Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging

Sociodemographic characteristics and outcomes of surgically managed central cord syndrome patients

Introduction

Undiagnosed cervical spine stenosis is a risk factor for central cord syndrome (CCS), especially in vulnerable individuals. Social determinants of health (SDOH) are correlated with health outcomes. The aim of this study was to characterize the sociodemographic characteristics and outcomes in surgically-treated central cord syndrome (CCS) patients, and explore potential associations between them.

Methods

This is a retrospective cohort study of surgically-treated CCS patients at a Level-1 trauma center between 2015 and 2021. Patient demographics, radiological findings, and clinical outcomes were collected. SDOH were estimated using the Social Deprivation Index (SDI) and Area Deprivation Index (ADI). Descriptive statistics and regression analyses assessed associations between SDI/ADI, demographics and clinical outcomes.

Results

Of 56 patients, 75 % were insured by Medicare/Medicaid and 70 % were discharged to care facilities. Mean SDI was 66.4 ± 24.4, and mean ADI was 7.4 ± 2.2. Three patients required reoperation for post-operative complications. Post-operative neurologic outcomes varied, with 60.7 % stable, 30.4 % improved, and 8.9 % declined. While SDI/ADI did not correlate with outcomes, higher ADI quartiles were associated with decreased likelihood of home discharge (p = 0.048). Decline in neurologic function was associated with Medicare/Medicaid or Military insurance (p = 0.011).

Conclusions

The results of this study indicated that CCS patients typically come from lower socioeconomic backgrounds, as indicated by high SDI and ADI scores. Despite this, we did not find significant correlations between SDI or ADI with post-operative outcomes, and most patients had stable or improved neurological function post-surgery in our cohort. Future studies with larger sample sizes will provide a more comprehensive understanding of these findings.

Longitudinal association between posterior occlusal contact and dementia development in a large retrospective cohort study using a Japanese claims database

This study examines the association between posterior occlusal contact and the risk of dementia development in the Japanese population, utilizing Eichner classification to evaluate occlusal status. Data from Japanese health insurance claims were analyzed for the period from April 2016 to March 2022. Participants had undergone specific health checkups, had no prior history of dementia, and were classified according to their dental occlusal contact. Dementia diagnoses were determined using ICD-10 codes, and participants were divided into three groups-A, B, and C-based on the Eichner classification, which indicates the extent of occlusal contact. Over an average follow-up period of 35.6 months, 691 dementia were identified among 931,309 participants. Those diagnosed with dementia were more likely to belong to Eichner B and C groups, signifying reduced occlusal contact. After adjusting for covariates, the hazard ratios (95% confidence intervals) for Eichner B and C were 1.73 (1.31-2.28) and 2.10 (1.35-3.26), respectively. Sensitivity analyses confirmed these findings in adults aged 60-75. These findings suggest that reduced posterior occlusal contact correlates with an increased risk of dementia. Since the study is limited to participants under the age of 75, further research is required to determine its generalizability to older populations.

Income-Related Disparities in Mortality Among Young Adults With Type 2 Diabetes

Importance

Previous studies have indicated an inverse association between income and mortality. However, differences in health outcomes according to the income level of young adults with type 2 diabetes (T2D) compared with older adults with T2D have not been elucidated.

Objective

To estimate the overall and cause-specific mortality risks among patients with T2D according to income and age.

Design, Setting, and Participants

This retrospective nationwide cohort study in South Korea included adults aged 20 to 79 years who were diagnosed with T2D between January 1, 2008, and December 31, 2013, and followed up until December 31, 2019, and age- and sex-matched controls without diabetes. Data were analyzed between January 1, 2023, and August 27, 2024.

Main Outcomes and Measures

Risks of all-cause, cardiovascular, and cancer mortality were estimated according to participants' income, which was categorized into 3 levels (low, middle, and high) based on the health insurance premium. Logistic regression analyses and Cox proportional hazard regression analyses were performed according to age groups (20-39, 40-59, and 60-79 years).

Results

A total of 1 240 780 adults (604 975 patients with T2D and 635 805 age- and sex-matched controls without diabetes) were included in the analyses. Their mean (SD) age was 56.9 (11.8) years, and 626 176 (50.5%) were men. Overall, the risk of mortality increased with lower income among patients with T2D, as well as in comparison with controls without diabetes. There was an inverse association between income and mortality risk in younger individuals (adjusted hazard ratios of all-cause mortality in the low income vs high income subgroups with T2D were 2.88 [95% CI, 2.25-3.69] in those aged 20 to 39 years, 1.90 [95% CI, 1.81-2.00] in those aged 40 to 59 years, and 1.26 [95% CI, 1.23-1.29] in those aged 60 to 79 years; P < .001 for comparing risk ratios between age groups). The pattern of income-related disparities in younger individuals was observed in cardiovascular mortality but less in cancer mortality.

Conclusions and Relevance

In this cohort study of 1 240 780 individuals aged 20 to 79 years, the risk of mortality with low income was most prominent among individuals with T2D aged 20 to 39 years. These findings highlight the need for socioeconomic support to reduce income-related health disparities in younger individuals.

Perception of Utility and Efficacy of Implementation of TEC-MED Model of Care for Frail Older People and Their Caregivers: A Qualitative Study

INTRODUCTION

The global population is ageing, and healthcare systems continue to adopt outdated social models of ageing that do not respond to older people's needs. The aim of this study was to explore the experiences of participants in the implementation of the Transcultural social-ethical-care (TEC-MED) model for integrated community care.

METHODS

A qualitative descriptive research study was conducted. Qualitative data were collected through individual interviews and focus groups with purposive sampling.

RESULTS

We gathered experiences from five older people, five informal caregivers, two training agents (nurses), six healthcare professionals and eight stakeholders (senior management of businesses, public administrators, researchers and educators). Four themes were extracted: TEC-MED as a new model of home care, TEC-MED model outcome, key role of training agent and platform and resources. Overall, all the participants were satisfied with the model and various positive outcomes were found. The TEC-MED model of care was inclusive and personalised and bridged the communication and integration gaps between different services for the care of dependent older people and their caregivers in the community. Recommendations were made for improvements to the model.

CONCLUSION

New models of care that are inclusive, personalised and integrated are necessary to respond to the multiple needs of the older people. A model that integrates the multiple skills of healthcare professionals is an optimum solution in the care of the older people and their caregivers in Mediterranean countries. Similar research is imperative for other healthcare systems to help them prepare adequately to respond effectively to the needs of present and new generations of older people.

IMPLICATIONS FOR PRACTICE

The TEC-MED model presents a promising approach to addressing the complex care needs of older people and their caregivers by fostering inclusivity, personalisation and integration across services. For nursing practice, this model emphasizes the importance of multidisciplinary collaboration and the role of nurses in facilitating the adoption of new care strategies. Implementing such models in everyday practice could improve the quality of care provided to older adults, enhancing communication between healthcare providers and ensuring that care is more aligned with the individual needs of patients. Furthermore, integrating digital platforms and targeted resources, as highlighted in the TEC-MED model, can aid in overcoming existing barriers in healthcare systems, improving the coordination of care at the community level.

Bidirectional association between attitudes toward own aging and quality of life in Chinese older adults: A prospective cohort study

Although positive attitudes toward own aging (ATOA) have been shown to be associated with higher levels of quality of life (QoL) among older adults, the potential interrelationship between ATOA and QoL has not been fully explored. A sample of 2129 older adults aged 60 and above who participated in the three waves of the Chinese longitudinal healthy longevity survey was used. QoL was measured using three indicators, including self-rated health, loneliness, and life satisfaction. The cross-lagged analysis results showed that the bidirectional association between ATOA and QoL was not significant, while positive ATOA predicted better self-rated health, higher life satisfaction, and less loneliness. And there are no gender or age differences in the above relationships. In addition, economic status, sleep quality, and activity participation were common influences on self-rated health, life satisfaction, and loneliness, as well as important factors affecting ATOA. Several variables, such as demographic characteristics, health behaviors, and health status, also influenced QoL and ATOA. Measures to promote positive ATOA can help improve QoL. In addition, emphasis should be placed on improving economic status, sleep quality, and activity participation levels to enhance QoL and ATOA in older adults, with appropriate interventions targeting other factors affecting QoL and ATOA.

Who Are the People With Chronic Severe Back Pain Not Receiving Pain Treatment?

There is substantial access to care barriers for persons with chronic pain. Little is known about persons who do not receive treatment for chronic severe back pain as most studies rely on clinical samples. We sought to explore demographic, socioeconomic, and clinical characteristics of U.S. adults with chronic severe back pain who had not received pain care in the preceding 3 months. In this cross-sectional study, we used data from the 2019 National Health Interview Survey and identified persons who did/did not receive treatment (including self-management strategies) in the last 3 months for their chronic severe back pain. We used bivariate and multivariable analyses to explore factors associated with not receiving pain treatment. Almost 21% of persons with chronic severe back pain did not receive treatment in the past 3 months. The following were independently associated with not having treatment in the preceding 3 months: male sex (OR: 1.40, 95% CI: 1.11-1.76), living near or below the poverty level (OR: 1.92, 95% CI: 1.33-2.77), having less than a high school education (OR: 2.37, 95% CI: 1.52-3.68), not having insurance coverage (OR: 1.77, 95% CI: 1.21-2.59), living in the South (OR: 2.05, 95% CI: 1.40-3.00), and having heart disease (OR: 1.47, 95% CI: 1.11-1.93). Being a single parent, having depression, and multiple comorbid painful health conditions were associated with having treatment. Our conclusions are that one-fifth of persons with chronic severe back pain did not receive treatment for at least 3 months and socioeconomic factors were highly associated with not receiving treatment. PERSPECTIVE: In a nationally representative sample of persons with chronic severe back pain, one-fifth did not receive treatment for at least 3 months. Socioeconomic factors were highly associated with not receiving treatment. There is a need to implement solutions to reduce barriers to care.

