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Akinsola KO, Bakare AA, Gobbo E, King C, Hanson C, Falade A, Herzig van Wees S. A systematic review of measures of healthcare workers' vaccine confidence. Hum Vaccin Immunother 2024; 20:2322796. [PMID: 38506574 PMCID: PMC10956625 DOI: 10.1080/21645515.2024.2322796] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Healthcare workers (HCW) perceptions toward vaccines influence patient and community vaccine decision making. In an era of rising vaccine hesitancy, understanding HCW vaccine confidence is critical. This systematic review aims to review instruments that have been validated to measure HCW vaccine confidence. We conducted a search in five databases in June 2023. Data was descriptively synthesized. Twelve articles describing 10 different tools were included. Most tools included dimensions or items on vaccine knowledge (n = 9), safety (n = 8), vaccine usefulness (n = 8), recommendation behavior (n = 8), and self-vaccination practice (n = 7). All, except one study, were conducted in high-income countries. There was variability in the quality of the validation process. There is limited existing literature on development and validation of tools for HCW vaccine confidence. Based on the tools currently available, the Pro-VC-Be tool is the most well validated. Further research needs to include low- and middle-income contexts.
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Affiliation(s)
| | - Ayobami A. Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
- Global Public Health Department, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Gobbo
- Global Public Health Department, Karolinska Institutet, Stockholm, Sweden
| | - Carina King
- Global Public Health Department, Karolinska Institute, Stockholm, Sweden
| | - Claudia Hanson
- Global Public Health Department, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Adegoke Falade
- Department of Pediatrics, University College Hospital, Ibadan, Nigeria
- Pediatrics Department, University of Ibadan, Ibadan, Nigeria
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Yang J, Lee SG. Association between retirement age and depressive symptoms among Korean retirees: Results from Korean Retirement and Income Panel Study. J Affect Disord 2024; 352:454-459. [PMID: 38403136 DOI: 10.1016/j.jad.2024.02.082] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The effective age of retirement in South Korea is higher than the average of Organization for Economic Co-operation and Development (OECD) countries. Early retirement in Asia may affect mental health differently compared to western countries. Thus, we examined the association between retirement age and depressive symptoms among South Korean retirees. METHODS We used data from the 2011, 2013, 2015, 2017, and 2019 Korean Retirement and Income Panel Study, including a total of 2998, 3152, 3203, 3154, and 3055 participants, respectively. We excluded those younger than 50 years, non-retirees, those without information on the Center for Epidemiological Studies-Depression (CES-D) scale, and those with other missing values. We used a generalized estimating equation model to identify the association between retirement age and depressive symptoms measured using the CES-D. RESULTS Participants who retired at age < 50 years had significantly higher CES-D scores (β = 1.764, P = 0.0003) compared to those who retired at age ≥ 70 years. The negative effects of early retirement on depressive symptoms were greater among male participants, heads of households, young involuntary retirees, those who retired within the past 20 years, and those who had no difficulties in activities of daily living. LIMITATIONS Since we evaluated the association between retirement age and depressive symptoms in one direction, there is a possibility of reverse causality. CONCLUSION Our findings highlight the importance of managing depressive symptoms in early retirees, especially young involuntary retirees and those burdened with family care.
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Affiliation(s)
- Jieun Yang
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Republic of Korea; Division of New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
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Amboree TL, Damgacioglu H, Sonawane K, Adsul P, Montealegre JR, Deshmukh AA. Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county-level income in the United States, 2000-2019. Int J Cancer 2024; 154:1549-1555. [PMID: 38270521 DOI: 10.1002/ijc.34860] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
Early evidence suggests that declining cervical cancer incidence reversed in low-income regions in the United States in recent years; however, it is unclear whether there are distinct patterns by race/ethnicity and stage at diagnosis and if the increase has translated into rising mortality. Using Surveillance, Epidemiology, and End Results data, we evaluated trends in hysterectomy-corrected cervical cancer incidence rates (2000-2019) and mortality rates (2005-2019) by county-level income and race/ethnicity, with further stratification of incidence by stage at diagnosis. Following a period of decline, hysterectomy-corrected cervical cancer incidence increased 1.0%/year (95% CI = 0.1% to 4.5%) among Non-Hispanic White women in low-income counties. Particularly, a statistically significant 4.4%/year (95% CI = 1.7% to 7.5%) increase in distant-stage cancer occurred in this group. Additionally, recent increases in cervical cancer mortality (1.1%/year [95% CI = -1.4% to 3.7%]) were observed among this group and Non-Hispanic Black women in low-income counties (2.9%/year [95% CI = -2.3% to 18.2%]), but trends were not statistically significant. Among Hispanic women in low-income counties, distant-stage cervical cancer incidence increased 1.5%/year (95% CI = -0.6% to 4.1%), albeit not statistically significant. The increasing incidence of distant-stage cervical cancer and mortality in specific racial/ethnic groups suggests that the recent introduction of higher sensitivity screening tests may not explain increasing trends in low-income counties. Our findings suggest that the observed rise in cervical cancer incidence may reflect disruptions along the screening and treatment continuum. Future research to further comprehend these trends and continued enhancements in prevention are crucial to combat rising cervical cancer incidence and mortality in low-income counties in the United States.
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Affiliation(s)
- Trisha L Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Haluk Damgacioglu
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kalyani Sonawane
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Epstein LH, Temple JL, Faith MS, Hostler D, Rizwan A. A psychobioecological model to understand the income-food insecurity-obesity relationship. Appetite 2024; 196:107275. [PMID: 38367912 DOI: 10.1016/j.appet.2024.107275] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
Food insecurity, defined by unpredictable access to food that may not meet a person's nutritional needs, is associated with higher BMI (kg/m2) and obesity. People with food insecurity often have less access to food, miss meals and go hungry, which can lead to psychological and metabolic changes that favor energy conservation and weight gain. We describe a conceptual model that includes psychological (food reinforcement and delay discounting) and physiological (thermic effect of food and substrate oxidation) factors to understand how resource scarcity associated with food insecurity evolves into the food insecurity-obesity paradox. We present both animal and human translational research to describe how behavioral and metabolic adaptations to resource scarcity based on behavioral ecology theory may occur for people with food insecurity. We conclude with ideas for interventions to prevent or modify the behaviors and underlying physiology that characterize the income-food insecurity-obesity relationship.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Jennifer L Temple
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Myles S Faith
- Department of Counseling, School and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, NY, USA
| | - David Hostler
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Ashfique Rizwan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Counseling, School and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, NY, USA
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Lee HM, Liu DY, Hsu HL, Yu TL, Yu TS, Shen TC, Tsai FJ. Risk of depression in patients with pneumoconiosis: A population-based retrospective cohort study. J Affect Disord 2024; 352:146-152. [PMID: 38369263 DOI: 10.1016/j.jad.2024.02.057] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pneumoconiosis is an important occupational disease; the association between pneumoconiosis and depression was largely unknown. This study aimed to investigate the relationship between pneumoconiosis and the risk of subsequent depression. METHODS A retrospective cohort study was conducted using Taiwan's National Health Insurance database. The study included 16,795 patients diagnosed with pneumoconiosis between 2008 and 2018 and a comparison cohort of 67,180 individuals without pneumoconiosis, propensity score matched in a 1:4 ratio based on age, sex, monthly income, residential urbanization level, and date of pneumoconiosis diagnosis. The development of depression was monitored until the end of 2019. RESULTS The incidence of depression was 1.68 times higher in the pneumoconiosis cohort than that in the comparison cohort, with an incidence rate of 10.07 versus 5.99 per 1000 person-years (adjusted hazard ratio [aHR] = 1.84, 95 % confidence interval [CI] = 1.70-1.99). The risk of depression increased with an increased mean annual number of emergency department visits for pneumoconiosis, with aHRs of 1.34 (95 % CI = 1.13-1.59) and 2.31 (95 % CI = 1.94-2.76) for 1 ≤ n < 2, and n ≥ 2 compared to n < 1, respectively. LIMITATION The database lacked detailed socioeconomic history, family history, and clinical variables. CONCLUSION This study found that patients with pneumoconiosis have a significantly higher risk of depression than those without pneumoconiosis. Furthermore, the risk of depression increases with the frequency of emergency department visits for pneumoconiosis. Healthcare professionals should pay close attention to the mental health of patients with pneumoconiosis.
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Affiliation(s)
- Hsiu-Ming Lee
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - De-Yi Liu
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Li Hsu
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Ling Yu
- Department of Education, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Shen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Critical Care Medicine, Chu Shang Show Chwan Hospital, Nantou, Taiwan.
