IntroductionSocial determinants are contextual factors that influence health outcomes through individuals’ living, working, and social conditions, alongside overarching structural dimensions that shape these conditions. In contrast, demographic factors refer to personal characteristics, such as age and ethnicity, which shape individual experiences. Understanding these experiences requires examining how aspects of identity interact with one another and with societal structures of power. The purpose of this study was to examine the associations between contextual and personal factors and interpersonal conflict among emerging adult men.MethodsA secondary analysis of 322 individuals utilized multiple linear regression analyses to assess the relationships between contextual factors and interpersonal conflict experiences. Key predictors included age, race/ethnicity, education status, employment status, individual income, and current health insurance. Moderation analyses were performed to explore the interactive effects of these individual characteristics and perceptions of physical safety on interpersonal conflict.ResultsOur findings revealed several significant predictors of interpersonal conflict. Notably, lack of health insurance was positively associated with experiences of interpersonal conflict (β = 0.09, p < 0.001). Unemployment (β = 0.58, p < 0.01) and housing instability (β = 0.65, p < 0.001) also significantly contributed to this outcome. Concerns about safety in living environments correlated with increased experiences of interpersonal conflict (β = 0.58, p < 0.001). Additionally, age positively influenced interpersonal conflict among Hispanic participants (β = 0.05, p < 0.01), indicating that older individuals reported heightened levels of conflict. Interaction effects demonstrated that Hispanic participants with greater concerns about physical safety experienced increased levels of interpersonal conflict (β = 0.72, p < 0.05).DiscussionThis study identified that external factors, such as lack of health insurance, unemployment, housing instability, and safety concerns were associated with experiences of interpersonal conflict. Unmet basic needs, like housing, can lead to transactional behaviors, which elevate health risks. Future studies should employ mixed methods and longitudinal designs to explore the mechanisms underlying these associations. Implications for practice include healthcare providers incorporating routine assessments of housing stability and safety concerns into clinical encounters. Implications for policy include prioritization for increasing access to healthcare and addressing structural barriers.

Objectives:Limited research has explored how social policies influence cognitive function at older ages. This study examined the association between the U.S. state minimum wage and subsequent cognitive function among older American adults. Methods:Using data from the U.S. Health and Retirement Study, we studied non-self-employed workers who were aged 50-75 without dementia at baseline and followed between 1998 and 2020 (N = 7263). We employed fixed-effects linear models to estimate associations between the state minimum wage and cognitive function, measured by the modified version of Telephone Interview for Cognitive Status (TICS; higher values indicating better cognitive function), using 2, 6, and 10-year lags. We further stratified our models by levels of earning wages, working hours, race/ethnicity, and sex. Results:Among all workers (n = 7263), the state minimum wage was not associated with cognitive function (β = 0.05; 95% CI = -0.01 to 0.12). However, for low-wage workers (n = 880) and part-time workers (n = 1432), a $1 higher state minimum wage was associated with a 0.29 point (95% CI = 0.14 to 0.45, p = .001) and a 0.17 point (95% CI = 0.04 to 0.30, p = .014) higher TICS score 6 years later, respectively, controlling for time-invariant individual factors and time-varying individual- and state-level covariates. Among Hispanic low-wage workers, a higher state minimum wage was associated with lower cognitive function in a 2-year lagged model (β = -0.41; 95% CI = -0.77 to -0.06) but with higher cognitive function in a 6-year lagged model (β = 0.41, 95% CI = 0.03, 0.79, p = .036). Discussion:Our findings suggest that increases in the state minimum wage may benefit the cognitive health of low-earning older adults, though heterogeneities by race/ethnicity may exist.

