Disparate Areas Research Articles

Abstract TP148: The Need for Standardized Stroke Care: Assessing Global Provider Training and Institutional Disparities

The development of vascular neurology as the primary specialty for stroke evaluation and treatment is a relatively recent advancement. Vascular neurology is well-established in the United States, ensuring most stroke patients receive specialized care, but many stroke patients globally are managed by physicians without specialized training in cerebrovascular and neurological medicine that is partly manifested by the availability of institutions that incorporate dedicated stroke training. Our goal is to evaluate the training of stroke providers worldwide to identify who is leading stroke care in different regions, and to assess the availability of dedicated stroke education within these regions. This evaluation aims to highlight disparities and ultimately work towards the global standardization of stroke care. We distributed an international survey to assess level of training of physicians treating stroke, if dedicated stroke training (e.g., fellowships) is available at their institution and location where they practice. Preliminary results from our ongoing survey show the average age of 83 respondents was 38.29 ± 7.72 and no difference in proportion of males (n=44) and females (n=39, p=0.0025). Physicians who treat the hyperacute phase of stroke indicated their level of training (Vascular Neurologist n=19, Other n=40, p=0.0045) ( Figure 1 ). A subset analysis of non-vascular neurologists revealed that most ‘Other’ physicians worked in areas where no vascular neurology training was available (vascular neurology training available n=11, not available n=24, p=0.0410) ( Figure 2 ). Distribution of vascular neurologist’s vs other physicians treating stroke indicate countries where there is increased proportion (i.e UK, Switzerland, Czech Republic, Argentina, USA) and decreased proportion of dedicated vascular neurology training (Honduras, Colombia, Nepal, Kenya, Papua New Guinea, Tanzania, Bolivia, Hungary) ( Figure 3 ). While the availability of vascular neurology is growing internationally, our preliminary results from this ongoing survey indicate there is still a disparity amongst currently practicing physicians who are taking care of acute and subacute patients. Accordingly, this disparity in training may affect patient outcomes; hence, these preliminary data serve to bolster stroke care internationally by identifying areas of training and institutional disparity, all with the goal of improving outcomes in stroke patients through global standardization of care.

Study of Fluid Flow Characteristics and Mechanical Properties of Aviation Fuel-Welded Pipelines via the Fluid–Solid Coupling Method

The welded pipeline structure of aircraft fuel is a complex and diverse entity, significantly influenced by fluid–solid coupling. The refined aviation fuel-welded pipeline model plays a pivotal role in the investigation of its fluid–solid coupling mechanical properties. However, the mechanical analyses of pipelines with welded structures frequently simplify or ignore the influence of the weld zone (WZ). Consequently, these analyses fail to reveal the complex interactions between different weld zones in detail. In this study, a comprehensive and precise fuel-welded pipeline refinement model is developed through the acquisition of microstructural dimensions and mechanical parameters of the weld zone via metallographic inspection and microtensile testing. Additionally, the influence of clamps and brackets under airborne conditions is fully considered. Furthermore, the numerical simulation results are compared and verified using modal and random vibration tests. This paper addresses the impact of diverse fluid characteristics on the velocity field, pressure field, and stress in disparate areas, and it also conducts an investigation into the random vibration characteristics of the pipeline. The results demonstrate that the fluid pressure and velocity exert a considerable influence on the fluid flow state and structural stress distribution within the pipeline. An increase in flow velocity and alteration to the pipeline geometry will result in a change to the local velocity distribution, which in turn affects the distribution of the fluid pressure field. The highest stresses are observed in the weld zone, particularly at the junction between the weld zone and the heat-affected zone (HAZ). In contrast, the stresses in the bend region exhibit a corrugated distribution in both the axial and circumferential directions. An increase in fluid pressure has a significant impact on the natural frequency of the pipeline. This study enhances our comprehension of the mechanical properties of aircraft fuel lines with fluid–solid coupling and provides a foundation and guidance for the optimal design of fuel-welded lines.