| | - Fuu-Jen Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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Loftus TJ, McDowell LD, Upchurch GR. Surgical leadership: Ensuring financial stability through growth. Surgery 2024; 175:1218-1223. [PMID: 37839969 DOI: 10.1016/j.surg.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Maintaining financial stability is important for leaders in surgery because it (1) allows consistent, fair (market value) reimbursement for employees, which conveys that they are valued; (2) enables strategic investment in new programs that may not generate direct financial gains but are required; and (3) builds trust with stakeholders outside the department while strengthening the department's position in negotiations. Key strategies that we have used to increase revenue (income) over the past 6 years have been hiring more faculty, advocating for greater operating room and staffing capacity, staffing surgeons at other institutions using affiliation agreements, attempting to shift grant-funded efforts to non-clinical (research) faculty to mitigate National Institutes of Health salary cap penalties, and increasing efforts to identify external funding for educational and administrative tasks performed by surgeons (eg, increasing contact hours with medical students to secure a greater proportion of state general revenue). Using these strategies, our total revenue has increased 66% over the past 6 years, whereas Academic Support Agreement funds from the College of Medicine concurrently have decreased by 75%. Key strategies that we have used for curtailing expenses have been increasing clinic workflow efficiency; shifting advance practice provider contractual expenses and trainee indirect costs to the hospital; focusing on driving down delayed accounts receivable over time; and using net collections to preferentially invest in research likely to receive future external funding, for which indirect costs return to the department. Despite using these strategies, the total expenses of our department have increased 74% over the past 6 years, driven primarily by the doubling of clinic costs and contractual expenses for advance practice providers. These losses could theoretically be offset by (1) increasing billing by advance practice providers who can also facilitate excellent continuity of surgical care while allowing residents and fellows to shift their effort from service toward education and (2) increasing clinic capacity to generate increasing operative volumes. A department's financial stability is affected by complex interactions among several stakeholders, including the College of Medicine, faculty group practices, and hospitals, with competing interests. Leaders in surgery must understand and manage major categories of revenue and expenses to create a financially stable environment in which they can fulfill their multi-prong missions.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL. https://twitter.com/_TylerLoftus
| | - Lonn D McDowell
- Department of Surgery, University of Florida Health, Gainesville, FL
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Cash-Gibson L, Benach J. Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings. Int J Soc Determinants Health Health Serv 2024; 54:163-170. [PMID: 38311911 DOI: 10.1177/27551938241230006] [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] [Indexed: 02/06/2024]
Abstract
Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- UPF- Barcelona School of Management (UPF-BSM), University Pompeu Fabra, Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- UPF- Barcelona School of Management (UPF-BSM), University Pompeu Fabra, Barcelona, Spain
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
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Smith MD, Wesselbaum D. Well-Being Inequality Among Adolescents and Young Adults. J Adolesc Health 2024; 74:703-712. [PMID: 38069931 DOI: 10.1016/j.jadohealth.2023.10.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/07/2023] [Accepted: 10/16/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE This study aimed to examine patterns of well-being across developmental stages and patterns of inequality in well-being among young adults and adolescents. Well-being exists when adolescents and young adults thrive and can achieve their full potential. METHODS We used individual-level survey data from the Gallup World Poll from 164 countries between 2009 and 2017 (N = 446,934). Regression analyses were used to determine associations. RESULTS We documented substantial inequality in well-being across three developmental stages (adolescence, early adulthood, young adulthood). Health, education, income, and social relations are strongly associated with mean well-being and well-being inequality. We showed, for mean well-being, the relative importance of these factors varies over life-cycle stages. For inequality, most factors were consistent across developmental groups; however, we identified certain characteristics that were only relevant at certain developmental stages. DISCUSSION Given the policy importance of well-being at all stages of life and the significance of adolescence and early adulthood in developing positive health-related behaviors, policies and programs targeting the highlighted characteristics are likely to be effective but require a multisectoral approach.
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Affiliation(s)
- Michael D Smith
- National Oceanic and Atmospheric Administration, Economics and Social Sciences Research, Alaska Fisheries Science Center, Seattle, Washington
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O'Donnell O. Health and health system effects on poverty: A narrative review of global evidence. Health Policy 2024; 142:105018. [PMID: 38382426 DOI: 10.1016/j.healthpol.2024.105018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Ill-health causes poverty. The effect runs through multiple mechanisms that span lifetimes and cross generations. Health systems can reduce poverty by improving health and weakening links from ill-health to poverty. This paper maps routes through which ill-health can cause poverty and identifies those that are potentially amenable to health policy. The review confirms that ill-health is an important contributor to poverty and it finds that the effect through health-related loss of earnings is often larger than that through medical expenses. Both effects are smaller in countries that are closer to universal health coverage and have higher social safety nets. The paper also reviews evidence from low- and middle-income countries (LMICs) and the United States (US) on the poverty-reduction effectiveness of public health insurance (PubHI) for low-income households. This reveals that PubHI does not always deliver financial protection to its targeted population in LMICs. Countries that have succeeded in achieving this goal often combine extension of coverage with supply-side interventions to build capacity and avoid perverse provider incentives in response to insurance. In the US, PubHI is effective in reducing poverty by shielding low-income households with children from healthcare costs and, consequently, generating long-run improvements in health that increase lifetime earnings. Poverty reduction is a potentially important co-benefit of health systems.
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Affiliation(s)
- Owen O'Donnell
- Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands.
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Hua Z, Wang S, Yuan X. Trends in age-standardized incidence rates of depression in adolescents aged 10-24 in 204 countries and regions from 1990 to 2019. J Affect Disord 2024; 350:831-837. [PMID: 38242215 DOI: 10.1016/j.jad.2024.01.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/24/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The objective of this study was to provide a comprehensive analysis of the spatial distribution and temporal trends in the age-standardized incidence rates (ASIRs) of depression in adolescents aged 10-24 worldwide. METHODS Data from the Global Burden of Disease Study (GBD) 2019 were analyzed, adopting Sawyer's broad definition of adolescence encompassing ages 10 to 24. Estimated annual percentage changes (EAPCs) were used to assess temporal trends. RESULTS Globally, from 1990 to 2019, there was a decrease in the ASIR of depression in adolescents (EAPC = -0.23). Notably, this decrease was more pronounced in female adolescents compared to their male counterparts (EAPC = -0.12 and - 0.29, respectively). Conversely, high Sociodemographic Index (SDI) regions experienced a significant increase in the ASIR of depression among adolescents (EAPC = 0.87). Furthermore, it is worth mentioning that individuals aged 20-24 exhibited the highest incidence rate for depression followed by those aged 15-19 and then those aged 10-14. The largest increases in the ASIRs of depression occurred in High-income North America (EAPC = 1.19) and Malaysia (EAPC = 2.4), respectively. LIMITATIONS Mathematical models were used to reconstruct and adjust data of different qualities, which might have introduced bias. CONCLUSIONS The global burden of disease for depression among adolescents aged 10-24 years declined from 1990 to 2019. Special attention must be paid to older adolescents and areas with higher SDIs.
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Affiliation(s)
- Zuguang Hua
- Department of Plastic Surgery, The First Affiliated Hospital of Ningbo University, No.59, Liuting Street Haishu District, Ningbo 315010, Zhejiang, China
| | - Shuyu Wang
- Chinese Center for Disease Control and Prevention, 13 Zhengfu Street, Changping District, 102200 Beijing, China
| | - Xinhua Yuan
- Department of Orthopedics, Ningbo No.2 Hospital, No.41 Northwest Street, Haishu District, Ningbo 315099, Zhejiang, China.
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Bond AE, Karnick AT, Capron DW, Anestis MD. Predicting potential underreporting of firearm ownership in a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 2024; 59:715-723. [PMID: 37351596 DOI: 10.1007/s00127-023-02515-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study utilized demographic and intrapersonal variables to identify individuals who may have falsely denied firearm ownership and determined if individuals can be divided into meaningful subgroups. METHODS Participants were United States residents (N = 3500) recruited from January to June 2020. matched to the 2010 census data for age, race, sex, income, and education level. A Zero-Inflated Negative Binomial (ZINB) regression was utilized to determine potential underreporting of firearm ownership, and a latent class analysis was utilized to determine unique subgroups of those who were identified as underreporting firearm ownership in the ZINB. RESULTS Participants (N = 1306) were identified as underreporting firearm ownership (excess zeros) based on a model that included demographic and intrapersonal variables. A latent class analysis indicated that among excess zeros, three unique subgroups exist. CONCLUSIONS Determining who may be underreporting firearm ownership will allow for a more comprehensive understanding of firearm ownership in the US and more targeted safe storage messages that may reach those who own firearms and are at risk for firearm-related injury and death.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, Newark, USA.
- The Department of Psychology, Rutgers University, Newark, USA.
| | - Aleksandr T Karnick
- The School of Psychology, The University of Southern Mississippi, Hattiesburg, USA
| | - Daniel W Capron
- The School of Psychology, The University of Southern Mississippi, Hattiesburg, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, Newark, USA
- The School of Public Health, Rutgers University, Newark, USA
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Hawn MT. Philanthropic support of academic programs. Surgery 2024; 175:1250-1251. [PMID: 38281853 DOI: 10.1016/j.surg.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
Academic surgical departments must subsidize the research mission, as most funded research does not fully support the faculty effort and true costs of the investigation. Most departments support their research program with the margin from clinical revenue; however, increased pressure on clinical income poses a challenge to this strategy. Philanthropy is an increasingly important revenue source to fund academic missions. The opportunities and challenges of this funding source are discussed in this article.
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Affiliation(s)
- Mary T Hawn
- Stanford University School of Medicine, Stanford, CA.
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13
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Kryston A, Woods CG, Manga M. Social barriers to safe sanitation access among housed populations in the United States: A systematic review. Int J Hyg Environ Health 2024; 257:114326. [PMID: 38295493 DOI: 10.1016/j.ijheh.2024.114326] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Nearly six million people residing in the United States do not have access to safely managed sanitation. Housed populations may lack access to centralized wastewater treatment systems or functioning onsite wastewater treatment systems, which subsequently places them at higher risk for adverse health outcomes associated with unsafe sanitation. OBJECTIVES We sought to understand the various social barriers that impact access to safe sanitation in the United States. METHODS We included peer-reviewed studies published between January 2000 and March 2023. The publication search was conducted using Scopus, ProQuest Social Science Database, and HeinOnline. We extracted data on social barriers and physical factors associated with access to sanitation. RESULTS Twenty publications met the inclusion criteria, and data relating to 11 social barriers and two physical factors were extracted. The social barriers to safe sanitation access mentioned most frequently were found to be socioeconomic status and race-based discrimination. Studies discussed sanitation in communities in five states. DISCUSSION Barriers pertained to lack of access to centralized wastewater treatment system, inadequate repair or replacement of septic systems, and lack of safely managed onsite sanitation systems. We discuss the intersectionality of the barriers, the underlying policy and history that leads to them, and make recommendations to address inequitable access to safe sanitation. Legislation and policy must be critically reviewed at national, state, and local levels to limit or eliminate ability for utilities to be extended on the basis of a community's income and property values or racial makeup. Policy recommendations also include additional community engagement, onsite sanitation system monitoring, and knowledge dissemination and education of septic system users. More geographically diverse research and research on sanitation in specific communities such as those of migrant farmworkers, undocumented persons, and tenants are recommended.
