Association between sociodemographic factors and diagnosis of lethal prostate cancer in early life

OBJECTIVE

A subset of patients are diagnosed with lethal prostate cancer (CaP) early in life before prostate-specific antigen (PSA) screening is typically initiated. To identify opportunities for improved detection, we evaluated patient sociodemographic factors associated with advanced vs. localized (CaP) diagnosis across the age spectrum.

METHODS

We conducted a retrospective cohort study using the National Cancer Database, identifying patients diagnosed with CaP from 2004 to 2020. We compared characteristics of patients diagnosed at the advanced (cN1 or M1) versus localized (cT1-4N0M0) stage. Using multivariable logistic regression, we evaluated the associations among patient clinical and sociodemographic factors and advanced diagnosis, stratifying patients by age as ≤55 (before screening is recommended for most patients), 56 to 65, 66 to 75, and ≥76 years.

RESULTS

We identified 977,722 patients who met the inclusion criteria. The mean age at diagnosis was 65.3 years and 50,663 (5.1%) had advanced disease. Overall, uninsured (OR = 3.20, 95% CI 3.03-3.78) and Medicaid-insured (OR 2.58, 95% CI 2.48-2.69) vs. privately insured status was associated with higher odds of diagnosis with advanced disease and this effect was more pronounced for younger patients. Among patients ≤55 years, uninsured (OR 4.14, 95% CI 3.69-4.65) and Medicaid-insured (OR 3.39, 95% CI 3.10-3.72) vs. privately insured patients were associated with higher odds of advanced cancer at diagnosis. Similarly, residence in the lowest vs. highest income quartile was associated with increased odds of advanced CaP in patients ≤55 years (OR 1.15, 95% CI 1.02-1.30). Black vs. White race was associated with increased odds of advanced CaP at diagnosis later in life (OR 1.17, 95% CI 1.09-1.25); however, race was not significantly associated with advanced stage CaP in those ≤55 years (P = 0.635).

CONCLUSIONS

Sociodemographic disparities in diagnosis at advanced stages of CaP were more pronounced in younger patients, particularly with respect to insurance status. These findings may support greater attention to differential use of early CaP screening based on patient health insurance.

Relationship Quality Change Among Partnered Older Adults During the COVID-19 Pandemic

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic dramatically changed social life, but we know less about whether partnered relationships changed during this time. Because high-quality intimate relationships are key to many older Americans' well-being, we explore whether, how, and for whom the pandemic changed relationship quality among partnered older Americans.

METHODS

Nationally representative data from 1,642 partnered adults aged 50 and older come from the 2020 National Social Life, Health, and Aging Project COVID-19 Study. Multinomial logistic regression analyses estimate the likelihood of reporting improved, unchanged, or worsened relationship quality since the pandemic began across sociodemographic groups.

RESULTS

Two thirds of respondents reported that relationship quality stayed the same during the pandemic, 22.8% reported their relationship quality got better, and 10.5% reported their relationship quality got worse. Although women and the oldest old were less likely to report improved relationship quality, Black respondents were more likely to do so, even after controlling for explanatory variables.

DISCUSSION

Resilience describes many partnered older adults' experiences during the first year of the pandemic, suggesting that they were able to protect their partnerships during this public health crisis.

