Contribution Of Socioeconomic Factors Research Articles

The Contribution of Socioeconomic Factors to HIV RNA Suppression in Persons With HIV Engaged in Care in the NA-ACCORD.

Socioeconomic status (SES) influences well-being among people living with HIV (people with HIV [PWH]); when individual-level SES information is not available, area-level SES indicators may be a suitable alternative. We hypothesized that (1) select ZIP code-level SES indicators would be associated with viral suppression and (2) accounting for ZIP code-level SES would attenuate racial disparities in viral suppression among PWH. The NA-ACCORD, a collaboration of clinical and interval cohorts of PWH, was used. Participants with ≥1 viral load measurement and ≥1 US residential 5-digit ZIP code(s) between 2010 and 2018 were included. In this serial cross-sectional analysis, multivariable logistic regression models were used to quantify the annual association of race and ethnicity with viral suppression, in the presence of SES indicators and sex, hepatitis C status, and age. We observed a dose-response relationship between SES factors and viral suppression. Lower income and education were associated with 0.5-0.7-fold annual decreases in odds of viral suppression. We observed racial disparities of approximately 40% decreased odds of viral suppression among non-Hispanic Black compared with non-Hispanic White participants. The disparity persisted but narrowed by 3%-4% when including SES in the models. ZIP code-based SES was associated with viral suppression, and accounting for SES narrowed racial disparities in viral suppression among PWH in the NA-ACCORD. Inclusion of ZIP code-level indicators of SES as surrogates for individual-level SES should be considered to improve our understanding of the impact of social determinants of health and racial disparities on key outcomes among PWH in North America.

Spatio-Temporal Changes and Driving Forces Analysis of Urban Open Spaces in Shanghai between 1980 and 2020: An Integrated Geospatial Approach

Although there is extensive research demonstrating the significant loss and fragmentation of urban spaces caused by rapid urbanization, to date, no empirical research in Shanghai has investigated the spatiotemporal dynamics of urban open spaces using a comprehensive set of integrated geospatial techniques based on long-sequence time series. Based on the Google Earth Engine (GEE) platform and using the Random Forest (RF) classifier, multiple techniques, namely landscape metrics, trend analysis, open space ratio, transition matrix, Normalized Difference Vegetation Index (NDVI), and fractal dimension analysis, were applied to analyze the Landsat satellite data. Next, Geographic Detector (GeoDetector) methods were used to investigate the driving forces of such spatial variations. The results showed that (1) the RF classification algorithm, supported by the GEE, can accurately and quickly obtain a research object dataset, and that calculating the optimal spatial grain size for open space pattern was 70 m; (2) open spaces exhibited declining and contracting trends; and open spaces in the city experienced a decline from 91.83% in 1980 to 69.63% in 2020. Meanwhile, the degree of open spaces in each district increased to different extents, whilst connectivity markedly decreased. Furthermore, the open space of city center districts showed the lowest rate of decrease, with open space patterns fragmenting due to encroaching urbanization; (3) the contribution of socioeconomic factors to the spatial–temporal changes in open space continually has increased over the past 40 years, and were also higher than natural geographic factors to some extent. Apart from offering policy insights guiding the future spatial planning and development of the city, this paper has contributions from both methodological and empirical perspectives. Based on integrated remote sensing and geographic information science (GIS) techniques, this paper provides updated evidence and a clearer understanding of the spatiotemporal variations in urban spaces and their influencing mechanisms in Shanghai.

Income-related inequality in health outcomes among older individuals in China: A measurement and decomposition analysis

Population aging in China presents a significant challenge, with projections indicating that individuals aged 65 and above will exceed 30% of the total population by 2050, thereby increasing health-care and long-term care (LTC) demands. Therefore, this study aimed to examine income-related inequality in self-rated health (SRH) and functional ability among older individuals in China while also examining the contribution of socioeconomic factors to health inequality. Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Well-established tools, such as concentration curves, the Erreygers concentration index (EI), and decomposition analysis, were employed to elucidate income-related inequality in health within the sample. The results revealed that for SRH, both unstandardized and standardized concentration curves were observed below the 45° line, with unstandardized EI at 0.068 and standardized EI at 0.033. For functional ability, both unstandardized and standardized concentration curves were observed above the 45° line, with unstandardized EI at −0.016 and standardized EI at −0.003. These results suggest that, after controlling for demographic factors, the better-off group is more likely to report better SRH and less likely to experience functional limitations compared to the worse-off group. Furthermore, this inequality in health outcomes is predominantly driven by socioeconomic factors rather than demographic factors. For SRH, income emerges as the primary contributor to total inequality. Similarly, for functional ability, income emerges as the key factor driving inequality, disproportionately affecting the less affluent population. Consequently, it is crucial for the government to protect older individuals with lower socioeconomic status to mitigate income-related inequality in health by directly providing cash aids and formal LTC, which could contribute to promoting healthy aging in the context of global aging.