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Affiliation(s)
- Amy Kryston
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Courtney G Woods
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
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14
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Lin JJ, Evans EM, Praxedes K, Agrawal AK, Winestone LE. Financial assistance and other financial coping strategies after a pediatric cancer diagnosis. Pediatr Blood Cancer 2024; 71:e30890. [PMID: 38302828 DOI: 10.1002/pbc.30890] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/24/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Families experience financial burden and household material hardship (HMH) after a pediatric cancer diagnosis. This study investigates types of financial assistance and other financial coping strategies (FCS) adopted by families during the first year after diagnosis. METHODS Retrospective survey of caregivers of pediatric patients diagnosed with cancer from 2015 to 2019. The survey collected data on demographics, diagnosis, income, HMH, and private, hospital, and government assistance received and other FCS adopted after diagnosis. Bivariate and multivariable logistic regressions were used to analyze FCS by income. Subgroup analysis of families experiencing HMH was used to identify predictors of receiving government assistance. RESULTS Of 156 respondents, 52% were low-to-middle income, 29% had public insurance, and 22% had non-English language preference. Low-to-middle-income families were more likely to incur debt (odds ratio [OR] 6.24, p < .001) and reduce consumption (OR 2.16, p = .03) than high-income families, and this association persisted in multivariable analysis. Among families with housing, food, and energy insecurity, 40%, 70%, and 39%, respectively, received hospital or government assistance specific to the experienced hardship. In subgroup analysis of families with HMH, after adjusting for income and other confounders, non-English language preference was associated with lower odds of receiving government assistance. CONCLUSIONS After a pediatric cancer diagnosis, low-to-middle-income families are more likely to incur debt than high-income families. Most families experiencing food insecurity received some food assistance, while housing and energy assistance were less common. Future studies should investigate methods to equitably improve access to financial assistance and minimize long-term financial consequences.
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Affiliation(s)
- Jackie J Lin
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Erica M Evans
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
| | - Kathleen Praxedes
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
| | - Anurag K Agrawal
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Lena E Winestone
- Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, California, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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15
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Kaplan CM, Waters TM, Clear ER, Graves EE, Henderson S. The Impact of Prescription Drug Coverage on Disparities in Adherence and Medication Use: A Systematic Review. Med Care Res Rev 2024; 81:87-95. [PMID: 38174355 DOI: 10.1177/10775587231218050] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Prescription drug cost-sharing is a barrier to medication adherence, particularly for low-income and minority populations. In this systematic review, we examined the impact of prescription drug cost-sharing and policies to reduce cost-sharing on racial/ethnic and income disparities in medication utilization. We screened 2,145 titles and abstracts and identified 19 peer-reviewed papers that examined the interaction between cost-sharing and racial/ethnic and income disparities in medication adherence or utilization. We found weak but inconsistent evidence that lower cost-sharing is associated with reduced disparities in adherence and utilization, but studies consistently found that significant disparities remained even after adjusting for differences in cost-sharing across individuals. Study designs varied in their ability to measure the causal effect of policy or cost-sharing changes on disparities, and a wide range of policies were examined across studies. Further research is needed to identify the types of policies that are best suited to reduce disparities in medication adherence.
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Krakauer KN, Wong LY, Tobias J, Majekodunmi O, Balumuka D, Bravo K, Ameh E, Finlayson S, Nwomeh B, Sifri Z, Charles A, Krishnaswami S. Evaluating Global Surgery Partnerships From Low and Middle Income Country Perspectives. J Surg Res 2024; 296:681-688. [PMID: 38364695 DOI: 10.1016/j.jss.2024.01.040] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Little is known about perceptions of low-income and middle-income country (LMIC) partners regarding global surgery collaborations with high-income countries (HICs). METHODS A survey was distributed to surgeons from LMICs to assess the nature and perception of collaborations, funding, benefits, communication, and the effects of COVID-19 on partnerships. RESULTS We received 19 responses from LMIC representatives in 12 countries on three continents. The majority (83%) had participated in collaborations within the past 5 y with 39% of collaborations were facilitated virtually. Clinical and educational partnerships (39% each) were ranked most important by respondents. Sustainability of the partnership was most successfully achieved in domains of education/training (78%) and research (61%). The majority (77%) of respondents reported expressing their needs before HIC team arrival. However, 54% of respondents were the ones to initiate the conversation and only 47% said HIC partners understood the overall environment well at arrival to LMIC. Almost all participants (95%) felt a formal process of collaboration and a structured partnership would benefit all parties in assessing needs. During the COVID-19 pandemic, 87% of participants reported continued collaborations; however, 44% of partners felt that relationships were weaker, 31% felt relationships were stronger, and 25% felt they were unchanged. CONCLUSIONS Our study provides a snapshot of LMIC surgeons' perspectives on collaboration in global surgery. Independent of location, LMIC partners cite inadequate structure for long-term collaborations. We propose a formal pathway and initiation process to assess resources and needs at the outset of a partnership.
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Affiliation(s)
- Kelsi N Krakauer
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Lye-Yeng Wong
- Department of Surgery, Oregon Health And Science University, Portland, Oregon.
| | - Joseph Tobias
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Olubunmi Majekodunmi
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | - Darius Balumuka
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Kali Bravo
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Emmanuel Ameh
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | | | - Benedict Nwomeh
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anthony Charles
- Department of Surgery, University Of North Carolina At Chapel Hill, Chapel Hill, North Carolina
| | - Sanjay Krishnaswami
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
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17
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Bann D, Wright L, Hughes A, Chaturvedi N. Socioeconomic inequalities in cardiovascular disease: a causal perspective. Nat Rev Cardiol 2024; 21:238-249. [PMID: 37821646 DOI: 10.1038/s41569-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK.
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
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18
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Tao Y, Tan RKJ, Wohlfarth M, Ahumuza E, Aribodor OB, Cruz JRB, Fajardo MS, Magista M, Marley G, Mier-Alpaño JD, Ogwaluonye UC, Paipilla KA, Scott CP, Ulitin A, Chen E, Wu D, Awor P, Tang W, Labarda M, Tucker JD. Social innovation in health training to engage researchers in resource-limited settings: process description and evaluation. Health Promot Int 2024; 39:daae025. [PMID: 38501311 DOI: 10.1093/heapro/daae025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.
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Affiliation(s)
- Yusha Tao
- University of North Carolina Project-China, Guangzhou, No. 7 Lujing Road, China
- Dermatology Hospital of South Medical University, Guangzhou, No. 2 Lujing Road, China
| | - Rayner Kay Jin Tan
- University of North Carolina Project-China, Guangzhou, No. 7 Lujing Road, China
- Dermatology Hospital of South Medical University, Guangzhou, No. 2 Lujing Road, China
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Megan Wohlfarth
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emmanuel Ahumuza
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ogechukwu Benedicta Aribodor
- Social Innovation in Health Initiative (SIHI), Nnamdi Azikiwe University, Awka, Nigeria
- Department of Zoology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | | | - Malida Magista
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, No. 7 Lujing Road, China
- Dermatology Hospital of South Medical University, Guangzhou, No. 2 Lujing Road, China
| | | | - Uchenna Chukwunonso Ogwaluonye
- Social Innovation in Health Initiative (SIHI), Nnamdi Azikiwe University, Awka, Nigeria
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Charlotte Pana Scott
- Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Allan Ulitin
- Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Phyllis Awor
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, No. 7 Lujing Road, China
- Dermatology Hospital of South Medical University, Guangzhou, No. 2 Lujing Road, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 2nd Floor, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, USA
| | - Meredith Labarda
- Department of Medicine, School of Health Sciences, University of the Philippines Manila, Manila, Philippines
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, No. 7 Lujing Road, China
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 2nd Floor, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, USA
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Newell P, Zogg C, Asokan S, Reed A, Vinholo TF, Harloff M, Hirji S, Kerolos M, Kaneko T, Sabe A. Race and Socioeconomic Disparities in Proximal Aortic Surgery. Ann Thorac Surg 2024; 117:761-768. [PMID: 37031768 DOI: 10.1016/j.athoracsur.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Substantial socioeconomics-based disparities exist in cardiac surgery. Although there are robust data for revascularization and valve procedures, the effect of race and socioeconomic status on proximal aortic surgery is not well studied. This study analyzed the impact of race and socioeconomic status on in-hospital outcomes after proximal aortic surgery. METHODS All adult patients who underwent proximal aortic surgery for aortic dissection or thoracic aneurysm from the 2016 to 2018 National Inpatient Sample were included. Primary outcomes included in-hospital mortality and in-hospital composite morbidity (stroke, pulmonary embolus, major bleeding, acute kidney injury, or permanent pacemaker insertion). Adjusted outcomes were assessed with multivariable analysis. RESULTS A weighted total of 32,895 patients were included; 25,461 (77.4%) classified as White, 3224 (9.8%) Black, 2039 (6.2%) Hispanic, and 2171 (6.6%) other. Black and Hispanic patients had significantly lower median household income, higher proportion of self-pay insurance status, younger age, higher comorbidity burden, and a higher proportion of urgent or emergency procedures compared with White patients. There was no significant difference in observed in-hospital mortality by patient race, but non-White patients had significantly higher composite morbidity. On adjusted analysis, there was no difference in in-hospital mortality, but non-White race was an independent predictor of in-hospital morbidity (adjusted odds ratio, 1.6; 95% CI, 1.4-1.8; P < .001). CONCLUSIONS Patients of non-White race who undergo proximal aortic surgery have less insurance coverage, more urgent procedures, and a higher comorbidity burden than White patients, disparities that translate to significantly higher morbidity in non-White. A greater focus on nonfatal outcome differentials and improving access to care likely will improve aortic surgery disparities.
