Effect Of Social Risk Factors Research Articles

Contextual Factors Relevant to Implementing Social Risk Factor Screening and Referrals in Cancer Survivorship: A Qualitative Study.

Social risk factors such as food insecurity and lack of transportation can negatively affect health outcomes, yet implementation of screening and referral for social risk factors is limited in medical settings, particularly in cancer survivorship. We conducted 18 qualitative, semistructured interviews among oncology teams in 3 health systems in Washington, DC, during February and March 2022. We applied the Exploration, Preparation, Implementation, Sustainment Framework to develop a deductive codebook, performed thematic analysis on the interview transcripts, and summarized our results descriptively. Health systems varied in clinical and support staff roles and capacity. None of the participating clinics had an electronic health record (EHR)-based process for identifying patients who completed their cancer treatment ("survivors") or a standardized cancer survivorship program. Their capacities also differed for documenting social risk factors and referrals in the EHR. Interviewees expressed awareness of the prevalence and effect of social risk factors on cancer survivors, but none employed a systematic process for identifying and addressing social risk factors. Recommendations for increasing screening for social risk factors included designating a person to fulfill this role, improving data tracking tools in the EHR, and creating systems to maintain up-to-date information and contacts for community-based organizations. The complexity of cancer care workflows and lack of reimbursement results in a limited ability for clinic staff members to screen and make referrals for social risk factors. Creating clinical workflows that are flexible and tailored to staffing realities may contribute to successful implementation of a screening and referral program. Improving ongoing communication with community-based organizations to address needs was deemed important by interviewees.

172 Does the Number of Social Risk Factors Affect Long-term Patient-Reported Outcomes and Satisfaction in Those With Cervical Myelopathy? A QOD Study

INTRODUCTION: It is not clear whether there is an additive effect of social risk factors in affecting patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery. METHODS: This was a retrospective study of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort. Social risk factors included race, education, employment, and insurance. Patients were considered to have improved from surgery if 1) they reported a score of 1 or 2 on the NASS index and 2) met the MCID in patient-reported outcomes (VAS neck and arm pain, NDI, EQ5D, or mJOA score) at 24-month follow-up. RESULTS: Of the 1,141 patients included in the study, 205 (18.0%) had zero, 347 (30.4%) had one, 334 (29.3%) had two, and 255 (22.3%) had three social risk factors. The 24-month follow-up rate was 87.4% for patient-reported outcomes. After adjusting for all significant covariates, patients with one or more social risk factors were less likely to improve from surgery in all measured outcomes including VAS neck and arm pain, NDI, EQ-5D, and mJOA (all p < 0.05) compared to those without any social risk factors. Patients with two or three social risk factors were more likely to fare worse in all outcomes compared to those with only one social risk factor (all p < 0.05). CONCLUSIONS: Compared to those without any social risk factors, patients who had at least one social risk factor were less likely to achieve MCID and feel satisfied after surgery. The effect of social risk factors is additive in that those with a higher number of risk factors are less likely to improve compared to those with only one social risk factor.

Abstract 15698: Association of Social Factors on Sex-Specific Management of Atrial Fibrillation

