1 step increase in severity category at follow-up. Modified Poisson regression analysis was used to determine the associations of PLSES and ALSES with incidence and progression of DR and VI, adjusting for relevant confounders.ResultsIn multivariable models, per SD increase in ALSES score was associated with greater DR incidence (risk ratio (95% CI) 1.27 (1.13 to 1.44)), DR progression (1.10 (1.00 to 1.20)) and VI incidence (1.10 (1.04 to 1.16)), while lower PLSES variables were associated with increased DR (low income: 1.68 (1.21 to 2.34)) and VI (low income: 1.44 (1.13 to 1.83); ≤4 room housing: 2.00 (1.57 to 2.54)) incidence.ConclusionsWe found that both PLSES and ALSES variables were independently associated with DR incidence, progression and associated vision loss in Asians. Novel intervention strategies targeted at low socioeconomic status communities to decrease rates of DR and VI are warranted.

scholarly journals Early-Life Adversities and Recalcitrant Smoking in Midlife: An Examination of Gender and Life-Course Pathways

2020 ◽  
Vol 54 (11) ◽  
pp. 867-879
Author(s):  
Chioun Lee ◽  
Lexi Harari ◽  
Soojin Park
Keyword(s):  
Life Course ◽  
Low Socioeconomic Status ◽  
Early Life ◽  
Financial Strain ◽  
Low Ses ◽  
Family Instability ◽  
Family Problems ◽  
Low Socioeconomic ◽  
Logistic Regression Models

Abstract Background Little is known about life-course factors that explain why some individuals continue smoking despite having smoking-related diseases. Purpose We examined (a) the extent to which early-life adversities are associated with the risk of recalcitrant smoking, (b) psychosocial factors that mediate the association, and (c) gender differences in the associations. Methods Data were from 4,932 respondents (53% women) who participated in the first and follow-up waves of the Midlife Development in the U.S. National Survey. Early-life adversities include low socioeconomic status (SES), abuse, and family instability. Potential mediators include education, financial strain, purpose in life, mood disorder, family problems/support, and marital status. We used sequential logistic regression models to estimate the effect of early-life adversities on the risk of each of the three stages on the path to recalcitrant smoking (ever-smoking, smoking-related illness, and recalcitrant smoking). Results For women, low SES (odds ratio [OR] = 1.29; 1.06–1.55) and family instability (OR = 1.73; 1.14–2.62) are associated with an elevated risk of recalcitrant smoking. Education significantly reduces the effect of childhood SES, yet the effect of family instability remains significant even after accounting for life-course mediators. For men, the effect of low SES on recalcitrant smoking is robust (OR = 1.48; 1.10–2.00) even after controlling for potential mediators. There are noteworthy life-course factors that independently affect recalcitrant smoking: for both genders, not living with a partner; for women, education; and for men, family problems. Conclusions The findings can help shape intervention programs that address the underlying factors of recalcitrant smoking.

scholarly journals Impact of Socioeconomic Status on Return to Work after Acute Ankle Fracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Alessandra L. Falk ◽  
Regina Hanstein ◽  
Chaiyaporn Kulsakdinun
Keyword(s):  
Socioeconomic Status ◽  
Return To Work ◽  
Low Socioeconomic Status ◽  
Ankle Fracture ◽  
Low Ses ◽  
Insurance Status ◽  
Low Socioeconomic ◽  
The Impact ◽  
Zip Code

Category: Ankle; Trauma Introduction/Purpose: Socioeconomic status has been recognized throughout the medical literature, both within orthopedics and beyond, as a factor that influences outcomes after surgery, and can result in substandard care. Within the foot and ankle subspecialty, there is limited data regarding socioeconomic status and post-operative outcomes, with the current literature focusing on outcomes for diabetic feet. However, ankle fractures are among the most common fractures encountered by orthopedic surgeons. While a few studies have explored the impact of ankle fractures on employment and disability status, the effect of socioeconomic status on return to work post operatively has not yet been investigated. The purpose of this study was to determine the impact of low socioeconomic status on return to work. Methods: We retrospectively reviewed 592 medical charts of patients with CPT code 27766, 27792, 27814, 27822, 27823, 27827, 27829, 27826, 27828 from 2015-2018. Included were patients >18 yrs of age who sustained an acute ankle fracture, were employed prior to the injury, and with information on return to work after ankle surgery, zip code, race, ethnicity and insurance status. Excluded were patients who were not employed prior to their injury. Socioeconomic status was either defined by insurance status - Medicaid/Medicare, commercial, or workman’s compensation -, or by assessing socioeconomic status (SES) using medial household per capita income by zip code as generated and reported by the US National Census Bureau’s 2013-2017 American Community Survey 5-Year Estimates. The national dataset was divided into quartiles with the lowest quartile defined as low SES. Patients who had income that fell within this income category were classified as low SES. Results: 174 patients were included with an average follow-up of 10.2months. 22/174 (12.6%) patients didn’t return to work post-operatively. Univariate analysis identified non-sedentary work to decrease the likelihood of return to work (HR:0.637; p=0.03). Patients with a low SES were more prevalent in the no return group compared to the return to work group (86% vs 60%; p=0.028). 95% of patients with low SES were a minority compared to 56% with average/high SES (p<0.005). Patients with low SES had a higher BMI (p=0.026), a longer hospitalization (p=0.04) and more wound complications (p=0.032). Insurance type didn’t affect return to work (p=0.158). Patients with workman’s compensation had a longer follow-up time and a longer time to return to work compared to other insurances (p<0.005 for each comparison). Conclusion: Low socioeconomic status based on income, not insurance type, affected return to work after an ankle fracture ORIF. Patients with workman’s compensation took a longer time to return to work compared to other insurance types. These findings warrants the need to consider socioeconomic status when allocating resources to treat these patients.

