Disparities In Quality Of Life Research Articles

Abstract 4123886: Health Disparities in Quality of Life Among Black Patients with Heart Failure: The Roles of Depressive Symptoms and Functional Status

Background: Black patients with heart failure (HF) have a higher physical and psychological distress which disproportionately worsens their health and quality of life (QOL) than those from other racial/ethnic groups. Black patients less commonly receive optimal therapy for HF than white patients, which can result in poorer functional status. Black patients report higher levels of depressive symptoms. Higher levels of depressive symptoms can further worsen functional status and lower QOL. Hypothesis: We hypothesized that depressive symptoms would predict QOL in Black patients with HF and that this relationship would be mediated by functional status. Methods: Using the RICH Heart Program HF Database, we included all 226 Black patients (57±12 years old, 49% male) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, the Duke Activity Status Index for functional status, and the Minnesota Living with Heart Failure Questionnaire for QOL. Mediation analysis was performed using the PROCESS macro. Results: Depressive symptoms were directly associated with QOL (effect coefficient [c’] =2.386, 95% confidence interval [CI] = 2.549, 3.450). There was a significant indirect effect of depressive symptoms on QOL mediated by functional status (ab=0.614, 95% CI [0.406, 0.856]). Those with worse depressive symptoms had lower functional status (a = -0.901, p< 0.001), in turn, lower functional status was associated with worse QOL (b = -0.681 p<0.001). Conclusions: Depressive symptoms are directly associated with QOL and there also is an indirect association, mediated by functional status in Black patients with HF. Inequities in the management of HF among Black patients that contribute to these findings must be explored as the causes of the disparity in depressive symptoms are not yet known.

Housing Australian Children: A Snapshot of Health Inequities in the First 2000 Days.

Housing is a critical social determinant of children's health. While individual pathways between housing and health are well evidenced, there has been less attention on the co-occurrence of housing disadvantages. We aim to identify typologies of children's housing disadvantage and describe the health inequities they generate. A cross-sectional latent class analysis (LCA) was conducted on 4355 Australian children aged 4 to 5years who participated in the Longitudinal Study of Australian Children. Nine binary indicators-dwelling tenure, external condition, affordability, stability, crowding, cleanliness, fuel poverty, and noise exposure-were used to generate latent housing typologies. Generalized linear models with robust standard errors described disparities in quality of life, injury, disability, and health service use across these housing typologies. Four distinct housing typologies were identified in this cohort: "good condition, affordable, and secure" (60%); "insecure" (11%); "crowded" (24%); and "unsuitable" (5%). Unsuitable housing, characterized by crowding, poor external conditions, and noise exposure, was more likely to be occupied by single-parent families, low-income households, and be headed by parents with low levels of education. Children in unsuitable housing lagged on quality of life indicators at preschool age (e.g., by 8.0 points on emotional functioning, 95% CI - 10.6, - 5.5), and underutilized primary healthcare services (e.g., prevalence ratio 0.76 for GP services, 95% CI 0.67, 0.87), compared to children in good quality housing. This finding supports the case for early intervention strategies that account for children's housing circumstances.

Sleep as a Predictor of Health-Related Quality of Life among Economically Disadvantaged Black Older Adults.

Sleep disturbances may partially account for the health-related quality of life (HRQoL) disparities experienced by Black older adults when compared to non-Hispanic White (NHW) adults. The present study examined the role of self-reported sleep duration and the belief that one is not getting enough sleep on physical and mental HRQoL among Black older adults. Participants were 281 community-dwelling, economically disadvantaged Black older adults between 60 and 97 years of age (Mean=69.01, SD=6.97) who lived in a large city in the Southeastern United States. The present study uses baseline data from a larger intervention study aimed at promoting social connection and food security among older adults. For this study (and as part of the larger intervention), participants completed an assessment battery that included (1) a demographic data and health questionnaire that included self-reported sleep duration and a belief that one is not getting enough sleep questions; (2) the CDC (Centers for Disease Control and Prevention) Health-Related Quality of Life-14 Healthy Days Core Module; and (3) the World Health Organization Quality of Life-Brief Form. Descriptive results show that most participants slept less than 7 hours and felt like they did not get enough sleep. Results from 2 hierarchical regressions also showed that believing one is not getting enough sleep predicts lower self-reported mental and physical HRQoL. While sleep deprivation has a serious impact on quality of life for Black older adults, sleep disturbances in this population are understudied. Interventions to improve sleep duration and quality among Black older adults may help reduce disparities in quality of life between Black older adults and NHW adults.