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Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Boston, Massachusetts
| | - Cheryl Zogg
- Yale School of Medicine, New Haven, Connecticut
| | - Sainath Asokan
- Boston University School of Medicine, Boston, Massachusetts
| | - Alexander Reed
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thais Faggion Vinholo
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mariam Kerolos
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ashraf Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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20
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Fadel MA, McCoy JL, Shaffer AD, Kurland KS, Simons JP. Socioeconomic Barriers to Care for Pediatric Airways Utilizing Geographic Information Systems. Laryngoscope 2024; 134:1919-1925. [PMID: 37622670 DOI: 10.1002/lary.30982] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Geographic information systems (GIS) provide a unique set of tools to spatially analyze health care and identify patterns of health outcomes to help optimize delivery. Our goal is to create maps of pediatric tracheostomy patients using GIS to assess socioeconomic and other factors that impact postoperative care after discharge to home. METHODS A retrospective study was performed on patients (≤21 years old) who underwent tracheostomy at a tertiary care pediatric hospital from January 1, 2015 to December 31, 2020. Using GIS, we geocoded patient addresses and conducted spatial analyses of the relationship between patients and access to health care providers as well as vulnerable population factors including poverty, educational attainment, and single-parent households. RESULTS A total of 156 patients were included. Patients initially discharged to transitional care (108/156, 69.2%) had significantly higher likelihood of presenting to the ED regardless of socioeconomic status (OR: 2.28, 95% CI: 1.03-5.05; p = 0.042). There was no relationship between ED visit rate and median household income, poverty level, and percentage of uneducated adults (p = 0.490; p = 0.424; p = 0.752). Median distance to the tertiary care pediatric hospital was significantly longer for patients with no ED visit (median = 61.28 miles; SD = 50.90) compared with those with an ED visit (median = 37.75 miles; SD = 35.92) (p = 0.002). CONCLUSION The application of GIS could provide geo-localized data to better understand the healthcare barriers to access for children with tracheostomies. This study uniquely integrates medical record data with socioeconomic factors and social determinants of health. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1919-1925, 2024.
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Affiliation(s)
- Mark A Fadel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kristen S Kurland
- H. John Heinz III College and School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania, U.S.A
| | - Jeffrey P Simons
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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Munir MM, Lima HA, Endo Y, Moazzam Z, Woldesenbet S, Azap L, Katayama E, Dilhoff M, Cloyd J, Ejaz A, Pawlik TM. Association of Racial and Economic Privilege on Postoperative Outcomes Among Medicare Beneficiaries. J Surg Res 2024; 296:37-46. [PMID: 38215675 DOI: 10.1016/j.jss.2023.12.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Social determinants of health can play an important role in patient health. Privilege is a right, benefit, advantage, or opportunity that can positively affect all social determinants of health. We sought to assess variations in the prevalence of privilege among patient populations and define the association of privilege on postoperative surgical outcomes. METHODS Medicare beneficiaries who underwent elective coronary artery bypass grafting, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, colectomy, and lung resection were identified. The Index of Concentration of Extremes (ICE), a validated metric of both social spatial polarization and privilege was calculated and merged with county-level data obtained from the American Community Survey. Textbook outcome (TO) was defined as absence of postoperative complications, extended length of stay, 90-day mortality, and 90-day readmission. Multivariable regression analysis was performed to assess the relationship between ICE and TO. RESULTS Among 1,885,889 Medicare beneficiaries who met inclusion criteria, 655,980 (34.8%) individuals resided in areas with the highest privilege (i.e., White, high-income homogeneity), whereas 221,314 (11.7%) individuals resided in areas of the lowest privilege (i.e., Black, low-income homogeneity). The overall incidence of TO was 66.2% (n = 1,247,558). On multivariable regression, residence in the most advantaged neighbourhoods was associated with a lower chance of surgical complications (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.88-0.91), a prolonged length of stay (OR 0.81, 95% CI 0.79-82), 90-day readmission (OR 0.94, 95% CI 0.92-0.95), and 90-day mortality (OR 0.71, 95% CI 0.68-0.74) (all P < 0.001). Residence in the most privileged areas was associated with 19% increased odds of achieving TO (OR 1.19, 95% CI 1.18-1.21), as well as a 6% reduction in Medicare expenditures versus individuals in the least privileged counties (OR 0.94, 95% CI 0.94-0.94) (both P < 0.001). CONCLUSIONS Privilege, based on the ICE joint measure of racial/ethnic and economic spatial concentration, was strongly associated with the likelihood to achieve an "optimal" TO following surgery. As healthcare is a basic human right, privilege should not be associated with disparities in surgical care.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Mary Dilhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
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Fuller-Thomson E, Deng Z, Fuller-Thomson EG. Association Between Area Temperature and Severe Vision Impairment in a Nationally Representative Sample of Older Americans. Ophthalmic Epidemiol 2024; 31:119-126. [PMID: 37338863 DOI: 10.1080/09286586.2023.2221727] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Several small studies have associated exposure to elevated average temperature with specific vision problems. However, no large-scale studies have examined the relationship between vision impairment and average area temperature in the general population. We conducted a cross-sectional analysis of a large nationally representative sample of older adults to further explore this relationship. METHODS Secondary analysis of the American Community Survey (ACS). The survey was conducted through mail, telephone and in-person interviews. Data from six consecutive years of the cross-sectional survey were analysed (2012-2017). The subsample analysed included community-dwelling and institutionalized older adults aged 65 and older in the coterminous US who lived in the same state in which they were born (n = 1,707,333). The question on severe vision impairment was "Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?". Average annual temperature data from the National Oceanic and Atmospheric Administration was combined into a 100-year average and mapped to corresponding US Census Bureau's public use microdata areas from the ACS. RESULTS Higher average temperature is consistently associated with increased odds of severe vision impairment across all cohorts (i.e. age, sex, race, income, and educational attainment cohorts) with the exception of Hispanic older adults. Compared to those who lived in counties with average temperature of < 50 °F (< 10 °C) , the odds of severe vision impairment were 44% higher in counties with average temperature of 60 °F (15.5 °C) or above (OR 1.44; 95% CI 1.42-1.46). CONCLUSION If the association is found to be causal, the predicted rise in global temperatures could impact the number of older Americans affected by severe vision impairment and the associated health and economic burden.
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Affiliation(s)
- Esme Fuller-Thomson
- Institute for Life Course & Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - ZhiDi Deng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elysia G Fuller-Thomson
- Institute for Life Course & Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Berkowitz ST, Groth S, Sternberg P, Patel S. Drug Savings for Medicare Part D Beneficiaries Using a Direct-to-Consumer Model. Ophthalmology 2024; 131:509-510. [PMID: 38072014 DOI: 10.1016/j.ophtha.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024] Open
Affiliation(s)
- Sean T Berkowitz
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Sylvia Groth
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Paul Sternberg
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Shriji Patel
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee.
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24
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Jehan S, Zahnd WE, Wooten NR, Seay KD. Geographic variation in availability of opioid treatment programs across U.S. communities. J Addict Dis 2024; 42:136-146. [PMID: 36645315 DOI: 10.1080/10550887.2023.2165869] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methadone for Opioid Use Disorder (OUD) treatment is only dispensed at Opioid Treatment Programs (OTPs). Little is known about the geographic variation in OTP availability and community characteristics associated with the availability across smaller geographic communities in the U.S. To (1) describe geographic distribution of OTPs and (2) examine OTP availability by community characteristics in the contiguous U.S. at Zip Code Area Tabulation (ZCTA) level. Logistic regression was used to examine community characteristics associated with OTP availability (N = 30,367). Chi-square and t-tests were conducted to examine statistically significant differences in OTP availability. Maps and descriptive statistics were used to examine geographic variation in OTP availability. Only 5% (1,417) of ZCTAs had at least one OTP for a total of 1,682 OTPs. Rural ZCTAs had 50% lower odds of having an OTP compared to urban ZCTAs [AOR 0.5; (95% CI: 0.41-0.60)]. ZCTAs in the lowest income quartile had higher odds of having an OTP compared to ZCTAs in the highest income quartile [AOR 3.4; (95% CI: 2.71-4.18)]. Further, ZCTAs with OTPs had a higher proportion of minority residents [Black: 17.5% vs. 7.2%; Hispanic: 19.2% vs. 9%] and a lower proportion of White residents [55.1% vs. 78.2%]. Nationally, OTPs are extremely scarce with notable regional and urban-rural disparities. Potential solutions to address these disparities are discussed.
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Affiliation(s)
- Sadia Jehan
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Whitney E Zahnd
- Department of Health Policy and Management, University of Iowa, Iowa City, IA, USA
| | - Nikki R Wooten
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Kristen D Seay
- College of Social Work, University of South Carolina, Columbia, SC, USA
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25
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Sheehy L, Crawford T, River J. The reported experiences of internationally qualified nurses in aged care: A scoping review. J Adv Nurs 2024; 80:1299-1313. [PMID: 37904718 DOI: 10.1111/jan.15913] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/05/2023] [Accepted: 10/15/2023] [Indexed: 11/01/2023]
Abstract
AIM To examine the experiences of internationally qualified nurses, including those from culturally and linguistically diverse backgrounds, transitioning to and working in the aged care sector of high-income countries. DESIGN A scoping review. DATA SOURCES CINAHL, MEDLINE and PSychINFO databases were searched to find eligible literature published from January 2010 onwards. REVIEW METHODS This scoping review was based on the framework by Arksey and O'Malley and the PRISMA-ScR guidelines. The literature search was conducted by the first author, and all three authors reviewed the retrieved studies for eligibility and inclusion. RESULTS Fourteen articles were eligible. Data was categorized into three broad themes: stress of migration and transition; miscommunication, racism and discrimination; and aged care specific challenges which included two sub-themes 'shock of aged care' and 'bottom care'. CONCLUSION Internationally qualified nurses, particularly if they are culturally and linguistically diverse, face unique stresses and challenges in aged care and face barriers in the recognition of skills and qualifications. The under-utilization of skills is not only a loss in terms of patient care but is linked to fears of de-skilling, losing professional development and opportunities for career progression. IMPACT Internationally qualified nurses are positioned as a solution to aged care shortages in high-income countries; however, there is a scarcity of research exploring their experiences. In the context of the global aged care staffing crisis, an understanding of the stresses and challenges faced by internationally qualified nurses will further strengthen efforts to recruit, support and retain skilled nurses in aged care.