Introduction: Prior studies have reported disparities by sex in managing atrial fibrillation (AF), with many studies having limited analysis of the effects of social risk factors. We examined the effect of social risk factors on sex differences in the management of AF in a large, socially diverse cohort of insured patients. Hypothesis: We hypothesized that women with AF would receive less AF care, including the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up, compared to men. Methods: We identified individuals with AF from 2013-2019 captured by Optum’s de-identified Clinformatics® Data Mart Database. Sex was categorized as men and women. Covariates included demographics (age, sex, race, and ethnicity), Elixhauser variables, and social factors such as estimated annual household income and race or ethnicity. We used stepwise multivariable-adjusted Cox proportional hazards models to assess the effect of race, ethnicity, and household annual income on sex-specific differences in the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up. Results: We identified 190,760 individuals (age 74.0±11.4 years; 49.9% women) with incident AF. Women with AF were less likely to receive pulmonary vein isolation ablation and cardiology follow-up over a six-year follow-up than men. Prescriptions of antiarrhythmic were identical among both sexes. When stratified by race and ethnicity, women of Black (HR 0.75, 95% CI 0.61,0.92) and White race (HR 0.83, 95% CI 0.78, 0.88) were less likely to receive pulmonary vein isolation ablation than men. Women of Asian (HR 0.90, 95% CI 0.83,0.97) and White race (HR 0.93, 95% CI 0.92,0.94) were less likely to have cardiology follow-up after initial diagnosis of AF than men. Higher household income did not attenuate sex-specific differences in AF care. Across all income categories, women were less likely to have pulmonary vein isolation and cardiology follow-up. Conclusions: We identified sex differences in AF management that were not attenuated when considering race, ethnicity, and annual household income. Our findings suggest continued evidence of sex, racial, ethnic, and socioeconomic inequities in contemporary AF management.

Association of cumulative social risk and gestational diabetes mellitus in the US, 2007–2018

AimsLittle is known regarding the association of multiple social risk factors and gestational diabetes mellitus (GDM). MethodsWe analyzed the 2007–2018 National Health and Nutrition Examination Surveys including 10,439 women aged ≥20 years (8 % with history of GDM). We created a cumulative social risk score (CSR) by adding scores assigned to each of the following: race/ethnicity, citizenship status and country of birth, education, and family income (score of 0 used as reference group). Using logistic regression, we assessed the associations of individual social risk factors (education, income, race/ethnicity and citizenship status) and CSR score with GDM, adjusting for age, parity, insurance status, care access, smoking, diet, physical activity, and body mass index. ResultsAmong individual social risk factors, being a non-U.S. citizen (OR:1.51, 95% CI: 1.06–2.15) or belonging to a minority racial/ethnic group (OR:1.30, 95% CI: 1.04–1.59) was significantly associated with a greater odds of GDM. When examining the combined effects of social risk factors, a CSR score ≥3 was associated with an increased odds of GDM (OR:1.64, 95% CI: 1.22–2.1). ConclusionsWomen with a greater burden of social risk factors are more likely to have GDM, thus should be the focus of interventions to prevent and treat GDM.

Associations of polysocial risk score with incident rosacea: a prospective cohort study of government employees in China.

The associations between single risk factors and incident rosacea have been reported, but the effects of social risk factors from multiple domains coupled remain less studied. To quantify the influence of social determinants on rosacea comprehensively and investigate associations between the polysocial risk score (PsRS) with the risks of incident rosacea. This was a prospective cohort study of government employees undertaken from January 2018 to December 2021 among participants aged >20 from five cities in Hunan province of China. At baseline, information was collected by a questionnaire and participants were involved in an examination of the skin. Dermatologists with certification confirmed the diagnosis of rosacea. The skin health status of participants was reassessed every year since the enrolment of study during the follow-up period. The PsRS was determined using the nine social determinants of health from three social risk domains (namely socioeconomic status, psychosocial factors, and living environment). Incident rosacea was estimated using binary logistic regression models adjusted for possible confounding variables. Among the 3,773 participants who completed at least two consecutive skin examinations, there were 2,993 participants included in the primary analyses. With 7,457 person-years of total follow-up, we detected 69 incident rosacea cases. After adjustment for major confounders, participants in the group with high social risk had significantly raised risks of incident rosacea with the adjusted odds ratio (aOR) being 2.42 (95% CI 1.06, 5.55), compared to those in low social risk group. Our findings suggest that a higher PsRS was associated with an elevated risk of incident rosacea in our study population.