Influence of Migrations of Some Azov-Black Sea Basin Fish Species on Their Invasion with the Nematode <i>Hysterothylacium aduncum</i> in Different Seasons

The paper examines the influence of pre-spawning and post-spawning planktophagous and ichthyophagous fish migrations on the invasion degree of nematode Hysterothylacium aduncum (Rudolphi., 1802) in the northern part of the Azov-Black Sea basin. For the first time, a decrease in the parameters of invasion with an adult nematode in herring during its wintering in the Black Sea has been shown, compared with similar indicators during the period of post-spawning migration after spawning in the Azov Sea. According to the authors, the diet change is the main cause of the difference in the invasion rate of migrating planktophagus as well as ichthyophagous fish. The authors consider that one of the indirect reasons for the differences in the invasion values of migrating fish is the inequality in salinity in disparate water areas of the northern parts of the Black and Azov Seas.

Status Hierarchies and Stigma Shifting in International Relations

Abstract How do states as social actors cope with stigma-induced status anxiety? I propose the concept of “stigma shifting” as a way in which status-anxious states overcompensate for their stigma-induced inferiority and reaffirm their place in the world: by seeking identification with higher-status states and differentiation from lower-status states. In identifying with the desired group of states, stigmatized states engage in approval-seeking behavior and reaffirm their in-group status in areas where they feel discredited. In differentiating themselves from the undesired group, stigmatized states engage in distinction-seeking behavior, claiming their superiority over this “lesser” group in areas that gave rise to their status anxiety in the first place. Stigma shifting, in other words, allows a stigmatized state to take the role of a stigmatizer. To demonstrate the concept's depth and analytical utility, I draw on the case of East Asia in three disparate issue areas: colonial redress, nuclear disaster, and international order making. Japan, stigmatized in all three areas, has reaffirmed its status by shifting the stigma onto its significant but “lesser” others: China and Korea. Ultimately, stigma shifting solidifies status hierarchies in the world—not just the hierarchy as represented by the “Western” dominance of international society but also the regional hierarchies of the non-Western world.

Histiocytosis Advancements Parallel Ophthalmic Innovations. The LXXXI Edward Jackson Memorial Lecture

PurposeTo highlight innovations in ophthalmic oncology through histiocytosis advancements. DesignPerspective and retrospective review. MethodsThe literature outlining the recent advancements in histiocytosis and ocular oncology were reviewed and combined with trial data and personal recollection. Intersections between these two fields were discussed. ResultsThe understanding of genetic mutations in disease—both in which cells they occur and the timing of mutation development—has expanded in tandem for the fields of ophthalmic oncology and histiocytosis. Similarly, advancements in diagnostic and treatment technology in one field can help patients in the other. For example, in one study, cell-free DNA testing reliably detected mutations in 14 of 18 (78%) patients with suspected histiocytosis. This technique has also been used in ophthalmic oncology as an alternative to invasive biopsy to avoid the risk of tumor externalization, vision impairment, and other side effects. These and other advancements, have allowed both fields to utilize targeted agents to successfully treat diseases with an actionable mutation; or deliver more targeted chemotherapy via the intraarterial technique. ConclusionsThe explosion of molecular genetics technology and targeted therapies has revolutionized cancer treatment, including histiocytosis and ophthalmic oncology. Recent progress in both fields has shown how these seemingly disparate areas have many intersections, and this speaks to the collaborative spirit that is inherent in clinical research.

Deficits of Molecular Prognosis/Diagnosis Studies in Underserved Populations.

Molecular prognostic and diagnostic tools allow for targeted cancer surveillance, prognostication, and treatment, and these assays have the potential to improve the lives of patients and their relatives. The impact of these advances, however, is not uniform across populations. Underserved communities frequently do not have the same level of access to novel assays, and the clinical application of these tools is often limited by disproportionate representation of White and European ancestry populations in foundational data, as well as limited diversity in clinical trials. In this review, we highlight major advances in clinical molecular assays, key areas of disparity, and contributing factors. We then list ongoing and future areas of intervention to improve access to and efficacy of molecular assays across populations, so that we as a community may work to improve equity at this critical area of cancer care.

