Disparities In Health Status Research Articles

Bayesian adjustment for unidirectional misclassification in ordinal covariates

ABSTRACTIn this paper, we study the identification of Bayesian regression models, when an ordinal covariate is subject to unidirectional misclassification. Xia and Gustafson [Bayesian regression models adjusting for unidirectional covariate misclassification. Can J Stat. 2016;44(2):198–218] obtained model identifiability for non-binary regression models, when there is a binary covariate subject to unidirectional misclassification. In the current paper, we establish the moment identifiability of regression models for misclassified ordinal covariates with more than two categories, based on forms of observable moments. Computational studies are conducted that confirm the theoretical results. We apply the method to two datasets, one from the Medical Expenditure Panel Survey (MEPS), and the other from Translational Research Investigating Underlying Disparities in Acute Myocardial infarction Patients Health Status (TRIUMPH).

Measuring Change Over Time in Socio-economic Deprivation and Health in an Urban Context: The Case Study of Genoa

The inverse relationship between socioeconomic and health status has been well established in the literature. Disparities in health status due to socioeconomic conditions are unfair and can be prevented through appropriate health and social policies. The relation between socioeconomic factors and health outcomes can be proven at both the individual and geographic level. In this study, we follow the second stream of literature. The objective of the study is to measure how deprivation changes over time in an urban context, finding out whether socioeconomic inequalities association with health outcomes endure over time. To do so, a census-based deprivation index (GDI—Genoa Deprivation Index) have been developed using three aggregation methods—additive, Mazziotta–Pareto, and Pena distance. The innovation of the work is the attempt to evaluate deprivation over time, trying to formalize a methodological path replicable in other situation. Health status has been assessed using the standardized (premature) mortality ratios. The findings reveal that although deprivation inequalities continue to exist in Genoa, global levels have been decreasing. In addition, the rate of premature mortality has shown improvements. Despite this, GDI scores continue to be associated with premature deaths: individuals living in deprived areas report consistently high standardised mortality ratios.

Sex differences in health status and rehabilitation outcomes in patients with atrial fibrillation treated with ablation: Results from the CopenHeartRFA trial

Increased physical capacity after comprehensive rehabilitation in patients with atrial fibrillation (AF) undergoing ablation has been found in the CopenHeartRFA trial. The purpose of this study was to investigate: (a) sex differences in health status, psychological distress and quality of life, (b) sex differences in rehabilitation outcomes and (c) predictors of effect of rehabilitation. We conducted an exploratory analysis of data from the randomized CopenHeartRFA trial, where patients treated with ablation were randomized with 1:1 to comprehensive rehabilitation consisting of a physical exercise program and psycho-educational consultations versus usual care. Sex disparities in health status were tested using Chi-square and t-tests. Included were: 151 men (median age 59.25 years) and 59 women (median age 62.5 years). At hospital discharge, women reported lower physical health status compared with men. Among women, significant differences were found in the 6-min walk test [rehabilitation: 496.8 meters (SD 98.5) versus 559.3meters (SD 55.5) and usual care: 521.9 meters (SD 97.8) versus 530.9 meters (SD 102.2), p = 0.01] and exercise time [rehabilitation: 387.6 s (SD 126.0) versus 463.2 s (SD 121.8) and usual care: 353.4 s (SD 145.2) versus 355.8 s (SD 154.8), p < 0.004] and among men in the sit-to-stand test. Significant differences were found in mental health outcomes among men and in quality of life scores among women. Patients with a European Heart Rhythm Association (EHRA) score I-II had a positive effect of rehabilitation. The results suggest that sex differences exist in self-reported health after rehabilitation in patients ablated for AF. Patients with an I-II EHRA score seem more likely to gain from the rehabilitation programme compared with those with a III-IV score.