Sense of community and residential well-being among rural-urban migrants in China

This paper aims to provide an empirical prediction of residential well-being (RWB) and sense of community (SoC) among Chinese rural-urban migrants (RUMs). Multiple linear regressions are used with survey data derived from a representative sample of 15 migrant villages located in three major urban regions of China in order to evaluate the contributions of socioeconomic factors, living conditions, and neighborhood conditions to the SoC score and RWB score. The majority of the sample consists of middle-aged, married men who live in shared housing, are registered in the agricultural Hukou (household registration) system, and have subpar housing. Empirical analyses show that, after adjusting for socioeconomic factors, living conditions, and community neighborhood conditions, Hukou status (urban or rural) significantly influences the RWB score rather than the SoC score. In the simultaneous equation models, the following factors can predict the SoC score and RWB score: age, gender, educational attainment, home ownership, number of housing facilities, monthly household income, number of living rooms, number of problem-solving channels, and converted residences. The SoC score and RWB score have a moderately strong correlation. Therefore, improving the living, institutional, socioeconomic, and neighborhood conditions will help to improve the SoC and RWB of RUMs.

Food insecurity and disability among working-age and older adults.

To explore relationships between disability, food insecurity (FI) and age and examine how socio-economic factors impact risk of FI among disabled people in working and older age. Logistic regression models used to analyse the contribution of socio-economic factors to gaps in risk of FI for disabled people. In models stratified into working and older age groups, differences in risk of FI for disabled and non-disabled people were examined by employment, education and assets. England, Wales and Northern Ireland, 2016 and 2018. A representative sample of 6187 adults aged 16+, of whom 28 % were disabled, from the Food & You survey. The gap in FI risk by disability status decreased as age increased. For ages 25-34 for disabled v. non-disabled people, risk of FI was 31 % (95 % CI 21-41 %) v. 10 % (8-12 %); at ages 45 to 54, it was 18 % (11-23 %) v. 7 % (5-8 %), and at ages 75+, there was no gap in risk. Accounting for socio-economic variables halved the gap in risk among working ages. However, among working-age adults, FI among disabled people in full-time work was 15 % (11-20 %) compared with only 7 % (6-9 %) among non-disabled people in full-time work. Among older people, disabled people without savings were at higher risk of FI (5 % (3-7 %)) than non-disabled people without savings (2 % (1-3 %)) but having savings closed risk gap. Socio-economic resources partially explain disparities in FI risk when disabled. Disparities remained for people in full-time work and among people without savings in older age.

Abstract 15494: Racial and Ethnic Differences in Cardiovascular Health Among US Adults With a History of Cancer

Introduction: Evidence reports co-occurring risk factors between cardiovascular disease (CVD) and cancer and treatment-resultant cardiotoxicities amplifying CVD risks. Hypothesis: Given demographic disparities in CVD and cancer outcomes, we illustrated race and ethnicity-specific distributions of cardiovascular health (CVH) and quantified the contributions of socioeconomic factors to racial disparities in CVH among those with prior cancer. Methods: In the National Health Examination and Nutrition Survey 2011-2020, we identified 2628 adults aged ≥18 years with prior cancer. CVH was assessed based on the American Heart Association’s Life’s Essential 8 metrics. The Kitagawa-Blinder-Oaxaca decomposition quantified the magnitude of individual socioeconomic factors contributing to racial differences in CVH. Results: Of the 2628 US adults with prior cancer (mean[SD] age, 63.4[13.8] years; 57% women), 6.0% identified as Hispanic or Latino, 1.6% as non-Hispanic (NH) Asian, 5.2% as NH Black or African American, 84.1% as NH White, and 3.1% as uncategorized or multiple categories. NH Asian had the highest Life’s Essential 8 score (out of 100, women: 66.0; male: 69.2) in contrast to the poorest CVH in NH Black women (59.0) and Hispanic men (57.7). Overall, diet, physical activity, and body mass index were suboptimal. Across race, NH Black had the poorest blood pressure (women: 52.6, men: 41.8) and sleep (women: 74.3, men: 70.2), whereas uncategorized or multiracial group had high tobacco exposure (women: 43.6; men: 53.2). NH White women had the worst lipids (62.4), whereas NH Asian women (65.2) and Hispanic men (69.0) had the lowest glycemic score. Differences were partly explained by deprivation and low education contributing to poorer CVH among Hispanic and NH Black, whereas lower US nativity contributed to better CVH in NH Asian. Conclusions: CVH in US adults with prior cancer was suboptimal with significant racial disparities explained by socioeconomic factors.