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Affiliation(s)
- Louise Sheehy
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tonia Crawford
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jo River
- Faculty of Health, UTS and Northern Sydney Local Health District, Sydney, New South Wales, Australia
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26
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Cross JH, Schoeler NE, Marston L, Freemantle N. Implications of the KIWE trial for low- income and lower-middle-income countries - Authors' reply. Lancet Neurol 2024; 23:332-333. [PMID: 38508825 DOI: 10.1016/s1474-4422(24)00080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Affiliation(s)
- J Helen Cross
- Developmental Neurosciences Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Paediatric Neurosciences, Great Ormond Street Hospital for Children, London, UK.
| | - Natasha E Schoeler
- Developmental Neurosciences Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Dietetics, Great Ormond Street Hospital for Children, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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Ettman CK, Subramanian M, Fan AY, Adam GP, Abdalla SM, Galea S, Stuart EA. Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2024; 59:571-583. [PMID: 37838630 DOI: 10.1007/s00127-023-02565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic. METHODS We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations. RESULTS Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups. CONCLUSION This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.
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Affiliation(s)
- Catherine K Ettman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Boston University School of Public Health, Boston, USA.
| | | | - Alice Y Fan
- Boston University School of Public Health, Boston, USA
| | - Gaelen P Adam
- Brown University School of Public Health, Providence, USA
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, USA
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Oliveira LM, Sfreddo CS, Ardenghi TM, Nascimento GG, Demarco FF, Zanatta FB. The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis. Community Dent Oral Epidemiol 2024; 52:239-247. [PMID: 37822131 DOI: 10.1111/cdoe.12920] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/24/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults. METHODS We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking. RESULTS The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]). CONCLUSION Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.
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Affiliation(s)
- Leandro Machado Oliveira
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Camila Silveira Sfreddo
- Department of Semiology and Clinic, Faculty of Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Fabrício Batistin Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
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Aravena-Rivas Y, Venturelli R, Stennett M, Tsakos G. Inequalities in dental services use by older adults in Chile according to eligibility for a national dental programme. Community Dent Oral Epidemiol 2024; 52:161-170. [PMID: 37691001 DOI: 10.1111/cdoe.12909] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 07/20/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES The objectives of this study were to determine the prevalence and trends in dental service use among Chilean older adults (60+ years) between 2006 and 2017; to assess the association between socioeconomic factors and dental service use and type (public/private) in 2017 and whether these differ by eligibility to a national dental programme (GES-60). METHODS This study involved secondary data analysis of five nationally representative cross-sectional surveys between 2006 and 2017. Trends were assessed for use of dental services and types of services used among 60-79-year-olds. Logistic regression models examined the association between use of dental services in 2017 and socioeconomic variables (income and education), accounting for covariates (age, gender, residence, ethnicity, cohabiting status, employment and disability). Estimated marginal means and odds ratios (ORs) were calculated to assess the association between socioeconomic variables and the outcomes by GES-60 eligibility. RESULTS Across surveys, the average prevalence of use of dental services in the last 3 months was 5.0%. There was a slight increase in dental visits between 2006 and 2017. This trend was higher among GES-60 eligible individuals using public dental services. Inequalities were observed in regression analyses. Compared to the poorest quintile and those with no formal education respectively, the ORs were 2.36 (95% confidence interval (CI) 1.79-5.68) for the richest quintile and ranged from 2.91 (95% CI 1.49-5.68) to 6.43 (3.26-12.68) for each higher level of educational attainment. Inequalities were wider among GES-60 non-eligible than GES-60 eligible older adults for both outcomes. CONCLUSIONS Socioeconomic inequalities were present among older adults regardless of GES-60 eligibility. However, these inequalities were more pronounced among non-eligible individuals. Our findings suggest a limited impact of GES-60 only among eligible older adults. Policies considering the needs of the whole older adult population are likely to have a stronger impact.
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Affiliation(s)
- Yanela Aravena-Rivas
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Renato Venturelli
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michelle Stennett
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
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Nguyen HB, Vo LNQ, Forse RJ, Wiemers AMC, Huynh HB, Dong TTT, Phan YTH, Creswell J, Dang TMH, Nguyen LH, Shedrawy J, Lönnroth K, Nguyen TD, Dinh LV, Annerstedt KS, Codlin AJ. Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study. Infect Dis Poverty 2024; 13:27. [PMID: 38528604 DOI: 10.1186/s40249-024-01196-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector. METHODS Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression. RESULTS The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021). CONCLUSIONS Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.
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Affiliation(s)
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Ha Noi, Viet Nam.
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Rachel Jeanette Forse
- Friends for International TB Relief, Ha Noi, Viet Nam
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Huy Ba Huynh
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | | | | | | | | | - Jad Shedrawy
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | - Kristi Sidney Annerstedt
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Andrew James Codlin
- Friends for International TB Relief, Ha Noi, Viet Nam
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
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Wang H, Chen B, Shen X. Extreme rainfall, farmer vulnerability, and labor mobility-Evidence from rural China. Sci Total Environ 2024; 918:170866. [PMID: 38340843 DOI: 10.1016/j.scitotenv.2024.170866] [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: 05/02/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
The recurrent occurrence of extreme weather events poses a significant threat to agricultural production, food security, and sustainable economic development. Understanding farmers' adaptive responses to cope with these challenges is pivotal for informing and implementing effective climate resilience policies. This study utilizes the Spatial Precipitation Index (SPI) to assess rainfall patterns and applies fixed effects methods to analyze extreme rainfall shocks' impact on rural households, using panel data from China's 2006-2015 National Rural Fixed Point Survey. Below are the results. Firstly, both drought and rainstorm shocks negatively affect agricultural yield and income, highlighting farmers' vulnerability to extreme rainfall events. Secondly, farmers respond to these shocks by reallocating labor from agriculture to non-agricultural sectors or migrating to urban areas, with these labor mobility patterns typically being temporary. Thirdly, there's notable heterogeneity linked to household affluence. Less affluent rural households experienced more pronounced declines in yield and income, compelling higher migration rates. Collectively, our findings shed light on how Chinese rural households strategically adjust their labor decisions to respond to extreme rainfall shocks through inter-sectoral and inter-regional labor mobility.
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Affiliation(s)
- Heer Wang
- School of Economics, Zhejiang University, Hangzhou 310058, PR China.
| | - Bo Chen
- School of Economics, Jinan University, Guangzhou 510632, PR China
| | - Xuhang Shen
- School of Economics, Zhejiang University, Hangzhou 310058, PR China
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Kipchumba E, Davey C, Marks S, Mugeere A, Chen S, Banks LM, Islam KE, Shakespeare T, Kuper H, Sulaiman M. Evaluation of a disability-inclusive ultra-poor graduation programme in Uganda: study protocol for a cluster-randomised controlled trial with process evaluation. Trials 2024; 25:206. [PMID: 38515150 PMCID: PMC10956226 DOI: 10.1186/s13063-024-08040-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor graduation model that has been shown to be effective in many contexts but not evaluated for people with disabilities. METHODS The DIG programme works with project participants over a period of 18 months. Participants receive unconditional cash transfers for 6 months, training, access to savings-and-loans groups, and a capital asset that forms the basis of their new livelihood. The programme is also adapted to address specific barriers that people with disabilities face. Eligible households are clustered by geographical proximity in order to deliver the intervention. Eligibility is based on household screening to identify the 'ultra-poor' based on proxy means testing-both households with and without people with disabilities are included in the programme. Clusters are randomly selected prior to implementation, resulting in 96 intervention and 89 control clusters. The primary outcome of the trial is per-capita household consumption. Before the start of the intervention, a baseline household survey is conducted (November 2020) among project participants and those not offered the programme, a similar endline survey is conducted with participants with disabilities at the end of programme implementation in July 2022, and a second endline survey for all participants in October 2023. These activities are complemented by a process evaluation to understand DIG programme implementation, mechanisms, and context using complementary qualitative and quantitative methods. Ethical approval for the research has been received from Mildmay Uganda Research Ethics Committee and London School of Hygiene and Tropical Medicine. DISCUSSION DIG is a promising intervention to evaluate for people with disabilities, adapted to be disability inclusive across programme components through extensive consultations and collaboration, and has proven efficacy at reducing poverty in other marginalised groups. However, evaluating a well-evidenced intervention among a new target group poses ethical considerations. TRIAL REGISTRATION Registry for International Development Impact Evaluations, RIDIE-STUDY-ID-626008898983a (20/04/22). ISRCTN registry, ISRCTN78592382 . Retrospectively registered on 17/08/2023.
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Affiliation(s)
- Elijah Kipchumba
- Independent Evaluation and Research Cell (IERC), BRAC International, Kampala, Uganda
- Trinity College Dublin, Dublin, Ireland
| | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Marks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony Mugeere
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - Munshi Sulaiman
- BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
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Mikou M, Vallet A, Guivarch C. Harmonized disposable income dataset for Europe at subnational level. Sci Data 2024; 11:308. [PMID: 38514683 PMCID: PMC10957931 DOI: 10.1038/s41597-024-03138-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
In recent decades, detailed country-level estimates of income and wealth have become widely available and inform us about the evolution of inequality between and within countries. But a substantial portion of these available datasets lack sub-national geographical information, precluding the exploration of the spatial distribution and evolution of inequalities within countries. We present here a new dataset of disposable income for Europe at the subnational level. It has been compiled from existing income data (gross income, gross earnings, equivalised income, etc.) published by national statistical institutes at different geographical levels. We used linear regressions and numerical operations to estimate disposable income from other available socio-economic statistics (e.g. household size, tax rates). We developed a harmonization and adjustment procedures to ensure of the consistency of statistical units, income indicators, costs of living and inflation. The dataset covers 42 European countries distributed over more than 120,000 geographical entities on the 1995 to 2021 period (most of the data being available for the 2010-2020 decade). This new dataset opens avenues for investigating the links between income inequality and other socio-economic or ecological processes.