A development and implementation of a preconception counseling program for black women and men in the southeastern United States: a pilot protocol.

Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

Integrating Curriculum and Instruction In Islamic Religious Education : Insights from Robin Fogarty's Theory

This research explores strategies to enhance the coherence between curriculum and instruction in Islamic Religious Education (IRE) by employing Robins Fogarty's theory of curriculum integration. Utilizing a qualitative approach with integrating a theoretical study as a research design. Specifically, the study highlights the utility of Fogarty’s tripartite integration model as a critical lens for developing a unified IRE curriculum. This model aims to synchronize disparate content areas, fostering a more integrated and holistic student understanding. For the data sources, the research examined the various theories linked with Forgaty’s theory, and the data analysis was qualitative, in which the research tried to explain and integrate the theory into IRE policy. The findings from the study emphasized the imperative for further applied research to develop integrated lesson plans, explore teachers’ experiences and professional development needs, and assess comprehensive learning outcomes. The research advocates for a collaborative approach between curriculum theorists and educators to refine and advance IRE policies. Such collaborative efforts ensure that IRE promotes intellectual advancement and contributes to students’ spiritual and personal growth, ultimately enriching their educational experience.

Assessment of green hydrogen production by volatile renewable energy under different SSPs scenarios in China

In the context of increasing global concerns about climate change and sustainable energy, the production of green hydrogen (GH) from volatile renewable energy (VRE) sources, such as solar and wind, is a natural choice for China to meet its climate change mitigation goals. However, there are a number of challenges in current research on the assessment of green hydrogen potential. This study evaluates the potential of GH production through VRE at the regional level in China, under the various scenarios of Shared Socioeconomic Pathways (SSPs). For this purpose, a power generation prediction model suitable for VRE is proposed to predict the energy supply capacity for GH production in six regions of China, which combined Multilevel Discrete Wavelet Decomposition and Bi-directional Long Short-Term Memory with attention mechanism (MDWD - AMBiLSTM). The total amount of GH could potentially reach up to 428.01 Mt under the SSP1, with the northern region leading at the regional level at 104.21 Mt. Furthermore, the study evaluated the potential for GH promotion in six regions of China between 2023 and 2035 b y combining the three dimensions of GH production potential, economic evaluation, and environmental contribution. This study tentative identify priority areas and development scenarios for promoting GH production in China, and made policy recommendations for the promotion of green hydrogen in disparate areas.

Recent approaches in computational modelling for controlling pathogen threats.

In this review, we assess the status of computational modelling of pathogens. We focus on three disparate but interlinked research areas that produce models with very different spatial and temporal scope. First, we examine antimicrobial resistance (AMR). Many mechanisms of AMR are not well understood. As a result, it is hard to measure the current incidence of AMR, predict the future incidence, and design strategies to preserve existing antibiotic effectiveness. Next, we look at how to choose the finite number of bacterial strains that can be included in a vaccine. To do this, we need to understand what happens to vaccine and non-vaccine strains after vaccination programmes. Finally, we look at within-host modelling of antibody dynamics. The SARS-CoV-2 pandemic produced huge amounts of antibody data, prompting improvements in this area of modelling. We finish by discussing the challenges that persist in understanding these complex biological systems.

The Interplay between Structural Inequality, Allostatic Load, Inflammation, and Cancer in Black Americans: A Narrative Review.

The impact of racial healthcare disparities has been well documented. Adverse social determinants of health, such as poverty, inadequate housing, and limited access to healthcare, are intricately linked to these disparities and negative health outcomes, highlighting the profound impact that social and economic factors have on individuals' overall well-being. Recent evidence underscores the role of residential location on individual health outcomes. Despite the importance of a healthy lifestyle, regular physical activity, balanced nutrition, and stress management for favorable health outcomes, individuals living in socioeconomically disadvantaged areas may face obstacles in achieving these practices. Adverse living conditions, environmental factors, and systemic biases against Black Americans perpetuate allostatic load. This, compounded by decreased physical activity and limited healthy food options, may contribute to increased oxidative stress and inflammation, fundamental drivers of morbidities such as cardiovascular disease and cancer. Herein, we perform a narrative review of associations between healthcare disparities, chronic stress, allostatic load, inflammation, and cancer in Black Americans, and we discuss potential mechanisms and solutions. Additional research is warranted in the very important area of cancer disparities.