Identifying the driving forces of global ecosystem services balance, 2000–2020

In 2019, the United Nations (UN) General Assembly announced the implementation of the “UN Decade on Ecosystem Restoration (2021–2030)” initiative. However, overexploitation continues to severely impact the global ecosystem services (ESs) balance. Identifying the global ESs balance and its driving forces can effectively identify sensitive areas under such high ecological stress and corresponding governance responses. The world is currently facing increasing pressure on natural resources, while research on this issue remains controversial at global level. To address the gap, we portrayed the spatial characteristics of global ESs balance across county units worldwide in 2000, 2010, and 2020, and we further examined the driving forces of ESs balance covering six continents of the world (excluding Antarctica) by Geodetector model. Our results showed that the deficit areas of ESs balance were concentrated in urban and barren areas, while the surplus areas were distributed in areas with dense vegetation, especially primary forest communities. Furthermore, the global Moran's I value of ESs balance averaged 0.719 over three years, demonstrating a significant spatial dependence of its spatial distribution. According to the spatial statistical analysis, the factors that affected ESs balance varied among continents and had evolved over the last two decades. Nevertheless, nighttime light intensity and forest proportion consistently showed high contributions, with maximum values of 0.569 and 0.546, respectively. The contribution of socio-economic factors is higher in the developed regions and lower in the less developed regions. This work provides a framework for future global large-scale ESs balance assessments. It identifies similarities in impact mechanisms across continents and the dominance of individual drivers to encourage contextualized, collaborative governance in environmental policy.

Partial Contribution of Socioeconomic Factors to the Mortality Rate of the Working-Age Population in Russia.

This study's relevance lies in the need to assess the role of socioeconomic, medical, and demographic factors on working-age population mortality in Russia. The purpose of this study is to substantiate the methodological tools for the assessment of the partial contribution of the most important factors that determine the dynamics of the mortality of the working-age population. Our hypothesis is that the factors determining the socioeconomic situation in the country affect the level and dynamics of mortality of the working-age population, but to a different extent in each separate period. To analyse the impact of the factors, we used official Rosstat data for the period from 2005 to 2021. We used the data that reflect the dynamics of socioeconomic and demographic indicators, including the dynamics of mortality of the working-age population in Russia as a whole and in its 85 regions. First, we selected 52 indicators of socioeconomic development and then grouped them into four factor blocks (working conditions, health care, life security, living standards). To reduce the level of statistical noise, we carried out a correlation analysis, which allowed us to narrow down the list to 15 key indicators with the strongest association with the mortality rate of the working-age population. The total period of 2005-2021 was divided into five segments of 3-4 years each, characterising the picture of the socioeconomic state of the country during the period under consideration. The socioeconomic approach used in the study made it possible to assess the extent to which the mortality rate was influenced by the indicators adopted for analysis. The results of this study show that over the whole period, life security (48%) and working conditions (29%) contributed most to the level and dynamics of mortality in the working-age population, while factors determining living standards and the state of the healthcare system accounted for much smaller shares (14% and 9%, respectively). The methodological apparatus of this study is based on the application of methods of machine learning and intelligent data analysis, which allowed us to identify the main factors and their share in the total influence on the mortality rate of the working-age population. The results of this study show the need to monitor the impact of socioeconomic factors on the dynamics and mortality rate of the working-age population in order to improve the effectiveness of social programme. When developing and adjusting government programmes to reduce mortality in the working-age population, the degree of influence of these factors should be taken into account.