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Affiliation(s)
- Mehdi Mikou
- Université Paris-Saclay, AgroParisTech, CNRS, Ecole des Ponts ParisTech, Cirad, EHESS, UMR CIRED, 94130, Nogent-sur-Marne, France.
- Université Paris-Saclay, CNRS, AgroParisTech, Ecologie Systématique et Evolution, 91190, Gif-sur-Yvette, France.
| | - Améline Vallet
- Université Paris-Saclay, AgroParisTech, CNRS, Ecole des Ponts ParisTech, Cirad, EHESS, UMR CIRED, 94130, Nogent-sur-Marne, France
- Université Paris-Saclay, CNRS, AgroParisTech, Ecologie Systématique et Evolution, 91190, Gif-sur-Yvette, France
| | - Céline Guivarch
- Université Paris-Saclay, AgroParisTech, CNRS, Ecole des Ponts ParisTech, Cirad, EHESS, UMR CIRED, 94130, Nogent-sur-Marne, France
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Petrovic N. Reassessing the VaxTax. J Med Ethics 2024; 50:222-225. [PMID: 37673670 DOI: 10.1136/jme-2023-109045] [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: 03/02/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
To counter the imbalance in vaccine distribution during the COVID-19 pandemic, Albertsen and more recently Germani et al have suggested a new system of taxation coined as 'VaxTax' that would force higher-income countries to fund the access of low-income and middle-income countries (LMICs) to new vaccines in times of pandemic. I will argue that this idea faces numerous challenges of ethical, sociopolitical and economical nature that may hinder any effort to solve the numerous health challenges that LMICs face. I argue that while it is an interesting idea, it is neither sufficient nor will it ever be easily implemented because of socioeconomic or practical reasons.
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Liu J, Liu Y, Ma W, Liu J, Tong Y, Wang C, Zheng J. Age-period-cohort analysis of ischemic stroke deaths attributable to physical inactivity in different income regions. Sci Rep 2024; 14:6547. [PMID: 38503900 PMCID: PMC10951293 DOI: 10.1038/s41598-024-57309-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 03/21/2024] Open
Abstract
This study assessed the global and regional burden of IS (ischemic stroke) deaths due to LPA (low physical activity) from 1990 to 2019, analyzed regional, sex, and age differences in ASMR (age-standardized mortality rate), and provided a comprehensive understanding of the impact of age, period, and cohort on low physical activity related ischemic stroke ASMR. We conducted an APC (age-period-cohort) analysis of the global and four World Bank income level regions' IS mortality data attributed to LPA from 1990 to 2019, using the GBD2019 database, and the results showed that the global net drift of the Ischemic stroke age-standardized mortality attributable to low physical activity was - 1.085%[95% CI: - 1.168, - 1.003].The ASMR drop is most pronounced in the high-income zone, with a net drift of - 2.473% [95% CI: - 2.759, - 2.187] across the four income groups. The influence of age on mortality is increasing in the worldwide old population, while the period and cohort effects are decreasing. We also performed a Joinpoint regression analysis, which revealed that the specific time of considerable drop in ASMR of IS in the global LPA population was 2002-2007, with an APC of -2.628%. The specific period of considerable drop in ASMR in high-income regions with the highest variation was 1999-2007, with an APC = - 4.726%. The global burden of public health deaths caused by LPA is diminishing, with the most notable progress observed in high-income regions. However, in low and lower-middle income areas, the situation continues to deteriorate. Within the global elderly population, the effects of age on mortality is increasing, while the effects of period and cohort are diminishing. These trends vary across income levels, highlighting the necessity for enhanced international collaboration to formulate context-specific public health strategies aimed at enhancing cardiovascular health on a global, regional, and national scale.
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Affiliation(s)
- Junjiao Liu
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yueyang Liu
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wenjun Ma
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jie Liu
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yan Tong
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Cui Wang
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianzhong Zheng
- College of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.
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Magistro B, Abramson C, Ebanks D, Debnath R, Alvarez RM. Identifying American climate change free riders and motivating sustainable behavior. Sci Rep 2024; 14:6575. [PMID: 38503779 PMCID: PMC10951196 DOI: 10.1038/s41598-024-57042-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
Free riders, who benefit from collective efforts to mitigate climate change but do not actively contribute, play a key role in shaping behavioral climate action. Using a sample of 2096 registered American voters, we explore the discrepancy between two groups of free riders: cynics, who recognize the significance of environmental issues but do not adopt sustainable behaviors, and doubters, who neither recognize the significance nor engage in such actions. Through statistical analyses, we show these two groups are different. Doubters are predominantly male, younger, with lower income and education, exhibit stronger conspiracy beliefs, lower altruism, and limited environmental knowledge, are more likely to have voted for Trump and lean towards conservative ideology. Cynics are younger, religious, higher in socioeconomic status, environmentally informed, liberal-leaning, and less likely to support Trump. Our research provides insights on who could be most effectively persuaded to make climate-sensitive lifestyle changes and provides recommendations to prompt involvement in individual sustainability behaviors. Our findings suggest that for doubters, incentivizing sustainability through positive incentives, such as financial rewards, may be particularly effective. Conversely, for cynics, we argue that engaging them in more community-driven and social influence initiatives could effectively translate their passive beliefs into active participation.
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Affiliation(s)
| | | | - Daniel Ebanks
- California Institute of Technology, Pasadena, CA, 91125, USA
- Harvard University, Cambridge, MA, 02138, USA
| | - Ramit Debnath
- California Institute of Technology, Pasadena, CA, 91125, USA.
- University of Cambridge, Cambridge, CB30HE, UK.
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Anticona C, Suominen AL, Holgerson PL, Gustafsson PE. Impact of an oral care subsidization reform on intersectional inequities in self-rated oral health in Sweden. Int J Equity Health 2024; 23:63. [PMID: 38504240 PMCID: PMC10953229 DOI: 10.1186/s12939-024-02121-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Oral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004-2018. METHODS Data from 14 national surveys conducted over 2004-2018 were divided into three study periods: pre-reform (2004-2007), early post-reform (2008-2012) and late post-reform (2013-2018). The final study population was 118,650 individuals aged 24-84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status. RESULTS Overall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform. CONCLUSIONS Increased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.
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Affiliation(s)
- Cynthia Anticona
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE-90187, Sweden.
- Department of Odontology, Umeå University, Umeå, SE-90187, Sweden.
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Teaching Unit, Kuopio University Hospital, Kuopio, Finland
| | - Pernilla Lif Holgerson
- Department of Odontology, Section of Pediatric Dentistry, Umeå University, Umeå, SE-90187, Sweden
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE-90187, Sweden
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Lewis NV, Kalichman B, Azeredo YN, Bacchus LJ, d'Oliveira AF. Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives. BMC Med Ethics 2024; 25:32. [PMID: 38504254 PMCID: PMC10949724 DOI: 10.1186/s12910-024-01034-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage of the global research projects on health system responses to VAW. METHODS We used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW. RESULTS We developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs' rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research. CONCLUSIONS The process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics.
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Affiliation(s)
- Natalia V Lewis
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Beatriz Kalichman
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil
| | - Yuri Nishijima Azeredo
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Flavia d'Oliveira
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil
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Chen Z, Xu N, Chen X, Zhang X, Yin S, Xiao G, Luo L, Liu Q, Su C. Dietary knowledge-attitude-practice status in hemodialysis patients: a latent profile analysis. BMC Public Health 2024; 24:836. [PMID: 38500120 PMCID: PMC10946152 DOI: 10.1186/s12889-024-18066-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Hemodialysis patients require a reasonable dietary intake to manage their disease progression effectively. However, there is limited research on these patients' overall dietary knowledge, attitude, and practice (KAP) status. This study aimed to investigate the dietary KAP status and latent profiles in hemodialysis patients and identify sociodemographic and disease-related factors associated with these profiles and dietary practice. METHODS A multicenter cross-sectional study involving 425 hemodialysis patients was conducted. A dietary KAP questionnaire in hemodialysis patients was used to evaluate the dietary KAP of the patients. A structural equation model was employed to analyze the correlations between dietary knowledge, attitude, and practice. Multiple linear regression analysis was used to identify factors associated with dietary practice scores. Latent profile analysis was conducted to determine the latent profiles of dietary KAP, and binary logistic regression was used to explore the sociodemographic and disease-related characteristics associated with each KAP profile in hemodialysis patients. RESULTS The normalized average scores for dietary knowledge, attitude, and practice in hemodialysis patients were 0.58, 0.82, and 0.58, respectively. The structural equation model revealed significant positive correlations between dietary knowledge and attitude, and attitude and practice. Attitude played an indirect effect between knowledge and practice. Gender, cerebrovascular disease, and dietary attitude scores were identified as independent influencing factors for dietary practice scores. Two dietary KAP profiles were developed: a profile with general knowledge and attitude but low practice (40.2%) and a profile with general knowledge and attitude and high practice (59.8%). Binary logistic regression analysis indicated gender and monthly income per household significantly predicted membership in each KAP profile. CONCLUSIONS The dietary practice of hemodialysis patients requires improvement. It is necessary to develop more individualized dietary interventions for these patients. Further exploration is needed to understand the motivation of patients to change their dietary behavior.
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Affiliation(s)
- Zhiqian Chen
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Na Xu
- Department of Nephrology, Peking University Third Hospital Yanqing Hospital, Beijing, China
| | - Xinxin Chen
- Department of Nursing, Peking University Third Hospital, Beijing, China
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Xiaoyu Zhang
- Department of Nursing, Peking University Third Hospital, Beijing, China
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Shuqing Yin
- Department of Nephrology, Fengtai Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Guanghui Xiao
- Department of Nephrology, Beijing Haidian Hospital, Beijing, China
| | - Li Luo
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Qun Liu
- Department of Nephrology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China.
| | - Chunyan Su
- Department of Nursing, Peking University Third Hospital, Beijing, China.
- Department of Nephrology, Peking University Third Hospital, Beijing, China.