Racial disparities in health conditions among prisoners compared with the general population

This paper compares black-white health disparities among prisoners to disparities in the noninstitutionalized community to provide a more complete portrait of the nation’s heath. We use data from the 2004 Survey of Inmates in State and Federal Correctional Facilities and the 2002 and 2004 National Health and Nutrition Examination Survey for incarcerated and noninstitutionalized adult (aged 18–65) men and women, respectively. Health disparities between black and white male prisoners based on self-reported prevalence are similar to disparities in the general population for hypertension and diabetes but significantly reduced for kidney problems and stroke. Health disparities between black and white female prisoners are similar to disparities in the general population for obesity but significantly reduced for hypertension, diabetes, heart problems, kidney problems, and stroke. Our study reveals that prisoners report far worse health profiles than non-prisoners but there is differential health selection into prison for whites and blacks, and population health estimates for adult black men in particular underreport the true health burden for U.S. adults. Our findings highlight the importance of incorporating prison populations in demographic and public health analyses.

Educational Attainment and Cardiovascular Disease Mortality in the Slovak Republic

IntroductionGood health is a crucial resource for social and economic development in each country. The higher interest of a society in the protection and development of health, the people enjoy a larger number of healthy life years and contribute more to the social and economic welfare (Mladovsky et al., 2009).Cardiovascular diseases (CVD), in other words diseases of the circulatory system, marked I00-I99 according to the International Classification of Diseases (WHO, 2010), are the leading causes of death and disability worldwide, as well as in the European countries including the Slovak Republic. They perform the biggest part of noncommunicable diseases, namely 46.2% worldwide, which are defined as those diseases which are not transmissible or caused by injury (WHO, 2014).In 2013, recent data of CVD mortality account for 37.5% of all deaths in the European Union (28), while ischemic heart disease and cerebrovascular diseases are the leading causes of death among CVD (Eurostat, 2016; Gavurova & Vagasova, 2016). In the Slovak Republic, there were 51,346 deaths in 2014, of which the proportion of cardiovascular diseases accounted for 49% (NCZI, 2014).CVD mortality rates are influenced by many determinants, therefore they are challenging to examine. Some behavioural factors are completely modifiable, like alcohol and tobacco consumption, obesity, physical activity; partly modifiable are socioeconomic characteristics, e.g. family income, education, occupational status, marital status; conversely, others are non-modifiable, such as age, sex, ethnicity (Pol & Thomas, 2013). One of the many factors that may play a role is educational level which used to be marked as an indicator of social and economic status. This can cause a certain level of psychosocial stress leading to the greater expected CVD mortality rate (Schmidt et al., 2012).The main aim of this paper is to reveal the structure of mortality from cardiovascular diseases by educational level, age and sex in the Slovak Republic throughout the time period 1996-2014. We would like to know if there are some differences in CVD mortality among sexes, age categories of people, various types of cardiovascular diagnoses, and educational attainment of the Slovak population.The paper consists of four parts. The first one contains brief overview of CVD mortality research with emphasis on educational attainment. In the second part, there is a description of data used and methodology. The next part is dedicated firstly to a development analysis of CVD mortality rate by sex, age and leading causes of deaths, and secondly a CVD mortality structure by education, age, sex is presented during the period of 2011-2014. Finally, we conclude and evaluate research findings.1.Literature ReviewDifferences in socioeconomic status, mainly in income, education and occupation, are associated with disparities in health status of population. Education is the most commonly used measure of socioeconomic status in epidemiological studies (Berkman & Kawachi, 2000).Many researchers provide the evidence that the educational attainment strongly and negatively correlates with the all-cause mortality (Kibele, 2012; Hoffmann, 2008; Muller, 2002; Kunst & Mackenbach, 1994). A variety of recent epidemiology studies devote to the cardiovascular disease mortality reporting the negative influence of risk factors, for example, alcohol and tobacco consumption, physical inactivity, unhealthy eating habits, high cholesterol, etc. (Nichols et al., 2014; Protulipac et al., 2015; GBD, 2013; Kamensky & Murin, 2009; Bowry et al., 2015; Psota et al., 2013; Odden et al., 2014).There are some studies showing that men and women with low socio-economic status, defined also as low educational level, have an increased all-cause as well as CVD mortality risk (e.g. Stringhini et al., 2010; Albert et al., 2006; Strand & Kunst, 2007; Mackenbach et al. …