The association of socioeconomic status with semen parameters in a cohort of men in the United States

BACKGROUND

Socioeconomic differences are present within the population of men who experience infertility and seek treatment.

OBJECTIVE

To study the association of socioeconomic status with semen parameters in a group of men using mail-in semen analyses.

MATERIALS AND METHODS

The records of 11,134 men that used mail-in semen analyses from a fertility company were identified. Their demographic information, semen parameters, and ZIP codes were collected. Area deprivation index (ADI) was used as a proxy for socioeconomic status and was calculated for each individual using their ZIP codes in order to measure their level of socioeconomic deprivation. A higher ADI signifies a more deprived area. The association between ADI and the semen parameters of this group was measured using linear regression analysis adjusted for age.

RESULTS

11,134 men were included in the study with a median age of 35 years (interquartile range (IQR): 32-40) and a median ADI of 83 (IQR: 68-97). The cohort had a median sperm concentration of 31 million/mL (IQR: 14-59), median total sperm count of 123 million (IQR: 57-224), median total motile sperm of 35 million (IQR: 9-95), median total motility of 32% (IQR: 15-52), progressive motility of 22% (IQR: 9-38), and morphology percent normal of 4% (IQR: 2-7). Higher ADI, indicating lower socioeconomic status, was negatively associated with various semen parameters, including sperm concentration, total sperm count, total motile sperm, and total and progressive motility.

DISCUSSION AND CONCLUSION

Men who live in more deprived areas are more likely to have worse semen parameters. Further research is needed to thoroughly examine the impact of socioeconomic status on male fertility. A comprehensive approach that targets upstream social, economic, and healthcare factors can possibly alleviate the negative association of socioeconomic status with fertility and semen parameters.

Neighborhood socioeconomic factors and characteristics correlated with avoidable emergency department visits: A spatial analysis of a Canadian academic hospital

INTRODUCTION

The influence of neighborhood characteristics and socioeconomic status (SES) factors on avoidable emergency department (ED) utilization is not well understood in a universal healthcare system. We examined correlations between these factors and avoidable ED visits at a Canadian academic hospital.

MATERIALS AND METHODS

We conducted a retrospective cohort study using administrative ED data from a hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023, and neighborhood data from the Statistics Canada Census of Population 2021. Avoidable visits were classified using the Emergency Department Avoidability Classification (EDAC), and mapped to neighborhoods using Canadian postal codes. SES was defined primarily based on education attained, household income, employment and housing security. The top 20 postal codes with the highest avoidable ED visits were categorized into quartiles and analyzed for trends using chi-squared tests of spatial association and Spearman rank correlations.

RESULTS

A consistent ordinal trend across quartiles was observed throughout the study period, with quartile 1 representing the lowest avoidable ED visits and quartile 4 the highest. The quartiles were unevenly distributed spatially, though there was a significant association between close proximity to the ED and avoidable visits (X2 = 7.07, p <0.05). The quartile with the highest avoidable ED visits (quartile 4) had the greatest proportion of one-person households (35.5%) and one-parent families (37.8%), and showed statistically significant positive correlations with male sex, living alone and having an indigenous identity. Quartile 4 had the highest rates of individuals not completing high school (18.6%, p < 0.05), unemployment (13.7%), households spending greater than 30% of their income on shelter (26.5%), and households earning less than $30,000 annually (16.6%, compared to 8.7% in quartile 1 with the lowest avoidable ED visits).

DISCUSSION

In a universal healthcare setting, lower SES neighborhoods were correlated with higher rates of avoidable ED visits. Targeted interventions that address social determinants of health disparities in neighborhoods with lower SES could reduce the burden of avoidable ED visits, and promote more equitable healthcare utilization.

Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis

BACKGROUND

In adults aged 50 + years, vaccine-preventable diseases (VPDs) pose a significant health burden and can lead to additional 'downstream effects' of infection beyond the acute phase e.g., increasing the risk for non-communicable disease and exacerbating chronic conditions. The aim was to understand and quantify the burden of VPD downstream effects in hospitalised adults in the United States.

METHODS

This retrospective observational study analysed hospitalisation claims data (2016-2019) with 1-year follow-up, in adults with a VPD diagnosis versus matched controls (using Optum's de-identified Clinformatics Data Mart Database). Outcomes included mortality; increase in Charlson Comorbidity Index (CCI) score; new diagnosis of comorbidities; and loss of independence (defined by need for home health/home care and/or move to long-term facility).

RESULTS

Mortality was significantly increased in VPD cases versus controls at 30-day (risk ratio [RR] of 4.08 [95% CI 3.98-4.18]) and 1-year follow-up (RR 2.76 [2.73-2.80]). Over a 1-year follow-up period, morbidity increased following VPD hospitalisation: 65-86% of VPD cases had new comorbidities diagnosed (versus 13-41% of controls); with a significantly higher mean increase in CCI score versus baseline (3.23 in VPD cases versus 0.89 in controls, p < 0.001). Adults were observed to experience a worsening of their health status and were less likely to return to their original health state. In addition, 41% of VPD cases had a loss of independence following hospitalisation versus 12% of controls; as seen by an increased need for home assistance (in 25% versus 9% of controls) and/or a move to a long-term care facility (in 29% versus 6% of controls).

CONCLUSIONS

This analysis suggests that VPD hospitalised cases suffer significantly worse clinical outcomes than controls, with downstream effects that include increased mortality and morbidity, and greater loss of independence. Evidence on potential downstream effects of infection is relatively new, and this additional burden is generally not considered in vaccine decision-making. More research is needed to disentangle the effect of VPDs on new comorbidities versus the natural course of the condition. Increasing awareness among adults, healthcare providers and decision makers could help to increase adult vaccination coverage, and reduce the clinical burden of VPDs.

DiScO: novel rapid systems mapping to inform digital transformation of health systems

Background

Global health systems are confronting challenges that intersect climate change with evolving communicable and non-communicable public health risks. Addressing these challenges requires systems integration via citizen big data that exist outside health systems. However, systems integration across jurisdictions is a complex challenge that requires stakeholder input. This study's purpose was to conduct rapid systems mapping with international health system stakeholders to inform the development and implementation of a global digital citizen science observatory (DiScO), which aims to catalyze digital transformation of health systems across jurisdictions.

Methods

A rapid qualitative systems mapping study was conducted during the International Society for Behavioral Nutrition and Physical Activity Annual Global Summit in Uppsala, Sweden, in June 2023. The choice of the venue and approach was informed by three key criteria: (1) Established evidence linking physical activity and nutrition with non-communicable diseases; (2) Concrete existing methods of obtaining citizen big data by physical activity and nutrition researchers; (3) Precedence of physical activity and nutrition researchers conducting citizen science as well behavioral/clinical big data collection. The design of this study was an innovative pre-post systems map development, which consisted of (1) real-time rapid systems mapping (pre/initial map) by engaging with international stakeholders and (2) adjustment of the real-time systems map (post/final map) after analyzing stakeholder discussion data.

Results

Rapid systems mapping resulted in a complex network that included key themes to successfully develop and implement DiScO: priorities, opportunities, risks, challenges, partnerships, and resources. Additionally, a new theme emerged organically through stakeholder group discussions - mitigation strategies. The adapted rapid systems map (i.e., after data analyses) depicts 23 key nodes of intervention across the seven key themes.

Conclusion

Rapid systems mapping at international symposia is a novel methodological approach to capture stakeholder input, particularly to understand complexity across international jurisdictions - an approach that can be replicated across disciplines and sectors to inform digital transformation of health systems. The development and implementation of DiScO, a platform for decentralization and democratization of technology, will take into consideration all the key nodes of intervention identified in the rapid systems map to promote digital health for equity across global jurisdictions.

Teeth, Health, and Mind: Understanding the Interplay of Social Determinants and Cognitive Decline in Older Adults

The study examines the association between social determinants of health, tooth loss, and cognitive decline. Using regression models, the 2020 Behavioral Risk Factor Surveillance data examined the study objective; it included 32,663 older adults who reported on cognitive status. Results suggested that older adults missing more than five teeth or unable to work are 1.61 times and 6.84 times more likely to report cognitive decline, respectively. Older adults with higher education and higher household incomes are less likely to report cognitive decline. Results suggested that older adults with no diabetes or who never smoked are 31% and 39% less likely to report a cognitive decline. The results suggested a significant association between tooth loss and cognitive decline among social determinants of health. A comprehensive approach to affect cognitive decline should include oral and social health strategies.

Income Disparities Have a Significant Impact on Thyroid Cancer Recurrence and Survival

PURPOSE

Income inequality profoundly impacts cancer outcomes, yet its specific effects on thyroid cancer remain unclear. Elucidating the influence of socioeconomic disparities is imperative to advance health equity and optimize patient care. This study evaluates associations between median household income and thyroid cancer recurrence and survival using national cancer registry data.

