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Sun S. Building Financial Capability and Assets to Reduce Poverty and Health Disparities: Race/Ethnicity Matters. J Racial Ethn Health Disparities 2024; 11:1754-1773. [PMID: 37273162 DOI: 10.1007/s40615-023-01648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Evidence has documented racial wealth inequity as one of the key pathways linking structural racism and racial health inequity. Most prior studies on the wealth-health relationship use net worth as the measure of wealth. This approach provides little evidence on the most effective interventions as various types of assets and debt affect health differently. This paper examines how U.S. young adults' wealth components (e.g., financial assets, nonfinancial assets, secured debt, and unsecured debt) are associated with physical and mental health, and if the associations differ by race/ethnicity. METHODS Data were drawn from the National Longitudinal Survey of Youth 1997. Health outcomes were measured by mental health inventory and self-rated health. Logistic regressions and ordinary least square regressions were used to assess the association between wealth components and physical and mental health. RESULTS I found that financial assets and secured debt were positively associated with self-rated health and mental health. Unsecured debt was negatively associated with mental health only. The positive associations between financial assets and health outcomes were significantly weaker for non-Hispanic Black respondents. Unsecured debt was protective of self-rated health for non-Hispanic Whites only. For Black young adults, unsecured debt had more severe negative health consequences compared to other racial/ethnic groups. CONCLUSION This study provides a nuanced understanding of the complex relationship among race/ethnicity, wealth components, and health. Findings could inform asset building and financial capability policies and programs to effectively reduce racialized poverty and health disparities.
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Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA.
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Hilland GH, Anthun KS. Socioeconomic determinants of myalgic encephalomyelitis/chronic fatigue syndrome in Norway: a registry study. BMC Public Health 2024; 24:1296. [PMID: 38741074 DOI: 10.1186/s12889-024-18757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Previous research has shown that socioeconomic status (SES) is a strong predictor of chronic disease. However, to the best of our knowledge, there has been no studies of how SES affects the risk of Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) that has not been based upon self-reporting or retrospectively screening of symptoms. As far as we know, this is therefore the first study that isolate and describe socioeconomic determinants of ME/CFS and calculate how these factors relate to the risk of ME/CFS diagnosis by utilizing individual level registry data. This allows for objective operationalization of the ME/CFS population, and makes it possible to model SES affect the risk of ME/CFS diagnosis, relative to control groups. DATA AND METHODS We conduct a pooled cross-sectional analysis of registry data from all adult patients diagnosed with ME/CFS from 2016 to 2018 in Norway, coupled with socioeconomic data from statistics Norway from 2011 to 2018. We operationalize SES as household income and educational attainment fixed at the beginning of the study period. We compare the effects of SES on the risk of ME/CFS diagnosis to a population of chronically ill patients with hospital diagnoses that share clinical characteristics of ME/CFS and a healthy random sample of the Norwegian population. Our models are estimated by logistic regression analyses. RESULTS When comparing the risk of ME/CFS diagnosis with a population consisting of people with four specific chronic diseases, we find that high educational attainment is associated with a 19% increase (OR: 1.19) in the risk of ME/CFS and that high household income is associated with a 17% decrease (OR:0.83) in risk of ME/CFS. In our second model we compare with a healthy population sample, and found that low educational attainment is associated with 69% decrease (OR:0.31) in the risk of ME/CFS and that low household income is associated with a 53% increase (OR: 1.53). CONCLUSION We find statistically significant associations between SES and the risk of ME/CFS. However, our more detailed analyses shows that our findings vary according to which population we compare the ME/CFS patients with, and that the effect of SES is larger when comparing with a healthy population sample, as opposed to controls with selected hospital diagnoses.
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Affiliation(s)
- Geir Haakon Hilland
- SINTEF Digital, Department of Health, Health services research group, Strindvegen 4, Trondheim, 7034, Norway
| | - Kjartan Sarheim Anthun
- SINTEF Digital, Department of Health, Health services research group, Strindvegen 4, Trondheim, 7034, Norway.
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Håkon Jarlsgate 11, Trondheim, 7030, Norway.
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Hussaini SMQ, Fan Q, Barrow LCJ, Yabroff KR, Pollack CE, Nogueira LM. Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States. JCO Oncol Pract 2024; 20:678-687. [PMID: 38320228 DOI: 10.1200/op.23.00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment. METHODS Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). RESULTS There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. CONCLUSION Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.
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Affiliation(s)
- S M Qasim Hussaini
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Qinjin Fan
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Lauren C J Barrow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - Leticia M Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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Duignan L, Dutton DJ. The association between allostatic load and guaranteed annual income using the Canadian Longitudinal Study on Aging: A cross-sectional analysis of the benefits of guaranteed public pensions. Health Policy 2024; 143:105054. [PMID: 38522246 DOI: 10.1016/j.healthpol.2024.105054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Old Age Security (OAS) represents an public policy through which income-related inequalities in health may be improved. The goal of this cross-sectional study was to investigate the health benefits of receiving OAS in financially insecure older Canadians. METHODS Using data from the Canadian Longitudinal Study on Aging (CLSA) (n=15,691), ordered logistic regression was used to measure associations between financial insecurity and allostatic load. RESULTS Receiving OAS as highest personal income source appeared to remove the health penalty of being financially insecure. While financial insecurity was associated with worse allostatic load in both males and females not receiving OAS, those receiving OAS as highest personal income source had better allostatic load compared to other financially insecure older adults (ORM: 0.398, 95 % CI: 0.227, 0.696; ORF: 0.677, 95 % CI: 0.483, 0.949). DISCUSSION While longitudinal data would be needed to draw causal inferences, these results suggest OAS may play a role improving health outcomes and narrowing income-related health inequalities. Such findings may have important implications on older adults, other vulnerable populations, and future directions of Canadian health and public policy.
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Affiliation(s)
- Luke Duignan
- Faculty of Medicine, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada.
| | - Daniel J Dutton
- Department of Community Health and Epidemiology, Dalhousie University, Canada
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Burns SD, Baker EH, Sheehan CM, Markides KS. Disability Among Older Immigrants in the United States: Exploring Differences by Region of Origin and Gender. Int J Aging Hum Dev 2024; 98:329-351. [PMID: 37593800 DOI: 10.1177/00914150231196093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Rapid aging in American society will be disproportionately concentrated among the foreign-born. Immigrants in the United States (U.S.) are a heterogeneous population, yet little is known regarding their differences in disability later in life by region of origin. We use data from the National Health Interview Survey on respondents ages 60+ (n = 313,072) and employ gender-specific logistic models to predict reports of any activity of daily living (ADL) disability. After accounting for socioeconomic factors, compared to their U.S.-born non-Hispanic (NH) White counterparts, the odds of reporting ADL disability were higher among U.S.-born respondents that are Hispanic, NH Black, and NH Multiracial as well as respondents with Mexican, Puerto Rican, Cuban, Russian/former Soviet, Middle Eastern, East Asian, and South Asian origins. Also, Dominican, African, and Southeast Asian women-and European men-reported high odds of ADL disability. Our results highlight heterogeneity in the disability profiles of foreign-born older adults in the U.S..
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Affiliation(s)
- Shane D Burns
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth H Baker
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Connor M Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Kyriakos S Markides
- Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston, TX, USA
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Ettman CK, Subramanian M, Fan AY, Adam GP, Abdalla SM, Galea S, Stuart EA. Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2024; 59:571-583. [PMID: 37838630 DOI: 10.1007/s00127-023-02565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic. METHODS We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations. RESULTS Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups. CONCLUSION This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.
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Affiliation(s)
- Catherine K Ettman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Boston University School of Public Health, Boston, USA.
| | | | - Alice Y Fan
- Boston University School of Public Health, Boston, USA
| | - Gaelen P Adam
- Brown University School of Public Health, Providence, USA
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, USA
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Cuevas AG, McSorley AM, Lyngdoh A, Kaba-Diakité F, Harris A, Rhodes-Bratton B, Rouhani S. Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities. Am J Prev Med 2024:S0749-3797(24)00078-3. [PMID: 38458268 DOI: 10.1016/j.amepre.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. METHODS Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. RESULTS Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. CONCLUSIONS Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York.
| | - Anna-Michelle McSorley
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Adiammi Lyngdoh
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Fatoumata Kaba-Diakité
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Adrian Harris
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Brennan Rhodes-Bratton
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Saba Rouhani
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York; Department of Epidemiology, New York University School of Global Public Health, New York, New York
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Himmelstein KEW, Tsai AC, Venkataramani AS. Wealth Redistribution to Extend Longevity in the US. JAMA Intern Med 2024; 184:311-320. [PMID: 38285594 PMCID: PMC10825783 DOI: 10.1001/jamainternmed.2023.7975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/10/2023] [Indexed: 01/31/2024]
Abstract
Importance The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity. Objective To examine the association between wealth and longevity and estimate the changes in longevity that could occur with simulated wealth distributions that were perfectly equal, similar to that observed in Japan (among the most equitable of Organisation for Economic Co-operation and Development [OECD] countries), generated by minimum inheritance proposals, and produced by baby bonds proposals. Design, Setting, and Participants This longitudinal cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study (1992-2018), a nationally representative panel study of middle-aged and older (≥50 years) community-dwelling, noninstitutionalized US adults. The data analysis was performed between November 15, 2022, and September 24, 2023. Exposure Household wealth on study entry, calculated as the sum of all assets minus the value of debts and classified into deciles. Main Outcomes and Measures Weibull survival models were used to estimate the association between per-person wealth decile and survival, adjusting for age, sex, marital status, household size, and race and ethnicity. Changes in longevity that might occur under alternative wealth distributions were then estimated. Results The sample included 35 164 participants (mean [SE] age at study entry, 59.1 [0.1] years; 50.1% female and 49.9% male [weighted]). The hazard of death generally decreased with increasing wealth, wherein participants in the highest wealth decile had a hazard ratio of 0.59 for death (95% CI, 0.53-0.66) compared with those in the lowest decile, corresponding to a 13.5-year difference in survival. A simulated wealth distribution of perfect equality would increase populationwide median longevity by 2.2 years (95% CI, 2.2-2.3 years), fully closing the mortality gap between the US and the OECD average. A simulated minimum inheritance proposal would increase populationwide median longevity by 1.7 years; a simulated wealth distribution similar to Japan's would increase populationwide median longevity by 1.2 years; and a simulated baby bonds proposal would increase populationwide median longevity by 1.0 year. Conclusions and Relevance These findings suggest that wealth inequality in the US is associated with significant inequities in survival. Wealth redistribution policies may substantially reduce those inequities and increase population longevity.