Sexual Inactivity and Dysfunction in Denmark: A Project SEXUS Study

Sexual dysfunctions are common experiences that often impact negatively on the health and well-being of affected individuals. We used baseline questionnaire data from 62,675 Danes aged 15-89 years, who participated in the cohort study Project SEXUS 2017-2018, to yield nationally representative estimates of the prevalence of sexual inactivity and dysfunction and to identify their sociodemographic correlates. Overall, we found that 23.0% of sexually experienced men and 28.8% of sexually experienced women had not been sexually active with another person within the last year. Sexual inactivity with another person was associated with both young and old age, single status, less favorable socioeconomic conditions, underweight and obesity, indicators of poor health, no use of alcohol, and physical inactivity. Among sexually active respondents, 18.0% of men had experienced any dysfunction within the last year, including erectile dysfunction (7.4%), premature ejaculation dysfunction (10.0%), orgasmic dysfunction (4.0%), and/or genital pain dysfunction (0.7%). Among women, 20.4% had experienced any dysfunction within the last year, including lubrication dysfunction (9.1%), orgasmic dysfunction (12.2%), genital pain dysfunction (5.0%), and/or vaginal cramp dysfunction (vaginismus) (0.8%). Additionally, 3.4% of men and 9.9% of women with a spouse/partner had experienced hypoactive sexual desire disorder within the last four weeks. Using the 5-item International Index of Erectile Function (IIEF-5) and the 6-item Female Sexual Function Index (FSFI-6) among respondents with a spouse/partner who had attempted sexual intercourse within the last four weeks, we found that 3.8% of men had experienced moderate or severe erectile dysfunction (IIEF-5 score ≤ 11) and 20.8% of women had experienced any sexual dysfunction (FSFI-6 score ≤ 19) during that period. Single status, difficulties paying bills and, among men, unemployment were positively associated with sexual dysfunction. In conclusion, we document several sociodemographic disparities in the prevalence of sexual inactivity and dysfunction in Denmark. In particular, both sexual inactivity and dysfunction were more common among singles and those reporting financial difficulties.

Exclusive and dual menthol/non-menthol cigarette use with ENDS among adults, 2013-2019

This study examines patterns of use for menthol/non-menthol cigarettes and Electronic Nicotine Delivery Systems (ENDS) from 2013 to 2019 among U.S. adults. We calculated the weighted population prevalence of current exclusive and dual use for each product (i.e., menthol/non-menthol cigarettes and ENDS) stratified by age, sex, race/ethnicity, household income, and education in all surveys using data from three nationally representative surveys: the Population Assessment of Tobacco and Health (PATH) Study Waves 1–4 (W1-W4), 2013–2018; the National Health Interview Survey (NHIS) 2015; and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2014–2015 (T1) and 2018–2019 (T2). Exclusive non-menthol cigarette use (PATH: 9.0%W1, 9.4%W4; NHIS: 8.7%; TUS-CPS: 8.1%T1, 6.9%T2) and dual non-menthol cigarette/ENDS use (PATH: 2.4%W1, 1.5%W4; NHIS: 1.5%; TUS-CPS: 1.1%T1, 0.6%T2) were the most common single and dual tobacco use patterns, respectively, across all surveys. Both exclusive menthol cigarette use (3.9%T1-3.3%T2) and non-menthol cigarette use (8.1%T1-6.9%T2) declined in TUS-CPS from 2014/5–2018/9. Dual menthol cigarette/ENDS use also declined (PATH: 1.5%W1-1.1%W4; TUS-CPS: 0.5%T1-0.3%T2), as did dual non-menthol cigarette/ENDS use (PATH: 2.4%W1-1.5%W4; TUS-CPS 1.1%T1-0.6%T2). Across surveys, exclusive menthol cigarette use and dual menthol cigarette/ENDS use were more common among individuals aged 25–34 years old; non-Hispanic Blacks (NHBs); and low-income earners. Single and dual use patterns of menthol/non-menthol cigarettes and ENDS have declined over time. Nevertheless, certain vulnerable population groups, including NHBs and low-income earners, disproportionately use exclusive menthol cigarettes and dual menthol cigarette/ENDS, making menthol bans a potential policy target for reducing tobacco-related health disparities.

Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study

BACKGROUND

Migrants account for a large part of China's population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China's Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China.

METHODS

This study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records.

RESULTS

The establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records.

CONCLUSION

There existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants' health literacy.