Urban/Rural Disparity in Quality of Life among the Older Adults in China: Mediation Effect of Leisure Activity.

The current study revisits the urban/rural quality of life (QOL) disparity among the older adults in China. It aims to test the potential leisure activity mechanism. Data for this study come from the 2011 and 2014 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Sample is restricted to the respondents who are 65 years old and older who are alive for both waves. Ordered logistic regression model is used to test the relationship between QOL and urban/rural residency. Mediation test is used to investigate the mediation effect of leisure activities. Findings from the analysis show that urban older adults have higher QOL, as well as higher frequency of participating leisure activities compare to their rural counterparts. Results also show that leisure activities, especially the cognitive stimulation activities mediate the relationship between urban/rural residency and QOL. The current study adds the role of leisure activities as an intervening variable between urban/rural residency and QOL among older adults in China. Policy application to reduce the QOL disparity through leisure activities is also discussed.

Measuring Consumer-Reported Quality of Life Among Recipients of Publicly Funded Home- and Community-Based Services: Implications for Health Equity.

Despite an increased policy focused on home- and community-based services (HCBS), little is known about their quality of life (QoL)-a key measure of person-centered care. This paper addresses this gap by measuring consumers' self-reported QoL and identifying factors associated with disparities in QoL. We analyzed the 2015-2016 National Core Indicators-Aging and Disability survey for 3426 respondents in Minnesota, using factor analyses to identify latent QoL domains. Multivariable regression models identified predictors of QoL domains. Factor analyses identified three valid and reliable latent QoL domains: security, self-determination, and care experiences. Younger consumers with disabilities (versus consumers ≥65 years of age), minoritized racial/ethnic groups, consumers with hearing loss, without a spouse/domestic partner, and not living in consumer's own/family home reported significantly lower QoL in various domains (p < .001). Disparities in HCBS consumer-reported QoL exist, necessitating equitable reforms to improve HCBS quality for its increasingly diversified consumer base.

Bayesian Spatio-Temporal Multilevel Modelling of Patient-Reported Quality of Life following Prostate Cancer Surgery.

Globally, prostate cancer is the second leading cause of cancer deaths among males. It is the most commonly diagnosed cancer in Australia. The quality of life of prostate cancer patients is poorer when compared to the general population due to the disease itself and its related complications. However, there is limited research on the geographic pattern of quality of life and its risk factors in Victoria. Therefore, an examination of the spatio-temporal pattern and risk factors of poor quality of life, along with the impact of spatial weight matrices on estimates and model performance, was conducted. A retrospective study was undertaken based on the Prostate Cancer Outcome Registry-Victoria data. Patient data (n = 5238) were extracted from the Prostate Cancer Outcome Registry, a population-based clinical quality outcome assessment from 2015 to 2021. A Bayesian spatio-temporal multilevel model was fitted to identify risk factors for poor quality of life. This study also evaluated the impact of distance- and adjacency-based spatial weight matrices. Model convergence was assessed using Gelman-Rubin statistical plots, and model comparison was based on the Watanabe-Akaike Information Criterion. A total of 1906 (36.38%) prostate cancer patients who had undergone surgery experienced poor quality of life in our study. Belonging to the age group between 76 and 85 years (adjusted odds ratio (AOR) = 2.90, 95% credible interval (CrI): 1.39, 2.08), having a prostate-specific antigen level between 10.1 and 20.0 (AOR = 1.33, 95% CrI: 1.12, 1.58), and being treated in a public hospital (AOR = 1.35, 95% CrI: 1.17, 1.53) were significantly associated with higher odds of poor quality of life. Conversely, residing in highly accessible areas (AOR = 0.60, 95% CrI: 0.38, 0.94) was significantly associated with lower odds of poor prostate-specific antigen levels. Variations in estimates and model performance were observed depending on the choice of spatial weight matrices. Belonging to an older age group, having a high prostate-specific antigen level, receiving treatment in public hospitals, and remoteness were statistically significant factors linked to poor quality of life. Substantial spatio-temporal variations in poor quality of life were observed in Victoria across local government areas. The distance-based weight matrix performed better than the adjacency-based matrix. This research finding highlights the need to reduce geographical disparities in quality of life. The statistical methods developed in this study may also be useful to apply to other population-based clinical registry settings.