INTRODUCTION:Within the U.S., affordability, the ability to purchase necessities like food, housing, and childcare, has become a principal focus of both political and public discourse. Lack of affordability is plausibly linked to health outcomes including mortality. Yet evidence is currently lacking on affordability and health relationships. METHODS:This study investigated a detailed, community-specific measure of affordability as a predictor of age-standardized all-cause mortality rates across 3,109 counties among males and females in the U.S. Multivariable linear regression was applied and all models controlled for key covariates including indicators of education, income, older age, racial and ethnic composition, health insurance coverage, and metro vs non-metro status at the county level, and were weighted by population size. RESULTS:Among males, a 1-standard deviation (1-SD) increase in the county-level affordability ratio (signifying less affordability) was associated with a 0.228-SD higher age-standardized all-cause mortality rate across all ages-equivalent to 125.9 additional deaths per 100,000. Compared to the most affordable quartile, mortality was 88.8 deaths per 100,000 higher in the least affordable quartile (P=0.003), with evidence of a monotonic increase in mortality with decreasing affordability (P for trend across quartiles <0.001). Among females, a 1-SD increase in the county-level affordability ratio was linked to a 0.162-SD higher age-standardized all-cause mortality rate-62.1 more deaths per 100,000. Relative to the most affordable quartile, mortality was 46.9 deaths per 100,000 higher in the least affordable quartile (P=0.01; P for trend across quartiles <0.001). Qualitatively similar results were found for working-aged mortality among those aged 15-64 years. CONCLUSIONS:This study finds novel associations between affordability and all-cause mortality among Americans. Future studies should further investigate the extent to which affordability may be a social determinant of mortality.

TPS12170 Background: Prostate cancer is the most commonly diagnosed cancer among men, and advanced disease often requires androgen deprivation therapy (ADT). ADT is associated with distressing side-effects, including hot flashes, sleep disturbance, fatigue, and cognitive symptoms. Acupuncture is a nonpharmacologic intervention shown to reduce hot flashes in other hormone-treated cancers, such as breast cancer; however, standardized acupuncture protocols for men receiving ADT are lacking. The primary objective of the MPOWER trial (NCT07335224) is to evaluate the feasibility and acceptability of study procedures, recruitment strategies, and delivery of a standardized acupuncture protocol to reduce hot flashes in men with prostate cancer. Feasibility will be assessed through enrollment and intervention engagement, and acceptability through satisfaction ratings and post-intervention qualitative feedback. Secondary objectives include patient-reported hot flash frequency and severity, hot flash interference, endocrine symptoms, sleep disturbance, and health-related quality of life. Methods: This randomized study compares Immediate Start Acupuncture (IA) with an Active Comparator: Delayed-Start Acupuncture (DA), allowing all participants eventual access to the intervention, among 24 men treated with ADT and/or androgen receptor pathway inhibitors. The intervention consists of a standardized 10-week protocol with weekly 30-minute manual acupuncture sessions delivered by a certified acupuncturist with oncology expertise. All participants receive lifestyle education from a nurse navigator as part of usual care. Participants randomized to the IA arm receive the acupuncture protocol during the initial 10-week intervention period, followed by 12 weeks of follow-up without acupuncture. Participants randomized to the activate comparator DA arm will receive lifestyle education per usual care without acupuncture during the initial 10-week comparison period, with bi-weekly check-ins serving as an attention control, and then initiate the acupuncture protocol after the delay period. Study assessments integrate real-time patient-reported hot flash diaries collected via a secure mobile application for remote symptom monitoring (Locus Health), validated patient-reported outcome measures, and continuous Fitbit monitoring to capture physiologic and sleep metrics, including heart rate variability, sleep duration, and nighttime awakenings. Feasibility outcomes include enrollment rates and intervention engagement. Acceptability is assessed quantitatively at multiple time points and qualitatively through semi-structured interviews. The primary patient outcome is the Hot Flash Severity Score, calculated as weekly mean hot flash frequency multiplied by severity. Enrollment began in January 2026, with accrual expected within 12 months. Clinical trial information: NCT07335224 .

Background The COVID-19 pandemic reversed a decade of progress in reducing child food insufficiency in the United States. Congress implemented a universal 15% increase in Supplemental Nutrition Assistance Program (SNAP) benefits from January 2021 through September 2021 to address rising child food hardship.Methods We conducted a difference-in-differences analysis using US Census Bureau data to evaluate the impact of this temporary expansion on child food insufficiency. We compared 9776 SNAP participating households with 18 961 eligible non-participating households, examining changes before and during the benefit expansion period while accounting for demographic and economic characteristics.Results The expansion was associated with a 20% reduction in the odds of child food insufficiency among SNAP participants compared with eligible non-participants (OR = 0.80; 95% CI = 0.66 to 0.97). Hispanic-American households experienced a 39% reduction (OR = 0.61; 95% CI = 0.47 to 0.80), and households with six or more members showed a 33% reduction (OR = 0.67; 95% CI = 0.45 to 1.02).Conclusions The 15% SNAP benefit expansion in 2021 effectively reduced child food insufficiency during the pandemic, with particularly strong protective effects among Hispanic-American and large households. These findings support a universal food benefit expansion improving child health needs during a national health and economic crisis.