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Nwaka ID, Emeagwali OL. Participation and returns from informal service-oriented non-farm enterprises: Evidence from a survey of Nigerian households. PLoS One 2024; 19:e0298794. [PMID: 38498475 PMCID: PMC10947675 DOI: 10.1371/journal.pone.0298794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
We investigate the factors that influence the selection and productivity of informal service-oriented family enterprises in Nigeria. Using nationally representative micro-data from the Nigerian General Household Survey (2010-2015), we employed random-effect probit and selectivity-adjusted regression models to estimate and analyze the results. The findings reveal that the location of informal Non-Farm Household Enterprises (NFHEs)-whether home-based or non-home-based-significantly impacts the wholesale, retail, personal, and consultancy service sectors operated by informal NFHEs. This impact remains significant even after accounting for variations in individuals, households, or locational characteristics. Furthermore, when considering selectivity in the earnings equation, we found that home-based informal enterprises exhibit lower productivity compared to non-home-based enterprises, a difference that varies across sectors. Overall, factors such as the gender of business owners, educational levels, geopolitical zones, infrastructure, and business characteristics play a crucial role in determining the locational and productivity disparities among service-oriented enterprises in Nigeria. Key recommendations stemming from this study include addressing gender-based segregation and economic disparities, prioritising financial inclusion for small business development, bridging infrastructure gaps, and implementing policies that acknowledge and bolster the informal sector.
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Affiliation(s)
- Ikechukwu Darlington Nwaka
- Department of Marketing, Business Economics and Law, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Okechukwu Lawrence Emeagwali
- Department of Business Management, Girne American University, Kyrenia, North Cyprus, via Mersin 10, Istanbul, Turkey
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Aderinto N, Olatunji G, Kokori E, Abdulrahmon MA, Akinmeji A, Fatoye JO. Expanding surgical access in Africa through improved health insurance schemes: A review. Medicine (Baltimore) 2024; 103:e37488. [PMID: 38489736 PMCID: PMC10939550 DOI: 10.1097/md.0000000000037488] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | - Ayodeji Akinmeji
- Department of Medicine, Olabisi Onabanjo University, Ogun, Nigeria
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Eyasmin F, Ghosh BC. Analyzing the determinants of beef cattle commercialization and Its market inefficiency: A case study of Pabna district, Bangladesh. PLoS One 2024; 19:e0300034. [PMID: 38489332 PMCID: PMC10942084 DOI: 10.1371/journal.pone.0300034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
The world has entered a new era of globalization and industrialization, which pose several challenges to ensuring food security. Beef cattle production is one of the fastest-growing subsectors that has the capacity to meet protein demand. Due to growing demand of meat and protein and a market-oriented production system, small-scale beef cattle production contribute most to marginal farmers as a means of rising income in many developing nations like Bangladesh. Though production and commercialization are not easier for households' due to various factors and a lack of market efficiency. To determine beef cattle commercialization and market inefficiency, the current study focused on the determinants of beef cattle commercialization and the challenges to the of market efficiency. Heckman's two-stage model used to determine the factors that influence households' commercialization decisions, and the two-stage least squares method is used to examine the constraints of market inefficiencies. However, commercialization decisions offer twofold decision of commercialization and degree of commercialization. The result showed that commercialization decisions are significantly influenced by households' age, extension services, and production costs. The degree of commercialization was affected by education, marketing costs, income from dairy, transportation costs, and training access. On the other hand, market inefficiency was influenced by formal market access, distance, extension services, and earning from cattle. As extension services worsen both commercialization decisions and market efficiency, the government should focus on extension services and offer farmers opportunities to increase their understanding and knowledge of marketing.
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Affiliation(s)
- Farjana Eyasmin
- Department of Economics, Pabna University of Science and Technology, Rajshahi, Bangladesh
| | - Bikash Chandra Ghosh
- Department of Economics, Pabna University of Science and Technology, Rajshahi, Bangladesh
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Rocha T, Melson E, Zamora J, Fernandez-Felix BM, Arlt W, Thangaratinam S. Sex-Specific Obesity and Cardiometabolic Disease Risks in Low- and Middle- Income Countries: A Meta-Analysis Involving 3 916 276 Individuals. J Clin Endocrinol Metab 2024; 109:1145-1153. [PMID: 37930879 PMCID: PMC10940259 DOI: 10.1210/clinem/dgad599] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT There is limited knowledge about the disparities between the sexes in obesity prevalence and associated cardiovascular complications in low- and middle-income countries (LMICs). OBJECTIVE We undertook a systematic review and meta-analysis to assess sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, the burden in women, and variations by region, country's income status, setting, and time. METHODS We searched major databases from inception to March 2023. Two independent reviewers selected the studies, assessed their quality, and extracted data. We used DerSimonian and Laird random-effects models to obtain pooled estimates of odds ratios and 95% CI for the association between sex and obesity and cardiometabolic diseases, and multilevel random-effects logistic regression models to estimate the prevalence of relevant outcomes (PROSPERO CRD42019132609). RESULTS We included 345 studies (3 916 276 individuals). The odds of obesity were 2.72-fold higher in women than men (OR 2.72; 95% CI, 2.54-2.91). The sex-specific disparities varied by region, with the greatest disparities in Sub-Saharan Africa (OR 3.91; 95% CI, 3.49-4.39). Among women in LMICs, 23% (95% CI, 21%-25%) had obesity, 27% (95% CI, 24%-29%) had hypertension, and 7% (95% CI, 6%-9%) had type 2 diabetes. The prevalence of obesity and type 2 diabetes in women varied by region, country's income, and setting, with the highest prevalence in the Middle East and North Africa, upper-middle-income countries and urban settings. The odds of hypertension (OR 2.41; 95% CI, 1.89-3.08) and type 2 diabetes (OR 2.65; 95% CI, 1.76-3.98) were doubled in women with vs without obesity. CONCLUSION There is an urgent need for a women-centred and region-stratified approach to tackle obesity awareness, treatment, and prevention in women in LMICs.
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Affiliation(s)
- Thaís Rocha
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Eka Melson
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Javier Zamora
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid 28034, Spain
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
| | - Borja Manuel Fernandez-Felix
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid 28034, Spain
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TQ, UK
- Medical Research Council London Institute of Medical Sciences (MRC LMS), London W12 0HS, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TQ, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham B15 2TG, UK
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Yazdizadeh B, Ahmadi A, Najafi F, Mohammad K, Fariden M, Khalili D, Mahdavi M, Rahimpour E, Jouyban A, Kelishadi R, Monazzam MR, Eftekhari MB, Falahat K, Nikooee S, Majdzadeh R. Establishing research impact assessment in Iran: The first report from a non-high- income country. J Glob Health 2024; 14:04050. [PMID: 38483444 PMCID: PMC10939117 DOI: 10.7189/jogh.14.04050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background This study presents the first report on research impact assessment (RIA) in non-high-income countries, undertaken as a pilot initiative in 2021. Within it, we aimed to explore the feasibility of employing the 'payback' model for evaluating the impact of health research and enhancing the accountability of universities. We focussed on three key impact domains: 'production of decision support documents and knowledge-based products,' 'implementation of research results,' and 'health and economic impact.' Methods We adopted a case study approach to assess the impact of 5334 health research projects conducted by researchers from 18 universities from 2018 to 2020. Researchers were required to submit evidence related to at least one of the specified impact domains; six scientific committees verified and scored claimed impacts at the national level. Results Only 25% of the assessed projects achieved impact in at least one domain, with the production of decision support documents and knowledge products being the most reported impact. Notably, economic impact was verified in only three projects, indicating room for improvement in this area. Technology research exhibited the highest acceptance rate of claimed impact, suggesting a positive correlation between technology-focused projects and impactful outcomes. Conclusions This study demonstrates the feasibility of employing a case study approach and the 'payback' model to evaluate the impact of health research, even within the constraints of a moderately equipped research infrastructure. These findings underscore the potential of integrating RIA into the governance of health research in Iran and other non-high-income countries, as well as the importance of using RIA to assess the accountability of health research systems, guide the allocation of research funding, and advocate for the advancement of health research. The study sets a precedent for future assessments in similar contexts and contributes to the ongoing global dialogue on the societal impact of health research.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Equal contribution
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Fariden
- Environmental Health Research Center, Department of Occupational Health and Safety at Work Engineering, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahdavi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Rahimpour
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Monazzam
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences
| | | | - Katayoun Falahat
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK
- Equal contribution
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Greenberg P, O'Callaghan L, Fournier AA, Gagnon-Sanschagrin P, Maitland J, Chitnis A. Impact of living with an adult with depressive symptoms among households in the United States. J Affect Disord 2024; 349:107-115. [PMID: 38154583 DOI: 10.1016/j.jad.2023.12.040] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The effect of depressive symptoms on individuals has been widely studied but their impact on households remains less explored. This study assessed the humanistic and economic impact of living with an adult with depressive symptoms on adults without depressive symptoms among households in the United States (US). METHODS The Medical Expenditure Panel Survey (MEPS) Household Component database was used to identify adults without depressive symptoms living in households with ≥1 adult with depressive symptoms (depression household) and adults without depressive symptoms living in households without an adult with depressive symptoms (no-depression household). Weighted generalized linear models with clustered standard errors were used to compare total income (USD 2020), employment status, workdays missed, quality of life (QoL), and healthcare resource utilization (HRU) between cohorts. RESULTS Adults without depressive symptoms living in a depression household (n = 1699) earned $4720 less in total annual income (representing 11.3% lower than the average income of $41,634 in MEPS), were less likely to be employed, missed more workdays per year, and had lower QoL than adults without depressive symptoms living in a no-depression household (n = 15,286). Differences in total annual healthcare costs and for most types of HRU, except for increased outpatient mental health-related visits, were not significant. LIMITATIONS Data is subject to reporting bias, misclassification, and other inaccuracies. Causal inferences could not be established. CONCLUSION The economic and humanistic consequences of depressive symptoms may extend beyond the affected adults and impact other adult members of the household.