Disparities in quality of life among patients with breast cancer based on surgical methods: a cross-sectional prospective study

To determine the impact of breast conservation on quality of life and identify treatment-related and other demographic factors associated with post-breast cancer treatment quality of life. A prospective study was conducted on 392 women who underwent breast cancer surgery at Hangzhou Cancer Hospital from January 1, 2013, to December 31, 2022. Operable breast cancer patients who had completed all treatments except endocrine therapy were included. Patients with tumor recurrence/metastasis, bilateral or male breast cancer, and other primary malignancies were excluded. After enrollment, patients were asked to complete the BREAST-Q scale, and their pathological and medical records were reviewed. Analysis of variance was used to compare the quality of life scores among the groups. Univariate and multivariate linear regression analyses were performed to identify independent factors associated with quality of life scores in different domains. Participants completed the BREAST-Q scale at a median of 4.6 years after surgery. Quality of life scores varied based on the therapeutic strategy. Breast conservation has significant advantages over mastectomy in terms of breast satisfaction, psychosocial, and sexual well-being. Compared to oncoplastic breast-conserving surgery, mastectomy was independently associated with decreased breast satisfaction, psychosocial, and sexual well-being, while conventional breast-conserving surgery showed comparable outcomes to oncoplastic breast-conserving surgery in terms of these factors. Breast conservation leads to an improvement in quality of life compared to mastectomy. Oncoplastic breast-conserving surgery does not lead to a decrease in quality of life compared to conventional breast-conserving surgery and offers better outcomes compared to mastectomy.

Gender Disparities in Quality of Life Outcomes Among Kidney Stone Formers.

Purpose: This study investigates gender-based disparities in health-related quality of life (HRQOL) outcomes among kidney stone patients and explores potential contributing factors. Methods: A retrospective review of medical records at the University of Rochester Medical Center was conducted on 2199 new urolithiasis patients who completed the Wisconsin Stone Quality of Life Questionnaire (WISQOL) standardized on a 0 to 100 scale. Demographic and clinical data were collected. Statistical analyses included univariate tests, chi-squared tests, and multivariate linear regression. Results: Of the 2199 kidney stone patients, 1085 (49.3%) were women. Women reported significantly lower quality of life (QoL) scores compared with men (71.6 vs 80.7; p < 0.001), and this persisted across all domains, including social impact (80.2 vs 86.9; p < 0.001), emotional impact (67.3 vs 77.1; p < 0.001), disease impact (67.3 vs 77.1; p < 0.001), and impact vitality (62.6 vs 72.9; p < 0.001). Female gender was identified as an independent predictor of diminished QoL scores, along with younger age, symptomatic status, number of surgeries, and presence of a psychosocial comorbidity. Conclusions: Our findings suggest that women with kidney stones experience lower HRQOL compared with men, even accounting for clinical and demographic factors. Although this study provides preliminary insights, additional research is needed to validate these findings in broader and more varied populations.