Exploring the association between multi-mode transport and the built environment: A comparative study of metro, bus, taxi, and shared bike use

Urban transportation plays a pivotal role in sustainable city planning, with multiple transportation modes coexisting to achieve sustainable goals. Despite the extensive use of various mobility datasets to analyze mobility behaviors, comparative studies focusing on multiple transportation modes for origin-destination (OD) trips remain scarce. This study, conducted in Shenzhen, presents three in-depth comparative analyses: (1) variations in the utilization of metros, buses, taxis, and shared bikes; (2) the clustering patterns of OD flows across different modes; and (3) the influence of the built environment at origins and destinations on OD flows. The findings reveal that the use of public transportation and taxis mirrors the city's polycentric layout, with each transportation mode fulfilling distinct roles in linking disparate urban areas. The nonlinear effect of the built environment on OD flows exhibits mode-specific variations, particularly in relation to thresholds. Additionally, network topology characteristics are identified as significant factors in explaining OD flows for all modes. Despite observed differences in weekday and weekend OD flow clustering, the built environment consistently correlates with daily OD flows. These findings provide valuable insights to inform mode-specific strategies that enhance sustainable urban development.

Health disparity viewed from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers, for tailored prevention measures, and for inter-agency population data harmonization.

152 Background: We searched public datasets released by CDC to answer the question ”Can we have a bird’s-eye view of health disparity in cancer care in the US?” By looking into historic data, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also signs of missing data. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. Since the 2022 AACR report on cancer in Asian Americans raised concerns, we then looked into the “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count liver cancer deaths (ICD10: C22) 2018-2021 among 6 Asian minority groups with population data from 2021 Census ACS data. 2020 GLOBOCAN estimated liver cancer mortality data were also compared. With anecdotal stories suggesting immigrants may seek end-of-life care in the birth country to access culture-concordant services, we looked into how cancer deaths abroad was reported. Results: Gastrointestinal (GI) cancers emerged as an area of cancer health disparity from USCS data. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to 1/4 of US cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have poor outcomes. Black non-hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in US under-50 population. Liver cancer mortality of US East Asian alone groups shown in the table were lower than GLOBOCAN estimated ASR of 16.1, with the greatest discrepancy in the Chinese (9.1 vs 17.2). Difference between the Vietnamese and Asian Indians may reflect that liver cancer is #1 cause of death in Vietnam, or HepB infection is low in India. Census data excluded expat US citizens, and consulate reports of death abroad have neither cause of death nor race/ethnicity data. Conclusions: We identified gastrointestinal cancers as a focus for cancer health disparity advocacy. Divergent risks for liver cancer in Asian Americans call for tailored prevention measures. Cross-agency death abroad data harmonisation to include race/ethnicity information will complete views of cancer mortality data in US. [Table: see text]

FRAP 2.0: a community engagement method applied to cervical cancer disparities among Hispanic women

focused Rapid Assessment Process (fRAP) 2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting...

A bird's-eye view of disparity from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers and for inter-agency data harmonization.