Sitting on the Sidelines: Disparities in Social, Recreational, and Community Participation Among Adolescents with Autism Spectrum Disorder

Participation in extracurricular activities and community involvement during secondary school is important for the healthy social, emotional, mental, and physical development of adolescents, especially those with autism spectrum disorder (ASD). The current study utilized three waves of data (2016, 2017, and 2018) from the National Survey of Children's Health (NSCH) to examine disparities in extracurricular participation among 12- to 17-year old adolescents with ASD. Across the three waves, data demonstrate clear sociodemographic disparities among adolescents with ASD. These disparities were more evident in adolescents with caregivers that had less education and lower household income, as well as males. These disparities suggest a continued need for targeted interventions to promote engagement among adolescents with ASD to narrow this social disparity gap.

Multiple myeloma, race, insurance and treatment

PURPOSE

Multiple Myeloma (MM), the second leading blood malignancy, has complex and costly disease management. We studied patterns of treatment disparities and unplanned interruptions among the MM patients after the Affordable Care Act to assess their prevalence and effect on survival.

MATERIALS AND METHODS

This retrospective study of 1002 MM patients at a tertiary referral center used standard guidelines as a reference to identify underuse of effective treatments. We used multivariate logistic regression and Cox proportionate hazard to study the prognostic effect on survival.

RESULTS

Median age in the cohort was 63.0 [IQR: 14] years. Non-Hispanic White (NHW) patients were older (p = 0.007) and more likely to present with stage I disease (p = 0.02). Underuse of maintenance therapy (aOR = 1.98; 95 % CI 1.12-3.48) and interruptions in treatment were associated with race/ethnicity and insurance (aOR = 4.14; 95 % CI: 1.78-9.74). Only underuse of induction therapy was associated with overall patient survival.

CONCLUSION

Age, race, ethnicity and primary insurance contribute to the underuse of treatment and in unplanned interruptions in MM treatment. Addressing underuse causes in such patients is warranted.

Trajectories of Mental Distress Among U.S. Adults During the COVID-19 Pandemic

Background

Cross-sectional studies have found that the coronavirus disease 2019 (COVID-19) pandemic has negatively affected population-level mental health. Longitudinal studies are necessary to examine trajectories of change in mental health over time and identify sociodemographic groups at risk for persistent distress.

Purpose

To examine the trajectories of mental distress between March 10 and August 4, 2020, a key period during the COVID-19 pandemic.

Methods

Participants included 6,901 adults from the nationally representative Understanding America Study, surveyed at baseline between March 10 and 31, 2020, with nine follow-up assessments between April 1 and August 4, 2020. Mixed-effects logistic regression was used to examine the association between date and self-reported mental distress (measured with the four-item Patient Health Questionnaire) among U.S. adults overall and among sociodemographic subgroups defined by sex, age, race/ethnicity, household structure, federal poverty line, and census region.

Results

Compared to March 11, the odds of mental distress among U.S. adults overall were 1.84 (95% confidence interval [CI] = 1.65–2.07) times higher on April 1 and 1.92 (95% CI = 1.62–2.28) times higher on May 1; by August 1, the odds of mental distress had returned to levels comparable to March 11 (odds ratio [OR] = 0.80, 95% CI = 0.66–0.96). Females experienced a sharper increase in mental distress between March and May compared to males (females: OR = 2.29, 95% CI = 1.85–2.82; males: OR = 1.53, 95% CI = 1.15–2.02).

Conclusions

These findings highlight the trajectory of mental health symptoms during an unprecedented pandemic, including the identification of populations at risk for sustained mental distress.

Preteen children's health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups

BACKGROUND

Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.

METHODS

During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child's country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.

RESULTS

Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1-1.3) and more mood problems (OR: 1.35, 95% CI: 1.2-1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents' occupation, however, children of parents with low or medium education levels reported less "mood problems" than those of parents with high education levels (OR: 0.65, 95% CI: 0.46-0.92) and (OR: 0.84, 95% CI: 0.73-0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14-2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08-6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.

CONCLUSION

More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.