Quality of Life After Axillary Lymph Node Dissection Among Racial and Ethnic Minority Women

Higher lymphedema rates after axillary lymph node dissection (ALND) have been found in Black and Hispanic women; however, there is poor correlation between subjective symptoms, quality of life (QOL), and measured lymphedema. Additionally, racial and ethnic differences in QOL have been understudied. To evaluate the association of race and ethnicity with long-term QOL in patients with breast cancer treated with ALND. This cohort study enrolled women aged 18 years and older with breast cancer who underwent unilateral ALND at a tertiary cancer center between November 2016 and March 2020. Preoperatively and at 6-month intervals, arm volume was measured by perometer and QOL was assessed using the Upper Limb Lymphedema-27 (ULL-27) questionnaire, a validated tool for assessing lymphedema that evaluates how arm symptoms affect physical, psychological, and social functioning. Data were analyzed from November 2016 to October 2023. Breast surgery and unilateral ALND in the primary setting or after sentinel lymph node biopsy. Scores in each domain of the ULL-27 were compared by race and ethnicity. Factors impacting QOL were identified using multivariable regression analyses. The study included 281 women (median [IQR] age, 48 [41-58] years) with breast cancer who underwent unilateral ALND and had at least 6 months of follow-up. Of these, 30 patients (11%) self-identified as Asian individuals, 57 (20%) as Black individuals, 23 (8%) as Hispanic individuals, and 162 (58%) as White individuals; 9 individuals (3%) who did not identify as part of a particular group or who were missing race and ethnicity data were categorized as having unknown race and ethnicity. Median (IQR) follow-up was 2.97 (1.96-3.67) years. The overall 2-year lymphedema rate was 20% and was higher among Black (31%) and Hispanic (27%) women compared with Asian (15%) and White (17%) women (P = .04). Subjective arm swelling was more common among Asian (57%), Black (70%), and Hispanic (87%) women than White (44%) women (P < .001), and lower physical QOL scores were reported by racial and ethnic minority women at nearly every follow-up. For example, at 24 months, median QOL scores were 87, 79, and 80 for Asian, Black, and Hispanic women compared with 92 for White women (P = .003). On multivariable analysis, Asian race (β = -5.7; 95% CI, -9.5 to -1.8), Hispanic ethnicity (β = -10.0; 95% CI, -15.0 to -5.2), and having Medicaid (β = -5.4; 95% CI, -9.2 to -1.7) or Medicare insurance (β = -6.9; 95% CI, -10.0 to -3.4) were independently associated with worse physical QOL (all P < .001). Findings of this cohort study suggest that Asian, Black, and Hispanic women experience more subjective arm swelling after unilateral ALND for breast cancer compared with White women. Black and Hispanic women had higher rates of objective lymphedema than their White counterparts. Both minority status and public medical insurance were associated with worse physical QOL. Understanding disparities in QOL after ALND is an unmet need and may enable targeted interventions to improve QOL for these patients.

Association Between Pharmacological Treatment Regimens and Quality of Life Among Rural Type 2 Diabetic Patients: A Comparative Analysis in Eastern China.

Numerous studies have explored the relationship between pharmacological treatment regimens and the quality of life (QoL) of type 2 diabetes (T2D) patients. However, there is a dearth of comparative studies focusing on the QoL among rural T2D patients in China across 3 distinct pharmacological treatments: oral antidiabetic drugs (OADs), insulin therapy, and a combination of OADs and insulin. Additionally, the specific correlation between these treatment regimens and distinct dimensions of QoL remains unclear, necessitating further investigation. Data from a survey of rural T2D patients in eastern China were analyzed to calculate QoL scores for different treatment groups. Multivariate linear regression was then used to assess variations in overall QoL and specific dimensions among patients on OADs, insulin, and combined therapy. OADs were most commonly used (70.36%), followed by combined (19.47%) and insulin therapy (10.17%). Patients on OADs reported the highest overall QoL, with reduced physical discomfort, improved psychological well-being, enhanced treatment satisfaction, and fewer medication side effects. Conversely, those on combined therapy had the lowest overall QoL, primarily due to increased physical discomfort. Insulin users had moderately positive overall QoL but lower psychological well-being and treatment satisfaction, along with more adverse reactions. Disparities in QoL and its dimensions exist among rural T2D patients based on treatment regimens. Healthcare providers should prioritize support systems and interventions to help patients manage side effects of insulin and combined therapy, thereby improving their QoL.

