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Spiers GF, Davies LE, Sinclair D, Tan MMC, Kingston A, Hanratty B. Which unmet social care needs have the biggest impact on healthy ageing? An analysis of data from the English Longitudinal Study of Ageing. BMJ Open 2025; 15:e084812. [PMID: 39843380 PMCID: PMC11758690 DOI: 10.1136/bmjopen-2024-084812] [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: 01/29/2024] [Accepted: 12/10/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND AND AIM Unmet need for social care is linked to numerous adverse health outcomes. Understanding which unmet needs have the biggest impact on healthy ageing could help resource-stretched services prioritise care. To address this evidence gap, our analysis aimed to explore the association between selected individual unmet care needs and an indicator of healthy ageing. DESIGN AND DATA Cross-sectional analysis of data from the English Longitudinal Study of Ageing (Wave 9). A total of 6109 people aged 50 years or over, with complete data items, formed the basis for this analysis. MEASURES Absolute unmet need for help with each: walking 100 yards and climbing one flight of steps (mobility); managing money, managing medication, doing housework and shopping for groceries (instrumental activities of daily living (IADLs)); and dressing, walking across a room, bathing or showering, eating, using the toilet and getting in and out of bed (activities of daily living (ADLs)). Our outcome measure was poor self-rated health . RESULTS Associations between poor self-rated health and most unmet ADL, IADL and mobility needs were not statistically significant. People with an unmet need for support with managing money were nine times more likely to report poor self-rated health than those whose support needs were met in this domain (OR=9.23, 95% CI: 2.12 to 40.23). In a comparison of people with met and unmet needs, individuals with met needs had higher levels of dependency than those with unmet needs. CONCLUSIONS Some unmet needs may be especially consequential for older people's health. However, shortcomings in current data limit a clear and confident assessment of this. Our analysis highlights the importance of data on the level of need to better understand the link between unmet care needs and healthy ageing.
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Reed RG, Hillmann AR. Neighborhood-level socioeconomic disadvantage is associated with multiple cognitive domains in a community sample of older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2025:1-15. [PMID: 39825636 DOI: 10.1080/13825585.2025.2454517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 01/12/2025] [Indexed: 01/20/2025]
Abstract
Greater neighborhood disadvantage is associated with poorer global cognition. However, less is known about the variation in the magnitude of neighborhood effects across individual cognitive domains and whether the strength of these associations differs by individual-level factors. The current study investigated these questions in a community sample of older adults (N = 166, mean age = 72.5 years, 51% women), who reported current addresses, linked to state-level Area Deprivation Index rankings, and completed remote and validated neuropsychological tests of verbal intelligence (North American Adult Reading Test), verbal fluency (Controlled Oral Word Association Test), attention (Digit Span Forward), and working memory (Digit Span Backward and Sequencing, Letter-Number Sequencing). Linear regressions tested associations between neighborhood disadvantage and each cognitive test, controlling for individual-level factors (age, sex, education). Exploratory analyses tested moderation by each individual-level factor. Independent of individual-level factors, greater neighborhood disadvantage was associated with lower cognitive performance across domains: verbal intelligence (β = 0.30, p < .001), verbal fluency (β = -0.19, p = .014), attention (β = -0.19, p = .024), and two of three tests of working memory (β = -0.17- -0.22, ps = .004-.039). Results were robust to correction for multiple comparisons and tests of spatial autocorrelation. In addition, higher neighborhood disadvantage was associated with lower verbal fluency for older - but not younger-older adults (p = .035) and with poorer working memory in women but not men (p < .001). Education did not moderate associations. Findings suggest that older adults living in more disadvantaged neighborhoods exhibit lower cognitive performance, particularly in the domain of verbal intelligence. Continued investigation of effect modification may be fruitful for uncovering for whom associations are strongest.
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Affiliation(s)
- Rebecca G Reed
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abby R Hillmann
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Davies LE, Sinclair DR, Kingston A, Spiers GF, Hanratty B. Is it possible to identify populations experiencing material disadvantage in primary care? A feasibility study using the Clinical Practice Research Database. J Epidemiol Community Health 2024; 78:806-808. [PMID: 39227144 PMCID: PMC11671866 DOI: 10.1136/jech-2024-222396] [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: 04/26/2024] [Accepted: 08/04/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Material disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records. METHODS Using data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes. RESULTS We identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles. CONCLUSION Data in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners.