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Affiliation(s)
- Kathryn E. W. Himmelstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Alexander C. Tsai
- Harvard Medical School, Boston, Massachusetts
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Atheendar S. Venkataramani
- Division of Health Policy, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Sato M, Tsuji T, Ueno T, Watanabe R, Ide K, Kondo K. Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan Gerontological Evaluation Study. Int J Geriatr Psychiatry 2024; 39:e6069. [PMID: 38357974 DOI: 10.1002/gps.6069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset. METHODS This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated. RESULTS We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p = 0.002), lower income (males: 1.64, [1.34-2.01], p < 0.001/females: 1.82, [1.49-2.22], p < 0.001), and fewer assets (males: 1.40, [1.16-1.68], p < 0.001/females: 1.21, [1.02-1.42], p = 0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously. CONCLUSIONS All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.
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Affiliation(s)
- Masashi Sato
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
- Faculty of Health Care and Medical Sports, Teikyo Heisei University, Chiba, Japan
| | - Taishi Tsuji
- Institute of Health and Sport Sciences, Tsukuba University, Ibaraki, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Takayuki Ueno
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Ryota Watanabe
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kazushige Ide
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
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Jørgensen RE, Hovde Lyngstad T. Does local income and wealth inequality affect mortality? A register-based fixed effects study of 58 million person-years. Scand J Public Health 2024; 52:58-63. [PMID: 36271601 PMCID: PMC10845829 DOI: 10.1177/14034948221126264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Aim: The Income Inequality Hypothesis asserts that income inequality causes negative health burdens within wealthy nations. We aimed to test the hypothesis in Norway, examining the relationship between both income and wealth inequality, net of individual economic resources, and individual all-cause mortality. To this day, little is known about the association between wealth inequality and mortality. In Norway, wealth is far more unequally distributed than income and can be a more prevalent indicator of long-term financial security. Methods: We estimated discrete-time event history models from Norwegian register data, covering all Norwegian-born men and women aged 25-84 years during the period 1993-2013. We include fixed effects at the municipal level, adjusting for time-invariant characteristics in the local area. Our data contain approximately 58.5 million person-year observations after sample restrictions. Results: Overall, increased income and wealth inequality (measured using Gini coefficients of individuals' pensionable income and net worth) is not associated with higher mortality risk in Norway. With a one percentage point increase in income inequality, odds ratio (OR) for mortality was estimated at 0.998 (95% confidence interval (CI) 0.996-1.001) for men and 1.002 (95% CI 0.999-1.006) for women. Corresponding OR from increased wealth inequality was 0.998 (95% CI 0.997-1.000) for men and 0.999 (95% CI 0.998-1.001) for women. Conclusions: Our results raise further doubts about the existence of a contextual effect of economic inequality on health, at least in a Nordic setting. Extensive health policies, relatively generous benefits and high levels of trust could potentially function as a buffer against negative health consequences of increased economic inequality in Norway.
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Affiliation(s)
- Ruth E. Jørgensen
- Department of Sociology and Human Geography, University of Oslo, Norway
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Murphy M, Grundy EMD. Housing tenure and disability in the UK: trends and projections 2004-2030. Front Public Health 2024; 11:1248909. [PMID: 38239788 PMCID: PMC10795505 DOI: 10.3389/fpubh.2023.1248909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Housing is a major influence on health. Housing tenure is associated with housing conditions, affordability, and security and is an important dimension of housing. In the UK there have been profound changes in both housing conditions and the distribution of households by tenure over the past century, that is during the lifetimes of the current population. Methods We firstly reviewed and summarise changes in housing conditions, housing policy and tenure distribution as they provide a context to possible explanations for health variations by housing tenure, including health related selection into different tenure types. We then use 2015-2021 data from a large nationally representative UK survey to analyse associations between housing tenure and self-reported disability among those aged 40-69 controlling for other socio-demographic factors also associated with health. We additionally examine changes in the association between housing tenure and self-reported disability in the population aged 25 and over in the first two decades of the 21st century and project trends forward to 2030. Results Results show that associations between housing tenure and disability by tenure were stronger than for any other indicator of socio-economic position considered with owner-occupiers having the best, and social renters the worst, health. Differences were particularly marked in reported mental health conditions and in economic activity, with 28% of social renters being economically inactive due to health problems, compared with 4% of owner-occupiers. Rates of disability have increased over time, and become increasingly polarised by tenure. By 2020 the age standardised disability rate among tenants of social housing was over twice as high as that for owner occupiers, with projections indicating further increases in both levels, and differentials in, disability by 2030. Discussion These results have substantial implications for housing providers, local authorities and for public health.
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Affiliation(s)
- Michael Murphy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Emily M. D. Grundy
- Institute for Economic and Social Research, University of Essex, Essex, United Kingdom
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Musty A, Lund JL, Yang YC, Niznik J, Shmuel S, Duchesneau ED. The association between wealth and sleep medication use in a nationally-representative sample of older Medicare beneficiaries. Pharmacoepidemiol Drug Saf 2024; 33:e5703. [PMID: 37743351 PMCID: PMC10841169 DOI: 10.1002/pds.5703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Sleep disorders are common among older adults, leading to high prevalence of over-the-counter and prescription sleep medication use. Socioeconomically disadvantaged individuals have higher prevalence of sleep disorders. Frequent use of sleep medications can increase the risk of falls. Little is known about the association between wealth and sleep medication use in older adults. METHODS We conducted a cross-sectional analysis using a nationwide sample of 7603 Medicare beneficiaries (65+ years) from Round 1 (2011) of the National Health and Aging Trends Study. We measured self-reported wealth as the sum of assets (retirement savings, stocks/bonds, checking/savings accounts, business assets, and home value) minus liabilities (mortgage, credit card, and medical debt). Self-reported sleep medication use in the past month was categorized as frequent (5-7 nights/week), sometimes (1-4 nights/week), or never (0 night/week). We estimated differences in the prevalence of sleep medication use by quintiles of wealth using crude and adjusted binomial regression models. Individuals missing sleep medication information were excluded. RESULTS Median wealth was $152 582 (IQR: $24 023-412 992). Sixteen percent reported frequent sleep medication use, 15% reported some use, and 70% reported no use. Frequent sleep medication use was more common in lower wealth quintiles (lowest: 20%, highest: 12%). Alternatively, some use was more common in higher wealth quintiles (lowest: 11%, highest: 18%). Results were similar after adjustment for demographic factors, anxiety, depression, and sleep disorders. CONCLUSIONS In this study, less wealthy older adults had higher prevalence of frequent sleep medication use. This may lead to dependency or increased fall risk in this vulnerable population.
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Affiliation(s)
- Allison Musty
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yang Claire Yang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua Niznik
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shahar Shmuel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emilie D Duchesneau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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13
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Sun S. Racial/Ethnic Heterogeneity in Parental Wealth and Substance Use from Adolescence to Young Adulthood. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01893-y. [PMID: 38114858 DOI: 10.1007/s40615-023-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Substance use has a negative impact on health outcomes, at the individual and population levels. Little consensus exists regarding the relationship between socioeconomic position and substance use across race/ethnicity. This study examines how race/ethnicity and socioeconomic factors, especially parental wealth, are associated with substance use across an 18-year span from adolescence to young adulthood. METHOD Data were drawn from the National Longitudinal Survey of Youth 1997. Substance use behaviors were measured by self-reported heavy episodic drinking, daily cigarette smoking, and use of cannabis. Parental wealth and parental education were measured at baseline. Other socioeconomic factors included education, employment status, and household income. Two-level logistic regression was performed. RESULTS White respondents were more likely to drink, smoke cigarettes, and use cannabis compared to other racial/ethnic groups. More parental wealth was associated with greater odds of heavy episodic drinking, but lower odds of cigarette and cannabis usage. Race/ethnicity modifies the relationships between parental wealth and substance use. Whereas Black respondents from wealthier families had lower odds of heavy episodic drinking, the direction was opposite among white respondents. Wealth functioned as a protective factor against smoking for all groups, although to a lesser extent among respondents of color than for white respondents. Finally, wealthier Hispanics were more likely to smoke daily and use cannabis compared to other racial/ethnic groups. CONCLUSION These findings highlight a nuanced patterning of racial/ethnic heterogeneity in the relationship between parental wealth and substance use behaviors. Implications for policy and programming are discussed.