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Affiliation(s)
- Paul Greenberg
- Analysis Group, Inc., 111 Huntington Ave., Boston, MA 02199, USA
| | | | | | | | - Jessica Maitland
- Analysis Group, Inc., 1190 Ave. des Canadiens-de-Montréal, Montréal, QC H3B 0G7, Canada.
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46
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Akay A, Caner A. Relative income concerns and smoking behaviour: The role of unobserved heterogeneity. PLoS One 2024; 19:e0295333. [PMID: 38483967 PMCID: PMC10939234 DOI: 10.1371/journal.pone.0295333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/21/2023] [Indexed: 03/17/2024] Open
Abstract
Status or relative concerns (as in the idiom 'keeping up with the Joneses') can lead to negative feelings such as stress and anxiety. One key question is whether these concerns relate to daily smoking behaviour. The conjecture is that status concerns and the accompanying stress and anxiety might be associated with a higher likelihood of smoking and a higher number of cigarettes smoked, generating a higher instant physical reward and reducing the stress and anxiety. The literature aiming to identify this relationship focuses mostly on a single cross section of individuals, ignoring potential differences in unobserved characteristics of smokers and non-smokers (e.g., genetic factors, personality differences, parental smoking during childhood). This paper investigates the role of unobserved individual characteristics on this relationship, which has not been done in previous studies. Using a long panel data of smoking information in Germany and a variety of panel data model specifications, we show that there is no statistically significant association between relative income concerns and the likelihood of smoking or the number of cigarettes smoked among the overall population. We find a positive and significant relationship only among people who smoked at least one cigarette in the past. A 10% appreciation in the income of comparable other individuals relates to about 3.5 more cigarettes per month among these people. Importantly, failing to allow for the unobserved influences of smoking leads to three times larger estimates than when using models with unobserved factors correlating to the income and smoking behaviour. The results are robust with respect to alternative assumptions and specifications where we use different functional forms of unobserved heterogeneity, definitions of relative concerns, incomes, and reference groups.
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Affiliation(s)
- Alpaslan Akay
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
- Department of Economics, Bahçeşehir University, Istanbul, Türkiye
| | - Asena Caner
- Department of Economics, TOBB University of Economics and Technology, Ankara, Türkiye
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47
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Fraser HL, Feldhaus I, Edoka IP, Wade AN, Kohli-Lynch CN, Hofman K, Verguet S. Extended cost-effectiveness analysis of interventions to improve uptake of diabetes services in South Africa. Health Policy Plan 2024; 39:253-267. [PMID: 38252592 DOI: 10.1093/heapol/czae001] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/07/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The rising prevalence of diabetes in South Africa (SA), coupled with significant levels of unmet need for diagnosis and treatment, results in high rates of diabetes-associated complications. Income status is a determinant of utilization of diagnosis and treatment services, with transport costs and loss of wages being key barriers to care. A conditional cash transfer (CCT) programme, targeted to compensate for such costs, may improve service utilization. We applied extended cost-effectiveness analysis (ECEA) methods and used a Markov model to compare the costs, health benefits and financial risk protection (FRP) attributes of a CCT programme. A population was simulated, drawing from SA-specific data, which transitioned yearly through various health states, based on specific probabilities obtained from local data, over a 45-year time horizon. Costs and disability-adjusted life years (DALYs) were applied to each health state. Three CCT programme strategies were simulated and compared to a 'no programme' scenario: (1) covering diagnosis services only; (2) covering treatment services only; (3) covering both diagnosis and treatment services. Cost-effectiveness was reported as incremental net monetary benefit (INMB) using a cost-effectiveness threshold of USD3015 per DALY for SA, while FRP outcomes were reported as catastrophic health expenditure (CHE) cases averted. Distributions of the outcomes were reported by income quintile and sex. Covering both diagnosis and treatment services for the bottom two quintiles resulted in the greatest INMB (USD22 per person) and the greatest CHE cases averted. There were greater FRP benefits for women compared to men. A CCT programme covering diabetes diagnosis and treatment services was found to be cost-effective, when provided to the poorest 40% of the SA population. ECEA provides a useful platform for including equity considerations to inform priority setting and implementation policies in SA.
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Affiliation(s)
- Heather L Fraser
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building (Level 3), 90 Byres Road, United Kingdom
- SA MRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Isabelle Feldhaus
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ijeoma P Edoka
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Johannesburg 2193, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Ciaran N Kohli-Lynch
- SA MRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Chicago, IL 60611, United States
| | - Karen Hofman
- SA MRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Kwak S, Usyk M, Beggs D, Choi H, Ahdoot D, Wu F, Maceda L, Li H, Im EO, Han HR, Lee E, Wu AH, Hayes RB, Ahn J. Sociobiome - Individual and neighborhood socioeconomic status influence the gut microbiome in a multi-ethnic population in the US. NPJ Biofilms Microbiomes 2024; 10:19. [PMID: 38467678 PMCID: PMC10928180 DOI: 10.1038/s41522-024-00491-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
Lower socioeconomic status (SES) is related to increased incidence and mortality due to chronic diseases in adults. Association between SES variables and gut microbiome variation has been observed in adults at the population level, suggesting that biological mechanisms may underlie the SES associations; however, there is a need for larger studies that consider individual- and neighborhood-level measures of SES in racially diverse populations. In 825 participants from a multi-ethnic cohort, we investigated how SES shapes the gut microbiome. We determined the relationship of a range of individual- and neighborhood-level SES indicators with the gut microbiome. Individual education level and occupation were self-reported by questionnaire. Geocoding was applied to link participants' addresses with neighborhood census tract socioeconomic indicators, including average income and social deprivation in the census tract. Gut microbiome was measured using 16SV4 region rRNA gene sequencing of stool samples. We compared α-diversity, β-diversity, and taxonomic and functional pathway abundance by SES. Lower SES was significantly associated with greater α-diversity and compositional differences among groups, as measured by β-diversity. Several taxa related to low SES were identified, especially an increasing abundance of Prevotella copri and Catenibacterium sp000437715, and decreasing abundance of Dysosmobacter welbionis in terms of their high log-fold change differences. In addition, nativity and race/ethnicity have emerged as ecosocial factors that also influence the gut microbiota. Together, these results showed that lower SES was strongly associated with compositional and taxonomic measures of the gut microbiome, and may contribute to shaping the gut microbiota.
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Affiliation(s)
- Soyoung Kwak
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Mykhaylo Usyk
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Dia Beggs
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Heesun Choi
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Dariush Ahdoot
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Feng Wu
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorraine Maceda
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Huilin Li
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Eun-Ok Im
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eunjung Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard B Hayes
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jiyoung Ahn
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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49
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Zhou M, Zhang L, Liang Y, Chen Y. The effect of trans-provincial immediate reimbursement for healthcare expenses on inequity in the utilization of healthcare services for migrants. Int J Equity Health 2024; 23:49. [PMID: 38468302 DOI: 10.1186/s12939-024-02096-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/06/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Improving the accessibility of public services for migrants is an important endeavor to promote equity in economic and social development. As a response to the large-scale movement of migrants and the fragmentation of China's health insurance system, the Chinese Government has launched a policy of trans-provincial immediate reimbursement for healthcare expenses. The present study hopes to examine the effect of immediate reimbursement policy on the utilization of healthcare services for migrants in China. METHODS This study used two waves of data from the China Migrants Dynamic Survey (CMDS) collected in 2013 and 2017, with the sample comprising 13,540 individuals. We constructed a difference-in-differences (DID) model to investigate the impact of the policy on the utilization of healthcare services for migrants. Meanwhile, we also analyzed the heterogeneity of the policy effect by grouping the samples by industry, gender, income, and education level. RESULTS The results found that the trans-provincial immediate reimbursement significantly promoted the probability of migrants' utilization of quality healthcare services (average treatment effect on the treated = 0.072, p < 0.05). Heterogeneity analyses revealed that the policy effect was more pronounced among higher-income and better-educated migrants. In addition, the policy effect was more significant for female migrants, and the benefits were more marked for migrants in high-risk industries. CONCLUSIONS The trans-provincial immediate reimbursement policy has improved the inequity of healthcare services utilization among migrants as a whole; however, within the migrants, inequity still exists. More attention should also be paid to low-income or low-education groups in future policy design.
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Affiliation(s)
- Mei Zhou
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Longwei Zhang
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Yunjia Liang
- Department of Economics, Sichuan University, Chengdu, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, China.
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50
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Kim C, Bai Y, O'Campo P, Chum A. Impact of the minimum wage increase on intimate partner violence (IPV): a quasi-experimental study in South Korea. J Epidemiol Community Health 2024; 78:235-240. [PMID: 38262734 DOI: 10.1136/jech-2023-221339] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Poverty is associated with intimate partner violence (IPV), but whether exogenous increases in wage could reduce IPV among low-income women is still unclear. We examined whether the 2018 minimum wage hike led to a reduction in IPV risk among women. METHODS Using the 2015-2019 Korean Welfare Panel Study, we employed a difference-in-differences (DID) approach to assess the effect of the minimum wage hike on IPV. The analysis focused on married women aged 19 or older. We categorised participants into a target group (likely affected by the minimum wage increase) and a comparison group based on their hourly wage. Three IPV outcomes were examined: verbal abuse, physical threat and physical assault. We conducted DID analyses with two-way fixed-effects models. RESULTS The increase in minimum wage was correlated with a 3.2% decrease in the likelihood of experiencing physical threat among low-income female workers (95% CI: -6.2% to -0.1%). However, the policy change did not significantly influence the risk of verbal abuse, physical assault or a combined IPV outcome. The study also highlights a higher incidence of all IPV outcomes in the target group compared with the comparison group. CONCLUSIONS The 2018 minimum wage increase in Korea was associated with a modest reduction in physical threat among low-income female workers. While economic empowerment through minimum wage policies may contribute to IPV prevention, additional measures should be explored. Further research is needed to understand the intricate relationship between minimum wage policies and IPV, and evidence-based prevention strategies are crucial to address IPV risk.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Yihong Bai
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Patricia O'Campo
- Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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