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Junkins A, Chu DI, Burkholder GA, Wiener HW, George J, Kempf MC, Shrestha S. Demographic, clinical, and social characteristics of anal cancer among patients stratified by age (<50 and ≥50 years) in Alabama between 2012 and 2018. Cancer Epidemiol 2024; 92:102612. [PMID: 39018888 DOI: 10.1016/j.canep.2024.102612] [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: 04/21/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Anal cancer is increasing globally, with a high number of new cases occurring in highly developed countries, including the U.S. The incidence of anal cancer is higher among people living with HIV (PLHIV), and the U.S. South continues to see higher HIV incidence rates and lagging HPV vaccination rates. We aimed to identify factors associated with early onset anal cancer in Alabama which may help explain cancer disparities in the South. METHODS Using a cross-sectional study design, we examined demographic, clinical, and social characteristics among anal cancer patients stratified by diagnosis age (<50 and ≥50 years) in the Alabama cancer registry between 2012 and 2018. We used Wilcoxon rank sums and Pearson chi-square tests to assess associations between age at diagnosis, demographic (i.e., sex, race, marital status), clinical (i.e., BMI, HIV infection, site, stage, and histological type), and social (i.e. social vulnerability) characteristics, and multivariable logistic regression to estimate the odds of early onset cancer. RESULTS Among 519 patients with anal cancer in Alabama, 92 (17.7 %) were diagnosed at <50 years. The majority of patients were female (66.5 %) and White (83.4 %). Male sex, Black race, and HIV infection were associated with younger age at diagnosis. Black patients had a 4-fold increased odds of early onset anal cancer compared to White patients (AOR=4.39, CI=1.54-12.49). Black patients disproportionately lived in areas with higher social vulnerability. About 42 % of patients in areas with the highest social vulnerability were diagnosed with stage 3 or 4 cancer. About 8 % of cases were among people aged 35-44 years, which is close to double the proportion of anal cancer cases in this age group in the U.S. (4.7 %). CONCLUSIONS Patients who are Black, male, and PLHIV may be at higher risk of early onset anal cancer compared to other populations in the South.
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Affiliation(s)
- Anna Junkins
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Daniel I Chu
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Greer A Burkholder
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Howard W Wiener
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Justin George
- Alabama Department of Public Health, Montgomery, AL, USA
| | - Mirjam-Colette Kempf
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadeep Shrestha
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Gibbons RD, Olfson M, Saulsberry L, Edlund MJ, Zangeneh S, Bareis N, Chwastiak L, Gibbons JB, Kessler RC. Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders. JAMA Psychiatry 2024; 81:976-984. [PMID: 39046728 DOI: 10.1001/jamapsychiatry.2024.1870] [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] [Indexed: 07/25/2024]
Abstract
Importance Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. Objective To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older. Design, Setting, and Participants A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews. Main Outcomes and Measures Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level. Results The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80). Conclusions and Relevance In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.