Purpose:While adjuvant radiation therapy (RT) may prolong progression-free survival in resected atypical meningiomas, whether such progression-free survival benefit outweighs potential treatment toxicities remains controversial. Here, we compare the acute and late toxicity outcomes of atypical meningiomas managed with upfront adjuvant RT versus surveillance. Methods and Materials:In our prior single-institution retrospective study of 230 patients with resected atypical meningiomas between 2000 and 2015, adjuvant RT was associated with a significantly lower risk of progression/recurrence compared with surveillance (hazard ratio, 0.21; P < .01), with 36% of surveillance patients eventually requiring salvage RT. In this study, the acute (≤6 months) and late (>6 months) RT toxicities from the same patient cohort for those who received adjuvant (n = 51) versus salvage RT (n = 64) were compared. Additionally, treatment toxicity at the last follow-up was compared between the adjuvant RT (n = 51) and the surveillance (n = 179) groups. Toxicities were graded per the Common Terminology Criteria for Adverse Events v5.0. Results:RT in the adjuvant compared with the salvage setting was generally associated with greater RT toxicities both in the acute (90% vs 69%, P < .01) and late (57% vs 33%, P = .01) setting. While there was no significant difference in grade 3 to 4 acute toxicities, late grade 3 to 4 toxicities were present in 14% of the adjuvant group versus 3% of the salvage RT group (P = .04). Radionecrosis was present in 18% of adjuvant RT versus 8% of salvage RT group (P = .11). Between the adjuvant RT and surveillance groups, any treatment-related toxicity at the last follow-up was greater in the adjuvant RT group (31% vs 15%, P < .01), with a trend toward greater grade 3 to 4 toxicities (8% vs 3%, P = .10). There was no difference in the rate of cerebrovascular accident (4% vs 4%, P = .99). Conclusions:Adjuvant RT may be associated with greater acute and late treatment toxicities, which can significantly impact the quality of life of patients with atypical meningioma. Potential RT toxicity should be carefully weighed against tumor control benefits in deciding the optimal use and timing of RT.

BACKGROUND:Substantial gaps remain in life expectancy (LE) between Black and White Americans. The present study aimed to simulate hypothetical reductions in excess mortality risk for Black Americans across all ages; to identify the extent to which LE can improve as one varies the excess risk reduction level; and to provide quantitative estimates of potential LE gains if racial disparities in mortality were reduced in particular age groups. METHODS:I simulated counterfactual reductions in the Black-White mortality gap by scaling down the excess relative risk across all ages. I further calculated the overall LE weighted according to population shares of all major racial/ethnic groups, and then disaggregated these impacts by age group-children (0-17 years), young adults (18-29 years), middle-aged adults (30-49 years), older adults (50-64 years), and seniors (65+ years). RESULTS:Each successive 25% reduction in excess mortality risk was associated with an incremental improvement in LE, and closing the excess risk gap entirely was projected to improve overall LE by 0.48 years in females and 0.77 years in males. In both sexes, there was a striking pattern of the biggest LE gains being observed with narrowing the excess mortality gaps in middle-aged adult (30-49 years) and older adult (50-64 years) populations. CONCLUSIONS:Overall, this study provides new quantitative evidence that addressing racial inequities in mortality-in particular the excess risks faced by Black Americans-could yield meaningful gains in national life expectancy.

In the United States, health-adjusted life expectancy (HALE) declined by 0.3 years between 2009 and 2019, which may reflect increased deaths related to drug overdose, suicide, and alcohol. To combat the rise in such “deaths of despair,” it is critical to identify their root causes including social and economic determinants and address them through corresponding policies. We obtained county-level HALE from 2009 and 2019 through the Global Burden of Diseases, Injuries, and Risk Factors Study. Using state fixed effects models and these panel data, we explored multiple social and economic determinants of HALE simultaneously including the state-level percentage in poverty, gender pay gap ratio, violent crime rate, tax burden, earned income tax credit rate, income inequality, welfare spending, and education spending; and county-level social capital, debt-to-income ratio, and racial segregation. We found several of these factors to be positively associated with HALE including a higher state tax burden and earned income tax credit rate as well as county-level median household income, social capital, and debt-to-income ratio. Moreover, we determined other factors to be inversely linked to HALE including state-level median income, the percentage in poverty, percentage unemployed, and income inequality level; as well as the county-level percentage unemployed. Overall, our findings suggest a variety of specific social and economic determinants of HALE that may help to inform future interventions and policies in order to promote healthy aging and advance healthy longevity among Americans.

