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Valenzuela S, Peak KD, Huguet N, Marino M, Schmidt TD, Voss R, Quiñones AR, Nagel C. Social Deprivation and Multimorbidity Among Community-Based Health Center Patients in the United States. Prev Chronic Dis 2024; 21:E75. [PMID: 39325637 PMCID: PMC11451564 DOI: 10.5888/pcd21.240060] [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] [Indexed: 09/28/2024] Open
Abstract
Introduction Multimorbidity - having 2 or more chronic diseases - is a national public health concern that entails burdensome and costly care for patients, their families, and public health programs. Adults residing in socially deprived areas often have limited access to social and material resources. They also experience a greater multimorbidity burden. Methods We conducted a retrospective cohort analysis of electronic health record (EHR) data from 678 community-based health centers (CHCs) in 27 states from the Accelerating Data Value Across a National Community Health Center (ADVANCE) Network, a clinical research network, from 2012-2019. We used mixed-effects Poisson regression to examine the relationship of area-level social deprivation (eg, educational attainment, household income, unemployment) to chronic disease accumulation among a sample of patients aged 45 years or older (N = 816,921) residing across 9,362 zip code tabulation areas and receiving care in safety-net health organizations. Results We observed high rates of chronic disease among this national sample. Prevalence of multimorbidity varied considerably by geographic location, both within and between states. People in more socially deprived areas with Social Deprivation Index (SDI) scores in quartiles 2, 3, and 4 had greater initial chronic disease counts - 17.1%, 17.7%, and 18.0%, respectively - but a slower rate of accumulation compared with people in the least-deprived quartile. Our findings were consistent for models of the composite SDI and those evaluating disaggregated measures of area-level educational attainment, household income, and unemployment. Conclusion Social factors play an important role in the development and progression of multimorbidity, which suggests that an assessment and understanding of area-level social deprivation is necessary for developing public health strategies to address multimorbidity.
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Affiliation(s)
- Steele Valenzuela
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Katherine D Peak
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Robert Voss
- Research Department, OCHIN Inc., Portland, Oregon
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock
- University of Arkansas for Medical Sciences, 4310 West Markham St, Little Rock, AR 72205
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Jin Y, Brown R, Bhattarai M, Song J. Urban-rural differences in associations among perceived stress, resilience and self-care in Chinese older adults with multiple chronic conditions. Int J Older People Nurs 2024; 19:e12591. [PMID: 37986098 DOI: 10.1111/opn.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Social determinants of health (SDH) are mainly comprised of structural and intermediary domains. Emerging evidence suggests that the burden of multiple chronic conditions (MCCs) in older adults is exacerbated by structural determinants (e.g. low income and low education). However, less attention was paid to the intermediary determinants (i.e. material circumstances, psychosocial factors and behavioural factors) of MCCs. OBJECTIVES To investigate the associations among perceived stress, resilience and self-care in Chinese older adults with MCCs by comparing urban and rural groups. METHODS A convenience sample (125 and 115 participants from urban and rural settings, respectively) of Chinese older adults with MCCs was enrolled between January and April 2022. Hierarchical multiple regression analyses and propensity score weights were used to determine the associations among perceived stress, resilience and self-care. RESULTS Hypothesis 1 regarding the negative associations between perceived stress and self-care was fully supported in the rural group. However, for the urban group, the negative association was only supported for the relationship between MCCs-related perceived stress and self-care maintenance. Hypothesis 2 was fully supported regarding the positive associations between resilience and the three components of self-care in both groups, although the relationship between resilience and self-care monitoring was marginally significant in the urban group. Hypothesis 3 regarding the moderating effect of resilience was only supported in the relationship between general perceived stress and self-care monitoring in the rural group. After adding the propensity score weights, the moderating effect was no longer statistically significant in the rural group. CONCLUSIONS The urban-rural disparities in the Chinese context might largely be attributed to the complex interactions of the structural determinants and intermediary determinants. Findings can inform the development of culturally tailored interventions to promote self-care and reduce urban-rural disparities for Chinese older adults with MCCs. IMPLICATIONS FOR PRACTICE With the increasing number of older adults in China who are living with multiple chronic conditions and the call for effective interventions to improve their health outcomes, current findings can inform the development and implementation of nurse-led culturally tailored interventions to promote self-care and reduce urban-rural disparities for Chinese older adults with MCCs.