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Affiliation(s)
- Robert D Gibbons
- Department of Medicine, Division of Biological Sciences, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, Division of Biological Sciences, University of Chicago, Chicago, Illinois
- Center for Health Statistics, University of Chicago, Chicago, Illinois
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York
| | - Loren Saulsberry
- Department of Public Health Sciences, Division of Biological Sciences, University of Chicago, Chicago, Illinois
| | | | - Sahar Zangeneh
- RTI International
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Natalie Bareis
- Department of Psychiatry, Columbia University, New York, New York
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jason B Gibbons
- Department of Health Systems, Management and Policy, University of Colorado, Aurora
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Shangani S, Winter MR, Shea M, Kim TW, So-Armah K, Magane KM, Bellamy SL, Saitz R, Stein MD. Social Vulnerability and Mental Health Among People with HIV and Substance Use: The Role of Race. AIDS Behav 2024:10.1007/s10461-024-04510-z. [PMID: 39327395 DOI: 10.1007/s10461-024-04510-z] [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] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
Poor mental health significantly impacts people with HIV (PWH) and those who drink alcohol. Limited data exist on the combined effects of social determinants of health (social vulnerability) on mental health in PWH with unhealthy substance use. We investigated the relationship between social vulnerability and poor mental health in PWH and whether this relationship differed by race/ethnicity. We conducted a cross-sectional analysis using data from the Boston ARCH Cohort among PWH with current or past unhealthy substance use. We created a 23-item social vulnerability index (SVI) using a deficit accumulation approach comprised of social determinants of health indicators. We estimated whether higher SVI score is associated with anxiety and depressive symptoms using logistic regression analysis. Among 251 participants with a mean age of 52 (SD = 10) years, 67.3% were male, 52% Black, 21% Hispanic, 19% White, and 73% unemployed. The SVI had a mean of 9.30 (SD = 3.4) with a 1.5-18 range. Nearly two in five persons reported past month heavy alcohol use and 35% illicit drug use. The prevalence of anxiety and depressive symptoms was 34.4% and 54.2% respectively. Higher SVI score was associated with anxiety symptoms (adjusted odds ratio [aOR] = 2.01, 95% confidence interval [CI] 1.46, 2.76, p ≤ 0.001), and depressive symptoms (aOR = 2.42, 95% CI 1.74, 3.36, p ≤ 0.001). Race/ethnicity did not moderate the relationship between SVI and each mental health outcome. SVI was significantly associated with poor mental health across racial/ethnicity groups in this cohort. Interventions that address social vulnerability may improve well-being and quality of life for PWH.
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Affiliation(s)
- Sylvia Shangani
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Margaret Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Theresa W Kim
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA
| | - Scarlett L Bellamy
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
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Menzies V, Webb F, Lyon DE, Pruinelli L, Kelly DL, Jacobs M. Anxiety and depression among individuals with long COVID: Associations with social vulnerabilities. J Affect Disord 2024; 367:286-296. [PMID: 39233251 DOI: 10.1016/j.jad.2024.08.214] [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: 03/28/2024] [Revised: 08/21/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND We examined the association between symptoms of anxiety and depression among individuals with long COVID and five social vulnerabilities (expenses, employment, food insufficiency, housing, and insurance). METHODS Data from the Census Bureau's Household Pulse Survey (HPS) detailing COVID incidence, duration, and symptoms between June 1st and November 14th, 2022 contained versions of the Generalized Anxiety Disorder (GAD-2) and the Patient Health Questionnaire (PHQ-2) questionnaires. Associations between anxiety, depression, and the five social vulnerabilities among respondents from different racial and ethnic groups experiencing long COVID were evaluated using generalized binomial logistic regression. Structural equation models tested whether social vulnerabilities mediated the pathway between race/ethnicity and anxiety/depression. RESULTS Blacks, Asians/others, and Hispanics with long COVID were significantly more likely to report anxiety and depression and various social vulnerabilities than Whites. Anxiety among Blacks was significantly associated with difficulty with expenses [Odds Ratio (OR) = 1.743, 95 % Confidence Interval (CI) = 1.739, 1.747], employment (OR = 1.519, 95 % CI = 1.516, 1.523), and housing (OR = 1.192, 95 % CI = 1.19, 1.194). Anxiety among Hispanics was significantly associated with food insufficiency (OR = 1.048, 95 % CI = 1.044, 1.052). Depression among Blacks was significantly associated with trouble with expenses (OR = 1.201, 95 % CI = 1.198, 1.205) and employment (OR = 1.129, 95 % CI = 1.127, 1.132). Mediation analysis showed that the number of social vulnerabilities partially mediated the association between race and anxiety. LIMITATIONS This retrospective study utilized secondary, observational, self-reported data from the HPS. Therefore, results may not be generalizable outside of the context in which they were collected. CONCLUSIONS The development of tailored programs for population health should address the differential associations of anxiety and depression with social difficulties among racial and ethnic groups.