Dollar for Dollar: Racial and ethnic inequalities in health and health-related outcomes among persons with very high income

Racial and ethnic disparities in health have been well-documented, and low SES is widely considered to be a driver of this relationship. However, the race-social class-health interrelationship is complex, as several studies have found race disparities between racial/ethnic minorities and whites at middle- income levels. Research on higher income persons is complicated by the lack of data for persons with incomes about $75,000. Most national datasets collect income data in categories with the highest income category being $75,000 and above. In our study, we examined racial/ethnic disparities in health status and behaviors among persons of very high income, reported income of $175,000 or above per year. Data are from the Medical Expenditure Panel Surveys (MEPS). Our findings revealed health disparities in 10 of the 16 health-related outcomes selected. African Americans were most dissimilar to whites at this income and with disadvantages on 6 health outcomes relative to whites. While results also showed some disparities for Asian Americans and Hispanic Americans relative to whites, these groups were advantaged, relative to whites on several health outcomes. Our findings indicate that income does not fully explain racial/ethnic disparities in health. Most public interventions are targeted to low income persons. However, public health interventions should target minority individuals of very high income as well, especially African Americans.

Looking Forward

Health care in the United States is characterized by advances in science and delivery with new forms of financing and growing attention to wellness and prevention. Despite this, disparities in health status, access, and health care quality persist, which lead to poor outcomes in selected populations and our inability to equal the quality of care in other high-income nations. This column includes a selective summary of the Vital Directions for health care report from the National Academy of Medicine. David J. Dries, MSE, MD, is assistant medical director for surgical services at HealthPartners Medical Group and professor of surgery and anesthesiology at the University of Minnesota in St Paul, MN, and can be reached at [email protected]

Unequal Living Conditions between Urban Migrants and Local Residents in China

Although migrants are the majority of increased urban population in China, the most of migrants cannot access the equal local social welfare system as the urban local residents because of the hukou policy (household registration) The migrants are more likely to live in an adverse conditions due to inferior socioeconomic status, which results to the disparity in health status between migrants and local residents. This study compares the unequal living conditions among urban population with 4 different resident statuses based on hukou residence and attributes, I compare the living conditions in terms of traffic, cooking and housing conditions to identify the disparities in the living conditions. The hypothesis is that the migrants’ living conditions are worse than local residents.The data comes from China Labor-force Dynamics Survey in 2012. It is a nationwide, large-scale, random sampled survey. The survey adopted three-stage stratified sampling and can represent the national population very well. The migrant household is defined as the households whose hukou residences have not be registered in the local cities. The urban population can be divided into (1) local resident household with non-agriculture hukou, (2) local resident household with agriculture hukou, (3) migrant household with non-agriculture hukou, and (4) migrant household with agriculture hukou. The variables about living conditions are compared by means of normal regression for continuous variables, logistical for categorical variables, and order logistic regression for ordinal variables. The results show that migrants with agriculture hukou and local residents with agriculture hukou have inferior living conditions that are significantly different from local residents. This suggests the special policy to adopt to address unequal living conditions in urban areas for policymakers.

Health and Development:An Introduction

Good quality affordable health is crucial and central to human well-being and happiness. In general, healthy people live longer, are more productive, and contribute more to their households and society. India is undergoing a rapid and unprecedented health transition in recent decades. We are faced with the huge burden of infectious diseases, unsafe pregnancies, and malnourishment on one side and the growing incidences of non-communicable and costly-to-treat diseases on the other. Considerable disparities still persists between social groups and across the regions/states in India wherein the most disadvantaged sections reporting the worst health conditions. Added to this, another challenge is the widening gender disparities in health status and utilization of health services. Despite the considerable improvement over the decades in the provision of primary healthcare services to the rural and remotest areas of this vast nation, inequalities by socio-economic classes continue as an unfinished agenda. This may be attributed to a range of social, economic and political factors which determines the distribution and accessibility of healthcare. Efficient allocation of health resources across regions and communities is required to ensure the availability of basic healthcare services to all and needy.