A characteristics analysis of carbon emission based on multi-dimensional carbon emission accounting methods and structural decomposition analysis: A case study of Beijing, China

The city’s industrial transformation leads to a large amount of carbon emissions, which poses a thorny problem for the allocation of carbon responsibilities. This study established a multi-dimension long-term carbon emission analysis model to explore the characteristic of Beijing’s embodied carbon emissions, which could calculate the production-based, consumption-based and income-based carbon emissions. Then, structural decomposition analysis was adopted to quantify the contribution of socioeconomic factors in local and imported carbon emissions. In addition, emission linkage analysis was used for revealing the long-term evolutionary trajectories of sectors. The key discovery can be summarized as follows: 1) the fluctuation trend of production-side and income-side carbon emissions in Beijing is stable and decreased by 3.53% from 2002 to 2017, while consumption-side carbon emissions increased rapidly by 795.45%. 2) The energy, transportation and other services sectors from the supply, production and consumption perspectives. 3)Per capita consumption, production structure and consumption structure are the major contributors of carbon emissions. The study is expected to provide decision support for policymakers to reasonably formulate carbon mitigation policies and allocate carbon mitigation responsibilities from multiple perspectives, and promote the realization of the “carbon peak and carbon neutrality” strategy.

The Relative Roles of Socioeconomic Factors and Governance Policies in Urban Traffic Congestion: A Global Perspective

There is still doubt about how to accurately distinguish the objective and subjective factors that affect traffic congestion. This study aims to re-examine the role of socioeconomic factors and governance policies in the variation of urban traffic congestion from a global perspective at the macro-social development level. The heterogeneous characteristics of the traffic congestion index under the influence of changes in governance policies and variations of social–economic factors are distinguished through a residual trend model. Different time scenarios are addressed in the study to assess the respective contribution of socioeconomic factors and governance policies to variations of traffic congestion, which is helpful for identifying the most destructive factors and the most effective combination of governance policies. Taking Beijing City as the case, the results show that the social-economic factors and governance policies jointly drive congestion fluctuations, but the contribution of governance policies is greater. In addition, governance policies play an important role in alleviating traffic congestion, but unfortunately, an unreasonable combination of governance policies is also the chief culprit for the rise of the traffic congestion index in certain periods. The findings presented here can make us understand macro-mechanisms in response to urban traffic congestion and provide evidence for formulating regional development policies.

Measuring socioeconomic inequalities in prenatal HIV test service uptake for prevention of mother to child transmission of HIV in East Africa: A decomposition analysis.

Despite efforts made towards the elimination of mother-to-child HIV transmission, socioeconomic inequality in prenatal HIV test uptake in East Africa is not well understood. Therefore, this study aimed at measuring socioeconomic inequalities in prenatal HIV test uptake and explaining its main determinants in East Africa. We analysed a total weighted sample of 45,476 women aged 15-49 years who birthed in the two years preceding the survey. The study used the most recent DHS data from ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe). The socioeconomic inequality in prenatal HIV test uptake was measured by the concentration index and illustrated by the concentration curve. Then, regression based Erreygers decomposition method was applied to quantify the contribution of socioeconomic factors to inequalities of prenatal HIV test uptake in East Africa. The concentration index for prenatal HIV test uptake indicates that utilization of this service was concentrated in higher socio-economic groups with it being 15.94% higher among these groups in entire East Africa (p <0.001), 40.33% higher in Ethiopia (p <0.001) which was the highest and only 1.87% higher in Rwanda (p <0.01) which was the lowest. The decomposition analysis revealed that household wealth index (38.99%) followed by maternal education (13.69%), place of residence (11.78%), partner education (8.24%), watching television (7.32%), listening to the radio (7.11%) and reading newsletters (2.90%) made the largest contribution to socioeconomic inequality in prenatal HIV test in East Africa. In this study, pro-rich inequality in the utilization of prenatal HIV tests was evident. The decomposition analysis findings suggest that policymakers should focus on improving household wealth, educational attainment, and awareness of mother-to-child transmission of HIV (MTCT) through various media outlets targeting disadvantaged sub-groups.