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Affiliation(s)
- Victoria Menzies
- Department of Family & Community Health Sciences, University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL 32610, United States of America.
| | - Fern Webb
- Department of Surgery, Center for Health Equity & Engagement Research (CHEER), University of Florida College of Medicine, 653-1 West 8(th) Street, Jacksonville, FL 32209, United States of America
| | - Debra E Lyon
- Professor and Kirbo Endowed Chair, University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL 32610, United States of America
| | - Lisiane Pruinelli
- Department of Family & Community Health Sciences, University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL 32610, United States of America
| | - Debra Lynch Kelly
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL 31610, United States of America
| | - Molly Jacobs
- Department of Health Services Research, Management and Policy, University of Florida College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL 32610, United States of America
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Gelb J, Apparicio P, Alizadeh H. A synthetic vulnerable population dataset for fine scale geographical equity analysis and urban planning. Sci Data 2024; 11:954. [PMID: 39217157 PMCID: PMC11366005 DOI: 10.1038/s41597-024-03771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
Assessing the social and economic vulnerability of populations within a given area is essential for conducting environmental equity evaluations and devising effective public policies to mitigate disparities. However, prevailing indicators used to measure socio-economic vulnerability exhibit several shortcomings. Primarily relying on factor analysis, these indicators face challenges in terms of comparability over time, lack of standardized scales, and inherent limitations associated with composite indicators. To address these shortcomings, we propose a novel approach that estimates the number of potentially vulnerable individuals by constructing a synthetic population. Our methodology, developed using open tools and datasets, offers a scalable solution applicable to the entire Canadian context. The resulting percentage of potentially vulnerable populations demonstrates strong correlations with traditional vulnerability indicators commonly used in Canada, while overcoming their inherent limitations. The generated dataset holds significant potential and serves as a valuable resource for both researchers and governmental organizations. It provides a robust foundation for conducting equity analyses, assessments, and policy evaluations, thereby facilitating evidence-based decision-making processes aimed at promoting social and economic inclusivity.
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Affiliation(s)
- Jérémy Gelb
- Autorité Régionale de Transport Métropolitain - équipe Recherche et Valorisation des Données, 1001 Boulevard Robert-Bourassa, Montréal, QC, H3B 4L4, Canada.
| | - Philippe Apparicio
- Université de Sherbrooke - département de géomatique, 2500 Boulevard de l'université, Sherbrooke, QC, J1K 2R1, Canada
| | - Hamzeh Alizadeh
- Autorité Régionale de Transport Métropolitain - équipe Recherche et Valorisation des Données, 1001 Boulevard Robert-Bourassa, Montréal, QC, H3B 4L4, Canada
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Rabi S, Patton M, Santana MJ, Tang KL. Patient engagement in the development and implementation of navigation services: a scoping review protocol. BMJ Open 2024; 14:e082666. [PMID: 39097302 PMCID: PMC11298741 DOI: 10.1136/bmjopen-2023-082666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Patient navigation, a complex health intervention meant to address widespread fragmentation across the healthcare landscape, has been widely adopted internationally. This rapid uptake in patient navigation has led to a broadening of the service's reach to include those of different social positions and different health conditions. Despite the popularity and prevalence of patient navigation programmes, the extent of patient involvement and/or partnership in their construction has yet to be articulated. This scoping review will explore and describe the extent to which patients have been engaged in the development and/or implementation of patient navigation programmes to date. METHODS AND ANALYSIS This scoping review will adhere to the Arksey and O'Malley framework for conducting scoping reviews. The electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO, SocINDEX and Scopus were searched in September 2023 using terms related to patient navigation and programme implementation. Inclusion criteria stipulate that the studies must: (1) include an intervention labelled as 'navigation' in a healthcare setting and (2) describe patient engagement in the design, development and/or implementation process of said patient navigation programme. To assess study eligibility, two reviewers will independently read through the titles and abstracts, followed by the full texts, of each study identified from the search strategy to determine whether they meet inclusion criteria. Reviewers will then extract data from the included studies, present descriptive study characteristics in tables, and perform qualitative content analysis. ETHICS AND DISSEMINATION This review does not require ethics approval as data will be collated exclusively from peer-reviewed articles and thesis dissertations. A manuscript summarising the results of the review will be written and submitted to a peer-reviewed journal for publication. The review will map aspects of programme development that have repeatedly utilised patient perspectives and areas where engagement has lagged. This review will also depict how patient engagement varies across programme characteristics.