Relationship between resting heart rate and law enforcement involvement: The moderating role of socioeconomic status in a sample of urban youth

PurposeResting heart rate (RHR) is a well-established biological risk factor for criminal behavior. However, potential moderating effects of social risk factors like socioeconomic status on this relationship remain unclear. The current study sought to clarify the moderating impact of socioeconomic status on the relation between low RHR in childhood and adolescence and subsequent legal system involvement by young adulthood. MethodsA subset of twins and triplets from the Risk Factors for Antisocial Behavior (RFAB) project (N = 347) were utilized to test hypotheses. Logistic regression analyses were performed to test for a moderating effect of socioeconomic status on the relationship between RHR and later law enforcement involvement (trouble with police, arrest). ResultsResting HR and SES were individually associated with an increased likelihood of being in trouble with the police and being arrested. In addition, RHR and SES in adolescence interacted to predict trouble with the police and arrest history by young adulthood, such that low RHR predicted these outcomes among adolescents who remained in low SES backgrounds. ConclusionsAdolescents who remain in low socioeconomic backgrounds from childhood will be a particularly important group to target in terms of treatment efforts to prevent criminal behavior.

Судебно-фармацевтические исследования причинно-следственных связей между социальными и медицинскими факторами риска при формировании аддиктивных расстройств здоровья

Актуальность. Статья посвящена проблеме причинно-следственных связей между воздействием социальных факторов риска в виде чрезмерного потребления психоактивных веществ на медицинские факторы риска, последствиями чего являются формирование и распространение аддиктивных расстройств здоровья. Цель исследования: установка и обработки причинно-следственных связей между социальными и медицинскими факторами риска при формировании аддиктивных расстройств здоровья на примере Днепропетровской области путем корреляционного анализа с позиции судебной фармации. Материалы и методы. При проведении исследования использовали действующие законодательные, нормативно-правовые и инструктивно-методические документы; Интернет-ресурсы. Применяли документальный, судебно-фармацевтический, статистический, корреляционный, сравнительный и графический методы анализа. Результаты. В статье приведены результаты судебно-фармацевтических исследований, обоснована их актуальность, сформулированы цель, разработан дизайн, описано материалы и методы исследования. Установление причинно-следственных связей между социальными и медицинскими факторами риска при формировании аддиктивных расстройств здоровья проводилось на примере наиболее типичной для Приднепровского региона Украины Днепропетровской области путем корреляционного анализа в течении 2014-2018 годов. Сбор, анализ и обработка императивных данных проводились с учетом 5 показателей социальных факторов риска: оборот психоактивного вещества I уровня крепости этанола (пиво); оборот психоактивного вещества II уровня крепости этанола (ликеры); оборот психоактивного вещества III уровня крепости этанола (водка); индекс потребительских цен; оборот совместного употребления психоактивных веществ (в частности, алкогольные напитки + табак). Сбор, анализ и обработка данных по показателям медицинских факторов риска проводились с учетом 4 факторов: количество впервые зарегистрированных случаев аддиктивных расстройств здоровья; количество случаев болезней нервной системы; количество случаев аддиктивных расстройств здоровья из-за употребления психоактивного вещества алкоголя; количество случаев аддиктивных расстройств здоровья вследствие совместного употребления психоактивных веществ. По результатам исследования было установлено, что показатели социальных факторов риска оборота психоактивных веществ III уровня крепости этанола (водка) причинно влияют на показатели медицинских факторов риска, следствием чего является рост количества случаев болезней нервной системы. Определена структура нормированного t-критерия социальных и медицинских факторов риска при формировании аддиктивных расстройств здоровья. Выводы. Установлено, что на формирование аддиктивных расстройств здоровья первопричиною выступают социальные факторы риска (чрезмерное и неконтролируемое употребление психоактивных веществ в виде алкогольных напитков различного уровня крепости или сочетанное применение психоактивных веществ различных классификационно-правовых групп, например алкогольные напитки + табак). Социальные факторы риска влияют на медицинские факторы риска, следствием чего является рост количества впервые зарегистрированных случаев аддиктивных расстройств здоровья и количества случаев болезней нервной системы. Полученные данные являются основанием для планирования дальнейших судебно-фармацевтических исследований в этом направлении и акцентируют внимание государственных органов власти на необходимость разработки социально ориентированных профилактических мероприятий, направленных на совершенствование оборота алкогольных напитков I, II и III уровней крепости (пиво, ликеры, водка), неумеренное потребление которых приводит к формированию аддиктивных расстройств здоровья.