scholarly journals 1.2 Cm Lung Nodule Developed into Metastatic Lung Adenocarcinoma in Two Years in Patient Low Socioeconomic Status

2020 ◽  
Vol 2 (2) ◽  
pp. 1-2
Author(s):  
Mukesh Kumar ◽  
◽  
Fnu Sonia ◽  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Socioeconomic Status ◽  
Lung Adenocarcinoma ◽  
Low Socioeconomic Status ◽  
Lung Nodule ◽  
Stage Iv ◽  
Metastatic Lung ◽  
Size Growth

Lung cancer is number one cause of cancer mortality in United States both in men and women. Lung cancer is uncommon in patients younger than 35 years with no smoking and family history. Malignancy from lung nodule depends on size, growth rate, borders, calcification and location. Appropriate follow up for lung nodules in older patient with risk factors has been well described in literature based on various researches. However there is very limited data regarding follow up and management of lung nodule in younger patient with risk factors. We describe a patient who was 30 year old when he presented with acute appendicitis and incidentally found to have lung nodule of 1.2 cm. It was decided that patient should follow up as an outpatient for lung nodule. As patient was uninsured with poor socioeconomic he never followed up as outpatient. After 2 years patient was diagnosed with stage IV lung adenocarcinoma and died shortly after. Guidelines should be used in the proper clinical context as a tool to help with patient management, though exceptions always exist. Some expert believe lung nodule between 8-30 mm in patient with poor follow-up due to socioeconomic status, psychological issues, or young age should get complete resection of nodule.

scholarly journals Life Course Socioeconomic Position, Allostatic Load, and Incidence of Type 2 Diabetes among African America n Adults: The Jackson Heart Study, 2000-04 to 2012

2019 ◽  
Vol 29 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Gloria L. Beckles ◽  
Kai McKeever Bullard ◽  
Sharon Saydah ◽  
Giuseppina Imperatore ◽  
Fleetwood Loustalot ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Life Course ◽  
African American Women ◽  
Socioeconomic Position ◽  
Allostatic Load ◽  
Secondary Analysis ◽  
Self Report ◽  
Jackson Heart Study ◽  
Heart Study

Objective: We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans.Design: Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP.Participants: Sample of 4,012 nondiabetic adults aged 25-84 years at baseline.Outcome Measure: Incident t2DM identi­fied by self-report, hemoglobin A1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, or use of diabetes medication.Results: During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjust­ment for adult SEP or t2DM risk factors. Up­ward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex.Conclusions: Childhood SEP and up­ward social mobility may influence t2DM incidence in African American women but not in men.Ethn Dis. 2019;29(1):39-46; doi:10.18865/ed.29.1.39

scholarly journals Lifestyle Factors and Indices of Kidney Function in the Framingham Heart Study

2015 ◽  
Vol 41 (4-5) ◽  
pp. 267-274 ◽  
Author(s):  
Meredith C. Foster ◽  
Shih-Jen Hwang ◽  
Joseph M. Massaro ◽  
Paul F. Jacques ◽  
Caroline S. Fox ◽  
...  
Keyword(s):  
Physical Activity ◽  
Kidney Function ◽  
Diet Quality ◽  
Alcohol Intake ◽  
Smoking Status ◽  
The United States ◽  
Heart Study ◽  
Modifiable Factors ◽  
Egfr Decline

Background and Objectives: Lifestyle characteristics are modifiable factors that could be targeted as part of chronic kidney disease (CKD) prevention. We sought to determine the association of lifestyle characteristics with incident estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 and rapid eGFR decline in older adults in the United States. Methods: Prospective cohort study of Framingham Offspring participants with baseline eGFR <60 ml/min/1.73 m2 (n = 1,802) who attended the seventh (1998-2001; baseline) and eighth (2005-2008; follow-up) examinations (mean age = 59 years, 54.8% women). Predictors included measures of diet quality, physical activity, alcohol intake, and current smoking status assessed during baseline. Outcomes were based on creatinine-based eGFR at baseline and follow-up and included incident eGFR <60 ml/min/1.73 m2 (at follow-up) and rapid eGFR decline (annual eGFR decrease ≥3 ml/min/1.73 m2). Results: Over an average follow-up of 6.6 years, 9.5% (n = 171) of participants developed incident eGFR <60. A trend was observed across quartiles of diet quality, with higher levels of diet quality associated with a decreased odds ratio (OR) of incident eGFR <60 (p trend = 0.045). Higher diet quality was associated with decreased odds of rapid eGFR decline (p trend = 0.03) and was attenuated with additional adjustment (p trend = 0.07). In sensitivity analysis for rapid eGFR decline using a secondary definition (annual eGFR decrease ≥3 and incident eGFR <60), diet associations remained significant with additional adjustment (p trend = 0.04). No associations were observed with physical activity, smoking status, or alcohol intake with incident eGFR <60 or rapid eGFR decline (all p > 0.19). Conclusions: Higher diet quality may be associated with a decreased risk of incident eGFR <60 ml/min/1.73 m2, and rapid eGFR decline. Whether adherence to a healthy diet can prevent reduction in kidney function warrants further study.

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