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Affiliation(s)
- Laurie E Davies
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David R Sinclair
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Kingston
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Frances Spiers
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Paust A, Vestergaard C, Smith SM, Friis K, Schramm S, Bro F, Mygind A, Bech Utoft N, Larkin J, Prior A. Economic, cultural, and social inequalities in potentially inappropriate medication: A nationwide survey- and register-based study in Denmark. PLoS Med 2024; 21:e1004473. [PMID: 39565747 PMCID: PMC11578507 DOI: 10.1371/journal.pmed.1004473] [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: 12/17/2023] [Accepted: 09/06/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND Potentially inappropriate medication (PIM) is associated with negative health outcomes and can serve as an indicator of treatment quality. Previous studies have identified social inequality in treatment but often relied on narrow understandings of social position or failed to account for mediation by differential disease risk among social groups. Understanding how social position influences PIM exposure is crucial for improving the targeting of treatment quality and addressing health disparities. This study investigates the association between social position and PIM, considering the mediation effect of long-term conditions. METHODS AND FINDINGS This cross-sectional study utilized data from the 2017 Danish National Health Survey, including 177,495 individuals aged 18 or older. Data were linked to national registers on individual-level. PIM was defined from the STOPP/START criteria and social position was assessed through indicators of economic, cultural, and social capital (from Bourdieu's Capital Theory). We analyzed odds ratios (ORs) and prevalence proportion differences (PPDs) for PIM using logistic regression, negative binomial regression, and generalized structural equation modeling. The models were adjusted for age and sex and analyzed separately for indicators of under- (START) and overtreatment (STOPP). The mediation analysis was conducted to separate direct and indirect effects via long-term conditions. Overall, 14.7% of participants were exposed to one or more PIMs, with START PIMs being more prevalent (12.5%) than STOPP PIMs (3.1%). All variables for social position except health education were associated with PIM in a dose-response pattern. Individuals with lower wealth (OR: 1.85 [95% CI 1.77, 1.94]), lower income (OR: 1.78 [95% CI 1.69, 1.87]), and lower education level (OR: 1.66 [95% CI 1.56, 1.76]) exhibited the strongest associations with PIM. Similar associations were observed for immigrants, people with low social support, and people with limited social networks. The association with PIM remained significant for most variables after accounting for mediation by long-term conditions. The disparities were predominantly related to overtreatment and did not relate to the number of PIMs. The study's main limitation is the risk of reverse causation due to the complex nature of social position and medical treatment. CONCLUSIONS The findings highlight significant social inequalities in PIM exposure, driven by both economic, cultural, and social capital despite a universal healthcare system. Understanding the social determinants of PIM can inform policies to reduce inappropriate medication use and improve healthcare quality and equity.
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Affiliation(s)
- Amanda Paust
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Susan M. Smith
- Discipline of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karina Friis
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Stine Schramm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Mygind
- Research Unit for General Practice, Aarhus, Denmark
| | | | - James Larkin
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
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Gireesh A, Sacker A, McMunn A, Bhatt R, Cadar D. Socioeconomic inequalities linked to the transitioning to neurocognitive disorders and mortality. Sci Rep 2024; 14:24690. [PMID: 39487192 PMCID: PMC11530460 DOI: 10.1038/s41598-024-74125-w] [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: 12/27/2023] [Accepted: 09/24/2024] [Indexed: 11/04/2024] Open
Abstract
Research on socioeconomic position (SEP) and mild neurocognitive impairment, considered a transient state between normal cognitive function and dementia is limited. The purpose of this study was to determine the role of SEP in transitioning between different cognitive states and mortality risk. Using nationally representative English data and utilising a multistate model association between SEP and the risk of transitioning from no cognitive impairment (NOCI) to Cognitive impairment no dementia (CIND), dementia and death were investigated. The potential reverse transition from CIND to NOCI was also explored. The probabilities of transitioning between cognitive states and time spent in each state differed significantly between those with lower and higher levels of SEP. Higher wealth was associated with a reverse transition from CIND to NOCI [HR = 1.56, CI (1.42,1.72)]. Socioeconomic advantage might protect against the progression to the early stages of neurocognitive disorders (CIND) and facilitate the potential reversion from mild cognitive impairment to a healthy cognitive state in later life. Lower levels of education affect the risk of mortality after the onset of dementia.