e13723 Background: We searched into public datasets released by CDC to answer a question raised during an NCI Health Disparity Workshop: "Can we have a bird’s-eye view of health disparity in cancer care in the US?" By looking into the historic data reported, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also what might be missing from the data-reporting. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. We then looked into the recently available “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count cancer deaths 2018-2021 in California comparing cancer mortality among 7 Asian minority groups, including Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asians. We then matched census data for these Asian minority groups published by Census 2020. Results: We identified gastrointestinal (GI) cancers as an area of cancer health disparity. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to a quarter of cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have very poor outcomes. Based on USCS data, Black non-Hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in the under-50 US population. Since the 2022 AACR report on cancer in Asian Americans raised concerns on liver and stomach cancers, we counted cancer deaths in recent 4 years for different Asian groups in California that numbered about 7 million (alone or in combination) in 2020 Census. This includes 1.8 million Chinese, 1.7 million Filipino, 900k Asian Indian, 800k Vietnamese, 560k Korean, 470k Japanese, and other Asian ethnicities. Chinese has the highest numbers of deaths (2.8k) in 4 years from these 5 GI cancers followed by Filipino (2k), Vietnamese (1.2k), Korean (1.1k), Japanese (800), other Asians (1.1k), and Asian Indian (< 400). The lower cancer deaths in Asian Indians may be associated with their younger median age based on Census. With anecdotal stories suggesting immigrants may seek end-of-life care in their birth country to access more culture-concordant services, we looked into how cancer deaths abroad were reported. The data appeared missing. Conclusions: We identified gastrointestinal cancers as focuses for cancer health disparity advocacy. Harmonized consulate report of death abroad to include detailed race/ethnicity information will complete view of cancer mortality data in the US.

Patient Surveillance Adherence After Treatment for Endometrial Cancer

BACKGROUND: To assess factors that may affect patients' adherence to recommended surveillance after treatment for endometrial cancer. METHODS: We performed a retrospective study of all patients undergoing primary treatment for endometrial cancer from January 1, 2010, to December 30, 2017, at a tertiary referral center. Patients were included for analysis if there was sufficient information in the electronic medical records. Patient demographic information, cancer characteristics, and surveillance adherence data were collected. The median inflation-adjusted income was calculated from the patients' ZIP codes and U.S. Census data. The primary outcome assessed was adherence to surveillance, defined as two or more visits per 12 months in individuals at low risk and four or more visits per 12 months in individuals at high risk, consistent with recommended guidelines. RESULTS: During the study period, 870 patients were included for analysis. The mean age at diagnosis and body mass index (BMI) of the entire cohort were 63.4 years and 35.8, respectively. Overall, 761 patients (87.5%) were adherent to the recommended surveillance guidelines. Patients who were not adherent to recommended surveillance lived significantly farther from the cancer center (39.2 miles vs 20.7 miles, P=.026) and had a significantly lower median inflation-adjusted income ($74,015 vs $80,435, P=.027). CONCLUSION: Increased distance to a tertiary care center and lower median income were significantly associated with decreased adherence to recommended surveillance guidelines. This is consistent with current literature on increased distance traveled as a proxy for worse survival in gynecologic malignancies, as well as worse endometrial cancer outcomes in patients of lower socioeconomic status. This highlights an area of disparity that needs improvement and warrants further investigation.

Extending trait dispersion across trophic levels: Predator assemblages act as top-down filters on prey communities.

Studies of community assembly typically focus on the effects of abiotic environmental filters and stabilizing competition on functional trait dispersion within single trophic levels. Predation is a well-known driver of community diversity and composition, yet the role of functionally diverse predator communities in filtering prey community traits has received less attention. We examined functionally diverse communities of predators (fishes) and prey (epifaunal crustaceans) in eelgrass (Zostera marina) beds in two northern California estuaries to evaluate the filtering effects of predator traits on community assembly and how filters acting on predators influence their ability to mediate prey community assembly. Fish traits related to bottom orientation were correlated with more clustered epifauna communities, and epifauna were generally overdispersed while fishes were clustered, suggesting prey may be pushed to disparate areas of trait space to avoid capture by benthic sit-and-wait predators. We also found correlations between the trait dispersions of predator and prey communities that strengthened after accounting for the effects of habitat filters on predator dispersion, suggesting that habitat filtering effects on predator species pools may hinder their ability to affect prey community assembly. Our results present compelling observational evidence that specific predator traits have measurable impacts on the community assembly of prey, inviting experimental tests of predator trait means on community assembly and explicit comparisons of how the relative effects of habitat filters and intraguild competition on predators impact their ability to affect prey community assembly. Integrating our understanding of traits at multiple trophic levels can help us better predict the impacts of community composition on food web dynamics as regional species pools shift with climate change and anthropogenic introductions.