A shock to the (health) system: experiences of adults with rare disorders during the first COVID-19 wave

BackgroundBefore COVID-19, people with rare diseases (RD) experienced numerous disparities in quality of life and healthcare access and quality, yet little is known about the experiences of this underserved group during the pandemic.ResultsDuring the first wave of the COVID-19 pandemic in the United States, spring and summer of 2020, 759 participants representing 231 unique RDs responded to open-ended questions about the impact of the pandemic on life with a RD, healthcare access, and coping. Qualitative conventional content analysis was used to analyze responses. Identified themes represented positive and negative dimensions of change, including a shock to the (health) system, coping with uncertainty, and the value of social support while isolated.ConclusionsLimitations in healthcare access and quality were the most frequently described as impacts of COVID-19. Other major negative impacts included exacerbation of symptoms, psychological distress, and a lack of usual social support and reliable information. However, participants also noted silver linings, especially in healthcare. For some, expanded telehealth enhanced their ability to access medical and mental health providers and RD specialists. Finally, many participants hoped that, by highlighting social and health inequities faced by people with RDs and other minorities, the pandemic would prompt greater understanding and policies that could improve the quality of life of the RD community.

The “Real Man” and National Security

This article explores the relationship between masculinity and national security. There may be a reluctance to view the values, attitudes, and beliefs associated with a particular version of masculinity as a driver for violence. Yet, the “real man” version of masculinity is consistently correlated with those who in engage in mass violence, mobilized violence, and violent extremism—which present a threat to national security. The “real man” identity is also correlated with significant gender disparities in quality of life including income, health, happiness, and mortality for men. Such grievances represent yet another driver of discontent and violence. National security requires that we recognize and understand potential threats and subsequently work to mitigate those threats. Men in the US military have traditionally been viewed as prototypical of masculine identity and its associated values, attitudes, and beliefs. As such, this version of masculinity represents a unique institutional context to examine the “real man” version of masculinity, and to advance gender equality and overcome the harms that rigid gender roles present to national security.

EXTENDING HOLISTIC, MULTIDISCIPLINARY SLEEP HEALTH INTERVENTION TO OVERLOOKED GROUPS OF OLDER ADULTS

Abstract Sleep health and overall well-being across the lifespan are inextricably linked. Sleep difficulties are a common occurrence in older adulthood, with disturbed sleep ranking only second to pain as a problematic symptom interfering with older peoples’ daily lives. Exacerbating the issue are sleep health disparities such that sleep disturbances disproportionately affect members of under-represented, marginalized, and resource-poor communities. Building, implementing, and mobilizing knowledge from sleep-promoting interventions with potential to effect change on sleep health and quality of life disparities are urgently needed. From an occupational therapy lens, “rest and sleep” is classified as one of nine fundamental “occupations”—other more widely recognized occupations include those such as ADL and work. The Person, Environment, Occupation-Performance (PEOP) Model, an occupation-centric guiding framework that considers multiple layers of dynamic and interacting factors pertinent to individuals’ occupational performance, has been applied to sleep intervention. From this model, one can appreciate the myriad facilitators of and barriers to realizing healthy and restorative rest and sleep, directing attention to a wide range of relevant issues such as cultural practices, societal attitudes, and resource scarcity. This presentation will overview the need for addressing inequities in sleep health and extending socio-culturally responsive services to traditionally overlooked subgroups of older people. Examples will be provided of holistic, multidisciplinary intervention research and programming that work to transform the landscape of sleep health disparities in later life.