Alzheimer’s disease and related dementias (ADRD) pose a growing public health challenge in the U.S. and understanding protective factors against cognitive decline has become urgent, with over 6 million older Americans currently affected and projected 2025 costs of $781 billion. Financial security has been identified as a potential determinant of cognitive health, yet the longitudinal effects of social security (SS) and supplemental security income (SSI) on cognitive function remain underexplored. Using nationally-representative individual-level panel data from the Health and Retirement Study (2000-2018) and controlling for state and time fixed effects, we examined the associations between SS and SSI benefits with cognitive function among older adults. The SS analysis included 6,649 individuals aged 67 and older with at least 10 years’ work history; the SSI sub-analysis comprised 971 eligible individuals. Cognitive function was measured using the 27-point Telephone Interview for Cognitive Status (TICS) screening instrument. All models controlled for individual- and state-level covariates and time trends. Each additional $1,000 in annual SS benefits was associated with a 0.014-point increase in the TICS score (P < 0.01). Meanwhile, SSI benefits showed inverse and non-significant associations with cognition. Covariates such as age and comorbidities predicted lower cognitive scores, and health insurance coverage showed strong positive associations with cognition. Overall, SS benefits appear to confer modest and significant benefits to cognitive function among older Americans, suggesting protective effects of financial security on cognitive health. These findings support the importance of public sources of retirement income to help maintain cognitive function in late life for Americans.

Purpose Chemoradiation-induced lymphopenia is common and associated with poorer survival in multiple solid malignancies. However, the association between chemoradiation-related lymphopenia and survival outcomes in rectal cancer is yet unclear. The objective of this study was to evaluate the prognostic impact of lymphopenia and its predictors in patients with rectal cancer undergoing neoadjuvant chemoradiation. Methods The inclusion criteria for this single-institution retrospective study were as follows: (1) biopsy-proven diagnosis of rectal adenocarcinoma, (2) receipt of neoadjuvant chemoradiation followed by surgery, and (3) absolute lymphocyte count available prior to and within 12 weeks of chemoradiation. In general, chemoradiation consisted of 5-fluorouracil or capecitabine and radiotherapy with 50.4 Gy over 28 fractions. Lymphopenia was graded according to the Common Terminology Criteria for Adverse Events version 5.0. The primary variable of interest was absolute lymphocyte count nadir within 12 weeks of chemoradiation, dichotomized by <500/μL (grade 3 or worse lymphopenia). The primary endpoint was overall survival. Cox modeling and Kaplan-Meier methods were used to perform survival analyses. Results A total of 193 patients were identified with a median follow-up of 68 months. Overall clinical stage was 2 in 21% and 3 in 76%. Median baseline lymphocyte count for the entire cohort was 1700/μL. One hundred ten patients (57%) experienced chemoradiation-related severe lymphopenia. Pathologic complete response rate was 21%; 83% received adjuvant chemotherapy. Lower baseline lymphocyte count was significantly associated with increased risk for chemoradiation-related severe lymphopenia (odds ratio, 1.71). On multivariable Cox regression analysis, chemoradiation-related severe lymphopenia was significantly associated with worse disease-free survival (hazard ratio, 2.64) and overall survival (hazard ratio, 4.32). Five-year overall survival was 79% versus 92%, and 5-year disease-free survival was 70% versus 86% in the cohort that experienced versus did not experience severe lymphopenia, respectively. Discussion Chemoradiation-induced lymphopenia is common and a prognostic marker of poorer survival in rectal cancer. Closer observation in high-risk patients and treatment modifications may be potential approaches to mitigating treatment-related lymphopenia. Our findings also suggest an important role of the host immunity in rectal cancer outcomes and support future studies investigating ways to reduce treatment-induced lymphopenia.

