1
|
Caroz-Armayones JM, Benach J, Delclós C, Julià M. The double burden of precariousness: linking housing, employment, and perceived stress - a cross-sectional study. Int J Environ Health Res 2023; 33:1102-1111. [PMID: 35549954 DOI: 10.1080/09603123.2022.2075330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Employment precariousness is widely recognised as a social determinant of health and a chronic stressor. Yet precariousness extends beyond employment, into other aspects of life. Using a multidimensional social pathways approach, this study examines the synergistic effects of employment and housing precariousness on self-perceived stress. This study uses the PRESSED dataset (N = 255) derived from the Barcelona Health Survey, which collects data on stress using the Perceived Stress Scale (PSS). Employment precariousness was operationalized using the Employment Precariousness Scale (EPRES) and a multidimensional indicator of housing precariousness was constructed. Generalized structural equation modelling was used to estimate associations between these indicators and self-perceived stress measured by Perceived Stress Survey (PSS), after accounting for sociodemographic variables. Employment and housing precariousness were positively associated with self-perceived stress (OR = 3.23 ; p = 0.002) (OR = 4.28 ; p = 0.065) respectively. The mediating effect of housing precariousness accounted for 16% of the total effect of employment precariousness on stress after controlling for sociodemographic variables. Furthermore, we find that both precarious conditions were unequally distributed by age, sex educational level, and place of birth in the sample. We conclude that employment and housing precariousness are important chronic stressors and that a social pathway approach is needed.
Collapse
Affiliation(s)
- Josep M Caroz-Armayones
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- JHU-UPF Public Policy Center, Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- JHU-UPF Public Policy Center, Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Carlos Delclós
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- JHU-UPF Public Policy Center, Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Institute of Government and Public Policy (IGOP), Department of Political Science and Public Law, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mireia Julià
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, University Pompeu Fabra-affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| |
Collapse
|
2
|
Wypych-Ślusarska A, Krupa-Kotara K, Niewiadomska E. Social Inequalities: Do They Matter in Asthma, Bronchitis, and Respiratory Symptoms in Children? Int J Environ Res Public Health 2022; 19:15366. [PMID: 36430088 PMCID: PMC9691006 DOI: 10.3390/ijerph192215366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Background: Social inequalities (e.g., poverty and low level of education) generate inequalities in health. Aim: The aim of the study was to determine the relationships between indicators of social inequalities and the frequency of respiratory symptoms, asthma, and bronchitis in children. Material and Methods: In 2019, an epidemiological cross-sectional study on 3237 students from elementary schools in Silesia Voivodships (South Poland) was conducted. The students' parents completed a questionnaire based on the International Study on Asthma and Allergies in Childhood (ISAAC). Social inequalities in the children's families were determined according to parents' education and professional status (working vs. unemployed), self-assessment of economic status, and housing conditions. To determine the influence of social factors on the occurrence of asthma, bronchitis, and respiratory symptoms, the odds ratio (OR) was calculated. Results: Children living in apartments with traces of mold had a higher risk of developing asthma (OR = 1.5, 95%CI: 1.17-1.96; p = 0.002) or bronchitis (OR = 1.4, 95%CI: 1.13-1.72; p = 0.002), wheezing attacks at nights (OR = 1.4; 95%CI: 1.01-1.93), wheezy in the last 12 months (OR = 1.6; 95%CI:1.24-2.08; p < 0.001), and chronic cough (OR = 1.9; 95%CI: 1.49-2.46; p < 0.001). Exposure to environmental tobacco smoke (ETS) was associated with higher risk of cough (OR = 1.5 95%CI: 1.22-1.96; p < 0.001) and dyspnea in the last 12 months (OR = 1.4; 95%CI: 1.04-2.00; p = 0.02). Low socioeconomic status (SES) was associated with increased risk of chronic cough (OR = 1.5; 95%CI: 1.09-2.03; p = 0.009) and increased risk of wheezy in the last 12 months (OR = 1.4; 95%CI: 1.06-1.97; p = 0.008). Asthma and bronchitis were not dependent on parents' education or professional status. Conclusions: Social inequalities have significant impacts on the occurrence of respiratory symptoms, bronchitis, and asthma in children. Interventions aimed at preventing bronchitis and childhood asthma should also focus on social health determinants.