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Affiliation(s)
- Sarah Rabi
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Megan Patton
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Strategy for Patient-Oriented Research Patient Engagement Team, Edmonton, Alberta, Calgary
| | - Karen L Tang
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Medicine, University of Calgary, Calgary, Alberta, Canada
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Shaheen A, Medeiros FA, Swaminathan SS. Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery. Am J Ophthalmol 2024; 268:123-135. [PMID: 39089357 DOI: 10.1016/j.ajo.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/05/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Timing of surgical intervention in glaucoma is crucial to preserving sight. While ocular characteristics that increase surgical risk are known, the impact of neighborhood-level social risk factors such as the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) on time to glaucoma surgery is unknown. The objective of this study was to evaluate the association between SVI or ADI scores and the timing of glaucoma surgical intervention. DESIGN Retrospective cohort study. METHODS Adult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record. RESULTS A total of 10,553 eyes from 6934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3 ± 13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0 ± 2.1 years, with time to surgery of 3.2 ± 1.9 years. Multivariable accelerated failure time models demonstrated that higher mean intraocular pressure (time ratio [TR] 0.27 per 5 mm Hg higher; 95% confidence interval [CI]: 0.23-0.31, P < .001), faster standard automated perimetry rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, P < .001), moderate (TR 0.69; 95% CI: 0.56-0.85, P < .001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, P < .001), and thinner central corneal thickness (TR 0.85 per 50 µm thinner; 95% CI: 0.77-0.95, P = .003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, P = .006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, P = .037) and 4 (TR 1.11; 95% CI: 1.03-1.19, P = .006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, P = .002). CONCLUSIONS Residence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.
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Affiliation(s)
- Abdulla Shaheen
- From the Department of Ophthalmology, Bascom Palmer Eye Institute (A.S., F.A.M., S.S.S.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Felipe A Medeiros
- From the Department of Ophthalmology, Bascom Palmer Eye Institute (A.S., F.A.M., S.S.S.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Swarup S Swaminathan
- From the Department of Ophthalmology, Bascom Palmer Eye Institute (A.S., F.A.M., S.S.S.), University of Miami Miller School of Medicine, Miami, Florida, USA.
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Abdelhack M, Tripathi S, Chen Y, Avidan MS, King CR. Social vulnerability and surgery outcomes: a cross-sectional analysis. BMC Public Health 2024; 24:1907. [PMID: 39014400 PMCID: PMC11253435 DOI: 10.1186/s12889-024-19418-5] [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] [Received: 11/08/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. METHODS In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. RESULTS Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. CONCLUSIONS Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.