PENGARUH FAKTOR SOSIAL EKONOMI DAN MANAJERIAL TATAKELOLA PETERNAKAN TERHADAP KEBERHASILAN USAHA TERNAK SAPI PERAH (Suatu Kasus Pada Peternak Sapi Perah di Kecamatan Cipanas, Kabupaten Cianjur, Jawa Barat)

This research aims to find out the influence of socio-economicactors of breeders and managerial breeders on the success of dairy farming efforts. The unit of analysis is a dairy farmer in Cianjur Subdistrict, Cianjur Regency. Respondents were taken in a census of 65 people. Analytical techniques are used pathanalysis. The results of the study obtained the state of the socio-economic factors of dairy farmers consisting of aspects / indicators: age, formal education, knowledge, experience, burden of dependents, motivation usaha, business scale and capital show good criteria with achievement of 71.54%. Managerial governance of dairy farmers consists of dimensions/ indicators: data collectionrecords, milking techniques, livestock health, feed, marriage, business governa nce, trade, labor and marketing show good criteria with an achievement of 78.88%. Against the managerial aspects of the breeder, the aspect / dimension of livestock health and business governance shows excellent criteria. The success of dairy farming business consisting of dimensions: Productivity of cows; Production costs; and efficiency of farming. During lactation the average dairy product produces milk reaching 22 liters / tail / day, the average production cost is Rp 2,250 / liter and the average business efficiency of 1.98. The success rate of dairy farming is 75.64%. There is a strong and tangible positive relationship between the socio-economic factors of breeders and managerial governance of breeders. The strong relationship between the two variables is indicated by the pearson correlation coefficient = 0.533. Socio-economic factors of breeders and managerial governance have a positive and real influence on the success of dairy farming efforts. Contribution of socio-economic factors 15.54% and managerial governance 45.14%. Much bigger.

The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population

BackgroundIn the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China.MethodsData were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed.ResultsThe preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies.ConclusionsKey policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people’s excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.

Contribution of socio-economic factors in the spread of antimicrobial resistant infections in Australian primary healthcare clinics

ObjectivesTo effectively contain antimicrobial-resistant (AMR) infections, we must better understand the social determinates of health that contribute to transmission and spread of infections. MethodsWe used clinical data from patients attending primary healthcare clinics across three jurisdictions of Australia (2007–2019). Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) isolates and their corresponding antibiotic susceptibilities were included. Using multivariable logistic regression analysis, we assessed associations between AMR prevalence and indices of social disadvantage as reported by the Australian Bureau of Statistics (i.e., remoteness, socio-economic disadvantage and average person per household). ResultsThis study reports 12 years of longitudinal data from 43 448 isolates from a high-burden low-resource setting in Australia. Access to health and social services (as measured by remoteness index) was a risk factor for increased prevalence of third-generation cephalosporin-resistant (3GC) E. coli (odds ratio 5.05; 95% confidence interval 3.19, 8.04) and methicillin-resistant S. aureus (MRSA) (odds ratio 5.72; 95% confidence interval 5.02, 6.54). We did not find a positive correlation of AMR and socio-economic disadvantage or average person per household indices. ConclusionRemoteness is a risk factor for increased prevalence of 3GC-resistant E. coli and MRSA. We demonstrate that traditional disease surveillance systems can be repurposed to capture the broader social drivers of AMR. Access to pathogen-specific and social data early and within the local regional context will fill a significant gap in disease prevention and the global spread of AMR.

PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY Jacob Knorr, Rebecca Campbell, Jarrod Dalton, Prithvi Murthy, Georges-Pascal Haber, and Byron Lee Jacob KnorrJacob Knorr More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Jarrod DaltonJarrod Dalton More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent efforts to optimize recovery following radical cystectomy have not led to substantial improvement in complication rates. Though clinical risk factors have been routinely studied, the contribution of socioeconomic factors has not been well-defined. The Area Deprivation Index (ADI) is derived from 17 U.S. Census variables in income, education, employment, and housing, and describes neighborhood disadvantage down to the geographic block-group (600-3,000 people). Our objective was to examine associations between ADI and perioperative outcomes following radical cystectomy. METHODS: A prospective database of radical cystectomy patients was queried from 2010-2018. Residential locations at time of surgery were geocoded using SQL Server with TIGER/LINE census data to assign a block-group for each patient. National ADI percentile ranks were imported from the Neighborhood Atlas. Patients were stratified by national ADI quartile with the 1st quartile representing least disadvantaged and 4th quartile the greatest disadvantaged. Outcomes were compared using Cochran Armitage Trend or Kruskal-Wallis tests. RESULTS: The distribution of 906 patients across ADI quartiles was: 12.7%, 31.8%, 35.1%, and 20.4%. The 4th quartile was associated with younger age (p=0.01), black race (p=<0.0001), and active smoking (p=<0.0001). The 90-day (90d) mortality rates observed in the 1st and 4th quartiles were 0% (0/115) and 6.5% (12/185), respectively. ADI quartile was significantly associated with 30d (p=0.01) and 90d (p=0.002) mortality. When evaluating ADI as a continuous variable, the unit and range odds ratios for 90d mortality were 1.021 (CI: 1.004 - 1.04) and 8.11 (CI: 1.5 - 47.83), respectively. ADI was also associated with late (30-90d) complications (p=0.04), though there were no significant differences in 30 and 90d major complications, readmission rates, or length of stay between ADI quartiles. CONCLUSIONS: We present the first use of the Area Deprivation Index at the block-group level in Urology. ADI was significantly associated with late complication and 30 and 90d mortality, with nearly half of all 90d deaths occurring in the most disadvantaged ADI quartile. Our findings suggest that post-cystectomy morbidity and mortality may be partially attributable to socioeconomic factors. Source of Funding: CWRU CCC © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e833-e833 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Knorr More articles by this author Rebecca Campbell More articles by this author Jarrod Dalton More articles by this author Prithvi Murthy More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Expand All Advertisement Loading ...