Collapse
Affiliation(s)
- Agata Wypych-Ślusarska
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Karolina Krupa-Kotara
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Ewa Niewiadomska
- Department of Biostatistics, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| |
Collapse
|
3
|
Fabregas JC, Riley KE, Brant JM, George TJ, Orav EJ, Lam MB. Association of social determinants of health with late diagnosis and survival of patients with pancreatic cancer. J Gastrointest Oncol 2022; 13:1204-1214. [PMID: 35837201 DOI: 10.21037/jgo-21-788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 12/22/2022] Open
Abstract
Background Pancreatic cancer disparities have been described. However, it is unknown if they contribute to a late diagnosis and survival of patients with metastatic disease. Identifying their role is important as it will open the door for interventions. We hypothesize that social determinants of health (SDH) such as income, education, race, and insurance status impact (I) stage of diagnosis of PC (Stage IV vs. other stages), and (II) overall survival (OS) in Stage IV patients. Methods Using the National Cancer Database, we evaluated a primary outcome of diagnosis of Stage IV PC and a secondary outcome of OS. Primary predictors included race, income, education, and insurance. Covariates included age, sex and Charlson-Deyo comorbidity score. Univariate, multivariable logistic regression models evaluated risk of a late diagnosis. Univariate, multivariable Cox proportional hazards model examined OS. 95% confidence intervals were used. Results 230,877 patients were included, median age of 68 years (SD 12.1). In univariate analysis, a better education, higher income, and insurance decreased the odds of Stage IV PC, while Black race increased it. In multivariable analysis, education [>93% high-school completion (HSC) vs. <82.4%, OR 0.96 (0.93-0.99)] and insurance [private vs. no, OR 0.72 (0.67-0.74)] significantly decreased the risk of a late diagnosis, whereas Black race increased the odds [vs. White, OR 1.09 (1.07-1.12)]. In univariate Cox analysis, having a higher income, insurance and better education improved OS, while Black race worsened it. In multivariable Cox, higher income [>$63,333 (vs. <$40,277), HR 0.87 (0.85-0.89)] and insurance [private vs. no, HR 0.77 (0.74-0.79)] improved OS. Conclusions SDH impacted the continuum of care for patients with advanced pancreatic cancer, including stage at diagnosis and overall survival.
Collapse
Affiliation(s)
- Jesus C Fabregas
- Division of Hematology Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Kristen E Riley
- Harvard Medical School, Department of Medicine, Boston, MA, USA
| | | | - Thomas J George
- Division of Hematology Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - E John Orav
- Harvard Medical School, Department of Medicine, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Miranda B Lam
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA.,Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA, USA
| |
Collapse
|
4
|
Lawson NR, Acorda D, Guffey D, Bracken J, Bavare A, Checchia P, Afonso NS. Association of Social Determinants of Health With Rapid Response Events: A Retrospective Cohort Trial in a Large Pediatric Academic Hospital System. Front Pediatr 2022; 10:853691. [PMID: 35515353 PMCID: PMC9070691 DOI: 10.3389/fped.2022.853691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) are known to impact hospital and intensive care unit (ICU) outcomes. Little is known about the association between SDH and pediatric rapid response (RR) events and understanding this impact will help guide future interventions aimed to eliminate health disparities in the inpatient setting. OBJECTIVES The primary objective of this study is to describe the association between SDH and RR utilization (number of RR events, time to RR event, shift of event and caller). The secondary objective is to determine if SDH can predict hospital length of stay (LOS), ICU transfer, critical deterioration (CD), and mortality. METHODS A retrospective cohort study was conducted. We reviewed all RR events from 2016 to 2019 at a large, academic, pediatric hospital system including a level 1 trauma center and two satellite community campuses. All hospitalized patients up to age 25 who had a RR event during their index hospitalization were included. Exposure variables included age, gender, race/ethnicity, language, income, insurance status, chronic disease status, and repeat RR event. The primary outcome variables were hospital LOS, ICU transfer, CD, and mortality. The odds of mortality, CD events and ICU transfer were assessed using unadjusted and multivariable logistic regression. Associations with hospital LOS were assessed with unadjusted and multivariable quantile regression. RESULTS Four thousand five hundred and sixty-eight RR events occurred from 3,690 unique admissions and 3301 unique patients, and the cohort was reduced to the index admission. The cohort was largely representative of the population served by the hospital system and varied according to race and ethnicity. There was no variation by race/ethnicity in the number of RR events or the shift in which RR events occurred. Attending physicians initiated RR calls more for event for non-Hispanic patients of mixed or other race (31.6% of events), and fellows and residents were more likely to be the callers for Hispanic patients (29.7% of events, p = 0.002). Families who are non-English speaking are also less likely to activate the RR system (12% of total RR events, p = 0.048). LOS was longest for patients speaking languages other than Spanish or English and CD was more common in patients with government insurance. In adjusted logistic regression, Hispanic patients had 2.5 times the odds of mortality (95% CI: 1.43-4.53, p = 0.002) compared with non-Hispanic white patients. CONCLUSION Disparities exist in access to and within the inpatient management of pediatric patients. Our results suggest that interventions to address disparities should focus on Hispanic patients and non-English speaking patients to improve inpatient health equity. More research is needed to understand and address the mortality outcomes in Hispanic children compared to other groups.