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Affiliation(s)
- Mohamed Abdelhack
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sandhya Tripathi
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Yixin Chen
- Department of Computer Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher R King
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
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Sakamoto T, Asano K, Miyata H, Amagai T. Meals in Shelters during Noto Peninsula Earthquakes Are Deficient in Energy and Protein for Older Adults Vulnerable to the Disaster: Challenges and Responses. Nutrients 2024; 16:1904. [PMID: 38931259 PMCID: PMC11207093 DOI: 10.3390/nu16121904] [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: 05/28/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Japan is a country often subject to natural disasters, influenced by a rapidly increasing aging demographic. The current research aims to analyze the food distribution for elderly evacuees who were relocated to a care facility in Wajima City, administered by the non-profit organization Tokushukai Medical Assistant Team (TMAT), post the Noto Peninsula Earthquake on 1 January 2024. A significant portion of the shelter's inhabitants were elderly individuals. METHODS TMAT's operations began immediately after the calamity, concentrating on evaluating the nutritional content of meals provided during the initial and subsequent phases, along with a thorough nutritional assessment. During this process, researchers examined the meal conditions for evacuees, including the elderly and those with disabilities, observed the actual meal distribution at welfare centers, and discussed the challenges and potential solutions. RESULT Throughout the TMAT mission, a total of 700 evacuees received assistance, with 65% being 65 years old or above. An analysis of the nutritional content of the 10 meal varieties served at the shelter revealed inadequate energy and protein levels for elderly individuals, particularly men, indicating the need for future enhancements. CONCLUSIONS Following a detailed evaluation of TMAT's response to the Noto Peninsula earthquake, it was determined that the food provided in the shelters in the affected areas did not meet the nutritional needs of elderly individuals, especially men, based on nutritional analysis. To stress the importance of establishing an effective framework, it is recommended to promptly revise the emergency food provisions for the elderly population, considering they constitute the majority of the affected individuals.
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Affiliation(s)
- Takamitsu Sakamoto
- Department of General Medicine, Fukuoka Tokushukai General Hospital, Fukuoka 816-0864, Japan
- The Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Kyoka Asano
- Tokunoshima Tokushukai General Hospital, Kagoshima 891-7101, Japan;
| | - Hiroyo Miyata
- Department of Clinical Nutrition, Kindai University Hospital, Osaka 589-8511, Japan
| | - Teruyoshi Amagai
- Department of Clinical Engineering, Faculty of Health Care Sciences, Jikei University of Health Care Sciences, Osaka 532-0003, Japan;
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Fuertes-Bucheli JF, Buenaventura-Alegría DP, Rivas-Mina AM, Pacheco-López R. Congenital Syphilis Prevention Challenges, Pacific Coast of Colombia, 2018-2022. Emerg Infect Dis 2024; 30:890-899. [PMID: 38666579 PMCID: PMC11060441 DOI: 10.3201/eid3005.231273] [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: 05/02/2024] Open
Abstract
High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018-2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having >1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.
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Reynolds JA, Pecorari IL, Ledet A, Agarwal V. High-Grade Glioma Recurrence Is Delayed in Hispanic Patients despite Severe Social Vulnerability: A Retrospective Cohort Study. Cancers (Basel) 2024; 16:1579. [PMID: 38672661 PMCID: PMC11048820 DOI: 10.3390/cancers16081579] [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: 03/24/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
High-grade gliomas (HGGs; WHO grade III or IV) are the most common and lethal brain malignancy. Patients of Hispanic ethnicity are diagnosed with HGGs earlier than non-Hispanic patients, but they exhibit improved HGG survival following diagnosis. Either environmental or biological factors could explain this survival benefit. We aimed to determine if post-diagnosis advantages would still be present in Hispanic patients with high social vulnerability, an environmental condition predisposing patients to poor oncologic outcomes. HGG outcomes were retrospectively assessed in a cohort of 22 Hispanic patients and 33 non-Hispanic patients treated for HGGs from 2015 to 2020 at a single institution that serves a highly vulnerable region. Compared to non-Hispanic patients, Hispanic patients demonstrated higher social vulnerability index scores (96.8 + 0.7 vs. 76.3 + 4.6; *** p = 0.0002) and a 14-month longer interval between diagnosis and recurrence (19.7 + 5.9 (n = 13) vs. 5.5 + 0.6 months (n = 19); ** p = 0.001). In only those patients with more aggressive IDH-1 wildtype tumors (glioblastoma), Hispanic ethnicity still related to a longer time before recurrence (15.8 + 5.9 months (n = 9); 5.5 + 0.6 months (n = 18); * p = 0.034), and in a multivariate analysis, Hispanic ethnicity predicted time-to-recurrence (* p = 0.027) independent of patient age, functional status, MGMT gene methylation, or treatments received. Therefore, environmental factors, specifically social vulnerability, did not obscure the post-diagnosis benefits associated with Hispanic ethnicity. In future experiments, basic studies should be prioritized which investigate the cellular or genetic mechanisms underlying this ethnicity effect on HGG progression in the hopes of improving care for these devastating malignancies.