A Qualitative Analysis of the Association of Treatment Outcomes, Psychosocial Factors, and Multimorbidity in Severe Hypertensive Patients Attending Health Institutions in Southeast Nigeria

Severe hypertension is associated with a two-fold increase in relative risk of death. Interventions to date fail to achieve sustained improvement in blood pressure, particularly in regional areas of high social disparity. Growing evidence points to multiple psychological, social and morbidity factors as contributors to the onset of and trajectory of hypertension. This study aims to examine the association of psychosocial factors and multimorbidity with response to treatment and treatment outcomes in the management of severe hypertensive patients providing updated knowledge and recommendations to improve their quality of care. We employed a hospital based comparative cross-sectional study using a quantitative and qualitative approach. Semi-structured questionnaires were used to collect information from 733 severe hypertensive patients attending cardiology clinics in two tertiary health institutions in southeastern Nigeria. Data collected was transcribed, coded, and analysed with IBM SPSS version 23 software with appropriate descriptive tools used in presenting findings. We observed a significant association between age of the respondents and their response to treatment. Overweight/obese respondents were 1.5times less likely to respond to treatment. These findings add to existing knowledge provoking thoughtful discussions among relevant public health actors and stakeholders to update management policies for severe hypertension.

Understanding the Influence of Psychosocial Factors and Multimorbidity on Patient Outcomes in Severe Hypertensive Patients Attending Health Institutions in Southeastern Nigeria

Hypertension is a prevalent problem worldwide and it is an important risk factor for a variety of health conditions. Severe hypertension (180+ systolic or 110+ diastolic) is associated with a two-fold increase in relative risk of death. Interventions to date fail to achieve sustained improvement in blood pressure, particularly in regional areas of high social disparity. Growing evidence points to multiple psychological, social and morbidity factors as contributors to the onset of and trajectory of hypertension. The main objective of this study is to examine the association of psychosocial factors and multimorbidity with response to treatment and treatment outcomes in the management of severe hypertensive patients providing additional knowledge and recommendations to improve their quality of care. We conducted cross-sectional research, using interview self-administered semi-structured questionnaires. Data collected was transcribed, coded, and analyzed thematically. Findings were presented in tables, charts, and in narrations as appropriate. Results: There was a significant association between age of the patients and response to treatment in severe hypertension. Overweight/obesity was noted to be significantly associated with response to treatment. In this study, the burden of psychosocial factors and multimorbidity’s in the management of severe hypertension is highlighted. There is a need for effective monitoring and surveillance to monitor progress in reducing the prevalence of severe hypertension and in increasing the awareness for the treatment and management of hypertension.

Area and individual level analyses of demographic and socio-economic disparities in COVID-19 vaccination uptake in Belgium

Vaccination has played a major role in overcoming the COVID-19 pandemic. However, vaccination status can be influenced by demographic and socio-economic factors at individual and area level.In the context of the LINK-VACC project, the Belgian vaccine register for the COVID-19 vaccination campaign was linked at individual level with other registers, notably the COVID-19 laboratory test results and demographic and socio-economic variables from the DEMOBEL database. The present article aims at investigating to which extent COVID-19 vaccination status is associated with area level and/or individual level demographic and socio-economic factors. From a sample of all individuals tested for SARS-CoV-2 (LINK-VACC sample) demographic and socio-economic indicators are derived and their impact on vaccination coverages at an aggregated geographical level (municipality) is quantified. The same indicators are calculated for the full Belgian population, allowing to assess the representativeness of the LINK-VACC sample with respect to the impact of demographic and socio-economic disparities on vaccination uptake.In a second step, hierarchical models are fitted to the individual level LINK-VACC data to disentangle the individual and municipality effects allowing to evaluate the added value of the availability of individual level data in this context.The most important effects observed at the individual level are reflected in the aggregated data at the municipality level. Multilevel analyses show that most of the demographic and socio-economic impacts on vaccination are captured at the individual level, although accounting for area level in individual level analyses improve the overall description.