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Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA.
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14
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Xu KQ, Payne CF. A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001-20. POPULATION STUDIES 2023:1-20. [PMID: 37669002 DOI: 10.1080/00324728.2023.2241429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/23/2023] [Indexed: 09/06/2023]
Abstract
This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position-education, occupation, and household wealth-and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001-20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.
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15
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Krzyzanowski MC, Ives CL, Jones NL, Entwisle B, Fernandez A, Cullen TA, Darity WA, Fossett M, Remington PL, Taualii M, Wilkins CH, Pérez-Stable EJ, Rajapakse N, Breen N, Zhang X, Maiese DR, Hendershot TP, Mandal M, Hwang SY, Huggins W, Gridley L, Riley A, Ramos EM, Hamilton CM. The PhenX Toolkit: Measurement Protocols for Assessment of Social Determinants of Health. Am J Prev Med 2023; 65:534-542. [PMID: 36935055 PMCID: PMC10505248 DOI: 10.1016/j.amepre.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Social determinants are structures and conditions in the biological, physical, built, and social environments that affect health, social and physical functioning, health risk, quality of life, and health outcomes. The adoption of recommended, standard measurement protocols for social determinants of health will advance the science of minority health and health disparities research and provide standard social determinants of health protocols for inclusion in all studies with human participants. METHODS A PhenX (consensus measures for Phenotypes and eXposures) Working Group of social determinants of health experts was convened from October 2018 to May 2020 and followed a well-established consensus process to identify and recommend social determinants of health measurement protocols. The PhenX Toolkit contains data collection protocols suitable for inclusion in a wide range of research studies. The recommended social determinants of health protocols were shared with the broader scientific community to invite review and feedback before being added to the Toolkit. RESULTS Nineteen social determinants of health protocols were released in the PhenX Toolkit (https://www.phenxtoolkit.org) in May 2020 to provide measures at the individual and structural levels for built and natural environments, structural racism, economic resources, employment status, occupational health and safety, education, environmental exposures, food environment, health and health care, and sociocultural community context. CONCLUSIONS Promoting the adoption of well-established social determinants of health protocols can enable consistent data collection and facilitate comparing and combining studies, with the potential to increase their scientific impact.
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Affiliation(s)
- Michelle C Krzyzanowski
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Cataia L Ives
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Nancy L Jones
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland.
| | - Barbara Entwisle
- Department of Sociology, College of Arts and Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alicia Fernandez
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Carolina
| | | | - William A Darity
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Mark Fossett
- Department of Sociology, College of Arts & Sciences, Texas A&M University, College Station, Texas
| | - Patrick L Remington
- Department of Population Health Sciences, University of Wisconsin-Madison College of Medicine and Public Health, Madison, Wisconsin
| | - Maile Taualii
- Center for Integrated Health Care Research, Hawaii Permanente Medical Group, Honolulu, Hawaii
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Nishadi Rajapakse
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Nancy Breen
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Xinzhi Zhang
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Deborah R Maiese
- Division for Research Services, RTI International, Research Triangle Park, North Carolina
| | - Tabitha P Hendershot
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Meisha Mandal
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Stephen Y Hwang
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Wayne Huggins
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Lauren Gridley
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Amanda Riley
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Erin M Ramos
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Carol M Hamilton
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
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Adabanya U, Awosika A, Moon JH, Reddy YU, Ugwuja F. Changing a Community: A Holistic View of the Fundamental Human Needs and Their Public Health Impacts. Cureus 2023; 15:e44023. [PMID: 37638264 PMCID: PMC10449002 DOI: 10.7759/cureus.44023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 08/29/2023] Open
Abstract
There are many approaches to changing a community to ensure it serves the people's fundamental needs. For example, enabling equitable access to critical aspects of the community, such as quality healthcare, high-quality education, and job training, is vital for promoting community safety through enhancing tolerance and respect for diversity. However, creating a community that serves the fundamental needs of the people demands a substantive investment of effort. Understanding the nature of these efforts requires discussion of community engagement, examining community networks and their role in fostering cooperative action, enhancing public safety, and identifying the structures of involvement and pertinent routes for developing community land. Understanding such efforts entails knowing the issues related to gentrification and disbandment. These hands-on possibilities can help avert the possibility of people being pushed out of their community settings. These insights further shed light on how the family unit and larger community are able to create collective unity and foster each member's responsibility in community service provision that promotes community integration. Examining how violence and other factors affect a community's collective power is necessary to determine how a community can avoid such violence and encourage positive changes at the individual and family levels to promote community cooperation and safety. Essentially, changing a community can yield significant improvements in public health. Addressing factors such as access to nutritious food, healthcare, physical activity, and social amenities and fostering social cohesion through community engagement can collectively contribute to reducing the burden of chronic diseases and promoting overall well-being. This review provides insight into crucial issues that have long plagued the societal disconnect between the local community and the leadership, policymakers, or other authoritative institutions that govern them, thus affecting the implementation of strategic social and public health initiatives. We will also explore strategies to mitigate these potential pitfalls.
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Affiliation(s)
| | - Ayoola Awosika
- College of Medicine, University of Illinois, Chicago, USA
| | - Jin Hyung Moon
- General Medicine, Mercer University School of Medicine, Columbus, USA
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17
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do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, Giordani JMDA. Wealth index association with self-reported oral health between white and non-white older Brazilians. CAD SAUDE PUBLICA 2023; 39:e00188122. [PMID: 37377295 PMCID: PMC10494672 DOI: 10.1590/0102-311xen188122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 06/29/2023] Open
Abstract
This cross-sectional study aimed to identify the association between self-reported oral health status and a wealth index among white and non-white older adults in Brazil. Data from individual assessments of 9,365 Brazilians aged 50 years or older were analyzed. Poisson regression models were performed to estimate the prevalence ratio between wealth index and self-reported oral health among whites and non-whites adjusted for intermediate and proximal determinants. The total prevalence of poor self-reported oral health on white and non-white individuals was 41.6% (95%CI: 40.0-43.4) and 48% (95%CI: 47.1-49.8) respectively. The adjusted analysis showed that, for whites, the wealth index is associated with self-reported oral health since individuals in the 3rd, 4th, and 5th quintiles have 25% (PR = 0.75; 95%CI: 0.65-0.88), 20% (PR = 0.80; 95%CI: 0.67-0.95), and 39% (PR = 0.61; 95%CI: 0.50-0.75) lower prevalence of poor self-reported oral health than those in the poorest quintile. For non-white individuals, the wealth index is associated with self-reported oral health only for those in the 5th quintile, with 25% (PR = 0.85; 95%CI: 0.72-0.99) lower prevalence of poor self-reported oral health than those in the poorest quintile. The wealth index showed different effects on self-reported oral health among whites and non-whites. Socioeconomic status indicators may reflect racial inequalities due to the historical legacy of institutional discrimination. This study highlights the importance of developing policies to combat racial inequities and how these can contribute to better oral health conditions for the older Brazilian population.
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Affiliation(s)
| | | | - Gabriele Rissotto Menegazzo
- Programa de Pós-graduação em Ciências Odontológicas, Universidade Federal de Santa Maria, Santa Maria, Brasil
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18
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Ettman CK, Fan AY, Philips AP, Adam GP, Ringlein G, Clark MA, Wilson IB, Vivier PM, Galea S. Financial strain and depression in the U.S.: a scoping review. Transl Psychiatry 2023; 13:168. [PMID: 37179345 PMCID: PMC10182750 DOI: 10.1038/s41398-023-02460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
While the association between assets and depression has been established, less is known about the link between financial strain and depression. Given rising financial strain and economic inequity due to the COVID-19 pandemic, understanding the role that financial strain plays in shaping population depression in the United States is particularly salient. We conducted a scoping review of the peer-reviewed literature on financial strain and depression published from inception through January 19, 2023, in Embase, Medline via PubMed, and PsycINFO, PsycArticles, SocINDEX, and EconLit via Ebsco. We searched, reviewed, and synthesized the literature on longitudinal studies on financial strain and depression conducted in the United States. Four thousand and four unique citations were screened for eligibility. Fifty-eight longitudinal, quantitative articles on adults in the United States were included in the review. Eighty-three percent of articles (n = 48) reported a significant, positive association between financial strain and depression. Eight articles reported mixed results, featuring non-significant associations for some sub-groups and significant associations for others, one article was unclear, and one article reported no significant association between financial strain and depression. Five articles featured interventions to reduce depressive symptoms. Effective interventions included coping mechanisms to improve one's financial situation (e.g., mechanisms to assist in finding employment), to modify cognitive behavior (e.g., reframing mindset), and to engage support (e.g., engaging social and community support). Successful interventions were tailored to participants, were group-based (e.g., they included family members or other job seekers), and occurred over multiple sessions. While depression was defined consistently, financial strain was defined variably. Gaps in the literature included studies featuring Asian populations in the United States and interventions to reduce financial strain. There is a consistent, positive association between financial strain and depression in the United States. More research is needed to identify and test interventions that mitigate the ill effects of financial strain on population's mental health.