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Affiliation(s)
- Joshua A. Reynolds
- Department of Neurological Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461, USA; (I.L.P.); (A.L.)
| | | | | | - Vijay Agarwal
- Department of Neurological Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461, USA; (I.L.P.); (A.L.)
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Levites Strekalova YA, Wang X, Sanchez O, Midence S. Trends in publication and levels of social determinants of health reporting in Journal of Clinical and Translational Science from 2017 to 2023. J Clin Transl Sci 2024; 8:e58. [PMID: 38655458 PMCID: PMC11036436 DOI: 10.1017/cts.2024.508] [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] [Received: 12/30/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
Social determinants of health affect clinical and translational research processes and outcomes but remain underreported in empirical studies. This scoping review examined the rate and types of social determinants of health (SDoH) variables included in the JCTS translational research studies published between 2017 and 2023 and included 129 studies. Most papers (91.7%) reported at least one SDoH variable with age, race and ethnicity, and sex included most often. Future studies to inform the role of SDoH data in translational research and science are recommended, and a draft SDoH data checklist is provided.
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Affiliation(s)
- Yulia A. Levites Strekalova
- Department of Health Services Research, Management and Policy, College of
Public Health and Health Professions, University of Florida,
Gainesville, FL, USA
- Clinical and Translational Science Institute, University of
Florida, Gainesville, FL, USA
| | - Xiangren Wang
- Department of Health Services Research, Management and Policy, College of
Public Health and Health Professions, University of Florida,
Gainesville, FL, USA
| | - Orlando Sanchez
- Clinical and Translational Science Institute, University of
Florida, Gainesville, FL, USA
| | - Sara Midence
- Department of Health Services Research, Management and Policy, College of
Public Health and Health Professions, University of Florida,
Gainesville, FL, USA
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Ho JYE, Lai ET, Chau PH, Chong KC, Woo J. The role of older adult-focused social vulnerability on the relationship between temperature and emergency department attendance in a subtropical Asian city. Arch Gerontol Geriatr 2024; 117:105195. [PMID: 37734171 DOI: 10.1016/j.archger.2023.105195] [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: 08/04/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Older adults exhibit a wide range of capabilities and vulnerabilities that affect their capacity to respond to heat. This study analysed the associations between hot temperatures and Accident & Emergency (A&E) attendance taking into account older adult-focused social vulnerability. METHODS Daily A&E attendance data of Young-old (65-74) and Old-old (75+) was obtained for Hong Kong 2010-2019 hot seasons and stratified into three Social Vulnerability Index (SVI) groups (Low, Moderate, High). Mean temperature (lag 0-2) was analysed on A&E attendance at each SVI using Generalized Additive Models and Distributed Lag Non-linear Models. RESULTS High temperatures were associated with increased same-day (lag 0) relative risk (RR) of A&E attendance for Young-old and Old-old in High SVI districts, with RR being 1.024 (95 % CI: 1.011, 1.037) and 1.036 (95 % CI: 1.018, 1.053), respectively. The Old-old living in Moderate and Low SVI districts also demonstrated increased RR of 1.037 (95 % CI: 1.028, 1.047) and 1.022 (95 % CI: 1.009, 1.036), respectively. Fewer emergency visits were found on the subsequent day (lag 1) of hot temperatures. CONCLUSIONS Older adults, both young-old and old-old, living in districts with higher social vulnerability tended to have increased risk of A&E attendance associated with same-day high temperature. With climate change and rapidly aging population, cities should prepare to meet needs of more vulnerable older adults in extreme heat.