METHODS

139,302 thyroid cancer patients undergoing surgery from 2000-2019 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized by median annual household income at the county level (> or <$75,000). Multivariable regression determined the impact of income on recurrence and overall mortality.

RESULTS

Higher-income patients had 26% lower recurrence odds (OR 0.74, 95%CI 0.55-0.99, p=0.042) and longer median survival (18.1 vs 17.7 years, p<0.001) compared to lower-income patients. On multivariate analysis, high income remained an independent predictor of reduced mortality after adjusting for demographics, tumor factors, and treatment (adjusted HR=0.84, 95%CI=0.81-0.87, p<0.001). Cancer-directed surgery (HR=0.28, 95%CI=0.26-0.30, p<0.001) and radioactive iodine (HR=0.69, 95%CI=0.66-0.71, p<0.001) were associated with lower mortality risk.

CONCLUSIONS

Income disparities have a significant influence on thyroid cancer outcomes, including lower recurrence and reduced mortality. Targeting socioeconomic inequity could substantially reduce recurrence, improve survival, and promote health equity for all patients.

The impact of healthcare system quality and economic factors on the older adult population: a health economics perspective

Purpose

This study investigates the influence of economic conditions, healthcare system capacity, and health-related variables on the proportion of the older adult population (Population ages 65 and above) in European Union countries. It aims to identify how factors such as GDP, unemployment, inflation, healthcare expenditure, hospital bed availability, and the prevalence of chronic diseases impact the aging demographic.

Methods

This study explores the dynamic interactions and temporal relationships between economic stability, healthcare capacity, chronic disease prevalence, and demographic aging patterns. The research employs a mixed-method approach, utilizing System GMM and wavelet coherence analysis on panel data from 27 EU countries between 2000 and 2021.

Results

The findings reveal significant positive associations between economic prosperity and healthcare resources with the size of the older adult population. Increased GDP, efficient healthcare spending, and hospital bed availability are positively correlated with a larger older adult demographic. In contrast, high unemployment and inflation are linked to negative outcomes for the older adult population, reducing available resources and access to healthcare. Wavelet coherence analysis further uncovers how fluctuations in the prevalence of chronic diseases influence aging trends across different periods and frequencies.

Conclusion

The study highlights the importance of integrated economic and healthcare policies to support the growing older adult population. Ensuring economic stability, enhancing healthcare infrastructure, and effectively managing chronic diseases are essential for improving quality of life and promoting sustainable aging in EU societies.

Association Between Median Household Income and Perioperative Outcomes of Lumbar Spinal Fusion: An Analysis of the National Inpatient Sample (2009-2020)

BACKGROUND

Relationships between low socioeconomic status and surgical outcomes are well established for certain procedures. However, scant literature has focused on relationships between median household income and lumbar fusion outcomes.

METHODS

Patients who underwent fusion procedures between January 1, 2009 and December 31, 2020 were identified from the National Inpatient Sample database. They were categorized into 4 quartiles, from lowest to highest, based on median household incomes in respective zip codes. We applied univariable and multivariable linear and logistic regression models to analyze perioperative data according to income quartiles.

RESULTS

We included 2,826,396 patients. In multivariable regression, patients in the 3 lowest income quartiles exhibited higher rates of in-hospital cardiac events perioperatively, with odds ratios (ORs) of 1.19 (95% confidence interval [CI]1.13-1.26, P < 0.001), 1.10 (95% CI 1.05-1.16, P < 0.001), and 1.06 (95% CI 1.01-1.12, P = 0.011) for the first, second, and third quartiles, respectively. Patients in the lowest income (first) quartile had a higher occurrence of perioperative urinary complications (OR = 1.07, 95% CI 1.03-1.12, P = 0.001), systemic infectious complications (OR = 1.17, 95% CI 1.04-1.32, P = 0.006), neurological deficit (OR = 1.17, 95% CI 1.06-1.30, P = 0.002), and wound infections (OR = 1.22, 95% CI 1.12-1.34, P < 0.001). Those in the 3 lowest income quartiles were less likely to experience respiratory, gastrointestinal, and venous thrombotic complications (P < 0.05). The lowest income quartile had protective associations for dural tears (OR 0.93, 95% CI 0.89-0.99, P = 0.038) and postprocedure anemia across all 3 lower quartiles, with OR < 1 and P < 0.001.

CONCLUSIONS

Reduced household income significantly affected perioperative outcomes after lumbar fusion and should be taken into consideration during the perioperative period.

Perspective: leveraging review protocols to advance implementation science in support of older adults' health equity

Globally, there has been an increasing call for dissemination and implementation science to improve the health equity of older adults. However, improving the health equity of older adults requires methods that allow for an in-depth understanding of the existing research. While the value of review articles is widely recognized, the value of publishing review protocols is an emerging paradigm with great potential to advance implementation science and aging research. In this article, we propose that prior to review articles, review protocols are necessary as they provide a clear and comprehensive search strategy, which greatly enhances the quality and rigor of reviews. More specifically, we argue that review protocols are indispensable because they support: (1) a clearly defined and comprehensive search methodology; (2) reviewer feedback to mitigate potential issues; and (3) registration to reduce risk of research replication. Additionally, we propose three strategies to accelerate review protocols in implementation science to support older adults' health equity.

Associations of socioeconomic status and chronic stress with incident atrial fibrillation among older adults: A prospective cohort study from the UK biobank

BACKGROUND

This study aimed to assess the relationship between socioeconomic status (SES) and chronic stress on the incidence of atrial fibrillation (AF) in older adults, and the potential role of chronic stress in the association.

METHODS

This study included 122,494 UK Biobank participants aged ≥60 years without AF at baseline. Latent class analysis was used to define the SES of participants. Chronic stress was measured using allostatic load (AL), and participants were categorized into low, medium and high AL groups. The Cox proportional hazards model, mediation, and interaction analyses were conducted to investigate the associations between SES, AL, and AF risk.

RESULTS

Low SES (hazard ratio [HR]: 1.10; 95 % confidence interval [CI]: 1.04-1.15) and high AL (HR: 1.37; 95 % CI: 1.30-1.45) were associated with an increased risk of AF, respectively. Individuals in the low SES and high AL groups exhibited the highest risk of AF compared to those in the high SES and low AL groups (HR: 1.46; 95 % CI: 1.32-1.61). We identified additive and multiplicative interactions in the low SES and high AL groups (relative risk due to interaction: 0.12 (95 % CI: 0.02-0.22); P for interaction = 0.0385). AL also exerted a partial mediating effect on the association between SES and the incidence of AF (mediation proportion: 17.3 %; 95 % CI: 5.9-28.7 %).

CONCLUSIONS

Our study revealed significant associations between SES, chronic stress, and the incidence of AF in older adults. Chronic stress was also shown to partially mediate the association.

Global prevalence of depression, anxiety, and stress in the elderly population: a systematic review and meta-analysis

BACKGROUND

Several preliminary studies have been conducted in the field of the prevalence of depression, anxiety, and stress in the elderly population. These studies have examined the prevalence in limited geographic areas with small sample sizes. Also, there are many limitations in the meta-analysis studies. The objective of the present study was to synthesize the global prevalence statistics of depression, anxiety, and stress in the elderly population through a systematic review and meta-analysis.

METHODS

The present systematic review included retrieval of primary studies from the oldest relevant study up to 2023. To find the relevant studies, international databases such as Scopus, Embase, PubMed, and Web of Science (WoS) were systematically searched. Also, a manual search was performed through the Google Scholar search engine and a review of the sources of related articles. The qualitative assessment of the studies was conducted using the Joanna Briggs Institute (JBI) checklist. Due to a high heterogeneity among the study results, a Random Effects model was chosen.

RESULTS

A total of 42 articles on depression, 47 articles on anxiety and 13 articles on stress were included in the meta-analysis. The overall estimates for prevalence based on a random-effects model were as follows: depression, 19.2% (95% CI: 13.0 - 27.5%); anxiety, 16.5% (95% CI: 11.1 - 22.8%); and stress, 13.9% (95% CI: 5.5 - 30.9%). The highest prevalence of depression and anxiety was recorded in Africa. The prevalence of depression was higher in nursing homes, and stress was more prevalent in individuals with COVID-19 compared to other populations.

CONCLUSION

The findings revealed a high prevalence of depression, anxiety, and stress in the elderly population. Therefore, it is recommended that healthcare professionals and policymakers pay more attention to the prevention and management of these disorders in the elderly population.

Priorities for multimorbidity management and research in cancer: a Delphi study of Australian cancer survivors, clinicians, and researchers

PURPOSE

Multimorbidity is common in people with cancer and associated with increased complexity of care, symptoms, mortality, and costs. This study aimed to identify priorities for care and research for cancer survivors with multimorbidity.

METHODS

A Delphi consensus process was conducted. Elements of care and research were based on Australia's National Strategic Framework for Chronic Conditions, a literature review, and expert input. In Round 1, health professionals, cancer survivors, and researchers rated the importance of 18 principles, 9 enablers, and 4 objectives. In Round 2, new elements were rated and all elements were ranked.

RESULTS

In Round 1, all elements reached consensus for care delivery; three principles and one enabler did not reach consensus for research and were eliminated. One principle and two enablers were added, reaching consensus. In the final list, 19 principles, 10 enablers, and 4 objectives were included under care delivery; 14 principles, 9 enablers, and 4 objectives were included under research. For care delivery, principles of 'survivorship' and 'self-management' were ranked highest, and 'peer support' and 'technology' were the most important enablers. For research, 'survivorship' and 'coordinated care' were the highest-ranked principles, with 'peer support' and 'education' the most important enablers.