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Affiliation(s)
- Catherine K Ettman
- Boston University School of Public Health, Boston, MA, USA.
- Brown University School of Public Health, Providence, RI, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alice Y Fan
- Boston University School of Public Health, Boston, MA, USA
| | | | - Gaelen P Adam
- Brown University School of Public Health, Providence, RI, USA
| | - Grace Ringlein
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa A Clark
- Brown University School of Public Health, Providence, RI, USA
| | - Ira B Wilson
- Brown University School of Public Health, Providence, RI, USA
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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Amegbor PM, Addae A. Spatiotemporal analysis of the effect of global development indicators on child mortality. Int J Health Geogr 2023; 22:9. [PMID: 37143085 PMCID: PMC10157969 DOI: 10.1186/s12942-023-00330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Child mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates. METHODS The data from 195 countries were curated from the World Bank's World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates. RESULTS In both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = - 1.26, [CI - 1.51; - 1.01]), current healthcare expenditure (β = - 0.40, [CI - 0.55; - 0.26]) and access to basic sanitation (β = - 0.03, [CI - 0.05; - 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5. CONCLUSION The findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.
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Affiliation(s)
- Prince M Amegbor
- Global and Environmental Public Health, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Angelina Addae
- Department of Economics, University of Saskatchewan, 129, 72 Campus Drive, Saskatoon, SK, S7N 5B5, Canada
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BRAVEMAN PAULA. The Black-White Disparity in Preterm Birth: Race or Racism? Milbank Q 2023; 101:356-378. [PMID: 37096619 PMCID: PMC10126979 DOI: 10.1111/1468-0009.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/20/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.
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21
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Ailshire JA, Herrera CA, Choi E, Osuna M, Suzuki E. Cross-national differences in wealth inequality in health services and caregiving used near the end of life. EClinicalMedicine 2023; 58:101911. [PMID: 36969343 PMCID: PMC10030998 DOI: 10.1016/j.eclinm.2023.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Background Socioeconomic inequality in access to and use of health services and social care provided near the end of life, or end-of-life care (EOLC), is not well understood in many countries. We examined wealth inequality in EOLC-hospital, nursing home, and hospice use and receipt of formal and informal caregiving-in 22 countries in Europe, Asia (South Korea), and North America (United States, Mexico). Methods We used harmonized data from nationally representative studies of people aged 50 and older that collected information on healthcare utilisation and caregiving receipt in the time preceding death. We categorized countries according to their level of public long-term care (LTC) spending and examined EOLC prevalence across countries. We used logistic regression models to estimate wealth inequality in each type of EOLC. Findings In the USA the least wealthy had more hospital (OR 1.30, p = 0.008) and nursing home/care use (OR 1.88, p < 0.001). In South Korea the least wealthy had more nursing home/care use (OR 2.24, p = 0.003). The least wealthy in high LTC Europe had less hospice use (OR 0.56, p = 0.003). The least wealthy were also less likely to be hospitalized in European countries with low LTC spending (OR 0.81, p = 0.04), but more likely to receive informal caregiving (OR 1.25, p = 0.033). Formal care was more common among the least wealthy in high LTC Europe (OR 1.57, p = 0.002), the USA (OR 1.42, p < 0.001) and South Korea (OR 1.69, p = 0.028), but less common among the least wealthy in Mexico (OR 0.17, p < 0.001). Interpretation Wealth inequality in EOLC exists across countries and reflects differences in the organization, financing, and delivery of care in different countries. The findings highlight the need to consider equity in current and future plans to improve EOLC access. Funding United States National Institute on Aging Grant R01AG030153.
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Affiliation(s)
- Jennifer A. Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
| | - Cristian A. Herrera
- The World Bank Group, Washington, DC, USA
- Department of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eunyoung Choi
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
| | - Margarita Osuna
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
| | - Elina Suzuki
- The Organization for Economic Co-operation and Development, Paris, France
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22
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Jamshaid S, Malik NI, Ullah I, Saboor S, Arain F, De Berardis D. Postpartum Depression and Health: Role of Perceived Social Support among Pakistani Women. Diseases 2023; 11:diseases11020053. [PMID: 37092435 PMCID: PMC10123603 DOI: 10.3390/diseases11020053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
Postpartum depression (PPD) can predispose to physical and mental health problems in Pakistani women. However, PPD is associated with health and perceived social support, yet their causal relationship is unclear. Therefore, this study intended to evaluate the association of PPD with insomnia, mental health, and physical health. The convenience sampling technique was used to collect data from 320 (52.8%) young and middle-aged postpartum women, at the outpatient departments of obstetrics and gynecology of the Government Maula Bakhsh Hospital, District Head Quarter in Sargodha, Pakistan. The Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, Warwick–Edinburgh Mental Well-being Scale, patient health questionnaire, and Multidimensional Scale of Perceived Social Support were used to measure study variables. The results revealed a significant positive relationship between PPD and physical health (r = 0.45, p = 0.001), negative relationships with insomnia (r = −0.24, p < 0.001), and perceived social support (r = −0.38, p = 0.001). Results further confirmed that perceived social support played a moderating role (β = 0.97, p = 0.01) in the relationship between PPD and mental health among Pakistani women. This study concluded that perceived social support has an important role in PPD and the health of Pakistani women. The study also concluded that poor health is a risk indicator for the identification of aid in the early stages of postpartum among Pakistani women.
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23
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Schmitz W, Naegele L, Frerichs F, Ellwardt L. Gendered late working life trajectories, family history and welfare regimes: evidence from SHARELIFE. Eur J Ageing 2023; 20:5. [PMID: 36854927 PMCID: PMC9975140 DOI: 10.1007/s10433-023-00752-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
Earlier employment choices based on family events in earlier life have an impact up until late working life, especially in welfare regimes that encourage the breadwinner-caretaker division. We investigate types of late employment patterns and how these are associated with earlier family events. We also test whether the association between early family history and late working life varies across five welfare regimes. Using retrospective life history data from SHARELIFE, our sample consists of 10,913 women and 10,614 men aged 65 years and older. Late working life trajectories are analyzed using gender-separate sequence analyses, which are summarized into eight groups applying cluster analyses. Using average marginal and interaction effects, we explain how the association between types of late working life, coresidential partnership history and parenthood history differs by welfare states. For instance, women's late employment is either shaped by unpaid care or paid (full- or part-time) work but not both, whereas men's late working life is mainly shaped by full-time work. Family history in earlier life is linked to unpaid care and part-time work-an association strongest in liberal and southern welfare regimes. However, among men earlier family events are linked to full-time work. Policymakers need gender-specific strategies to integrate workers into late working life. The implementation of new policies should aim to prevent these social inequalities in early life, as employment decisions caused by family history in earlier life stages-especially for women-tend to cumulate over the life course.
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Affiliation(s)
- Wiebke Schmitz
- Federal Institute for Vocational Education and Training (BIBB), Bonn, Germany. .,Cologne Graduate School in Management Economics and Social Sciences, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany.
| | - L. Naegele
- Federal Institute for Vocational Education and Training (BIBB), Bonn, Germany
| | - F. Frerichs
- Department of Ageing and Work, Institute for Gerontology, University of Vechta, Vechta, Germany
| | - L. Ellwardt
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
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24
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Sun S, Lee H, Hudson DL. Racial/ethnic differences in the relationship between wealth and health across young adulthood. SSM Popul Health 2023; 21:101313. [PMID: 36589274 PMCID: PMC9798167 DOI: 10.1016/j.ssmph.2022.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
•Wealth attenuated racial differences in self-rated health during young adulthood.•Wealth had consistent incremental effect on health among White & Hispanic Americans.•For Black Americans, wealth was protective of health in the highest wealth quartile.•Individual wealth, not parental wealth was associated with health among Hispanics.
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Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA
| | - Hedwig Lee
- Department of Sociology, Trinity College of Arts & Sciences, 417 Chapel Dr, Durham, NC, 27708, USA
| | - Darrell L. Hudson
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
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25
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Rose J, Arikat L, Gusoff G, Pollack CE. Mechanisms to Improve Health Through Community Land Trusts. J Urban Health 2023; 100:389-397. [PMID: 36689141 PMCID: PMC9869833 DOI: 10.1007/s11524-022-00706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/24/2023]
Abstract
Community land trusts (CLTs) provide long-term affordable housing and offer a range of mechanisms that may improve the health and well-being of low-income households. We sought to elucidate these mechanisms through thematic analysis of semi-structured interviews with a diverse sample of CLT staff and residents across the USA. Stakeholders most frequently identified improvements in mental health that come through increased housing stability and affordability. Other factors-including the ways that CLTs promote wealth generation, improvements in housing quality and neighborhood amenities, services and partnerships with healthcare organizations, and democratic governance-were raised by respondents though less frequently tied to health benefits. CLTs represent a promising area for future research on housing's impact on health.