Differences in the health-related quality of life in patients with asthma living in urban and rural areas in the Amur Region of Russian Federation

Background Asthma usually arises from an interaction between host and environmental factors. Growing attention has been paid to a place of residence as a factor shaping health-related quality of life (QoL). This study investigated the rural-urban disparity in QoL among adult asthma patients in the Amur region of Russian Federation. Materials and methods This cross-sectional study included 351 randomly selected adults with asthma. We analyzed QoL (SF-36 and AQLQ scores), asthma control (ACT), and anxiety and depression (HADS) depending on the place of residence (urban vs. rural). Results The scale “Role Emotional” (RE) of SF-36 was significantly lower in patients from rural areas compared to urban residents (59.3±3.1 vs. 70.4±2.3 points; p = 0.0042). In the urban group, the correlation analysis demonstrated a clear influence of RE on patients’ own assessment of their physical functioning (PF, r = 0.53; p&lt;0.0001). Both groups demonstrated low “Social Functioning” (SF). In the group of urban residents, correlation analysis revealed the presence of positive correlations of SF-36 domains reflecting physical (PF, RP, BP) and social functioning (SF, VT) with most scales of both QoL questionnaires. The domains of the emotional sphere (RE and MH) positively correlated with all scales of both QoL questionnaires among urban residents. In the group of rural residents, a comparative analysis showed the absence of significant correlations between more of the QoL scales. Although Asthma Control Test did not differ between groups, we noted a significantly higher need for β2-agonists in rural areas compared to urban areas (4.2±0.6 vs. 2.7±0.3 inh/day, respectively; p = 0.0221). The frequency of urban residents with a clinically significant level of anxiety (56 persons, or 25.2%) turned out to be lower compared to rural residents (45 persons, or 34.8%; χ2 = 34.08; p&lt;0.001). Conclusion The burden of asthma introduces a greater imbalance in the health-related QoL of rural residents compared to urban residents in the Amur region of the Russian Federation. The absence of interrelationships of some QoL domains in rural residents suggested a disunity of the physical, psychological and social aspects of life. The rural residents suppress physical discomfort by the more frequent use of short bronchodilators. They often showed emotional instability with a predominance of anxiety, which affected the decrease in QoL in the psycho-emotional sphere.

Disparities in Quality of Life Among European Cancer Survivors Aged 50 and Over

Abstract Background This study aims to investigate regional disparities of quality of life (QoL) among older cancer survivors across European countries. Methods This is a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) project. European-level, regional and national QoL among cancer survivors were investigated using mixed-effect regression models based on demographic and health-related factors. Findings The prevalence of low QoL vary from 12.4 (Denmark) to 84.9 (Greece) for women and from 10.4 (Denmark) to 74.6 (Greece) for men. Cancer survivors had higher risks of low QoL (prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.47 - 1.71) than general population. Numbers of mobility limitations has the largest effects on QoL (NL mobility =1: PR = 1.54, 95% CI = 1.45 -1.64; NL mobility ≥ 2: PR = 2.59, 95% CI = 2.47 - 2.73), followed by several other factors (e.g., age, gender, BMI, civil status, employment status, education level and geographical region). Most of the effects kept stable or decreased slightly after subjects survived more than 5 years. Conclusions Significant disparities of QoL were observed across Europe. Cancer survivors face a substantially increased risk of decreased QoL comparing to general population. Several factors were identified as risk factors for lower QoL. Key messages • QoL in general population show significant disparities across Europe. • Further steps should focus on improving QoL of cancer survivors simultaneously across European countries.

Assistive technology for people with intellectual and developmental disabilities in the United States in Home- and Community-Based Services

Purpose Unmet needs for assistive technology (AT) contribute to health and quality of life disparities among people with intellectual and developmental disabilities (IDD) [1–4]. The biggest barrier people with IDD face accessing technology is affordability and a lack of funding [1,3–6]. The purpose of this study was to examine how AT were provided to people with IDD in Medicaid Home- and Community-Based Services (HCBS) in the United States, the largest funding source for Long-Term Services and Supports for people with IDD. Materials and methods We analysed Medicaid HCBS 1915(c) waivers for people with IDD from across the USA in fiscal year (FY) 2021 using content analysis and descriptive statistics. Results and conclusions In FY2021, 31 states and the District of Columbia provided AT (stand-alone and combined services) through 68 waivers for people with IDD to improve functioning, communication, independence, and community integration. In total, $63.3 million was projected for the AT services for 23,753 people with IDD. Average spending per person on AT services was $2,663. We found significant variability in terms of how states allocated AT to people with IDD in their HCBS programs. Not only were less than 3% of people with IDD with HCBS projected to receive assistive technology services, there was also large variance across services and states. Assistive technology promotes the health, safety, quality of life, independence, and community integration of people with IDD – they align with the very aims of HCBS, and thus, should be expanded.