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Affiliation(s)
- Yuanyuan Jin
- School of Nursing, Medical College of Soochow University, Suzhou, China
- University of Wisconsin-Madison School of Nursing, Madison, USA
| | - Roger Brown
- University of Wisconsin-Madison School of Nursing, Medicine, and Public Health, Madison, USA
| | | | - Junyang Song
- School of Nursing, Medical College of Soochow University, Suzhou, China
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Ng Fat L, Patil P, Mindell JS, Manikam L, Scholes S. Ethnic differences in multimorbidity after accounting for social-economic factors, findings from The Health Survey for England. Eur J Public Health 2023; 33:959-967. [PMID: 37634091 PMCID: PMC10710338 DOI: 10.1093/eurpub/ckad146] [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] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Social-economic factors and health behaviours may be driving variation in ethnic health inequalities in multimorbidity including among distinct ethnic groups. METHODS Using the cross-sectional nationally representative Health Surveys for England 2011-18 (N = 54 438, aged 16+), we performed multivariable logistic regression on the odds of having general multimorbidity (≥2 longstanding conditions) by ethnicity [British White (reference group), White Irish, Other White, Indian, Pakistani, Bangladeshi, Chinese, African, Caribbean, White mixed, Other Mixed], adjusting for age, sex, education, area deprivation, obesity, smoking status and survey year. This was repeated for cardiovascular multimorbidity (N = 37 148, aged 40+: having ≥2 of the following: self-reported diabetes, hypertension, heart attack or stroke) and multiple cardiometabolic risk biomarkers (HbA1c ≥6.5%, raised blood pressure, total cholesterol ≥5mmol/L). RESULTS Twenty percent of adults had general multimorbidity. In fully adjusted models, compared with the White British majority, Other White [odds ratio (OR) = 0.63; 95% confidence interval (CI) 0.53-0.74], Chinese (OR = 0.58, 95% CI 0.36-0.93) and African adults (OR = 0.54, 95% CI 0.42-0.69), had lower odds of general multimorbidity. Among adults aged 40+, Pakistani (OR = 1.27, 95% CI 0.97-1.66; P = 0.080) and Bangladeshi (OR = 1.75, 95% CI 1.16-2.65) had increased odds, and African adults had decreased odds (OR = 0.63, 95% CI 0.47-0.83) of general multimorbidity. Risk of cardiovascular multimorbidity was higher among Indian (OR = 3.31, 95% CI 2.56-4.28), Pakistani (OR = 3.48, 95% CI 2.52-4.80), Bangladeshi (OR = 3.67, 95% CI 1.98-6.78), African (OR = 1.61, 95% CI 1.05-2.47), Caribbean (OR = 2.18, 95% CI 1.59-2.99) and White mixed (OR = 1.98, 95% CI 1.14-3.44) adults. Indian adults were also at risk of having multiple cardiometabolic risk biomarkers. CONCLUSION Ethnic inequalities in multimorbidity are independent of social-economic factors. Ethnic minority groups are particularly at risk of cardiovascular multimorbidity, which may be exacerbated by poorer management of cardiometabolic risk requiring further investigation.
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Affiliation(s)
- Linda Ng Fat
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Priyanka Patil
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
- Aceso Global Health Consultants Pte Limited, Singapore, Singapore
| | - Jennifer S Mindell
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Logan Manikam
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
- Aceso Global Health Consultants Pte Limited, Singapore, Singapore
| | - Shaun Scholes
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
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Magavern EF, Smedley D, Caulfield MJ. Factor V Leiden, estrogen, and multimorbidity association with venous thromboembolism in a British-South Asian cohort. iScience 2023; 26:107795. [PMID: 37810217 PMCID: PMC10550715 DOI: 10.1016/j.isci.2023.107795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Multimorbidity, estrogen use, and Factor V Leiden (FVL) are known independent risk factors for venous thromboembolism (VTE). This cross-sectional analysis of women in the Genes & Health British-South Asian cohort (N 20,048) linked the F5 SNP rs6025 with estrogen prescribing data and VTE events. Multivariable logistic regression was used to test the association between estrogen use, FVL, common medical co-morbidities, and VTE. Estrogens were prescribed to 30% of women. 3% of participants were FVL carriers. 439 participants had a VTE event (2.2%), and VTE prevalence increased with obesity, hypertension, dyslipidemia, chronic kidney disease, estrogen use, and in the presence of FVL. One medical condition above was independently associated with VTE with an OR 1.6 (CI 1.2-2.0, p 0.001); two medical conditions OR 2.7 (CI 2.0-3.7, p < 0.001); three OR 5.3 (CI 3.8-7.4, p < 0.001); four OR 8.1 (CI 4.9-13.0, p < 0.001). Multimorbidity and FVL compound risk of VTE with estrogen use.