Mental health and well-being in rural communities - factors associated with suicide, and integrated responses

Introduction Despite similar prevalence of mental illness across Australia, suicide rates are 50% higher in rural and remote populations compared to capital cities. These data suggest the need for different strategies to prevent rural suicide.In response to a geographic cluster of local suicides in three different communities in rural Australia, this paper examines the factors identified by community members as being associated with suicide. It also details the implementation of a wellbeing-focused collaborative response in one of these communities.Theory/Methods In each community, analysis of existing publicly-available health and social determinant data was analysed. In-depth interviews were conducted with key stakeholders and community members to identify their perceptions of factors in their communities (via thematic analysis). The combined objective and subjective data were fed back to each community via a report and community workshops wherein local responses were collaboratively developed.In one community, a documentation review and follow-up interviews have been held to examine implementation of the local response two years in. A retrospective program logic model was developed to frame the implementation of the response. Results Existing community data demonstrated that socio-economic factors were relevant in each of the communities. In the initial stages of each response [n= 99 (Community 1), n=56 (Community 2), n=153 (Community 3)] stakeholders were interviewed. In community 1, 65 documents were reviewed and 36 stakeholders interviewed to examine the implementation of the response. Common across communities was acknowledgement of the contribution of socio-economic factors and lack of integration at service, organisation and system level in health services, across agencies and community groups. The implementation in Community 1 also suggested a community-led collaborative model, with multi-agency participation, for response in other rural areas.DiscussionThe findings highlight the need for locally relevant integrated responses to suicide in rural communities which address broad socio-economic factors. Building on local community assets is essential for community empowerment and for sustainability. This initiative could serve as a model for other communities to address suicide, self-harm and improve wellbeing on a whole-of-community and multi-agency scale.Conclusions Communities recognised that there are multiple factors associated with suicide, many of which are outside the remit of the health sector. They also demanded that responses are tailored, locally relevant and integrated across the community and across agencies.Lessons learnedData from communities at the local population level was necessary for action and planning in each of the communities. Supported and sustained by local leadership from community members and from agencies, this enabled the development of a shared vision in each community and provided a platform for targeted strategies. Limitations To date, implementation results are reliant on perceptions of stakeholders only in one community only. There is limited assessment of impact to date.Suggestions for future research More rigorous evaluations of community-based initiatives such as described have the potential to inform knowledge about suicide prevention. However, the tension between the needs of communities and the requirements of rigorous research design need to be considered.

Measuring and explaining inequality of continuous care for people living with HIV receiving antiretroviral therapy in Kunming, China.

In the context of scaling up free antiretroviral therapy (ART), healthcare equality is essential for people living with HIV. We aimed to assess socioeconomic-related inequalities in uptake of continuous care for people living with HIV receiving ART, including retention in care in the last six months, routine toxicity monitoring, adequate immunological and virological monitoring, and uptake of mental health assessment in the last 12 months. We also determined the contributions of socioeconomic factors to the degree of inequalities. A hospital-based cross-sectional survey was conducted among consecutive clients visiting an HIV treatment center in Kunming, China in 2019. Participants were 702 people living with HIV aged ≥18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1-5 years. Socioeconomic-related inequality and its contributing factors were assessed by a normalized concentration index (CIn) with a decomposition approach. The uptake of mental health assessment was low (15%) but significantly higher among the rich (CIn 0.1337, 95% CI: 0.0140, 0.2534). Retention in care, toxicity, and immunological monitoring were over 80% but non-significant in favor of the rich (CIn: 0.0117, 0.0315, 0.0736, respectively). The uptake of adequate virological monitoring was 15% and higher among the poor (CIn = -0.0308). Socioeconomic status positively contributed to inequalities of all care indicators, with the highest contribution for mental health assessment (124.9%) and lowest for virological monitoring (2.7%). These findings suggest virological monitoring and mental health assessment be given more attention in long-term HIV care. Policies allocating need-oriented resources geared toward improving equality of continuous care should be developed.