Prevalence, seasonal variation, and antibiotic resistance pattern of enteric bacterial pathogens among hospitalized diarrheic children in suburban regions of central Kenya.

BackgroundThe epidemiology of enteric pathogens has not been well studied in Kenya because of wide disparities in health status across the country. Therefore, the present study describes the prevalence of enteropathogenic bacteria, their seasonal variation, and antibiotic resistance profiles among hospitalized diarrheic children in a suburban region of central Kenya.MethodsFecal samples were collected between July 2009 and December 2013 from a total of 1410 children younger than 5 years, hospitalized with acute diarrhea in Kiambu County Hospital, Kenya. Conventional culture, biochemical, and molecular methods were conducted to identify causative bacterial pathogens and their virulence factors. Antimicrobial susceptibility tests were performed using E-test strips and VITEK-2 advanced expert system (AES) to evaluate the drug-resistance pattern of the isolates.ResultsOf the 1410 isolates, bacterial infections were identified in 474 cases. Diarrheagenic Escherichia coli (DEC) was the most frequently isolated pathogen (86.5%). Other pathogens such as Aeromonas (5.5%), Shigella (4%), Salmonella (3.4%), Providencia (3.2%), Vibrio spp. (1.1%), Yersinia enterocolitica (1.1%), and Plesiomonas shigelloides (0.2%) were also identified. Mixed bacterial infection was observed among 11.1% of the cases. The highest infection rate was found during the dry season (59.3%, p = 0.04). Most of the DEC was found to be multidrug resistant to trimethoprim/sulfamethoxazole 97.6%, amoxicillin 97.6%, erythromycin 96.9%, ampicillin 96.6%, and streptomycin 89%.ConclusionsThis study suggests that DEC is the leading diarrhea-causing bacterial pathogen circulating in central Kenya, and seasonality has a significant effect on its transmission. Proper antibiotic prescription and susceptibility testing is important to guide appropriate antimicrobial therapy.

Association of Skin Color and Generation on Arrests Among Mexican-Origin Latinos

Arrest and interaction with the criminal justice system can have negative impacts to health and socioeconomic status. In the United States, Latinos are disproportionately arrested and jailed, when compared to their non-Latino peers. However, Latinos are not a homogeneous group. For example, generation and skin color are two factors that impact the social standing of Latinos in the United States. As a result, the present study tested if the effects of skin color on odds of arrest depended on generation among Mexican-origin Latinos living in the Greater Los Angeles County Area using data from the Immigration and International Mobility in Metropolitan Los Angeles (IIMMLA) survey ( N = 1,226). Unadjusted analyses showed that arrest rates increased with generation. Multivariate results revealed that darker skin color was associated with higher odds of arrest, but only for the second generation. These findings suggest that the likelihood of being arrested for Mexican-origin Latinos is not uniform. Observed differences could set the stage for disparities in health and socio-economic status.

Self-identified race, socially assigned skin tone, and adult physiological dysregulation: Assessing multiple dimensions of “race” in health disparities research

Despite a general acceptance of “race” as a social, rather than biological construct in the social sciences, racial health disparities research has given less consideration to the dimensions of race that may be most important for shaping persistent disparities in adult physical health status. In this study, we incorporate the social constructionist view that race is multidimensional to evaluate the health significance of two measures of race, racial self-identification and the socially perceived skin tone of black Americans, in a sample of black and white adults in the Nashville Stress and Health Study (N=1186). First, we use the approach most common in disparities research—comparing group differences in an outcome—to consider self-identified racial differences in allostatic load (AL), a cumulative biological indicator of physical dysregulation. Second, we examine intragroup variations in AL among blacks by skin tone (i.e. light, brown, or dark skin). Third, we assess whether the magnitude of black-white disparities are equal across black skin tone subgroups. Consistent with prior research, we find significantly higher rates of dysregulation among blacks. However, our results also show that racial differences in AL vary by blacks’ skin tone; AL disparities are largest between whites and dark-skinned blacks and smallest between whites and light-skinned blacks. This study highlights the importance of blacks’ skin tone as a marker of socially-assigned race for shaping intragroup and intergroup variations in adult physiological dysregulation. These results demonstrate the importance of assessing multiple dimensions of race in disparities research, as this approach may better capture the various mechanisms by which “race” continues to shape health.