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Affiliation(s)
- Emma F. Magavern
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Damian Smedley
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Mark J. Caulfield
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
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Buechner H, Toparlak SM, Ostinelli EG, Shokraneh F, Nicholls-Mindlin J, Cipriani A, Geddes JR, Syed Sheriff R. Community interventions for anxiety and depression in adults and young people: A systematic review. Aust N Z J Psychiatry 2023; 57:1223-1242. [PMID: 36722407 PMCID: PMC10466972 DOI: 10.1177/00048674221150362] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Growing evidence suggests that community-based interventions may be effective for anxiety and depression. This study aimed to describe studies of community interventions delivered to adults and/or young people, either in person or online, evaluated in randomised controlled trials and provide an indication as to their effectiveness, acceptability, quality of data and where possible, mechanisms of action. We included interventions delivered at and/or by museums, art galleries, libraries, gardens, music groups/choirs and sports clubs. METHOD We developed and followed a preregistered protocol: PROSPERO CRD42020204471. Randomised controlled trials in adults and young people were identified in an extensive search with no date/time, language, document type and publication status limitations. Studies were selected according to predetermined eligibility criteria and data independently extracted and then assessed using Risk of Bias 1. The studies were deemed too heterogeneous for meta-analysis and were therefore reported using a narrative synthesis. RESULTS Our analysis included 31 studies, with 2898 participants. Community interventions most studied in randomised controlled trials were community music (12 studies, 1432 participants), community exercise (14 studies, 955 participants) and community gardens/gardening (6 studies, 335 participants). The majority of studies were from high-income countries - many were in specific populations (such as those with physical health problems) and were generally of low quality. Dropout rates across the included studies were low (1 participant on average per 100 participants). The inadequate description of interventions limited identification of potential mechanisms of action. DISCUSSION The uncertainty of the evidence allows only a weak recommendation in support of community interventions for anxiety and depression. The results suggest community engagement is a promising area for wide-reaching interventions to be implemented and evaluated, but more high-quality trials are needed, especially in young people and under-represented communities.
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Affiliation(s)
| | - Sureyya M Toparlak
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Edoardo G Ostinelli
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Farhad Shokraneh
- Institute of Health Informatics, University College London, London, UK
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rebecca Syed Sheriff
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Bradford DRR, Allik M, McMahon AD, Brown D. Assessing the risk of endogeneity bias in health and mortality inequalities research using composite measures of multiple deprivation which include health-related indicators: A case study using the Scottish Index of Multiple Deprivation and population health and mortality data. Health Place 2023; 80:102998. [PMID: 36921377 DOI: 10.1016/j.healthplace.2023.102998] [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] [Received: 11/29/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
The inclusion of health-related indicators in composite measures of multiple deprivation introduces a risk of endogeneity bias when using the latter in health inequalities research. This bias may ultimately result in the inappropriate allocation of healthcare resources and maintenance of preventable health inequalities. Mitigation strategies to avoid this bias include removing the health-related indicators or using single constituent domains (such as income or employment class) in isolation. These strategies have not been widely validated. This study used population-level health and mortality data with a contemporary composite measure of multiple deprivation (Scottish Index of Multiple Deprivation; SIMD) to assess these mitigation strategies. The differences between deprivation methods (original, health excluded, and income domain) were negligible. The results of quantitative research on health inequalities are unlikely to be affected by endogeneity bias.
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Affiliation(s)
- D R R Bradford
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom.
| | - M Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom
| | - A D McMahon
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G2 3JZ, United Kingdom
| | - D Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom
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Dambha-Miller H, Cheema S, Saunders N, Simpson G. Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811492. [PMID: 36141763 PMCID: PMC9517156 DOI: 10.3390/ijerph191811492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 05/31/2023]
Abstract
Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinants in the MLTC sequelae is unclear. Aim: the aim of this review was to summarise and collate existing evidence on environmental determinants on established MLTC. Methods: comprehensive search of Medline, Embase, Cochrane, CINAHL and Bielefeld Academic Search Engine (BASE), from inception to 4th June 2022 in addition to grey literature. Two authors independently screened and extracted papers. Disagreements were resolved with a third author. Results: searches yielded 9079 articles, 12 of which met the review's inclusion criteria. Evidence of correlations between some environmental determinants and increased or decreased risks of MLTC were found, including the quality of internal housing/living environments, exposure to airborne environmental hazards and a beneficial association with socially cohesive, accessible and greener neighbourhood environments. Conclusions: The majority of the 12 included papers focused on the built and social environments. The review uncovered very limited evidence, indicating a need for further research to understand the role of environmental determinants in MLTC.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
| | - Sukhmani Cheema
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
| | - Nile Saunders
- Swansea Medical School, University of Swansea, Swansea SA2 8PP, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
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