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Affiliation(s)
- Justin Rose
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA.
| | - Loraine Arikat
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA
| | - Geoff Gusoff
- National Clinician Scholars Program, UCLA, Los Angeles, CA, USA
| | - Craig Evan Pollack
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University School of Nursing, Baltimore, MD, USA
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26
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Garcia-Grossman IR, Cenzer I, Steinman MA, Williams BA. History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood. JAMA Netw Open 2023; 6:e2249785. [PMID: 36607638 PMCID: PMC9856648 DOI: 10.1001/jamanetworkopen.2022.49785] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023] Open
Abstract
Importance Although incarcerated older adults experience higher rates of chronic disease and geriatric syndromes, it is unknown whether community-dwelling older adults with a history of incarceration are also at risk for worse health outcomes. Objective To evaluate the association between a history of incarceration and health outcomes, including chronic health conditions and geriatric syndromes, in older age. Design, Setting, and Participants This cross-sectional study using population-based data from the nationally representative Health and Retirement Study included US community-dwelling adults aged 50 years or older who completed the 2012 or 2014 survey waves assessing self-reported history of incarceration. Statistical analysis was completed from December 2021 to July 2022. Exposures Self-reported history of incarceration. Main Outcomes and Measures Geriatric health outcomes included cognitive impairment, mobility impairment, vision impairment, hearing impairment, urinary incontinence, and impairment of activities of daily living (ADLs). Chronic health outcomes included high blood pressure, diabetes, chronic lung disease, heart disease, stroke, mental health conditions, heavy alcohol use, and self-reported health. Survey weights were applied to adjust for the survey design. Results Among 13 462 participants, 946 (7.6%) had experienced incarceration (mean [SD] age, 62.4 [7.8] years); compared with 12 516 people with no prior incarceration (mean [SD] age, 66.7 [10.0] years), previously incarcerated adults were more likely to be male (83.0% vs 42.8%; P < .001) and in the lowest quartile of wealth (44.1% vs 21.4%; overall P < .001). After adjusting for age, sex, race and ethnicity, wealth, educational attainment, and uninsured status, a history of incarceration was associated with a 20% to 80% increased risk of all geriatric syndromes evaluated, including impairment of ADLs (relative risk [RR], 1.62; 95% CI, 1.40-1.88) and hearing impairment (RR, 1.22; 95% CI, 1.04-1.44). Incarceration was also associated with increased risk of some chronic diseases, including chronic lung disease (RR, 1.56; 95% CI, 1.27-1.91), mental health conditions (RR, 1.80; 95% CI, 1.55-2.08), and heavy alcohol use (RR, 2.13; 95% CI, 1.59-2.84). Prior incarceration was not associated with diabetes or cardiovascular conditions. Conclusions and Relevance In this study, at least 1 in 15 older US adults reported a history of incarceration in their lifetime. Past incarceration was associated with many chronic diseases and geriatric syndromes even after accounting for socioeconomic status. These findings suggest that attention to incarceration history may be an important consideration in understanding and mitigating health risks in older age.
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Affiliation(s)
- Ilana R. Garcia-Grossman
- Department of Medicine, University of California, San Francisco
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
| | - Irena Cenzer
- Department of Medicine, University of California, San Francisco
- Division of Geriatrics, University of California, San Francisco
| | - Michael A. Steinman
- Department of Medicine, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
- Division of Geriatrics, University of California, San Francisco
| | - Brie A. Williams
- Department of Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
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27
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Karlsson N, Skagerström J, O'Donnell A, Abidi L, Thomas K, Nilsen P, Lid TG. Relationship Between Educational Level and Attitudes Towards Alcohol Conversations in Healthcare: A Cross-Sectional Survey Conducted in Four European Countries. Int J Public Health 2023; 68:1605634. [PMID: 37035102 PMCID: PMC10079867 DOI: 10.3389/ijph.2023.1605634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives: To examine the association between educational level and attitudes towards alcohol conversations in healthcare using population-based surveys of adults in England, the Netherlands, Norway, and Sweden; and to compare attitudes towards alcohol conversations in healthcare between these four countries. Methods: Cross-sectional surveys were conducted amongst adults in the general population in England (n = 3,499), the Netherlands (n = 2,173), Norway (n = 1,208), and Sweden (n = 3,000). Logistic regression analysis was used to examine associations between attitudes towards alcohol conversations in healthcare and educational level, key demographic variables, alcohol consumption, and country of residence. Results: In all four countries, low educational level (p < 0.001) and male gender (p < 0.001) were associated with holding negative attitudes towards discussing alcohol in healthcare. Risky drinkers had more negative attitudes than low risky drinkers towards discussing alcohol in healthcare (p < 0.001) in all countries except England (p = 0.48), and also reported low levels of perceived honesty and confidence in healthcare (p < 0.001). Conclusion: These findings highlight the importance of considering patients' socio-economic status when developing and implementing alcohol prevention interventions in healthcare.
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Affiliation(s)
- Nadine Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Nadine Karlsson,
| | - Janna Skagerström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Research and Development Unit in Region Östergötland, Linköping, Sweden
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Latifa Abidi
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Yu R, Lai D, Leung G, Woo J. Trajectories of Intrinsic Capacity: Determinants and Associations with Disability. J Nutr Health Aging 2023; 27:174-181. [PMID: 36973922 DOI: 10.1007/s12603-023-1881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Intrinsic capacity (IC) declines progressively with age, thereby increasing the risk of disability. However, it is less known whether IC trajectories are associated with disability. This study aims to identify the different patterns of IC trajectories in older people, and examine their determinants and associations with Instrumental Activities of Daily Living (IADL). DESIGN Cohort study. SETTING Community centres in different regions in Hong Kong. PARTICIPANTS AND MEASUREMENTS Longitudinal data from community-dwelling older people aged 60 years or above (n = 1371) collected between 2016 and 2021 was analysed. Their mean age was 74.5 years, and 78.7% of them were female. Repeated measurements of a set of 14 self-reported items were used to generate IC scores at four time points using a bi-factor model. Latent class growth analysis was performed to identify classes with distinct IC trajectories. The association between class membership and IADL disability was then examined using logistic regression. RESULTS Three distinct IC trajectories were identified. The 1st class included those with the highest level of baseline IC and the least declining trajectory, whereas the 3rd class was composed by those with the lowest level of baseline IC and the most declining trajectory. Older age, female gender, lower perceived financial adequacy, living in public or subsidized housing, and chronic diseases were associated with the 3rd class. After adjusting for demographic factors, socioeconomic status, and the number of chronic diseases, the 1st class was more likely to preserve IADL when compared against the 2nd class, with OR being 3.179 (95% CI: 2.152-4.793), whereas for the 3rd class, the OR was 0.253 (95% CI: 0.178-0.359). CONCLUSION Monitoring IC trajectories is of relevance to clinical practice, as it helps shift the focus from treating acute episodes of illness to preserving the functional ability of older people.
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Affiliation(s)
- R Yu
- Ruby Yu, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China, Tel: (852) 3943 5142, Fax: (852) 2637 9215, E-mail:
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29
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Atkins N, Mukhida K. The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review. Can J Pain 2022; 6:142-170. [PMID: 36092247 PMCID: PMC9450907 DOI: 10.1080/24740527.2022.2104699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nicole Atkins
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karim Mukhida
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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30
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Paalanen L, Levälahti E, Mäki P, Tolonen H, Sassi F, Ezzati M, Laatikainen T. Association of socioeconomic position and childhood obesity in Finland: a registry-based study. BMJ Open 2022; 12:e068748. [PMID: 36581407 PMCID: PMC9806090 DOI: 10.1136/bmjopen-2022-068748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2-17 years in Finland. DESIGN Registry-based study. SETTING Data from several administrative registries linked on individual level covering the whole of Finland were used. Data on height and weight measurements in 2018 were obtained from the Register of Primary Health Care visits and data on sociodemographic and socioeconomic indicators (2014-2018) from Statistics Finland. PARTICIPANTS Children aged 2-17 years with valid height and weight measurements performed at the child health clinic or school healthcare in 2018 (final n=194 423). MAIN OUTCOME MEASURES Obesity was defined according to WHO Growth Reference curves. Sociodemographic and socioeconomic indicators were linked on individual level for adults (both parents) who lived in the same household (42 predictors). Boosted regression model was used to analyse the contribution of SEP to obesity. RESULTS From socioeconomic indicators, annual household income (12.6%) and mother and father's educational level (12.6% and 8.1%, respectively) had the highest relative influence on obesity risk. The relative influence of a child's sex was 7.7%. CONCLUSIONS The parents' SEP was inversely associated with obesity among the offspring. A remarkable number of objective SEP indicators were analysed with parents' education and household income finally being the indicators most strongly associated with obesity among children. In future research, more attention should be paid to reliable and objective ways of measuring educational status and income rather than on developing new SEP indicators. Administrative registries with information on both healthcare and socioeconomic indicators can in future provide better opportunities to assess the influence of SEP on various health risks.
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Affiliation(s)
- Laura Paalanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Esko Levälahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivi Mäki
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Joensuu, Finland
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31
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Himmelstein KEW, Lawrence JA, Jahn JL, Ceasar JN, Morse M, Bassett MT, Wispelwey BP, Darity WA, Venkataramani AS. Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018. JAMA Netw Open 2022; 5:e2240519. [PMID: 36342718 PMCID: PMC9641537 DOI: 10.1001/jamanetworkopen.2022.40519] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear. OBJECTIVE To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Data were analyzed from January 1 to September 17, 2022. EXPOSURES Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Additional models controlled for educational level and income. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated. RESULTS Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. Black participants' median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 [95% CI, 81.2-81.8] years). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 [95% CI, 0.92-1.08]). In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality.
