Browsing by Subject "socioeconomic status"

Now showing 1 - 7 of 7
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    Childhood Conditions and Multimorbidity Among Older Adults
    (Oxford University Press, 2016-09) Pavela, Gregory; Latham, Kenzie; Sociology, School of Liberal Arts
    Objectives: This research tests whether childhood conditions are associated with trajectories of chronic conditions among older adults. Methods: Using data from the Health and Retirement Study (1992–2008), a series of hierarchical linear models are used to estimate number of chronic conditions at survey midpoint and the rate of increase in chronic conditions across 18 years of data. Results: Results suggest that lower childhood socioeconomic status (SES) and poor childhood health are associated with increased number of chronic conditions; however, childhood SES is no longer associated with chronic conditions after adjustment for adult SES and adult health. Poor childhood health continues to be associated with total number of chronic conditions after adjustment for adult SES and health. Rate of change in chronic conditions was not associated with childhood conditions. Results from a multinomial logistic regression model further indicated that the association between childhood conditions and adult multimorbidity increased at higher levels of multimorbidity. Discussion: This research adds to the evidence that early life conditions have a lasting influence on adult health, and that their influence may be independent of adult health and SES.
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    Effect of Socioeconomic Status Bias on Medical Student–Patient Interactions Using an Emergency Medicine Simulation
    (Wiley, 2017-04) Pettit, Katie E.; Turner, Joseph S.; Kindrat, Jason K.; Blythe, Gregory J.; Hasty, Greg E.; Perkins, Anthony J.; Ashburn-Nardo, Leslie; Milgrom, Lesley B.; Hobgood, Cherri D.; Cooper, Dylan D.; Emergency Medicine, School of Medicine
    Objectives Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high‐fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. Methods Teams of MSs were randomly assigned to participate in a high‐fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low‐SES homeless man and a high‐SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, six information gathering, and five clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed‐effects model with a random effect for case to account for multiple observations per case. Results Fifty‐eight teams participated in an equal number of high‐ and low‐SES cases. MSs asked about pain control more often (p = 0.04) in patients of high SES. MSs touched the low‐SES patient more frequently (p = 0.01). There were no statistically significant differences in clinical care or information gathering measures. Conclusions This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size, and larger cohorts will be required to identify the factors that contribute to SES bias.
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    Examining the Effects of Contextually-Imposed Cognitive Load on Providers' Chronic Pain Treatment Decisions for Racially and Socioeconomically Diverse Patients
    (2022-08) Anastas, Tracy; Hirsh, Adam; Salyers, Michelle; Stewart, Jesse; Kroenke, Kurt
    Compared to people who are White and have high socioeconomic status (SES), those who are Black and have low SES are more likely to receive suboptimal pain care. One potential contributor to these disparities is biased provider decision-making—there is compelling evidence that providers are influenced by patient race and SES when making pain treatment decisions. According to the dual process model, people are more likely to be influenced by demographic stereotypes, including implicit beliefs, when they are under high cognitive load (i.e., mental workload). One stereotype belief relevant to pain care is that Black and low SES people are more pain tolerant. Aligned with the dual process model, providers who are under high cognitive load and have strong implicit beliefs that Black and low SES people are more pain tolerant may be particularly likely to recommend fewer pain treatments to them. To test this hypothesis, I recruited physician residents and fellows (n=120) to make pain treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the providers were randomized to the high cognitive load group in which they were interrupted during the decision task to make conversions involving hypertension medications for another patient. Remaining providers completed the task without being interrupted. Providers’ implicit beliefs about race and SES differences in pain tolerance were measured with two separate Implicit Association Tests (IATs). Multilevel modeling indicated that providers recommended stronger medications to low than high SES patients (OR=.68, p=.03). There was also a significant interaction between patient SES and cognitive load (OR=-.56, p=.05) and a trending interaction between patient race and cognitive load (OR=1.7, p=.07). Under low cognitive load, providers recommended more pain treatments to high SES (vs. low SES) and Black (vs. White) patients, but under high cognitive load, providers recommended more pain treatments to low SES (vs. high SES) patients and equivalent treatment to Black and White patients. There were no three-way interactions between patient demographics (race or SES), cognitive load, and providers’ implicit beliefs (race-pain or SES-pain IAT scores). However, there was a trending interaction between patient race and race-pain IAT scores (OR=2.56, p=.09). Providers with stronger implicit beliefs that White people are pain sensitive and Black people are pain tolerant recommended more pain treatments to White patients and fewer pain treatments to Black patients. Lastly, there was a trending effect that providers with stronger implicit beliefs that high SES people are pain sensitive and low SES people are pain tolerant recommended stronger medications in general (OR=13.03, p=.07). Results support that provider cognitive load is clinically relevant and impacts clinical decision-making for chronic pain for racially and socioeconomically diverse patients. Future studies are needed to further understand the impact of cognitive load on providers’ pain care decisions, which may inform evidence-based interventions to improve pain care and reduce disparities.