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Affiliation(s)
- Aswathikutty Gireesh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- Evaluation and Epidemiological Science, UK Health Security Agency, London, UK.
| | - Amanda Sacker
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rikesh Bhatt
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Dorina Cadar
- Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Department of Neuroscience, Centre for Dementia Studies, Brighton and Sussex Medical School, Trafford Centre, Brighton, BN1 9RY, UK
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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Shen A, Chen C, Zhang Z, Zhou J, Lv Y, Wang J, Li J. Associations between socioeconomic status and rates of blood pressure changes among Chinese older adults: a longitudinal community-based cohort study. Public Health 2024; 232:121-127. [PMID: 38772200 DOI: 10.1016/j.puhe.2024.04.027] [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: 11/12/2023] [Revised: 03/06/2024] [Accepted: 04/18/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES The relationships between socioeconomic status (SES) and blood pressure changes among older adults in China remain unclear. This study aimed to examine the associations between SES and rates of blood pressure changes among Chinese older adults. STUDY DESIGN Community-based, prospective, longitudinal cohort study. METHODS This study included 13,541 participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey between 2002 and 2018. SES was assessed by educational level, occupation, household yearly per capita income, and financial support. The estimated annual changes (EACs) of blood pressure were computed as the difference in blood pressure levels between any two adjacent surveys divided by the time interval. Associations between SES and EACs of blood pressure were evaluated using generalised estimating equations. RESULTS Lower SES was significantly associated with greater annual increases of blood pressure among Chinese older adults. The effect of SES on EACs of blood pressure was more pronounced among non-hypertensive participants. Compared to EACs among non-hypertensive participants with high SES, multivariable-adjusted EACs among those with low SES increased by 0.57 mmHg (95% confidence interval [CI]: 0.16, 0.99), 0.32 mmHg (95% CI: 0.07, 0.57), and 0.40 mmHg (95% CI: 0.13, 0.66) for systolic blood pressure, diastolic blood pressure, and mean arterial pressure, respectively. CONCLUSIONS This study revealed strong associations between SES and EACs of blood pressure among Chinese older adults, especially in the non-hypertensive population. Findings suggest that prevention strategies for hypertension should pay more attention to the older population with low SES.
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Affiliation(s)
- Anna Shen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zenghang Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Davies LE, Spiers GF, Sinclair DR, Kingston A, Hanratty B. Characteristics of older unpaid carers in England: a study of social patterning from the English Longitudinal Study of Ageing. Age Ageing 2024; 53:afae049. [PMID: 38497238 PMCID: PMC10945290 DOI: 10.1093/ageing/afae049] [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: 10/02/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND A growing number of older people provide unpaid care, but contemporary research evidence on this group is limited. AIM This study aims to describe the characteristics of older people who provide unpaid care and how these vary by socioeconomic position. METHODS Using recent information from the English Longitudinal Study of Ageing (ELSA wave 9, 2019), we analysed cross-sectional data on 1,282 unpaid carers aged ≥50. Data on sociodemographics, health, social wellbeing, care intensity and caregiver-recipient relationships were extracted. Total net non-pension wealth quintiles were used as a relative measure of socioeconomic position. Differences between the poorest and richest wealth quintiles were examined through logistic regression. FINDINGS Most older carers in ELSA were female and looking after another older person. Poor mental and physical health and social isolation were common, and socially patterned. Compared with carers in the middle wealth group, the poorest group were more likely to be living with the person they cared for (odds ratio (OR) 1.56 [95% confidence interval (CI) 1.03-2.36]) and more likely to experience loneliness (OR 2.29 [95% CI 1.42-3.69]), dependency (i.e. the need for help with activities of daily living) (OR 1.62 [95% CI 1.05-2.51]), chronic pain (OR 1.81 [95% CI 1.23-2.67]), a higher number of diseases (OR 1.75 [95% CI 1.15-2.65]) and fair/poor self-rated health (OR 2.59 [95% CI 1.79-3.76]). The poorest carers were also less likely to have a high quality of life (OR 0.51 [95% CI 0.33-0.80]) or be in work (OR 0.33 [95% CI 0.19-0.59]). CONCLUSION Our findings suggest that financially disadvantaged unpaid carers (and their households) may have the greatest needs for intervention and support. Focussing resources on this group has potential to address social inequalities.