Background:In 2023, the U.S. Biden administration called for an "all-hands-on-deck" response to address chronic absenteeism and disrupted learning among primary and secondary school students due to school closures and remote learning during the pandemic. To identify student populations that might benefit from interventions, this study examined the racial-ethnic composition of school districts as a predictor of wildfire smoke PM2.5 levels and in-person student visits to schools. Methods:In a lagged cross-sectional study, multivariable logistic regression was employed to investigate school district quartiles of mean percentages of non-White students as predictors of: 1) mean levels of wildfire smoke PM2.5 > 35 μg/m3 during school days for grade 3-8 students; and 2) being above the median for the mean decline in in-person K-12 student attendance (vs. pre-pandemic) during the 2020-2021 and 2021-2022 school years. Results:The highest (vs. lowest) quartile for the district-level percentage of non-White students predicted a nearly 3-fold higher odds (adjusted odds ratio, AOR = 2.78; 95 % CI = 2.07-3.74; P < .001) of high wildfire smoke exposure and 5-fold higher odds (AOR = 4.95; 95 % CI = 3.84-6.38; P < .001) of substantially reduced in-person learning levels. Successively higher odds for both outcomes were observed in higher quartiles (P for trend < .001). Similar patterns were seen when percentages of Asian-, Black-, and Hispanic-American students were modeled simultaneously. Conclusions:Districts with higher percentages of non-White students showed elevated odds of high wildfire smoke PM2.5 levels and distance learning. Distributing portable air filtration devices in these districts could be a cost-effective intervention to address these concomitant risks and mitigate learning loss among children and adolescents in the USA.

BACKGROUND:In the United States, concerns have been increasingly raised over the future public health and economic burden of long COVID including disability and declines in labor force participation. However, only a handful of U.S. studies have explored sociodemographic or socioeconomic characteristics that put people at risk of long COVID or have investigated its economic and mental health sequelae. METHODS:Using repeated cross-sectional data on over 375,000 adults including nearly 50,000 adults with long COVID pooled from U.S. nationally-representative Household Pulse Survey data collected between September and November 2022 and between August and October 2023, I fit age- and gender-adjusted and multivariable modified Poisson regression models to examine multiple sociodemographic and socioeconomic factors as predictors of long COVID. I further estimate the risks of unemployment, financial hardship, and anxiety and depression among working-aged adults and adults with current long COVID symptoms, and estimate the economic burden of lost wages due to long COVID. RESULTS:Nearly one in seven adults (~35 million) and working-aged adults (~30 million) reported having a history of long COVID by late 2022 and late 2023. In age- and gender-adjusted models and fully-adjusted multivariable models, I find several factors predict long COVID including lower household income, and being Hispanic, female, gay/lesbian or bisexual. I also find having long COVID is linked to higher risks of recent unemployment, financial hardship, and anxiety and depressive symptomatology, with evidence of dose-response relationships. CONCLUSIONS:Overall, an estimated 24 million working-aged adults with long COVID had been or may still be at risk of adverse socioeconomic and mental health outcomes. The lost earnings due to long COVID among working-aged adults are estimated to total $211 billion in 2022 and $218 billion in 2023. These findings highlight the substantial public health and economic implications of long COVID among Americans.

INTRODUCTION:Exposure to secondhand smoke is an important risk factor for cognitive impairment. This study aimed to investigate the associations between statewide comprehensive smoke-free policies and cognitive impairment among older Americans. METHODS:Using a difference-in-differences approach, we analysed data in a US nationally representative sample of adults aged 51 and older collected between 1998 and 2020 from the Health and Retirement Study. We compared the risk of cognitive impairment among older adults living in states with and without statewide comprehensive 100% smoke-free policies that prohibit smoking in workplaces, restaurants and bars. RESULTS:In an adjusted difference-in-differences model, we found that implementing statewide comprehensive smoke-free policies was associated with a 1.6 percentage point decrease in the probability of cognitive impairment among older adults (95% CI -2.4 to -0.7; p<0.001). A similar beneficial association was observed among non-smoking older adults but not among older adults who reported currently smoking cigarettes before the policy implementation. CONCLUSION:Our findings suggest that statewide comprehensive smoke-free policies could potentially serve as population-level interventions to reduce the risk of cognitive impairment.