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Affiliation(s)
- Kathryn E. W. Himmelstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jourdyn A. Lawrence
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jaquelyn L. Jahn
- The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Joniqua N. Ceasar
- Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pediatrics, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Morse
- Center for Health Equity and Community Wellness, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Bram P. Wispelwey
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - William A. Darity
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Atheendar S. Venkataramani
- Leonard Davis Institute of Health Economics, Division of Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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32
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Zhang R, Zhang C, Xia J, Feng D, Wu S. Household Wealth and Individuals' Mental Health: Evidence from the 2012-2018 China Family Panel Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11569. [PMID: 36141835 PMCID: PMC9517491 DOI: 10.3390/ijerph191811569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Based on the data from the 2012-2018 China Family Panel Survey, this study examines the impact of household wealth on individuals' mental health using a two-way fixed effects model. The findings indicate that household wealth exerts a significant positive effect on individuals' mental health. Furthermore, this study shows that the impact of household wealth on individuals' mental health is nonlinear but inverted U-shaped. Considering the possible endogeneity problem, this study further examines the effect of household wealth on residents' mental health using two-stage least squares, and the conclusions remain robust. The results of the heterogeneity analysis indicate that household wealth has a greater impact on the mental health of residents in the low-education group and western region. Furthermore, the results of the mechanisms reveal that household wealth affects mental health by influencing insurance investment and individuals' labor supply. Moreover, this study finds that household wealth affects individuals' mental health not only in the short term but also in the medium and long terms. This study provides policy implications for the government toward improving individuals' mental health.
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Affiliation(s)
- Rui Zhang
- Department of Economics, Jinan University, Guangzhou 510632, China
| | - Chenglei Zhang
- School of Economics & Trade, Guangdong University of Finance, Guangzhou 510521, China
| | - Jiahui Xia
- School of Management, Jinan University, Guangzhou 510632, China
| | - Dawei Feng
- Institute of Industrial Economics, Jiangxi University of Finance and Economics, Nanchang 330013, China
| | - Shaoyong Wu
- Institute of Industrial Economics, Jiangxi University of Finance and Economics, Nanchang 330013, China
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33
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Korous KM, Cuevas AG, Chahoud J, Ogbonnaya UC, Brooks E, Rogers CR. Examining the relationship between household wealth and colorectal cancer screening behaviors among U.S. men aged 45-75. SSM Popul Health 2022; 19:101222. [PMID: 36105558 PMCID: PMC9464961 DOI: 10.1016/j.ssmph.2022.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related death among men in the United States (U.S.), particularly among men aged 45 years and older. Early-detection screening remains a key method of decreasing CRC-related deaths, yet socioeconomic barriers exist to planning and completing CRC screening. While accumulating evidence shows income disparities in CRC screening prevalence, a dearth of research has investigated wealth disparities. This study aimed to determine whether household wealth was associated with CRC screening uptake and future screening intent. In February 2022, we sent an online survey to potential participants; U.S. men aged 45–75 years were eligible to participate. We examined four CRC screening behaviors as outcomes: ever completing a stool-based or exam-based screening test, current screening status, and future screening intent. Household net wealth, determined by self-reported household wealth and debt, was the primary predictor. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence interval (CI). Of the study participants (N = 499), most self-identified as Non-Hispanic White, were aged 50–64 years, and had previously completed a CRC screening test. Results revealed that, among men aged 45–49 years, higher net wealth decreased the odds of ever completing a stool- or exam-based test (OR = 0.58, 95% CI: 0.33, 0.98; OR = 0.55, 95% CI: 0.31, 0.94, respectively). By contrast, among men aged 50–75 years, higher net wealth increased the odds of being current with CRC screening (OR = 1.40, 95% CI: 1.03, 1.92). Net wealth was unassociated with CRC screening intent. These findings suggest that household net wealth, rather than income, is an important socioeconomic factor to consider in relation to uptake of CRC early-detection screening. The financial and social cognitive mechanisms linking household wealth to CRC screening behaviors merit future research and intervention. Wealth was associated with U.S men's adherence to screening for colorectal cancer. Age modified the association between wealth and colorectal cancer screening uptake. Wealth reduced the odds of past colorectal screening completion for men 45–49 years.
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Affiliation(s)
- Kevin M Korous
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.,Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Adolfo G Cuevas
- Community Health, School of Arts and Sciences, Tufts University, Medford, MA, 02155, USA
| | - Jad Chahoud
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Uchenna C Ogbonnaya
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Charles R Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.,Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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South E, Venkataramani A, Dalembert G. Building Black Wealth - The Role of Health Systems in Closing the Gap. N Engl J Med 2022; 387:844-849. [PMID: 36053512 DOI: 10.1056/nejmms2209521] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eugenia South
- From the Penn Urban Health Lab (E.S.), and the Departments of Emergency Medicine (E.S.), Medical Ethics and Health Policy (A.V.), and Pediatrics (G.D.), Perelman School of Medicine, and the Leonard Davis Institute for Health Economics (E.S., A.V., G.D.), University of Pennsylvania, and the Possibilities Project, Children's Hospital of Philadelphia (G.D.) - both in Philadelphia
| | - Atheendar Venkataramani
- From the Penn Urban Health Lab (E.S.), and the Departments of Emergency Medicine (E.S.), Medical Ethics and Health Policy (A.V.), and Pediatrics (G.D.), Perelman School of Medicine, and the Leonard Davis Institute for Health Economics (E.S., A.V., G.D.), University of Pennsylvania, and the Possibilities Project, Children's Hospital of Philadelphia (G.D.) - both in Philadelphia
| | - George Dalembert
- From the Penn Urban Health Lab (E.S.), and the Departments of Emergency Medicine (E.S.), Medical Ethics and Health Policy (A.V.), and Pediatrics (G.D.), Perelman School of Medicine, and the Leonard Davis Institute for Health Economics (E.S., A.V., G.D.), University of Pennsylvania, and the Possibilities Project, Children's Hospital of Philadelphia (G.D.) - both in Philadelphia
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35
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Patel AB, Bann CM, Kolhe CS, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Bucher S, Saleem S, Goldenberg RL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Hibberd PL. The Global Network Socioeconomic Status Index as a predictor of stillbirths, perinatal mortality, and neonatal mortality in rural communities in low and lower middle income country sites of the Global Network for Women's and Children's Health Research. PLoS One 2022; 17:e0272712. [PMID: 35972913 PMCID: PMC9380930 DOI: 10.1371/journal.pone.0272712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Globally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations. OBJECTIVE The current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia. METHODS The analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded Global Network for Women's and Children's Health Research. Generalized estimating equations models were computed for each outcome by SES level (high, moderate, or low) and controlling for site, maternal age, parity, years of schooling, body mass index, and facility birth, including sampling cluster as a random effect. RESULTS Women with low SES had significantly higher risks for stillbirth (p < 0.001), perinatal mortality (p = 0.001), and neonatal mortality (p = 0.005) than women with high SES. In addition, those with moderate SES had significantly higher risks of stillbirth (p = 0.003) and perinatal mortality (p = 0.008) in comparison to those with high SES. CONCLUSION The SES categories were associated with pregnancy outcomes, supporting the validity of the index as a non-income-based measure of SES for use in studies of pregnancy outcomes in LMICs.
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Affiliation(s)
- Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Carla M. Bann
- RTI International, Research Triangle Park, NC, United States of America
| | | | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, United States of America
| | | | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, United States of America
| | | | | | | | - Waldemar A. Carlo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | - Richard J. Derman
- Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | | | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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Mayfour KW, Hruschka D. Assessing comparative asset-based measures of material wealth as predictors of physical growth and mortality. SSM Popul Health 2022; 17:101065. [PMID: 35345449 PMCID: PMC8956810 DOI: 10.1016/j.ssmph.2022.101065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Social scientists and policymakers have increasingly relied on asset-based indices of household wealth to assess social disparities and to identify economically vulnerable populations in low- and middle-income countries. In the last decade, researchers have proposed a number of asset-based measures that permit global comparisons of household wealth across populations in different countries and over time. Each of these measures relies on different assumptions and indicators, and little is known about the relative performance of these measures in assessing disparities. In this study, we assess four comparative, asset-based measures of wealth—the Absolute Wealth Estimate (AWE), the International Wealth Index (IWI), the Comparative Wealth Index (CWI), and the “Standard of Living” portion of the Multi-Dimensional Poverty Index (MPI), along with a variable measuring television ownership—and compare how well each predicts health related variables such as women's BMI, children's height-for-age Z scores, and infant mortality at the household and survey level. Analyzing data from over 300 Demographic and Health surveys in 84 countries (n = 2,304,928 households), we found that AWE, IWI, CWI, MPI are all highly correlated (r = 0.7 to 0.9). However, IWI which is based on a common set of universally weighted indicators, typically best accounts for variation in all three health measures. We discuss the implications of these findings for choosing and interpreting these measures of wealth for different purposes. Assessing four comparative, asset-based measures of wealth. The four comparative asset-based measures of wealth are all highly correlated. International Wealth Index best accounts for variation in adult female BMI, child height-for-age, and infant mortality. Asset-based measures of wealth relying on universal indicators and weights perform better at explaining variance.