Intersection of class, caste, gender and unmet healthcare needs in India: Implications for health policy

Despite renewed policy priorities to universalise health coverage, unmet need for healthcare is long-standing concern in India. The recent data suggests the unmet healthcare need amounts to a notable share of twelve per cent. While studies have examined inequalities in healthcare utilisation in single axes of social power, there was no consensus on the role of the intersectionality between class, caste and gender in shaping the unmet health need. Utilising data from National Sample survey 75th round (2017–18), this paper identifies the factors contributing to such unmet need and investigate the intersectionality of class with caste and gender in determining unmet need. The contribution of socioeconomic factors was assessed by the decomposition method & multivariate logistic regression was used to measure inter and intra-class differentials in unmet need.The analysis informs that class inequality is fundamental to having unmet need with limited role of gender and caste. Economic class however, interacting with caste and gender unfolds wider gaps in access to healthcare. While inter-class differences in unmet need are observed across caste as well as gender, intra-class differences intensify more by caste inequalities. The findings indicate the significance of the intersectional approach in identifying the sources of health inequity and special recognition to the income-poor and socially marginalised in policy agenda. Eliminating the barriers to health care access therefore needs a multidimensional construct of identifying combination of attributes to be focused towards realization of universal health coverage. These observations should aid in formulation and restructuring of the existing healthcare interventions to achieve equity in healthcare provision.

Curse or Blessing? Obesity and Income-Related Inequality in the Chinese Labor Force.

China owns a huge labor force of around half billion workers in 2018. However, little is known about the prevalence of obesity and the association between obesity and economic status in this special population. By employing the concentration index (CI) and decomposition analysis, this paper addresses this knowledge gap by using the most recent nationally representative dataset. In specific, this study examines the prevalence of obesity and the socioeconomic gradient in the probability of obesity among Chinese workers between 16 and 65. Our results show that the prevalence of obesity is completely different by using a different measure: the overall prevalence of being general obesity (measured by body mass index, BMI ≥ 28) varies by gender and residency from a minimum of 5.88% to a maximum of 9.46%, whereas abdominal obesity (measured by waist circumference, WCmale ≥ 85 cm & WCfemale ≥ 80 cm) prevalence presents a socking level from 64.53% to 67.69%. Moreover, the results show a pro-rich distribution of obesity (general and abdominal) among male workers (CIBMI = 0.112; CIWC = 0.057) and a pro-poor distribution among female workers (CIBMI = −0.141; CIWC = −0.166). We also find that the direction of the contribution of socioeconomic factors to income-related inequalities in obesity differs by gender. These results have substantial implications for the measurement of socioeconomic inequality in adiposity and for improving health-related policies targeting the Chinese labor force.

Associations of physical activity at work and household income with obesity: a cross-sectional study among rural adults in Korea.

OBJECTIVESThis study was performed to identify the effect of physical activity at work on obesity and to analyze the contribution of socioeconomic factors and health behaviors to this association, which has been relatively little studied.METHODSFrom the Korean National Cancer Center Community Cohort, a total of 5,587 adults (2,125 men; 3,462 women) aged more than 30 years living in rural areas were enrolled. Information on socio-demographic factors, health behaviors, and body mass index was gathered using face-to-face interviews and measurements of height and weight.RESULTSInverse associations were identified between vigorous-intensity physical activity at work and obesity in both men and women, while no association was found between vigorous-intensity physical activity during leisure time and obesity. High household income was independently associated with a lower risk of obesity among those who had low levels of vigorous-intensity physical activity at work. Vigorous physical activity at work showed an inverse association with obesity in rural areas where heavy manual labor is common.CONCLUSIONSOur findings indicate the necessity to account for various types of physical activity to improve the assessment and prevention of obesity.