The rapidly rising cost of household water bills is an increasing financial burden and health concern for low-income households in the United States, a nation that offers neither a constitutional right nor an enforceable national statute that ensures peoples' access to water. Local water districts use their own discretion to develop, implement, and enforce distinct water rate structures, assistance programmes, and non-payment penalties. This study is a statistical analysis of water unaffordability and water shutoffs by racial/ethnic composition of communities in water districts across nine urban areas. We collected cross-sectional survey data from a multistage, stratified non-proportional quota sample of 6,938 adults who are responsible for paying their own household's water bill. Multivariable logistic regression analyses showed that racial/ethnic inequalities in water affordability and shutoff, previously documented in location-specific studies, are widespread urban problems across the U.S. Communities with greater shares of racial/ethnic minorities were more likely to experience unaffordable water bills compared to predominantly non-Hispanic white communities after controlling for respondents' household income, age, conservation efforts, and urban area. Communities with greater shares of racial/ethnic minorities had much higher odds of water shutoffs and this association was only partially explained by household water unaffordability. Improvement of local water infrastructure to reduce utilities' costs for delivering water services and providing more financial assistance for low-income households, which are disproportionately in communities of colour, are serious - and related - problems. We offer recommendations for how municipalities may improve practices and reduce racial/ethnic inequalities in access to affordable water.

Objective:To investigate the associations between county-level political group density, partisan polarization, and individual-level mortality from all causes and from coronary heart disease (CHD) in the United States. Methods:Using data from five survey waves (1998-2006) of the General Social Survey-National Death Index dataset and the County Presidential Election Return 2000 dataset, we fit weighted Cox proportional hazards models to estimate the associations between (1) political group density and (2) partisan polarization measured at the county level in 2000 (n = 313 counties) categorized into quartiles with individual-level mortality (n = 14,983 participants) from all causes and CHD, controlling for individual- and county-level factors. Maximum follow-up was from one year after the survey up until 2014. We conducted these analyses using two separate measures based on county-level vote share differences and party affiliation ideological extremes. Results:In the overall sample, we found no evidence of associations between county-level political group density and individual-level mortality from all causes. There was evidence of a 13% higher risk of dying from heart disease in the highest quartile of county-level polarization (hazards ratio, HR = 1.13; 95% CI = 0.74-1.71). We observed heterogeneity of effects based on individual-level political affiliation. Among those identifying as Democrats, residing in counties with high (vs. low) levels of polarization appeared to be protective against mortality, with an associated 18% lower risk of dying from all causes (HR = 0.82, 95% CI = 0.71-0.94). This association was strongest in areas with the highest concentrations of Democrats. Conclusions:Among all study participants, political group density and polarization at the county level in 2000 were not linked to individual-level mortality. At the same time, we found that Democratic party affiliation may be protective against the adverse effects of high polarization, particularly in counties with high concentrations of Democrats. Future research should further explore these associations to potentially identify new structural interventions to address political determinants of population health.

Abstract Limited research has explored how social policies influence cognitive health in older age. This study aimed to examine the associations between the state-level minimum wage and cognitive function in older US adults. We used data from the Health and Retirement Study (1998-2020) on non-self-employed workers who were age 50-75 and free of dementia at baseline, with cognitive function measured during the study period (N=7490). For cognitive function, we used data based on the Telephone Interview for Cognitive Score (TICS; 0-27, with higher values indicating better cognitive function). We explored the state-level minimum wage, adjusted to 2021 US dollars, lagged by 2, 6, and 10 years. We employed individual fixed-effects linear models and examined for differences in associations by wage, working hours, race/ethnicity, and sex. Among all workers, the state minimum wage was not associated with cognitive function. However, for low-wage workers and part-time workers, a $1 increase in the 6-year lagged state minimum wage was associated with a 0.40 (95% CI=0.17 to 0.64, p=.001) and 0.17 (95% CI=0.03 to 0.32, p=.01) point increase in the TICS, respectively, controlling for time-invariant individual factors and time-varying individual-level and state-level covariates. Among low-wage workers, stronger associations between the state minimum wage and increases in cognitive function were observed in non-Hispanic Whites (β= 0.43, p<.001) but not Black Americans (β=0.04, p=0.91) and Hispanic Americans (β=0.30, p=0.21). There were no differences by sex. Overall, our findings support that increasing the state minimum wage could benefit the cognitive health of older adults, particularly among low-wage workers.

To the Editor: With the advent of immune checkpoint inhibitors (ICIs), the prognosis of melanoma has improved significantly. However, immune-related adverse events (irAEs) remain frequent complications.1 Identifying risk factors for irAEs is important for clinical decision-making regarding treatment initiation and toxicity management.2 Existing literature have evaluated demographics, comorbidities, and clinical biomarkers as possible predictors.1 Studies of melanoma histopathology have primarily focused on their prognostication of survival and immunotherapy response.