Cardiovascular Health Status by Occupational Group - 21 States, 2013.

Cardiovascular disease (CVD) accounts for one of every three deaths in the United States, making it the leading cause of mortality in the country (1). The American Heart Association established seven ideal cardiovascular health behaviors or modifiable factors to improve CVD outcomes in the United States. These cardiovascular health metrics (CHMs) are 1) not smoking, 2) being physically active, 3) having normal blood pressure, 4) having normal blood glucose, 5) being of normal weight, 6) having normal cholesterol levels, and 7) eating a healthy diet (2). Meeting six or all seven CHMs is associated with a lower risk for all-cause, CVD, and ischemic heart disease mortalities compared with the risk to persons who meet none or only one CHM (3). Fewer than 2% of U.S. adults meet all seven of the American Heart Association's CHMs (4). Cardiovascular morbidity and mortality account for an estimated annual $120 billion in lost productivity in the workplace; thus, workplaces are viable settings for effective health promotion programs (5). With over 130 million employed persons in the United States, accounting for about 55% of all U.S. adults, the working population is an important demographic group to evaluate with regard to cardiovascular health status. To determine if an association between occupation and CHM score exists, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) industry and occupation module, which was implemented in 21 states. Among all occupational groups, community and social services employees (14.6%), transportation and material moving employees (14.3%), and architecture and engineering employees (11.6%) had the highest adjusted prevalence of meeting two or fewer CHMs. Transportation and material moving employees also had the highest prevalence of "not ideal" ("0" [i.e., no CHMs met]) scores for three of the seven CHMs: physical activity (54.1%), blood pressure (31.9%), and weight (body mass index [BMI]; 75.5%). Disparities in cardiovascular health status exist among U.S. occupational groups, making occupation an important consideration in employer-sponsored health promotion activities and allocation of prevention resources.

Racial and Ethnic Health Disparities Among People With Intellectual and Developmental Disabilities.

Racial and ethnic health disparities are a pervasive public health problem. Emerging research finds similar health disparities among people with intellectual and developmental disabilities (IDD) compared to nondisabled adults. However, few studies have examined racial and ethnic health disparities among adults with IDD. Using national data, we examined racial and ethnic disparities in health status among adults with IDD, and investigated differences in health status between adults with IDD and nondisabled adults within each racial and ethnic group. We found that Latino and Black adults with IDD had worse health outcomes compared to White adults with IDD, and Latino and Black adults with IDD had worse health outcomes than nondisabled adults from the same racial and ethnic group.

Medical Debt and Related Financial Consequences Among Older African American and White Adults.

To evaluate African American-White differences in medical debt among older adults and the extent to which economic and health factors explained these. We used nationally representative data from the 2007 and 2010 US Health Tracking Household Survey (n = 5838) and computed population-based estimates of medical debt attributable to economic and health factors with adjustment for age, gender, marital status, and education. African Americans had 2.6 times higher odds of medical debt (odds ratio = 2.62; 95% confidence interval = 1.85, 3.72) than did Whites. Health status explained 22.8% of the observed disparity, and income and insurance explained 19.4%. These factors combined explained 42.4% of the observed disparity. In addition, African Americans were more likely to be contacted by a collection agency and to borrow money because of medical debt, whereas Whites were more likely to use savings. African Americans incur substantial medical debt compared with Whites, and more than 40% of this is mediated by health status, income, and insurance disparities. Public health implications. In Medicare, low-income beneficiaries, especially low-income African Americans with poor health status, should be protected from the unintended financial consequences of cost-reduction strategies.