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Ettman CK, Adam GP, Clark MA, Wilson IB, Vivier PM, Galea S. Wealth and depression: A scoping review. Brain Behav 2022; 12:e2486. [PMID: 35134277 PMCID: PMC8933775 DOI: 10.1002/brb3.2486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/16/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The inverse relation between income and depression is well established. Less is understood about the relation between wealth and depression. We therefore conducted a scoping review to answer the question: What is known from the existing literature about the relation between wealth and depression? METHODS We searched for studies and articles in Medline (via PubMed), Embase, PsycINFO, PsycArticles, EconLit, and SocINDEX from inception through July 19, 2020. Ninety-six articles were included in our review. Key article characteristics were year of publication, sample size, country, study design, definition of depression, definition of wealth, and association between wealth and depression. Thirty-two longitudinal articles were included in a detailed charted review. RESULTS Depression was defined in a relatively standard manner across articles. In contrast, definitions and measurements of wealth varied greatly. The majority of studies in the full review (n = 56, 58%) and half of the studies in the longitudinal charted review (n = 16, 50%) reported an inverse relation between wealth and depression. The longitudinal charted review showed that (1) macro-economic events influenced depression, (2) wealth status influenced depression across the lifecourse, (3) wealth protected against depression in the face of stressors such as job loss, (4) subjective or psychosocial factors such as perception of wealth, relative comparison, and social status modified the relation between wealth and depression, and (5) savings interventions were successful in reducing depression and varied by context. CONCLUSION These findings suggest that wealth should be included in our consideration of the forces that shape mental health.
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Affiliation(s)
- Catherine K Ettman
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Gaelen P Adam
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Melissa A Clark
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ira B Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Patrick M Vivier
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Providence, Rhode Island, USA
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts, USA
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Larrabee Sonderlund A, Charifson M, Schoenthaler A, Carson T, Williams NJ. Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction. PLoS One 2022; 17:e0262962. [PMID: 35089963 PMCID: PMC8797220 DOI: 10.1371/journal.pone.0262962] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
Abstract
Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.
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Affiliation(s)
- Anders Larrabee Sonderlund
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mia Charifson
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| | - Traci Carson
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
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Kinney AR, Graham JE, Middleton A, Edelstein J, Wyrwa J, Malcolm MP. Mobility status and acute care physical therapy utilization: The Moderating roles of age, significant others, and insurance type. Arch Phys Med Rehabil 2022; 103:1600-1606.e1. [PMID: 35007549 DOI: 10.1016/j.apmr.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/03/2021] [Accepted: 12/16/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate whether a direct measure of need for PT, mobility status, was associated with acute care PT utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN In a secondary analysis of electronic health records data, we estimated logistic regression models to determine whether mobility status was associated with acute care PT utilization. Interactions between mobility and both sociodemographic factors (sex; age; significant other; minority status) and insurance type were included to investigate whether the relationship between mobility and PT utilization varied across patient characteristics. SETTING Five regional hospitals from one health system. PARTICIPANTS 60,459 adults admitted between 2014 and 2018 who received a PT evaluation. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Received acute care PT; Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" measure of mobility. RESULTS Half of patients who received a PT evaluation received subsequent treatment. Patients with mobility limitations were more likely to receive PT. Interaction terms indicated that among patients with mobility limitations, those who 1) were younger; 2) had significant others; and 3) had private insurance (vs. public) were more likely to receive PT. Among patients with greater mobility status, older patients and those without a significant other were more likely to receive PT. CONCLUSIONS The relationship between acute care PT need and utilization differed across sociodemographic factors and insurance type. We offer potential explanations for these findings to guide studies targeting equitable distribution of beneficial PT services.
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Affiliation(s)
- Adam R Kinney
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
| | - Addie Middleton
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Jessica Edelstein
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
| | - Jordan Wyrwa
- UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora, Colorado
| | - Matt P Malcolm
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO; Colorado School of Public Health, Colorado State University, Fort Collins, CO
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Kinney AR, Graham JE, Bukhari R, Hoffman A, Malcolm MP. Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors. Am J Occup Ther 2022; 76:23141. [PMID: 34997754 DOI: 10.5014/ajot.2022.049060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, and Director, Center for Community Partnerships, Colorado State University, Fort Collins
| | - Rayyan Bukhari
- Rayyan Bukhari, MSOT, is PhD Student, Department of Occupational Therapy, Colorado State University, Fort Collins, and Lecturer, Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, BCPR, is Inpatient Rehabilitation Supervisor, UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora
| | - Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor and PhD Program Director, Department of Occupational Therapy, Colorado State University, Fort Collins, and Colorado School of Public Health, Colorado State University, Fort Collins
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Kinney AR, Graham JE, Bukhari R, Hoffman A, Malcolm MP. Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors. Am J Occup Ther 2022; 76:23139. [PMID: 34990509 DOI: 10.5014/ajot.121.049060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, and Director, Center for Community Partnerships, Colorado State University, Fort Collins
| | - Rayyan Bukhari
- Rayyan Bukhari, MSOT, is PhD Student, Department of Occupational Therapy, Colorado State University, Fort Collins, and Lecturer, Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, BCPR, is Inpatient Rehabilitation Supervisor, UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora
| | - Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor and PhD Program Director, Department of Occupational Therapy, Colorado State University, Fort Collins, and Colorado School of Public Health, Colorado State University, Fort Collins
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Cerutti J, Lussier AA, Zhu Y, Liu J, Dunn EC. Associations between indicators of socioeconomic position and DNA methylation: a scoping review. Clin Epigenetics 2021; 13:221. [PMID: 34906220 PMCID: PMC8672601 DOI: 10.1186/s13148-021-01189-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Socioeconomic position (SEP) is a major determinant of health across the life course. Yet, little is known about the biological mechanisms explaining this relationship. One possibility widely pursued in the scientific literature is that SEP becomes biologically embedded through epigenetic processes such as DNA methylation (DNAm), wherein the socioeconomic environment causes no alteration in the DNA sequence but modifies gene activity in ways that shape health. METHODS To understand the evidence supporting a potential SEP-DNAm link, we performed a scoping review of published empirical findings on the association between SEP assessed from prenatal development to adulthood and DNAm measured across the life course, with an emphasis on exploring how the developmental timing, duration, and type of SEP exposure influenced DNAm. RESULTS Across the 37 identified studies, we found that: (1) SEP-related DNAm signatures varied across the timing, duration, and type of SEP indicator; (2) however, longitudinal studies examining repeated SEP and DNAm measures are generally lacking; and (3) prior studies are conceptually and methodologically diverse, limiting the interpretability of findings across studies with respect to these three SEP features. CONCLUSIONS Given the complex relationship between SEP and DNAm across the lifespan, these findings underscore the importance of analyzing SEP features, including timing, duration, and type. To guide future research, we highlight additional research gaps and propose four recommendations to further unravel the relationship between SEP and DNAm.
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Affiliation(s)
- Janine Cerutti
- Department of Pscyhology, University of Vermont, 2 Colchester Ave, Burlington, VT, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building 6th Floor, Boston, MA, 02114, USA
| | - Alexandre A Lussier
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building 6th Floor, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Yiwen Zhu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building 6th Floor, Boston, MA, 02114, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jiaxuan Liu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building 6th Floor, Boston, MA, 02114, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building 6th Floor, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA.
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Waters EA, Colditz GA, Davis KL. Essentialism and Exclusion: Racism in Cancer Risk Prediction Models. J Natl Cancer Inst 2021; 113:1620-1624. [PMID: 33905490 PMCID: PMC8634398 DOI: 10.1093/jnci/djab074] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/10/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
Cancer risk prediction models have the potential to revolutionize the science and practice of cancer prevention and control by identifying the likelihood that a patient will develop cancer at some point in the future, likely experience more benefit than harm from a given intervention, and survive their cancer for a certain number of years. The ability of risk prediction models to produce estimates that are valid and reliable for people from diverse socio-demographic backgrounds-and consequently their utility for broadening the reach of precision medicine to marginalized populations-depends on ensuring that the risk factors included in the model are represented as thoroughly and as accurately as possible. However, cancer risk prediction models created in the United States have a critical limitation, the origins of which stem from the country's earliest days: they either erroneously treat the social construct of race as an immutable biological factor (ie, they "essentialize" race), or they exclude from the model those socio-contextual factors that are associated with both race and health outcomes. Models that essentialize race and/or exclude socio-contextual factors sometimes incorporate "race corrections" that adjust a patient's risk estimate up or down based on their race. This commentary discusses the origins of race corrections, potential flaws with such corrections, and strategies for developing cohorts for developing risk prediction models that do not essentialize race or exclude key socio-contextual factors. Such models will help move the science of cancer prevention and control towards its goal of eliminating cancer disparities and achieving health equity.