CONCLUSION

Most elements apply to the general population and cancer survivors; however, additional elements relevant to survivorship need consideration when managing multimorbidity in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Chronic disease frameworks should be more inclusive of issues prioritised by people with, managing, or researching cancer through interdisciplinary approaches including acute and primary care.

Racial and socioeconomic disparities in survival among patients with metastatic non-small cell lung cancer

BACKGROUND

Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non-small cell lung cancer. However, population-based studies evaluating this impact on survival by race and socioeconomic factors are lacking.

METHODS

We used the Surveillance, Epidemiology, and End Results Program-Medicare database to identify patients with metastatic non-small cell lung cancer diagnosed between 2015 and 2019. The primary study outcomes were the receipt of an immune checkpoint inhibitor and overall survival. χ2 tests and logistic regression were used to identify demographic factors associated with receipt of immune checkpoint inhibitors. The Kaplan-Meier method was used to calculate 2-year overall survival rates, and log-rank tests were used to compare survival by race and ethnicity.

RESULTS

Of 17 134 patients, approximately 39% received an immune checkpoint inhibitor. Those diagnosed with cancer recently (in 2019); who are relatively younger (aged younger than 85 years); non-Hispanic White, non-Hispanic Asian, or Hispanic; living in high socioeconomic status or metropolitan areas; not Medicaid eligible; and with adenocarcinoma histology were more likely to receive immune checkpoint inhibitors. The 2-year overall survival rate from diagnosis was 21% for the overall population. The 2-year overall survival rate from immune checkpoint inhibitor initiation was 30%, among those who received at least 1 cycle and 11% among those who did not receive immune checkpoint inhibitors. The 2-year overall survival rates were higher among non-Hispanic White (22%) and non-Hispanic Asian (23%) patients compared with non-Hispanic Black (15%) and Hispanic (17%) patients. There was no statistically significant racial differences in survival for those who received immune checkpoint inhibitors.

CONCLUSION

Immune checkpoint inhibitor utilization rates and the resulting outcomes were inferior for certain vulnerable groups, mandating the need for strategies to improve access to care.

Material deprivation is associated with liver stiffness and liver-related outcomes in people with HIV

BACKGROUND

Socioeconomic status (SES) is a driver of health disparities and chronic diseases. People with HIV (PWH) are at risk for chronic liver diseases. We evaluated the association between low SES and hepatic outcomes in PWH.

METHODS

We included PWH from a prospective cohort. SES was assessed by the Pampalon material and social deprivation index to classify the cohort into quintiles of deprivation. Multivariable linear regression was used to investigate associations of material and social deprivation with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) as markers of hepatic fibrosis and steatosis, respectively. Incidence of outcomes was evaluated through survival analysis.

RESULTS

Among the 804 PWH included, 45% and 72% were living in areas of the highest material and social deprivation, respectively. Materially deprived PWH were more frequently female and of non-white ethnicity and had higher prevalence of metabolic comorbidities. After adjustments, material deprivation correlated with increased LSM (β = 1.86, 95% CI 0.53-3.17) but not with CAP (β = 6.47, 95% CI -5.55-18.49). Patients were observed for a median follow-up of 3.8 years. Incidence of liver-related events was higher in most materially deprived compared to most privileged PWH (hazard ratio 3.03, 95% CI 1.03-8.92), while there was no difference in extrahepatic outcomes or all-cause mortality. Social deprivation showed no association with either LSM or clinical outcomes.

CONCLUSIONS

Living in materially deprived neighbourhoods as a proxy for lower SES, is associated with LSM and liver-related events in PWH. Future strategies should explore mechanisms underlying these relationships and whether enhanced material security improves hepatic outcomes.

The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study

BACKGROUND

Loneliness is described as the subjective experience of unfulfilled personal and social needs, with emotional and social domains. Frailty is a state of vulnerability to stressors, which is often characterised by impairment in the physical, psychological and/or social domain.

OBJECTIVE

This study aims to examine the bidirectional association between loneliness and frailty across the different domains.

METHODS

The study included 1735 older adults from the Urban Health Centres Europe project. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale. Frailty was assessed by the Tilburg Frailty Indicator. Multivariate linear regression and cross-lagged panel models were used to explore the associations between the social and emotional loneliness dimensions and overall, physical, psychological and social frailty.

RESULTS

A bidirectional association existed between overall loneliness and overall frailty (loneliness to frailty: β = 0.09, 95% CI: 0.03, 0.15; frailty to loneliness: β = 0.05, 95% CI: 0.004, 0.10). Higher levels of overall loneliness at baseline were associated with higher levels of psychological frailty at follow-up (β = 0.05, 95% CI: 0.00, 0.10). The reverse association was not significant. A bidirectional association existed between overall loneliness and social frailty (loneliness to social frailty: β = 0.05, 95% CI: 0.01, 0.10; social frailty to loneliness: β = 0.05, 95% CI: 0.00, 0.09).

CONCLUSION

This study confirms the importance of addressing loneliness among older adults. Interventions that increase social support, exercise engagement and promote healthy behaviours may be effective in reducing the risk of frailty among older adults and simultaneously preventing loneliness.

Cognition and Wealth Changes in Mid-to-later Life: A Latent Class Trajectories Approach Using the Health and Retirement Study

ObjectivesTo assess how cognitive trajectories from mid-to-later life relate to wealth change, overall and by mid-life income. Methods: Data were from participants (51-64 years) in the 2000-2018 U.S. Health and Retirement Study who were cognitively healthy at baseline (year 2000; unweighted n = 3821). Longitudinal latent class analyses generated cognitive and wealth trajectories, independently, and multinomial logistic regressions estimated the association between cognitive trajectories and wealth profiles, overall and by median income. Results: We identified three cognitive: cognitively healthy (CH), increasing cognitive impairment (ICI), and increasing dementia (ID) and four wealth profiles: stable wealth loss (SWL), delayed gradual wealth loss (DGWL), stable wealth gain (SWG), and gradual wealth gain (GWG). The ID group had higher probability of being in the SWL group and lower probability of SWG, which was more pronounced in respondents with greater median income. Discussion: Individuals with ID may be vulnerable to wealth loss, particularly for middle-class households.

Socioeconomic status affects amputation and mortality rates in necrotizing fasciitis patients

PURPOSE

Necrotizing fasciitis (NF) is a rare, but rapidly progressing bacterial infection of the subcutaneous tissues and muscular fascia with high rates of morbidity and mortality. Our study aims to determine if socioeconomic status (SES) is a predictor of outcomes in NF.

METHODS

A retrospective review was conducted of patients diagnosed with NF at our institution. Demographic information, insurance status, medical and surgical history, vitals, ASA score, blood laboratory values, surgical procedure information, and outcomes prior to patient discharge were collected. Patient zip codes were utilized to obtain median household incomes at the time of the patient's surgical procedure to determine SES. Patients without complete data in their medical record were excluded. Initial descriptive statistics and logistic regression models were performed.

RESULTS

We identified 196 patients (mean age 50.13 ± 13.03 years, 31.6% female) for inclusion. Mortality rate was 15.3% (n = 30) and 33.7% (n = 66) underwent amputation. Mortality rate was not significantly different across income brackets. Lower income brackets had higher rates of amputation than higher income brackets (p < 0.05). A logistic regression models showed the rate of amputation decreases by 29% for every $10,000 increment in median household income and ASA score decreased by 0.15 units for every $10,000 increase in median household income.

CONCLUSIONS

Amputation rates in cases of NF are significantly higher in lower SES groups than higher SES groups. Patients with perivascular disease in lower SES groups were more likely to experience serious complications of NF than their counterparts in higher SES groups.

India's Potential as a Leader in Cancer Care Progress in the Future: A Synthetic Interdisciplinary Perspective

This paper comprehensively analyzes India's potential to become a leader in cancer care in the Global South, particularly in precision population cancer medicine (PPCM). Through an interdisciplinary lens, it examines the current landscape of cancer care in India, highlighting its strengths, weaknesses, opportunities, and threats in this domain. This review explores the concept of knowledge translation and its importance in bridging the gap between knowledge generation and implementation in medical sciences and applies this to the Indian healthcare scenario. The review then delves into India's technological prowess, exemplified by its digital health initiatives such as the CoWIN (winning over COVID-19) app and the Ayushman Bharat Digital Mission, which provide a strong foundation for leveraging advanced technologies in healthcare. The authors discuss India's pharmaceutical industry, often referred to as the "pharmacy of the world," emphasizing its crucial role in global drug manufacturing and distribution. It also examines the country's emerging genomic research landscape, including initiatives such as GenomeIndia and the Indian Cancer Genome Atlas Foundation, which are pivotal for advancing personalized medicine. A significant portion of the review is dedicated to analyzing India's clinical trial ecosystem. It traces the evolution of regulatory frameworks governing clinical research in the country and highlights recent reforms that have made India an increasingly attractive destination for global studies, the potential adoption of innovative trial designs and artificial intelligence (AI)-driven analyses. Crucially, the authors confront the formidable obstacles inherent in India's complex healthcare landscape, illuminating the unique challenges that must be overcome. The review acknowledges India's underrepresentation in global clinical trials despite its large population and significant cancer burden. The issue of financial toxicity in cancer care is discussed, underscoring the need for affordable treatment options. The study also points out the nascent state of India's genomic databases, which account for only a small percentage of global genetic data. Despite these challenges, the authors posit that by effectively leveraging its information technology (IT) infrastructure, robust pharmaceutical sector, and large, diverse population, India has the potential to develop unique, country-specific solutions for cancer care. The study suggests that by fostering genomic research, strategically reforming its clinical trial ecosystem, and harnessing its digital capabilities, India could transform its cancer care landscape and emerge as a model for other developing nations in the Global South. In essence, this paper provides a roadmap for India's journey towards becoming a leader in PPCM, offering valuable insights for policymakers, healthcare professionals, and researchers in the field of oncology and precision medicine. Indeed, by using PPCM as a "pilot project," India can learn to use its new strategies to improve non-cancer care disease prevention, early detection, and improved and more cost-effective management. This approach could revolutionize cancer care in India and serve as a model for other developing nations in the Global South. By leveraging the strategies and technologies developed for PPCM, India could significantly enhance its healthcare system, highlighting the importance and urgency of improving cancer care in the region.

Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy

BACKGROUND

Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy.

PURPOSE

To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADILow and ADIHigh cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction.

RESULTS

A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADILow cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADIHigh cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADIHigh cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool.

CONCLUSION

Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.

Exposure to family planning messages on social media and its association with maternal healthcare services in Mauritania

BACKGROUND

Mauritania, a lower-middle-income country in Northwest Africa, has one of the highest maternal and infant mortality rates worldwide and struggles to ensure optimal use of maternal healthcare services. Raising health awareness through family planning messages can promote maternal healthcare use, potentially reducing preventable maternal and child mortalities. The objective of the study was to assess the potential impact of exposure to family planning messages through social media on the utilization of maternal healthcare services among Mauritanian women.

METHODS

Data from the 2019-20 Mauritania Demographic and Health Survey (MDHS) on 7,640 women were analyzed. Multiple logistic regression models were applied to examine the associations between exposure to family planning messages through social media and maternal healthcare services, specifically the timing and adequacy of ANC visits, and facility-based childbirth. Adjusted odds ratios with 95% confidence intervals (CI) were estimated.

RESULTS

The percentage of timely initiation and adequate use of ANC among the participants were 65.6% and 45.1%, respectively. Approximately 75.0% of the women reported giving birth to their last child at a healthcare facility. Exposure to family planning messages on social media was significantly associated with increased odds of receiving adequate antenatal care visits (OR = 1.38, 95% CI = 1.12,1.71) and giving birth in a health facility (OR = 1.83, 95% CI = 1.09,3.08), Other factors such as age, health insurance, wealth, and desired timing of the last child were also found to be important predictors of maternal healthcare.

CONCLUSION

The findings suggest that exposure to family planning messages on social media is strongly associated with adequate antenatal care and health facility-based childbirth, but not with early timing of antenatal care. Comprehensive maternal healthcare policies should consider the role of social media in promoting family planning messages.

Association of socioeconomic status and physical therapy compliance after arthroscopic shoulder labrum repair

BACKGROUND

Socioeconomic status has been shown to impact a patient's access to orthopedic care, but outcomes such as compliance with physical therapy and time to return to full activities has not been established. The aim of this study is to investigate the impact of socioeconomic status on physical therapy compliance and return to play time specifically in patients with shoulder instability. The area deprivation index (ADI) is a validated tool using factors from the US Census that measures socioeconomic deprivation in neighborhoods. Our hypothesis is that patients with higher socioeconomic deprivation are more likely to have more missed scheduled physical therapy appointments and a longer return to play after arthroscopic shoulder labrum repair for instability.

METHODS

This study included patients who underwent arthroscopic shoulder labrum repair between 2019 and 2023 at a single orthopedic hospital by a single surgeon. Demographic information (race, age, and sex), insurance type, ADI, physical therapy no-show visit rates, and return to play times were recorded.

RESULTS

The cohort included 73 patients, 14 of whom did not have return to play times. A total of 82.2% of the patients were male, 63.0% were White, and the mean age was 24 years. Patients with increasing ADI were significantly more likely not to attend a scheduled physical therapy session (P = .035). No association between ADI and return to play time was found (P = .165). No significant association between insurance type (private vs. Medicaid) and missed scheduled physical therapy appointments (P = .139) and return to play times was found (P = .741).

CONCLUSION

Increasing socioeconomic deprivation is associated with increased likelihood to miss scheduled physical therapy visits after shoulder instability surgery. These findings elucidate gaps in orthopedic care as postoperative physical therapy is a crucial part in the comprehensive care of shoulder instability.

Enhancement or suppression: a double-edged sword? Differential association of digital literacy with subjective health of older adult-evidence from China

Background

The emergence of an aging society and the digital age makes healthy aging a hot topic in Chinese society. This paper explores the associations between digital literacy and the subjective health of older adult individuals in PR China, offering insights that May assist policymakers and service providers in developing strategies and interventions suited to the digital era, potentially enhancing the healthy aging process for this demographic in China.

Methods

This study utilized data from the China Longitudinal Aging Social Survey. Initially, demographic variables of 2086 individuals in the sample were analyzed. Subjective health differences among different populations and correlations between core variables were examined. Subsequently, multivariate linear regression and chain mediation methods were utilized to examine the relationships and potential pathways among the three dimensions of digital literacy and the subjective health of older adult individuals.

Results

(1) The subjective health status of older adult individuals in China was generally favorable, with an average score of 3.406 ± 0.764. (2) There was no direct correlation observed between the frequency of digital information use and the subjective health of the older adult (b = -0.032, p > 0.1). Digital entertainment information (b = 0.294, p > 0.1) did not show a significant effect, whereas life management information (b = 0.437, p < 0.01) demonstrated a positive association. Similarly, the use of smart healthcare devices (b = 0.842, p < 0.001) indicated a positive association (3) The frequency of digital information use indirectly enhanced the subjective health of the older adult through life management digital information and the use of smart healthcare devices, but had no indirect effect through entertainment and leisure digital information.

Conclusion

Digital literacy is significantly correlated with the subjective health of the older adult, especially when they acquire life management information and utilize smart healthcare devices. However, a potential negative relationship is suggested between digital entertainment information and the subjective health of older adult individuals. Therefore, digital infrastructure should have prioritized the provision of high-quality, age-friendly digital applications for the older adult. This approach could have better harnessed the potential of digitalization to enhance health and well-being in older adults.

Area deprivation index, a marker of socioeconomic disadvantage, may predict severity of COVID-19 in patients and which families may experience worse symptoms of PTSD, anxiety, and depression post-ICU

BACKGROUND

COVID-19 disproportionately impacted marginalized populations early in the pandemic. Families of patients admitted to the intensive care unit (ICU) experienced significant psychological effects. Little is known about whether individual and patient psychological outcomes after a loved ones stay in the ICU differs by socioeconomic status, as measured by the area deprivation index (ADI).

METHODS

Family members of patients with COVID-19 respiratory failure admitted to the ICU at twelve hospitals in five US states were enrolled in a larger study looking at rates of symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression in the months following their loved one's ICU stay. This secondary data analysis includes eight of the twelve hospitals in four of the five states. Each participant was assigned a number indicating a level of neighborhood disadvantage based on the patient's zip code. Patient and family level characteristics as well as symptoms of anxiety, depression, and PTSD were assessed among each neighborhood.

RESULTS

Patients from the most disadvantaged neighborhoods had the highest proportion of patients that needed to be intubated (p = 0.005). All the patients in the most disadvantaged neighborhoods were a race other than white (p = 0.17). At 12 months post-hospitalization, there was a statistically significant difference in the proportion of family members who experienced symptoms of PTSD, anxiety, and depression between the ADI groups.

CONCLUSIONS

ADI may be a predictor of COVID-19 disease severity for patients on presentation to the ICU. Patients and family members experience psychological effects after a loved one's admission to the ICU, and these outcomes vary among individuals of different socioeconomic status', as measured by the ADI. A larger study of family members' incidence of anxiety, depression, and post-traumatic stress disorder is needed to understand the extent to which these symptoms are impacted by neighborhood level factors as measured by the ADI.

Loneliness and pain among community-dwelling middle-aged and older Black, Latino, and White adults in the United States

Background

Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States.

Methods

Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors.

Results

Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (β = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (β = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness.

Discussion

Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.

New Evidence of the Impact of the National Drug Price Negotiation Policy on the Availability, Utilization, and Cost of Anticancer Medicines in China: An Interrupted Time Series Study

Purpose

The increasing global burden of cancer has become a significant challenge for public health. The Chinese government introduced the National Drug Price Negotiation (NDPN) policy with the goal of lowering the prices of innovative drugs and enhancing their accessibility. This study aims to evaluate the impact of the 2021 NDPN policy on the availability, utilization, and cost of anticancer medicines in China.

Methods

Data was gathered from 1519 hospitals between April 2021 and December 2022, with a focus on eight anticancer drugs affected by the 2021 NDPN policy. The availability, Defined Daily Doses (DDDs), and cost per Defined Daily Dose (DDDc) before and after the intervention were evaluated through interrupted time series analysis.

Results

The NDPN policy resulted in a substantial 5.10% increase in the availability of anticancer drugs (p < 0.001). Utilization also experienced a significant surge, with an immediate increase of 11,254.36 DDDs (p < 0.001) and a monthly increase of 1208.28 DDDs (p < 0.001) following policy implementation. The DDDc decreased by US$ 111.00 (p < 0.001) immediately after the policy. Disparities in regional drug utilization were evident, with higher usage in the eastern region.