Physical Activity Level and Quality of Life of Women aged 18-45

Maintaining an active lifestyle is crucial for maximizing the benefits of physical activity and avoiding the drawbacks of inactivity. Regular physical activity is a key factor in enhancing the quality of life. Having a high-quality life for women will positively impact the health of the current society and future generations. Additionally, women serve as role models for their children as they raise them. In this context, women play a significant role in shaping societal norms regarding participation in physical activity and people's quality of life. Regarding research on physical activity and quality of life, most studies focus on the elderly population. There are fewer studies examining women's quality of life and their physical activity levels. Thus, this study aimed to investigate the relationship between physical activity levels and the quality of life among women aged 18–45. Furthermore, the study aimed to compare the disparities in quality of life and physical activity levels between single and married individuals. A total of 200 women participated in this study. Significant differences were identified in various study variables between single and married women. Additionally, variations were observed in the correlations between dimensions of quality of life and levels of physical activity. Consequently, physical activity emerges as a vital tool for enhancing our quality of life. Hence, it should be integrated into daily routines to reap individual and societal health benefits. Moreover, physical activity interventions should be tailored to individuals' unique physical abilities and developmental stages.

Evaluating the quality of life for sustainable urban development

As urbanization is rapidly progressing worldwide, the cities need to assess their quality of life (QOL) not only to check their infrastructure but also to keep pace with the changing citizens' sense of values and lifestyles. We propose an integrated method to evaluate urban QOL from the detailed spatial aspects of a city with the subjective preferences of its citizens. In this study, we collected the spatial data of urban setting attributes at a 500-m mesh scale, and the subjective preferences that vary based on individual attributes, to evaluate the QOL across five metropolitan areas in Japan. Our results reveal a greater disparity in QOL within larger metropolitan areas. The optimal urban population density for the best QOL tends to be around 4000 people/km2. This level strikes a balance between the benefits and drawbacks associated with urban QOL, such as enhanced living and cultural opportunities versus high housing costs and limited space. Moreover, QOL within a city varied according to geographic location, and these differences were amplified by subjective preferences. These findings contribute to our understanding of the disparities in urban QOL, and provide a scientific basis for urban policies that achieve diversity and inclusiveness.

Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer's Disease and Related Dementias.

ObjectivesAmong nursing home (NH) residents with Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012-2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0-100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.

Investigating racial disparities in quality-of-life years after pediatric hematopoietic stem cell transplant.

While racial disparities in the clinical outcomes of hematopoietic stem cell transplant (HSCT) patients have been explored, racial disparities in quality of life (QoL) during the re-adjustment phase after transplant are yet to be investigated in pediatric patients. The objective of this study was to examine the role of patient race in QoL at least 2years after pediatric HSCT. We conducted a retrospective chart review of patients under 21years of age at diagnosis who received an allogeneic transplant at our institution between January 2007 and December 2017. Patient QoL was assessed using the Pediatric Quality-of-Life Inventory Generic Score Scales (PedsQL TM 4.0) at least 2years post transplant. Patient demographic, treatment, and transplant outcome data were obtained for subsequent analysis, where patient race was categorized as either Black, White, Hispanic, or Native American. Data were collected on 86 pediatric patients who underwent HSCT. Forty patients (46.5%) were non-Hispanic White, 29 (33.7%) Hispanic, 10 (11.6%) Black, and seven (8.1%) Native American. Where preliminary analyses indicated a difference in QoL by patient race, there were no significant differences in physical, emotional, social, and school functioning by patient race after adjusting for transplant characteristics (age at transplant, sex, diagnosis, donor type, and conditioning regimen) and determinants of socioeconomic status (insurance type, estimated household income). Pediatric patients had comparable QoL, regardless of race, at a median of 3years after HSCT in our study cohort.