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    The Influence of Age, Health Literacy, and Affluence on Adolescents’ Capacity to Consent to Research
    (Springer, 2016-04) Nelson, Lance R.; Stupiansky, Nathan W.; Ott, Mary A.; Department of Pediatrics, IU School of Medicine
    While adults are assumed to have the capacity to consent to medical research, and young children to have no capacity, adolescents’ capacity to consent is not well described. Adapting the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), we describe adolescents’ capacity to consent to medical research and factors influencing that capacity. Our pilot study included a community-based sample of 30 adolescents, 14 to 21 years of age, who completed the MacCAT-CR after undergoing a simulated informed consent process. We found that adolescents’ capacity to consent to research was associated with age, health literacy, and family affluence. These findings suggest that investigators and institutional review boards should be aware that factors other than age may influence capacity to consent, and, for modifiable factors, such as health literacy, consent processes for medical research with adolescents can be modified.
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    Racial and Ethnic Disparities in Diabetes Complications in the Northeastern United States: The Role of Socioeconomic Status
    (2013) Osborn, Chandra Y.; de Groot, Mary; Wagner, Julie A.
    The role of socioeconomic status (SES) in explaining racial/ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications, and the role of macro (e.g., income, education) and micro (e.g., ‘owning a home’ or ‘having a checking account’) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were on average 55 years old, and 55.6% non-Hispanic White, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic White, African American and Hispanic participants, with Hispanics having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (e.g., income) mediated racial differences (i.e., non-Hispanic Whites vs. African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (e.g., education, income, and ‘owning a home’ or ‘having a checking account’) mediated racial/ethnic differences (i.e., non-Hispanic Whites vs. Hispanics) in self-reported cardiovascular disease, and only micro SES indicators (e.g., ‘owning a home’ or ‘having a checking account’) mediated differences between lower income SES racial/ethnic minority groups (i.e., African Americans vs. Hispanics) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.
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    Racial and Socioeconomic Disparities in Cancer-Related Knowledge, Beliefs, and Behaviors in Indiana
    (AACR, 2019-03) Rawl, Susan M.; Dickinson, Stephanie; Lee, Joy L.; Roberts, Jamie L.; Teal, Evgenia; Baker, Layla B.; Kianersi, Sina; Haggstrom, David A.; School of Nursing
    Background: This statewide survey examined differences in cancer-related knowledge, beliefs, and behaviors between racial and socioeconomic groups in select counties in Indiana. Methods: A stratified random sample of 7,979 people aged 18–75 who lived in one of 34 Indiana counties with higher cancer mortality rates than the state average, and were seen at least once in the past year in a statewide health system were mailed surveys. Results: Completed surveys were returned by 970 participants, yielding a 12% response rate. Black respondents were less likely to perceive they were at risk for cancer and less worried about getting cancer. Individuals most likely to perceive that they were unlikely to get cancer were more often black, with low incomes (less than $20,000) or high incomes ($50,000 or more), or less than a high school degree. Black women were greater than six times more likely to be adherent to cervical cancer screening. Higher income was associated with receiving a sigmoidoscopy in the last 5 years and a lung scan in the past year. Those with the highest incomes were more likely to engage in physical activity. Both income and education were inversely related to smoking. Conclusions: Socioeconomic and racial disparities were observed in health behaviors and receipt of cancer screening. Black individuals had less worry about cancer. Impact: Understanding populations for whom cancer disparities exist and geographic areas where the cancer burden is disproportionately high is essential to decision-making about research priorities and the use of public health resources.
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    Transitioning to Adulthood: An Annotated Bibliography of the PSID-TA Publications
    (Indiana University Lilly Family School of Philanthropy, 2020-01) Herzog, Patricia Snell; Bopp, Monica; Watson, Bethany; Hall, Jessica; Sanburn, Karen; Hillier-Geisler, Megan; Fegley, Bryan; Pockette, Chris; Clark, Donna; Albritton, Brenna; Gates, Niki; Klink, Kendra; Brown, Sydney; Wang, Yujue
    This report provides an annotated bibliography of all 100 publications published to date on the Transition to Adulthood Supplement (TAS) of the Panel Study of Income Dynamics (PSID). Of these publications, 79 are articles in peer-reviewed journals, 6 are book chapters, and 15 are doctoral student dissertations. In terms of topic area, 40 publications focus on the impact of economics and socioeconomic status, another 18 study the effect of childhood and youth savings accounts, 41 study educational attainment and college-level outcomes, 32 study health and wellbeing, 20 investigate marriage and family dynamics, 31 explicitly attend to race and ethnicity, 10 study work and occupations, 7 neighborhood effects, 7 social capital and trust, 3 criminal activity, and 5 explicitly engage technology (note: since publications often engage multiple topics, these categories are not mutually-exclusive).