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Affiliation(s)
- Janice Ying-En Ho
- Department of Architecture, The University of Hong Kong, Hong Kong SAR, China; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Eric Tc Lai
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - Ka Chun Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jean Woo
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Pinho ECC, da Silva Galvão JJ, Ramos AMPC, Aben-Athar CYUP, da Silva RAR, Cunha CLF, Botelho EP, Ferreira GRON. Social and individual vulnerability factors associated with syphilis among populations living on islands in the Brazilian Amazon. BMC Infect Dis 2024; 24:23. [PMID: 38166680 PMCID: PMC10763490 DOI: 10.1186/s12879-023-08955-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: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The repercussions of the syphilis epidemic differ according to populations. Identifying and acknowledging the differences and specificities of populations is fundamental in the design and implementation of policies aimed at assisting the groups most vulnerable to syphilis. OBJECTIVE To estimate the prevalence of antibodies against Treponema pallidum and associated vulnerability factors among riverside populations of a capital city in the Brazilian Amazon. METHODS Cross-sectional study was conducted among residents of the periurban islands in Belém, northern Brazil, from August 2020 to January 2021. The inclusion criterion was being a resident of the riverside communities of the Combú Environmental Protection Area, aged 18 years or over. The participants responded to questionnaire and were tested for syphilis using rapid test. Data were analyzed using multiple logistic regression by Minitab version 20® software. RESULTS Overall, a total of 325 riverine were included. Age varied from 18 to 91 years (average 40 years). Prevalence of markers for syphilis was 5.9% (95% CI: 3.3%-8.4%). The multiple regression showed that as age increases, the chances of having syphilis also increase (p = 0.001; aOR: 1.04) and riverside dwellers with more than one sexual partner in the last 6 months had more than four chances of having syphilis compared to people who had only one sexual partner (p = 0.007; aOR: 4.20). CONCLUSION Syphilis circulates among traditional populations in the Amazon and is associated with factors of social and individual vulnerability.
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Affiliation(s)
- Ellen Christiane Correa Pinho
- Programa de Pós Graduação Em Enfermagem, Federal, University of Para, Rua Augusto Correa, 01 - Setor Saúde, Guamá, Belém, Pará, 66075-110, Brazil
| | - José Jorge da Silva Galvão
- Programa de Pós Graduação Em Enfermagem, Federal, University of Para, Rua Augusto Correa, 01 - Setor Saúde, Guamá, Belém, Pará, 66075-110, Brazil
| | - Aline Maria Pereira Cruz Ramos
- Programa de Pós Graduação Em Enfermagem, Federal, University of Para, Rua Augusto Correa, 01 - Setor Saúde, Guamá, Belém, Pará, 66075-110, Brazil
| | | | | | - Carlos Leonardo Figueiredo Cunha
- Programa de Pós Graduação Em Enfermagem, Federal, University of Para, Rua Augusto Correa, 01 - Setor Saúde, Guamá, Belém, Pará, 66075-110, Brazil
| | - Eliã Pinheiro Botelho
- Programa de Pós Graduação Em Enfermagem, Federal, University of Para, Rua Augusto Correa, 01 - Setor Saúde, Guamá, Belém, Pará, 66075-110, Brazil
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Abdelhack M, Tripathi S, Chen Y, Avidan MS, King CR. Social Vulnerability and Surgery Outcomes: A Cross-sectional Analysis. RESEARCH SQUARE 2023:rs.3.rs-3580911. [PMID: 38077013 PMCID: PMC10705703 DOI: 10.21203/rs.3.rs-3580911/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. However, the socioeconomic factors that relate to postoperative complications are still unclear as they can be heterogeneous based on communities, types of surgical services, and sex and gender. Methods In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We built statistical logistic regression models of postsurgical complications with social vulnerability index as the independent variable along with sex interaction. Results We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Conclusions Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could be related to health outcomes. This suggests that the domain of preventive medicine should place social vulnerability as a priority to achieve its goals.
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Affiliation(s)
- Mohamed Abdelhack
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON
| | - Sandhya Tripathi
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
| | - Yixin Chen
- Department of Computer Science, Washington University in St. Louis, St. Louis MO
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
| | - Christopher R King
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
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