Collapse
Affiliation(s)
- Nikki R Lawson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | | | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Julie Bracken
- Texas Children's Hospital, Houston, TX, United States
| | - Aarti Bavare
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Paul Checchia
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Natasha S Afonso
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
5
|
Elwell K, Camplain C, Kirby C, Sanderson K, Grover G, Morrison G, Gelatt A, Baldwin JA. A Formative Assessment of Social Determinants of Health Related to Early Childhood Caries in Two American Indian Communities. Int J Environ Res Public Health 2021; 18:9838. [PMID: 34574761 DOI: 10.3390/ijerph18189838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
In the United States, children from diverse ethnic groups and those with low socioeconomic status are at a significantly increased risk for early childhood caries. Despite the efforts focused on decreasing early childhood caries in American Indian (AI) populations, these children have the highest incidence of dental caries of any ethnic group, with four times the cases of untreated dental caries compared to white children. This qualitative formative assessment was conducted in two AI communities. Semi-structured interviews (n = 57) were conducted with caregivers and providers to understand the social and community contexts in which oral health behaviors and practices occur from the perspective of the caregivers, oral health care providers, and social service providers in the communities. The analysis was informed by the social determinants of health framework. The key social determinants of pediatric oral health relevant to our study communities included limited access to: oral health promoting nutritious foods, transportation for oral health appointments, and pediatric specialty care. This formative assessment provided locally and contextually relevant information to shape the development of an oral health clinical trial intervention to address early childhood caries in these two communities.
Collapse
|
6
|
Mosen DM, Banegas MP, Tucker-Seeley RD, Keast E, Hu W, Ertz-Berger B, Brooks N. Social Isolation Associated with Future Health Care Utilization. Popul Health Manag 2020; 24:333-337. [PMID: 32780631 DOI: 10.1089/pop.2020.0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Social isolation among individuals ages 65 years and older is associated with poor health outcomes. However, little is known about health care utilization patterns of socially isolated individuals. This retrospective, observational study evaluated associations between social isolation and hospital and emergency department (ED) utilization among Medicare patients ages 65 years and older. In a cohort of 18,557 Medicare members age 65 years and older at Kaiser Permanente Northwest, the authors compared rates of hospitalization and ED visits in the 12 months following a baseline survey between respondents who reported feeling lonely or socially isolated and those who did not, controlling for demographic and health variables and utilization in the 12 months prior to the survey. Statistical analysis was conducted in February 2020. In adjusted models, those who reported "sometimes" experiencing social isolation were more likely to have at least 1 hospital admission (odds ratio [ORsometimes]: 1.17, 95% confidence interval [CI]: 1.01-1.35, P = 0.04), than those who "rarely" or "never" experienced social isolation. Those who experienced social isolation "sometimes" or "often/always" were more likely to have at least 1 ED visit (ORsometimes: 1.28, 95% CI: 1.15-1.41, P < 0.0001, and ORoften/always: 1.51, 95% CI: 1.25-1.84, P < 0.0001, respectively) than those who "rarely" or "never" experienced social isolation. These findings suggest that self-reported social isolation may be predictive of future hospital admissions and ED utilization. Research is needed to determine how addressing social isolation needs within the health care system affects health care utilization and health outcomes.
Collapse
Affiliation(s)
- David M Mosen
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | - Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Weiming Hu
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Briar Ertz-Berger
- Continuum of Care Department, Northwest Permanente, Portland, Oregon, USA
| | - Neon Brooks
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| |
Collapse
|