지역별 심뇌혈관질환 사망률의 차이 및 영향요인

Background: Many studies have explained regional disparities in health by socioeconomic status and healthcare resources, focus-ing on differences between urban and rural area. However some cities in Korea have the highest cardiovascular mortality, even though they have sufficient healthcare resources. So this study aims to confirm three hypotheses. (1) There are also regional health disparities between cities not only between urban and rural area. (2) It has different regional risk factors affecting cardiovascular mortality whether it is urban or rural area. (3) Besides socioeconomic and healthcare resources factors, there are remnant factors that affect regional cardiovascular mortality such as health behavior and physical environment.Methods: The subject of this study is 227 local authorities (si, gun, and gu). They were categorized into city (gu and si consisting of urban area) and non-city (gun consisting of rural area), and the city group was subdivided into 3 parts to reflect relative different city status: city 1 (Seoul, Gyeonggi cities), city 2 (Gwangyeoksi cities), and city 3 (other cities). We compared their mortalities among four groups by using analysis of variance analysis. And we explored what had contributed to it in whole authorities, city and non-city group by using multiple regression analysis.Results: Cardiovascular mortality is highest in city 2 group, lowest in city 1 group and middle in non-city group. Socioeconomic sta-tus and current smoking significantly increase mortality regardless of group. Other than those things, in city, there are some factors associated with cardiovascular mortality: walking practice(-), weight control attempt(-), deficiency of sports facilities(+), and high rate of factory lot(+). In non-city, there are other factors different from those of city: obesity prevalence(+), self-perceiving obesity(-), number of public health institutions(-), and road ratio(-).Conclusion: To reduce cardiovascular mortality and it’s regional disparities, we need to consider differentiated approach, respecting regional character and different risk factors. Also, it is crucial to strengthen local government’s capacity for practicing community health policy.Keywords: Health status disparity; Residence characteristics; Cardiovascular diseases; Mortality

Disparities in Health Insurance Coverage and Health Status Among Farmworkers, Sonoma County, California, 2013-2014.

IntroductionThe Sonoma County Farmworker Health Survey (FHS) was conducted to describe the health and well-being of adult farmworkers in Sonoma County, California, and to identify preventable health disparities for this population.MethodsFrom September 2013 through January 2014, venue-based and convenience sampling were used to survey 293 farmworkers aged 18 years or older. The questions included self-rated general health, diabetes and hypertension, and body mass index. To identify disparities between surveyed farmworkers and Sonoma County residents overall, age-adjusted prevalence estimates were developed by using indirect standardization to the adult (≥18 years) Sonoma County sample from the California Health Interview Survey for 2011–2012.ResultsSurveyed farmworkers were mostly male (91%) and Latino or Hispanic (95%), and 54% had an educational attainment of 8th grade or less. Most (81%) farmworkers reported their families earned less than $30,000 in 2012. After adjusting for age, 30% of farmworkers had US-based health insurance as compared with the 86% of Sonoma County adults in 2011–2012 (P < .001), and 15% of farmworkers reported ever being diagnosed with diabetes after adjusting for age as compared with 5% of Sonoma County adults (P = .002). After adjusting for age, 44% of farmworkers reported poor or fair health in general as compared with 13% of Sonoma County adults (P < .001).ConclusionWe identified significant health disparities between Sonoma County farmworkers and Sonoma County adults overall. Additional research and new health policies are necessary to eliminate these health disparities and to facilitate farmworker access to the health care system.

Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan.