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Affiliation(s)
- Laurie E Davies
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Gemma F Spiers
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - David R Sinclair
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Andrew Kingston
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
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Ruiz M, Hu Y, Martikainen P, Bobak M. Life Course Socioeconomic Position and Cognitive Aging Trajectories: A Cross-National Cohort Study in China and England. Innov Aging 2023; 7:igad064. [PMID: 37746633 PMCID: PMC10516463 DOI: 10.1093/geroni/igad064] [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: 07/29/2022] [Indexed: 09/26/2023] Open
Abstract
Background and Objectives Cross-national research on cognitive aging inequality has largely concentrated on Western countries. It is unclear whether socioeconomic position (SEP) has similar effects on cognitive decline in emerging economies. We compared the association between life course SEP and cognitive function trajectories between China and England, the largest nation under state socialism and one of the oldest capitalist countries. Research Design and Methods This cross-cohort study examined participants aged 50 years and older from the China Health and Retirement Longitudinal Study (n = 12,832) and the English Longitudinal Study of aging (n = 8,875). Cognition z-scores were derived using comparable measures of memory and time orientation on 4 occasions. Life course SEP was self-reported by participants at baseline. Seven- to 8-year trajectories of cognition z-scores were estimated using latent growth curve modeling. Country- and gender-specific associations between childhood/adolescent deprivation, education, material wealth, and home ownership were evaluated in relation to model intercept (baseline level) and linear slope (annual rate of change) of cognition. Results After multivariable adjustment, education was positively associated with the greatest differences in baseline cognition across country and gender. Education was further linked to a slower rate of cognitive decline (z-score units per year); but compared with those with low education, Chinese men (b = 0.032) and women (b = 0.065) with high education had significantly slower declines than English men (b = -0.004) and women (b = 0.010) with high education. Discussion and Implications Despite substantial between-cohort differences in downstream and upstream determinants of dementia, education provided the greatest benefits to cognitive aging in England but particularly in China.
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Affiliation(s)
- Milagros Ruiz
- School of Health and Social Care, University of Essex, Colchester, UK
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Yaoyue Hu
- Lab 1, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
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Avis SR, Figtree GA. Poorer care for the poor? Having fewer assets is associated with poorer care during, and worse outcomes after, an IHCA. Resuscitation 2022; 180:78-80. [PMID: 36167197 DOI: 10.1016/j.resuscitation.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Suzanne R Avis
- Cardiovascular Discovery Group, Kolling Institute, University of Sydney, Sydney, Australia; Tasmanian School of Medicine, University of Tasmania, Sydney, Australia.
| | - Gemma A Figtree
- Cardiovascular Discovery Group, Kolling Institute, University of Sydney, Sydney, Australia
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Koffman J, Bajwah S, Davies JM, Hussain JA. Researching minoritised communities in palliative care: An agenda for change. Palliat Med 2022; 37:530-542. [PMID: 36271636 DOI: 10.1177/02692163221132091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care access, experiences and outcomes of care disadvantage those from ethnically diverse, Indigenous, First nation and First people communities. Research into this field of inquiry raises unique theoretical, methodological, and moral issues. Without the critical reflection of methods of study and reporting of findings, researchers may inadvertently compromise their contribution to reducing injustices and perpetuating racism. AIM To examine key evidence of the place of minoritised communities in palliative care research to devise recommendations that improve the precision and rigour of research and reporting of findings. METHODS Narrative review of articles identified from PubMed, CINAHL and Google Scholar for 10 years augmented with supplementary searches. RESULTS We identified and appraised 109 relevant articles. Four main themes were identified (i) Lack of precision when working with a difference; (ii) 'black box epidemiology' and its presence in palliative care research; (iii) the inclusion of minoritised communities in palliative care research; and (iv) the potential to cause harm. All stymie opportunities to 'level up' health experiences and outcomes across the palliative care spectrum. CONCLUSIONS Based on the findings of this review palliative care research must reflect on and justify the classification of minoritised communities, explore and understand intersectionality, optimise data quality, decolonise research teams and methods, and focus on reducing inequities to level up end-of-life care experiences and outcomes. Palliative care research must be forthright in explicitly indentifying instances of structural and systemic racism in palliative care research and engaging in non-judgemental debate on changes required.
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Affiliation(s)
- Jonathan Koffman
- University of Hull, Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Sabrina Bajwah
- King's College London, Cicely Saunders Institute, London, UK
| | - Joanna M Davies
- King's College London, Cicely Saunders Institute, London, UK
| | - Jamilla Akhter Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
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