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Affiliation(s)
- Erika A Waters
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Kia L Davis
- Washington University School of Medicine, St Louis, MO, USA
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Nidoi J, Muttamba W, Walusimbi S, Imoko JF, Lochoro P, Ictho J, Mugenyi L, Sekibira R, Turyahabwe S, Byaruhanga R, Putoto G, Villa S, Raviglione MC, Kirenga B. Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study. BMC Public Health 2021; 21:2167. [PMID: 34836521 PMCID: PMC8620143 DOI: 10.1186/s12889-021-12056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. METHODS We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. RESULTS A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. CONCLUSIONS This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
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Affiliation(s)
- Jasper Nidoi
- Makerere University Lung Institute (MLI), Kampala, Uganda.
| | | | | | - Joseph F Imoko
- Makerere University Lung Institute (MLI), Kampala, Uganda
| | | | | | | | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | - Raymond Byaruhanga
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | | | - Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Bruce Kirenga
- Makerere University Lung Institute (MLI), Kampala, Uganda
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Park S, Kim H, Park CG. Determinants of long-term care insurance applications in South Korea. J Public Health (Oxf) 2021; 43:604-610. [PMID: 32618329 DOI: 10.1093/pubmed/fdaa094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND South Korea established universal long-term care insurance (LTCI) in 2008. However, actual requests for LTCI remain lower than government estimates because some eligible candidates never apply despite their strong care needs. This study aimed to examine factors affecting LTCI applications for older, community-dwelling Koreans. METHODS Both individual- and community-level data were obtained from a national dataset from the Korea Health Panel Survey and the Korea National Statistical Office (N = 523). Data were analyzed using multilevel modeling. RESULTS Only 16.4% of older adults in need of care applied for LTCI. Those who applied were more likely to be older, report poor self-rated health, receive care from non-family caregivers, and have caregivers experiencing high levels of caregiving burden. Regional differences in LTCI applications existed concerning the financial condition of one's community. CONCLUSIONS Our study findings emphasize that Korean LTCI should implement both individual and community strategies to better assist older adults in properly acquiring LTCI. The government should make comprehensive efforts to increase access to LTCI in terms of availability, quality, cost, and information by collaborating with local centers.
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Affiliation(s)
- Sunhee Park
- Barun ICT Research Center, Yonsei University, Seoul 03722, Korea
| | - Heejung Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60607-7161, USA
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Dlott CC, Pei X, Ittner JL, Lefar SL, O'Connor MI. Intersectionality of Net Worth and Race Relative to Utilization of Total Hip and Knee Arthroplasty. J Arthroplasty 2021; 36:3060-3066.e1. [PMID: 34099350 DOI: 10.1016/j.arth.2021.04.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the number of total hip arthroplasty and total knee arthroplasty (THA and TKA) increases, individuals of color continue to be less likely to undergo these procedures. Socioeconomic status may be a key influencer of THA and TKA utilization and outcomes. We explore the influence of net worth and race on THA and TKA utilization and outcomes of length of stay and readmissions using a large patient database. METHODS The StrataSphere data set, an aggregation of 49 health systems representing 209 hospitals, was used for primary THA and TKA procedures performed in the calendar year 2019. Net worth was determined from Market Vue Partners' data sources. Statistical analyses were performed to investigate relationships between net worth and patients undergoing THA or TKA. RESULTS When comparing our overall patient cohorts with the US population using Census data, we found differences in the utilization pattern indicated by index ratios most clearly in the lowest net worth categories. In the <$10K net worth category, THA and TKA index ratios were 0.51 and 0.54, respectively. In addition, we found that patients in the $100-250 and $250-500K net worth categories had increased utilization of both THA (index ratios of 1.39, 1.53) and TKA (index ratios of 1.45, 1.47) surgeries. CONCLUSION Net worth is a strong driver of disparities in utilization of THA and TKA with lower utilization of these surgeries in patients with net worth <$10K and increased utilization in patients with net worth from $100-250 and $250-500K.
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Affiliation(s)
| | - Xun Pei
- Strata Decision Technology, Chicago, IL
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Lugo-Robles R, Garges EC, Olsen CH, Brett-Major DM. Identifying Nontraditional Epidemic Disease Risk Factors Associated with Major Health Events from World Health Organization and World Bank Open Data. Am J Trop Med Hyg 2021; 105:896-902. [PMID: 34460422 PMCID: PMC8592146 DOI: 10.4269/ajtmh.20-1318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
Health events emerge from host, community, environment, and pathogen factors-forecasting epidemics is a complex task. We describe an exploratory analysis to identify economic risk factors that could aid epidemic risk assessment. A line list was constructed using the World Health Organization Disease Outbreak News (2016-2018) and economic indicators from the World Bank. Poisson regression employing forward imputations was used to establish relationships with the frequency with which countries reported public health events. Economic indicators demonstrated strong performance appropriate for further assessment in surveillance programming. In our analysis, three economic indicators were significantly associated to event reporting: how much the country's urban population changed, its average forest area, and a novel economic indicator we developed that assessed how much the gross domestic product changed per capita. Other economic indicators performed less well: changes in total, female, urban, and rural population sizes; population density; net migration; change in per cent forest area; total forest area; and another novel indicator, change in percent of trade as a fraction of the total economy. We then undertook a further analysis of the start of the current COVID-19 pandemic that revealed similar associations, but confounding by global disease burden is likely. Continued development of forecasting approaches capturing information relevant to whole-of-society factors (e.g., economic factors as assessed in our study) could improve the risk management process through earlier hazard identification and inform strategic decision processes in multisectoral strategies to preventing, detecting, and responding to pandemic-threat events.
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Affiliation(s)
- Roberta Lugo-Robles
- Department of Preventive Medicine and Biostatics, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation, Bethesda, Maryland
| | - Eric C. Garges
- Department of Preventive Medicine and Biostatics, Uniformed Services University, Bethesda, Maryland
| | - Cara H. Olsen
- Department of Preventive Medicine and Biostatics, Uniformed Services University, Bethesda, Maryland
| | - David M. Brett-Major
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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Wagg E, Blyth FM, Cumming RG, Khalatbari-Soltani S. Socioeconomic position and healthy ageing: A systematic review of cross-sectional and longitudinal studies. Ageing Res Rev 2021; 69:101365. [PMID: 34004378 DOI: 10.1016/j.arr.2021.101365] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/25/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The association between socioeconomic position (SEP) and health is well-established. However, the association between SEP and healthy ageing as a multidimensional construct is unclear. METHODS We conducted a systematic review of peer-reviewed cross-sectional and longitudinal studies on the associations between SEP and multidimensional healthy ageing measures. Studies were identified from a systematic search across major electronic databases from inception to February 2021. RESULTS Fourthy-five articles met inclusion criteria (26 cross-sectional and 19 longitudinal studies). There was no consistency in method of operationalizing healthy ageing across studies, domains included in the healthy ageing measures, or in the definition and number of levels of SEP indicators. Overall, regardless of heterogeneity between studies, a positive association between educational level (85.0 % of studies) and income/wealth (81.4 % of studies) and healthy ageing was evident. Regarding occupational position, evidence from 11 studies was inconclusive. The number of studies including home ownership, parenteral SEP, or composite SEP scores was insufficient to be able to draw a conclusion. CONCLUSIONS There is evidence that socioeconomic inequalities, as assessed by educational level and income/wealth, are associated with healthy ageing. These findings, and the broader evidence base on SEP and healthy ageing, highlight the importance of addressing inequality through integrated health and social policies and strategies.
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Affiliation(s)
- Emma Wagg
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
| | - Fiona M Blyth
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia
| | - Robert G Cumming
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia
| | - Saman Khalatbari-Soltani
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia.
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Finegood ED, Briley DA, Turiano NA, Freedman A, South SC, Krueger RF, Chen E, Mroczek DK, Miller GE. Association of Wealth With Longevity in US Adults at Midlife. JAMA HEALTH FORUM 2021; 2:e211652. [PMID: 35977209 PMCID: PMC8796893 DOI: 10.1001/jamahealthforum.2021.1652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/24/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Eric D. Finegood
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Daniel A. Briley
- Department of Psychology, University of Illinois Urbana-Champaign, Urbana
| | | | - Alexa Freedman
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Susan C. South
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
| | | | - Edith Chen
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Daniel K. Mroczek
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois
| | - Gregory E. Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
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Chen YS, Zhou ZN, Glynn SM, Frey MK, Balogun OD, Kanis M, Holcomb K, Gorelick C, Thomas C, Christos PJ, Chapman‐Davis E. Financial toxicity, mental health, and gynecologic cancer treatment: The effect of the COVID-19 pandemic among low-income women in New York City. Cancer 2021; 127:2399-2408. [PMID: 33899220 PMCID: PMC8239639 DOI: 10.1002/cncr.33537] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND New York City (NYC) emerged as an epicenter of the COVID-19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID-19 on cancer treatment, anxiety, and financial distress among low-income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS Medicaid-insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self-report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19-86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID-19 prevalence area, a delay in medical care resulted in a 4-fold increased rate of anxiety (P = .023, 95% CI, 1.278-14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.
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Affiliation(s)
- Yiting Stefanie Chen
- Department of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Zhen Ni Zhou
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | | | - Melissa K. Frey
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Onyinye D. Balogun
- Department of Radiation OncologyWeill Cornell Medical College and New York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Margaux Kanis
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyNew York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Kevin Holcomb
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Constantine Gorelick
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyNew York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Charlene Thomas
- Clinical and Translational Science CenterDepartment of Biostatistics and EpidemiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Paul J. Christos
- Clinical and Translational Science CenterDepartment of Biostatistics and EpidemiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Eloise Chapman‐Davis
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
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