Conclusion

The 2021 NDPN policy has notably enhanced the availability and utilization of anticancer medications in China while reducing their cost, in line with the policy's objectives. However, continuous monitoring is essential to ensure sustained access and to tackle regional disparities in drug utilization.

Latent class analysis of health lifestyle among older adults living alone and associations with life satisfaction and depressive symptoms

BACKGROUND

Little is known about the collective patterns of health-related behaviors of older adults living alone. We aimed to identify subgroups of older adults living alone based on their health lifestyle and examine the relationship between these subgroups and sociodemographic characteristics, life satisfaction, and depressive symptoms.

METHODS

A total of 3137 older adults living alone were sampled from the 2020 National Survey of Older Koreans. Latent class analysis was performed using 11 health-related behaviors: smoking; alcohol consumption; fruit, vegetable, and dairy product consumption; exercise; cultural leisure; social groups; educational activities; health check-ups; and dementia screening. Multinomial logistic and multiple linear regression analyses were performed.

RESULTS

Three classes were identified: Consistently Healthy (CH), Moderately Healthy but Inactive (MHI), and Unhealthy but Active (UA). Compared to the CH, members of the MHI tend to have no formal education and rarely meet relatives. Members of the UA were more likely to be male and employed. The MHI and UA were more likely to have lower incomes, meet with children less frequently or have no children, and rarely meet friends, neighbors, and acquaintances when compared to the CH. Members of the UA group had the highest risk of reduced life satisfaction and increased depressive symptoms.

LIMITATIONS

The cross-sectional design precluded causal inferences.

CONCLUSION

Our study sheds light on the heterogeneity of health lifestyles among older adults living alone and highlights the need for tailored interventions to promote healthy aging in this population.

Geographical characteristics and influencing factors of the health level of older adults in the Yangtze River Economic Belt, China, from 2010 to 2020

The health of older adults is crucial for the overall health of the entire life cycle. Based on population sampling survey data and census data from 131 prefecture level units in the Yangtze River Economic Belt (YREB) during 2010-2020, this study used exploratory spatial data analysis, geographical detector, stepwise regression analysis, and GTWR model to analyze the spatiotemporal pattern and influencing factors of the health level of older adults in the YREB. The results show that the health level of older adults in the YREB slightly increased from 2010 to 2020, with the most significant improvement in the upstream region and the most significant decline in the midstream region. The older adults' health level in the YREB displays a gradient decreasing pattern of the downstream, midstream, and upstream regions. The health level of older adults in the YREB is influenced by a combination of natural and social environment factors. Areas with lower altitude and moderate humidity climates are more conducive to the health of older adults. The increase in influencing factors such as population migration rate, per capita GDP, average years of education, per capita housing construction area, per capita park green area, and green coverage rate in built-up areas is conducive to improving the health level of older adults, while lower number of health institutions per 1,000 people and higher household support rate are not conducive to improving the health level of older adults. In addition, over time, the health-promoting effect of natural environmental factors is enhanced from 2010 to 2020, and the influence of annual precipitation on shaping the spatial pattern of older adults' health level became more obvious. Although the promoting effect of population migration on the health level of older adults tends to weaken, it remains the primary factor affecting the spatiotemporal differentiation of older adults' health level in the YREB. The impact of social development on the health level of older adults has changed from a positive health effect (improvement) to a negative health effect (loss). The health-promoting effect of living environment factors is enhanced. The health-inhibitory effect of household support rate increased, and showed a gradient decreasing pattern from downstream to midstream to upstream. The findings of this study can provide a more in-depth understanding of the spatiotemporal pattern of the health level of older adults in the YREB and the factors influencing it, improve the health level of older adults in the region, and promote the development of healthy and active aging in the YREB, and improve the human health. At the same time, this study also supplements the related research on aging and the health level of the elderly. Firstly, it can provide reference for the research on the health of old adults in other countries and regions around the world. Secondly, it can also provide a basis for research on aging and the health of old adults in cities and counties under YREB.

Acceptance of COVID-19 Vaccination and Vaccine Hesitancy Among People with Chronic Diseases in Thailand: Role of Attitudes and Vaccine Literacy Towards Future Implications

Introduction

Vaccination is an important strategy to prevent or reduce hospitalizations and mortality caused by COVID-19 infection. However, some people with chronic diseases are hesitant to get the COVID-19 vaccination.

Objective

This study aimed to assess the acceptance of COVID-19 vaccination and associated factors among people with chronic diseases.

Methods

A cross-sectional online survey was conducted between May and August 2021. A sample of 457 Thai adults living with one or more chronic diseases was drawn from a larger online survey.

Results

Participants were 19 to 89 years old. The three most commonly reported chronic diseases were hypertension, diabetes, and obesity. The acceptance rate of COVID-19 vaccination was 89.1%. Forty-six percent of respondents had received the COVID-19 vaccination, and 43.1% intended to get the vaccine. Reasons for vaccine hesitancy/refusal included concerns about adverse side effects from the vaccines including long-term effects that might complicate their disease condition. Multiple logistic regression analyses revealed that having a bachelor's degree or higher [aOR 4.40; 95% CI: 2.12-9.14], being employed [aOR 2.11; 95% CI: 1.03-4.39], and having positive attitudes [aOR 2.36; 95% CI: 1.69-3.29] and negative attitudes [aOR 0.38; 95% CI: 0.27-0.55] predicted acceptance of the COVID-19 vaccination. Vaccine literacy was significantly associated with acceptance of COVID-19 vaccination in binary logistic regression analyses, but it was not retained in the multiple logistic regression model.

Conclusion

Vaccine literacy and attitudes influence acceptance of COVID-19 vaccination in people with chronic diseases.

Racial and Ethnic Differences in Diabetes Care Quality in A National Sample of Cancer Survivors Relative to Non-Cancer Controls

BACKGROUND

Among cancer survivors, diabetes is associated with greater morbidity and mortality. The objective of this study is to describe racial/ethnic disparities in diabetes care quality (DCQ) among cancer survivors compared to non-cancer controls.

METHODS

We used Medical Expenditure Panel Survey Household Component data (2010-2018). Black, non-Hispanic White (NHW), and Hispanic respondents diagnosed with diabetes and cancer were frequency matched 1:5 to non-cancer controls. Multivariable logistic regression estimated associations for specific indices and overall DCQ by race/ethnicity stratified by cancer site/status in partially adjusted (not controlling for socioeconomic indicators) and fully adjusted models.

RESULTS

The final sample of 4775 included cancer survivors (n = 907 all cancers; n = 401 breast; n = 167 colon; n = 339 prostate) and non-cancer controls (n = 3868) matched by age, race/ethnicity, and year. In partially adjusted models, Black (adjusted odds ratio, AOR) 0.67 [95% CI 0.54-0.83]) and Hispanic (AOR 0.68 [95% CI 0.54-0.87]) non-cancer controls had significant disparities for overall DCQ compared to NHWs. Among cancer survivors, DCQ disparities for Black (AOR 0.62, [95% CI 0.4-0.96]) and Hispanics (AOR 0.60, [95% CI 0.38-0.97]) were identified. Among prostate cancer survivors, DCQ disparities were identified for Blacks (AOR 0.38; [95% CI 0.20-0.72]) and Hispanics (AOR 0.39; [95% CI 0.17-0.89]) compared to NHWs. Racial disparities among Black controls and Black prostate cancer survivors remained significant in fully adjusted models.

CONCLUSION

Diabetes care disparities are evident among cancer survivors and salient among non-cancer controls. Strategies to promote health equity should target specific care indices among survivors and emphasize equitable DCQ strategies among Black and Hispanic communities.

Assessment of sociodemographic and psychiatric characteristics of transgender adults seen at a Midwest tertiary medical center

Background

The National Academy of Medicine has formally identified transgender adults as an understudied population in critical need of health research. While national surveys, like the US Transgender survey, have characterized higher rates of depression, anxiety, suicidality and socioeconomic need in the transgender community, studies have not examined the impact of sociodemographic and clinical characteristics on mental health related outcomes.

Objective

To describe the sociodemographic and mental health characteristics of transgender adults seen at a large Midwest transgender clinic and to determine factors associated with self-reported mental health conditions.

Methods

Descriptive, retrospective, cross-sectional study of new transgender patients 18 years and older seen at a large Midwest transgender clinic between December 2019 and June 2022.

Results

A total of 482 charts were reviewed. During their initial evaluation, 11.6% (56/482) reported having a history of suicide attempt and 81.3% (392/482) reported a mental health diagnosis with the most common being depression, anxiety, attention deficit disorder, and post-traumatic stress disorder. Multivariable logistic regression results show no single factor was significantly associated with mental health diagnosis after adjusting for the effect of age and race. Patients who were new to gender affirming hormone therapy (54%, 254/468) are 2.0 (95% CI 1.4-2.9) times more likely to report having a mental health care provider than patients who were seen for continuation of therapy (46%, 214/468). Ten records with race not disclosed, 3 records with gender identity "other" and 2 records with gender identity not disclosed were excluded from analysis.

Conclusion

This study reinforces the finding that transgender adults have an increased lifetime prevalence of mental health conditions. The higher prevalence of mental health conditions in our clinic was not associated with sociodemographic factors included in the study. Furthermore, transgender patients are less likely to have seen mental healthcare providers after initiation of gender affirming hormone therapy.

Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions

Importance

Serious cutaneous adverse drug reactions (cADRs) are potentially life-threatening drug hypersensitivity reactions involving the skin and internal organs. Antibiotics are a recognized cause of these reactions, but no studies have compared relative risks across antibiotic classes.

Objectives

To explore the risk of serious cADRs associated with commonly prescribed oral antibiotics, and to characterize outcomes of patients hospitalized for them.

Design, Setting, and Participants

Nested case-control study using population-based linked administrative datasets among adults aged 66 years or older who received at least 1 oral antibiotic between 2002 and 2022 in Ontario, Canada. Cases were those who had an emergency department (ED) visit or hospitalization for serious cADRs within 60 days of the prescription, and each case was matched with up to 4 controls who did not.

Exposure

Various classes of oral antibiotics.

Main Outcomes and Measures

Conditional logistic regression estimate of the association between different classes of oral antibiotics and serious cADRs, using macrolides as the reference group.

Results

During the 20-year study period, we identified 21 758 older adults (median age, 75 years; 64.1% female) who had an ED visit or hospitalization for serious cADRs following antibiotic therapy and 87 025 matched controls who did not. In the primary analysis, sulfonamide antibiotics (adjusted odds ratio [aOR], 2.9; 95% CI, 2.7-3.1) and cephalosporins (aOR, 2.6; 95% CI, 2.5-2.8) were most strongly associated with serious cADRs relative to macrolides. Additional associations were evident with nitrofurantoin (aOR, 2.2; 95% CI, 2.1-2.4), penicillins (aOR, 1.4; 95% CI, 1.3-1.5), and fluoroquinolones (aOR, 1.3; 95% CI, 1.2-1.4). The crude rate of ED visits or hospitalization for cADRs was highest for cephalosporins (4.92 per 1000 prescriptions; 95% CI, 4.86-4.99) and sulfonamide antibiotics (3.22 per 1000 prescriptions; 95% CI, 3.15-3.28). Among the 2852 case patients hospitalized for cADRs, the median length of stay was 6 days (IQR, 3-13 days), 9.6% required transfer to a critical care unit, and 5.3% died in the hospital.

Conclusion and Relevance

Commonly prescribed oral antibiotics are associated with an increased risk of serious cADRs compared with macrolides, with sulfonamides and cephalosporins carrying the highest risk. Prescribers should preferentially use lower-risk antibiotics when clinically appropriate.

Socioeconomic Indices Are Associated With Increased Resource Utilizations, but Not 90-Day Complications Following Total Hip and Knee Arthroplasty

BACKGROUND

Socioeconomic disadvantage has been associated with negative outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The area deprivation index (ADI) and distressed communities index (DCI) are composite rankings that score socioeconomic status (SES) using patients' home addresses. The purpose of this study was to examine the association of ADI and DCI with outcomes following THA and TKA while controlling for potential confounding covariates.

METHODS

A series of 4,146 consecutive patients undergoing primary THA and TKA between January 2018 and May 2023 were queried from our institutional total joint registry. The 90-day medical and surgical complications and resource utilization were collected. The ADI and DCI scores were obtained for each patient, and the association between these scores and postoperative outcomes was analyzed.

RESULTS

The ADI and DCI were both associated with patient age, sex, race, comorbidity burden, and smoking status. After controlling for these variables, higher ADI and DCI scores were associated with increased length of stay (P = 0.003 and P = 0.008, respectively), but were not associated with the occurrence of any 90-day complication, reoperation, or revision.

CONCLUSIONS

The SES, as quantified by ADI and DCI, was associated with multiple known risk factors for complications following THA and TKA, but was not independently associated with complications, reoperations, or revision surgeries at 90 days postoperatively. While convenient metrics for the quantification of SES, in some populations, ADI and DCI may not be independently associated with detrimental outcomes following THA and TKA.

Disparities in Access to Multidisciplinary Cancer Consultations and Treatment for Patients With Early-Stage Non-Small Cell Lung Cancer: A SEER-Medicare Analysis

PURPOSE

Disparities in access to a multidisciplinary cancer consultation (MDCc) persist, and the role of physician relationships remains understudied. This study examined the extent to which multilevel factors, including patient characteristics and patient-sharing network measures reflecting the structure of physician relationships, are associated with an MDCc and receipt of stereotactic body radiation therapy versus surgery among patients with early-stage non-small cell lung cancer (NSCLC).

METHODS AND MATERIALS

In this cross-sectional study, we analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare data for patients diagnosed with stage I-IIA NSCLC from 2016 to 2017. We assembled patient-sharing networks and identified cancer specialists who were locally unique for their specialty, herein referred to as linchpins. The proportion of linchpin cancer specialists for each hospital referral region (HRR) was calculated as a network-based measure of specialist scarcity. We used multilevel multinomial logistic regression to estimate associations between study variables and receipt of an MDCc and multilevel logistic regression to examine the relationship between patient receipt of an MDCc and initial treatment.

RESULTS

Our study included 6120 patients with stage I-IIA NSCLC, of whom 751 (12.3%) received an MDCc, 1729 (28.3%) consulted only a radiation oncologist, 2010 (32.8%) consulted only a surgeon, and 1630 (26.6%) consulted neither specialist within 2 months of diagnosis. Compared with patients residing in an HRR with a low proportion of linchpin surgeons, those residing in an HRR with a high proportion of linchpin surgeons had a 2.99 (95% CI, 1.87-4.78) greater relative risk of consulting only a radiation oncologist versus receiving an MDCc and a 2.70 (95% CI, 1.68-4.35) greater relative risk of consulting neither specialist versus receiving an MDCc. Patients who received an MDCc were 5.32 times (95% CI, 4.27-6.63) more likely to receive stereotactic body radiation therapy versus surgery.

CONCLUSIONS

Physician networks are associated with receipt of an MDCc and treatment, underscoring the potential for leveraging patient-sharing network analysis to improve access to lung cancer care.

Evaluating the Predictive Accuracy of Socioeconomic Metrics on Heart Failure Risk and Outcomes in Maryland

Introduction Annually, a significant number of Americans are hospitalized due to heart failure (HF), marking it as an important contributor to morbidity and mortality. It also poses a substantial financial burden and leads to considerable losses in productivity. Socioeconomic disparities may intensify the risk of hospital admissions following HF and worsen patient outcomes.  Objective This study investigates the predictive accuracy of different socioeconomic metrics on the risk and outcomes of HF in Maryland.  Methodology To evaluate the predictive accuracy of various socioeconomic metrics on the risk of HF, we utilized data from the Maryland State Inpatient Database. Our retrospective analysis covered hospital admissions for HF from 2016 to 2020, correlating these with poverty indicators derived from U.S. Census data at the zip code level with socioeconomic metrics like race/ethnicity, insurance, household median income, and neighborhood distress (Distressed Communities Index (DCI)). Multivariate logistic regression models adjusted for confounders and isolated the impact of socioeconomic factors.  Result During the study period, a total of 389,220 cases of HF were reported in the Maryland State Inpatient Database (SID). The majority of these patients were White individuals (56.8%) and female (51.1%), with a median age of 73 years (interquartile range (IQR) 62-82 years). The in-hospital mortality rate was 5.1%, while rates of atrial fibrillation, cardiac arrest, and prolonged hospital stay were 34.4%, 0.3%, and 48.4%, respectively. The studied socioeconomic metrics showed varying predictive power for the risk of HF-related admissions and selected outcomes, with the highest predictive accuracy for neighborhood distress on the risk of HF (AUC = 0.53, 95% CI 0.530-0.532), atrial fibrillation (AUC = 0.479, 95% CI 0.477-0.480), cardiac arrest (AUC = 0.511, 95% CI 0.498-0.525), prolonged hospital stays (AUC = 0.531, 95% CI 0.530-0.532), and mortality (AUC = 0.499, 95% CI 0.496-0.502).  Conclusions The Distressed Communities Index demonstrates significant predictive power for assessing the risk of hospital admissions following HF and outcomes among individuals with HF, exceeding factors like insurance, race/ethnicity, and household median income.

Influence of the Onset of Menopause on the Risk of Developing Alzheimer's Disease

Menopause is a natural phase marked by the permanent cessation of menstrual cycles, occurring when the production of reproductive hormones from the ovaries stops for at least 12 consecutive months. Studies have suggested a potential connection between menopause and a heightened risk of developing Alzheimer's disease (AD), underscoring the significant role of reduced estrogen levels in the development of AD. Estrogen plays a crucial role in brain metabolism, influencing energy metabolism, synaptic plasticity, and cognitive functions. The cognitive benefits associated with hormone replacement therapy (HRT) are believed to be linked to estrogen's neuroprotective effects, either through direct action on the brain or indirectly by improving cardiovascular health. Extensive literature supports the positive impact of estrogen on brain cells. While the physiological effects of estrogen on the brain have not been consistently replicated in clinical trials, further research is crucial to provide more definitive recommendations to menopausal patients regarding the influence of HRT on AD. This review aims to comprehensively explore the interplay between menopause and AD, as well as the potential of HRT to mitigate cognitive decline in post-menopausal individuals.