BackgroundPatients are being encouraged to go online to obtain health information and interact with their health care systems. However, a 2014 survey found that less than 60% of American adults aged 65 and older use the Internet, with much lower usage among black and Latino seniors compared with non-Hispanic white seniors, and among older versus younger seniors.ObjectiveOur aims were to (1) identify race/ethnic and age cohort disparities among seniors in use of the health plan’s patient portal, (2) determine whether race/ethnic and age cohort disparities exist in access to digital devices and preferences for using email- and Web-based modalities to interact with the health care system, (3) assess whether observed disparities in preferences and patient portal use are due simply to barriers to access and inability to use the Internet, and (4) learn whether older adults not currently using the health plan’s patient portal or website have a potential interest in doing so in the future and what kind of support might be best suited to help them.MethodsWe conducted two studies of seniors aged 65-79 years. First, we used administrative data about patient portal account status and utilization in 2013 for a large cohort of English-speaking non-Hispanic white (n=183,565), black (n=16,898), Latino (n=12,409), Filipino (n=11,896), and Chinese (n=6314) members of the Kaiser Permanente Northern California health plan. Second, we used data from a mailed survey conducted in 2013-2014 with a stratified random sample of this population (final sample: 849 non-Hispanic white, 567 black, 653 Latino, 219 Filipino, and 314 Chinese). These data were used to examine race/ethnic and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes.ResultsAdults aged 70-74 and 75-79 were significantly less likely than 65-69 year olds to be registered to use the patient portal, and among those registered, to have used the portal to send messages, view lab test results, or order prescription refills. Across all age groups, non-Hispanic whites and Chinese seniors were significantly more likely than black, Latino, and Filipino seniors to be registered and to have performed these actions. The survey found that black, Latino, and Filipino seniors and those 75 years old and older were significantly less likely to own digital devices (eg, computers, smartphones), use the Internet and email, and be able and willing to use digital technology to perform health care-related tasks, including obtaining health information, than non-Hispanic whites, Chinese, and younger seniors (aged 65-69), respectively. The preference for using non-digital modalities persisted even among Internet users.ConclusionsHealth plans, government agencies, and other organizations that serve diverse groups of seniors should include social determinants such as race/ethnicity and age when monitoring trends in eHealth to ensure that eHealth disparities do not induce greater health status and health care disparities between more privileged and less privileged groups.

How colonisation determines social justice and Indigenous health—a review of the literature

Disparities in health status persist for Indigenous people in Australia. In the bid to reduce the disparity gap, the concept of achieving social justice is central to advancing the services and systems that can challenge inequitable circumstances within a nation. Colonisation is well known as the underlying factor influencing the social injustices that result in inequitable health for Indigenous people. A literature review was conducted identifying how the colonial impact on social justice is described in the relationships with the health of Indigenous Australians. A comprehensive search strategy was developed, including four broad search terms of ‘Indigenous people’ and ‘health status’ and ‘colonisation’ or ‘social justice’, and applied within five databases. Publications were limited to Australia, dated from 1 January 2000 to 31 December 2014. The literature acknowledging the effect that colonisation has on Indigenous Australians includes evidence from oral and political histories, and social determinants frameworks. There was a general consensus that the impact of colonisation on the health of Indigenous people is highly complex and that the legacies are experienced intra-generationally and inter-generationally. There is paucity in the evidence that examines the associations of colonisation and its impact on social injustice. Because social justice is considered central to equitable practices across all sectors in society (health, education, legal etc.), questions are raised about the magnitude of the effect that colonisation has on health disparities and importantly how the desideratum to tackle disparities that have stemmed from colonisation are adequately addressed.

Expectancy and Achievement Gaps in Educational Attainment and Subsequent Adverse Health Effects among Adolescents With and without Chronic Medical Conditions

As a multiple determinants of health model posits that hierarchical and dynamic circumstances and environments play a substantial role in determining individual health, the importance of understanding developing socioeconomic context during critical periods cannot be overstated. While socioeconomic status is known to cumulatively affect health across the life-course, it is unknown to what extent pediatric onset chronic conditions contribute to achievement gaps in educational attainment, a critical component of SES, and how these disparities may independently or jointly contribute to disparities in health. As such, we sought to investigate disparities in educational aspiration, expectations, and achievement among adolescents and young adults with and without chronic conditions, and to determine if these relationships mediated subsequent disparities in health status during young adulthood.