The Diversity of Research Participants in Randomized Controlled Trials and Observational Studies Conducted by the Canadian Critical Care Trials Group

Rationale: Women, older individuals, and racial and ethnic minority groups are often underrepresented in research studies. Objectives: We evaluated the demographics and diversity of participants enrolled in randomized controlled trials (RCTs) and observational studies published by investigators in association with the Canadian Critical Care Trials Group. Methods: We performed quantitative content analysis of peer-reviewed RCTs and observational studies from December 1994 to December 2022. For each publication, we extracted participant demographic variables, including sex, gender, age, race or ethnicity, sexual orientation, pregnancy status, language proficiency, income/financial status, housing, education, disability, and geography. Results: A total of 120 publications (28 RCTs, 92 observational studies) included 211,144 enrolled participants. Most (107 of 120; 89.2%) were multicenter studies, and 70% (84 of 120) were conducted exclusively in Canadian centers; 77.5% (93 of 120) studies enrolled adult participants, and 19.2% (23 of 120) enrolled pediatric participants. All studies reported participant mean or median age, 118 (98.3%) reported binary sex or gender, and 9 (7.5%) reported race or ethnicity. No justification was provided in 35 studies that listed pregnancy as an exclusion. There was infrequent reporting of housing (n = 4), employment (n = 2), income (n = 2), and education (n = 1). No studies reported the language proficiency, sexual orientation, disability, or geography of participants. Of the studies reporting gender, women and/or girls comprised 42.3% participants (range, 8.9-67.7%). Within nine studies reporting race or ethnicity of 2,950 participants, 59.7% were White, 8% South Asian, 7% Indigenous, 3% Asian, 1% Black, 14% unknown, and 6% "other." Conclusions: Research publications from the Canadian Critical Care Trials Group infrequently report important participant demographics, and diversity of research participants is disproportionate compared with Canadian societal demographics.

Does stronger primary care improve access to health services for persons with spinal cord injury? Evidence from eleven European countries

OBJECTIVE

To determine the association between the strength of primary care and perceived access to follow-up care services among persons with chronic spinal cord injury (SCI).

DESIGN

Data analysis of the International Spinal Cord Injury (InSCI) cross-sectional, community-based questionnaire survey conducted in 2017-2019. The association between the strength of primary care (Kringos et al., 2003) and access to health services was established using univariable and multivariable logistic regression analysis, adjusted for socio-demographic and health status characteristics.

SETTING

Community in eleven European countries: France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Poland, Romania, Spain and Switzerland.

PARTICIPANTS

6658 adults with chronic SCI.

INTERVENTION

None.

OUTCOME MEASURES

Share of persons with SCI that reported unmet healthcare needs as a measure of access.

RESULTS

Twelve percent of the participants reported unmet healthcare needs: the highest in Poland (25%) and lowest in Switzerland and Spain (7%). The most prevalent access restriction was service unavailability (7%). Stronger primary care was associated with lower odds of reporting unmet healthcare needs, service unavailability, unaffordability and unacceptability. Females, persons of younger age and lower health status, had higher odds of reporting unmet needs.

CONCLUSIONS

In all investigated countries, persons with chronic SCI face access barriers, especially with service availability. Stronger primary care for the general population was also associated with better health service access for persons with SCI, which argues for further primary care strengthening.

The Impact of Social Determinants of Health on the Prognosis of Primary Bone Tumors: A Systematic Review

BACKGROUND

Although the prevalence of primary bone tumors (PBTs) was reported to be relatively low, they represent a difficult category of tumors for appropriate prediction, prevention, diagnosis, and treatment. Among different factors contributing to the prognosis and treatment outcomes of patients with these tumors, it is assumed that social determinants of health (SDOH) have not been well investigated nor applied in the process of decision making for these patients.

METHODS

In this systematic review, databases including PubMed, Web of Science, Scopus, Embase, Science Direct, and CINAHL were used. To ensure the quality of the studies and assess them for bias, we used the Methodological Index for Nonrandomized Studies scaling tool. The relevant data were extracted from the included studies and reported.

RESULTS

Twenty-five studies were included in our review based on the inclusion criteria. Age, socioeconomic status, education, and employment status; place of living and neighborhood; race and ethnicity; and insurance coverage were found to impact the outcomes and prognosis of PBTs.

CONCLUSION

Literature has shown correlations of various SDOH with the outcomes of PBTs. SDOH are not independent of each other; including and interpreting them in the process of decision making should be in a multifactorial and intercalated manner. We suggest prospective studies on finding the effect of inventing with SDOH through changes in health care policies, educating patients and care providers, improving socioeconomic conditions, and providing better insurance support, on the outcomes of PBTs.

LEVEL OF EVIDENCE

Level III. See Instructions for Authors for a complete description of levels of evidence.

Long-term patient-reported values following cancer surgery: A global survey study

BACKGROUND AND OBJECTIVES

We evaluated the long-term quality of life (QOL) and priorities of an international cohort of cancer surgery survivors.

METHODS

Patients were surveyed through online support groups. We utilized the Short Form-12 questionnaire to evaluate QOL and a novel survey to assess the relative importance of longevity, experience, and costs.

RESULTS

A total of 592 patients from six continents responded. They were 58 ± 12 years old, 70% female, and 92% White. Patients averaged 37 months from their initial cancer diagnosis, with a maximum survivorship of 46 years. Across 17 disease sites, respondents generally ranked longevity, functional independence, and emotional well-being most important, while treatment experience and costs were ranked least important (W = 33.6%, p < 0.001). However, a subset of respondents ranked costs as significantly important. There were no differences in QOL based on demographics, except patients with higher education and income reported better QOL scores. Despite improvements in QOL throughout survivorship, both physical-QOL (41.1 ± 11.1 at 1 year vs. 42.3 ± 12.6 at 5 years, p = 0.511) and mental-QOL (41.3 ± 13.4 at 1 year vs. 44.6 ± 13.9 at 5 years, p = 0.039) remained below that of the general population (50 ± 10; both p < 0.001).

CONCLUSIONS

Cancer survivors experience enduring physical and mental impairment throughout survivorship. Future efforts should aim to provide sustained support across varied socioeconomic groups, ensuring equitable care and enhancement of QOL postcancer treatment.

The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension

The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.

Investigation of Environmental Factors as a Key Progression in the Treatment of Fatty Liver Disease: A Study Protocol

Background Fatty liver disease (FLD) is currently a global health problem associated with environmental and metabolic diseases. In addition to air pollution, chemicals, and dietary choices, metabolic problems can also contribute to the development of FLD. However, in order to understand this situation, environmental conditions need to be investigated comprehensively. Materials and methods This study used a scientific method to assess the environmental factors that play a role in FLD. Individuals from different ethnic backgrounds will be recruited as participants to increase diversity in the sample. The survey will include questions on food, exposure to air pollution, finances, and cultural practices. Statistical analysis will be conducted to further reveal environmental changes and factors that affect FLD, leading to a better understanding of environmental factors that cause FLD in the population. Results The study will significantly identify the environmental factors, such as diet, physical activity, exposure to pollutants, etc., that influence the progression and treatment outcomes of FLD.  Conclusion This study will demonstrate that environmental factors influence the occurrence of FLD.

Socioeconomic Inequities in Pap Test Use Among Black Women in the United States: An Intersectional Approach

INTRODUCTION

Research investigating racialized inequities in cervical cancer screening has rarely considered the influence of socioeconomic position (SEP), a key social determinant of health that intersects with race/ethnicity and racism. Thus, data on socioeconomic inequities in Pap test use within racialized groups-including Black women, who are at elevated risk of cervical cancer morbidity and mortality-are limited.

METHODS

Using 2011-2019 data from the National Survey of Family Growth and guided by an intersectional framework, we used multivariable logistic regression to examine the association between educational attainment, employment status, and income and the adjusted odds of Pap test use in the last 3 years among Black U.S. women.

RESULTS

Compared to Black women with a bachelor's degree or greater, those with less than a high school diploma ([odds ratio] = 0.45; [95% confidence interval] 0.31-0.67) and a high school diploma/GED (0.57; 0.40-0.81) had significantly lower odds of Pap test use, adjusting for sociodemographic factors. Unemployed women had significantly lower adjusted odds of Pap test use compared to employed women (0.67; 0.50-0.89), and women living below 100% of the federal poverty level (FPL) had significantly lower adjusted odds of Pap test use relative to those living at or above 300% FPL (0.63; 0.45-0.88).

CONCLUSION

Low-SEP Black women had significantly lower adjusted odds of Pap test use relative to their higher SEP counterparts. Interventions that address both racism and economic barriers to care are needed to facilitate access to regular cervical cancer screening among low-SEP Black women.

Frailty and Health-Related Quality of Life Among European Older Adults: The Moderating Effect of Human Development Index

The Human Development Index (HDI) is a proxy for the social and economic level of countries, which is related to the health and well-being of older adults. This study aimed to examine the moderating effect of the HDI on the relationship between frailty and health-related quality of life among European older adults. Participants were 23,972 older adults (53.2% female, M = 74.2 years old, SD = 6.75 years old) from 24 European countries, joining wave 8 (2020) of the Survey of Health, Aging, and Retirement in Europe (SHARE). Multilevel modeling was used to analyze nested data. Significant differences in health-related quality of life among the several European Union countries were observed (intraclass correlation coefficient [ICC] = 0.18, LRT (1) = 5568.07, p < .001). The HDI has been shown to moderate the relationship between frailty and health-related quality of life among older adults, buffering the impact of frailty on the health-related quality of life. Since healthy aging is a priority for the European Union, policies mitigating the impact of HDI on the relationship between frailty and health-related quality of life should be implemented.