Social Risk Factors for Medication Nonadherence: Findings from the CARDIA Study.

Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.

Patient social risk factors and continuity of care for Medicare beneficiaries.

To identify patient social risk factors associated with Continuity of Care (COC) index. Medicare Current Beneficiary Survey (MCBS), the Dartmouth Institute, and Area Resource File for 2006-2013. We use regression methods to assess the effect of patient social risk factors on COC after adjusting for medical complexity. In secondary analyses, we assess the effect of social risk factors on annual utilization of physicians and specialists for evaluation and management (E&M). We retrospectively identified 59499 patient years for Medicare beneficiaries with one year of enrollment and three or more E&M visits. After adjustment for medical complexity, individual-level social risk factors such as lack of education, low income, and living alone are all associated with better patient COC (P<.05). Similarly, area-level social risk factors such as living in areas that are nonurban or high poverty, as well as in areas with low specialist or high primary care physician supply, are all associated with better patient COC (P<.05). We found the opposite pattern of associations between these same risk factors and annual patient utilization of physicians and specialists (P<.05). Medicare patients with multiple social risk factors have consistently better COC; these same social risk factors are associated with reduced patient-realized access to specialist physician care.

Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes

BackgroundQuantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes.Method and resultsData from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40–7.22), 10.32 (7.16–13.49) and 17.80 (12.94–22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15–2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60–4.17).ConclusionAn accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Socioecological Risk Predictors of Physical Activity and Associated Mortality

To assess (1) the cumulative effect of socioecological factors (social risk) on objectively measured physical activity, (2) the cumulative socioecological risk on all-cause mortality, (3) the potential interaction effects of social risk factors on physical activity and mortality, and (4) whether physical activity mediates the relationship between social risk and mortality. Cross-sectional and prospective. Laboratory- and survey-based testing of the general US population. Five thousand five hundred seventy-four adult participants of the National Health and Nutrition Examination Survey 2003 to 2006. Social risk was assessed from 4 variables, namely poverty level, education, minority status, and social living status. Moderate-to-vigorous physical activity (MVPA) was assessed via accelerometry. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011. Negative binomial regression and Cox proportional hazard model. Compared to those with 0 social risk factors, those with 1 and 2+ social risk factors engaged in 11% and 10% less MVPA, respectively. Those with 1 (vs 0) social risk factor had a 2.0-fold increase in mortality risk, and those with 2+ (vs 0) social risk factors had a 2.3-fold increase in mortality risk. Interaction effects for various socioecological factors on both MVPA and mortality were observable. Cumulative social risk is associated with less MVPA and increased all-cause mortality risk. Given the interaction effects of socioecological factors, targeted interventions in identified populations may be needed.

CONTEMPORARY EPIZOOTOLOGICAL AND EPIDEMIOLOGICAL FEATURES OF BRUCELLOSIS IN THE REPUBLIC OF TAJIKISTAN

Study epizootological and epidemiological features of brucellosis on the territory of the Republic of Tajikistan under the conditions of social-economic transformation with evaluation of width and scale of its spread, as well as reasons of the present situation. Official statistics data, results of expert evaluations, reports, analytical material of national and international organizations, results of clinical and epidemiological analysis were used. Descriptive- evaluative epidemiologic methods, serologic studies of samples obtained from humans, animals, environmental objects between 2000 and 2013; mapping using GIS-technology, as well as statisti- cal analysis were used. Techniques of calculation of DALY-index and population infection risk parameter were used. Features of situation by brucellosis were detected, that lay in its wide spread among humans and agricultural animals, changes in morbidity structure, as well as char- acter of its seasonal and territorial spread, connected with predominant effect of social risk factors. Contemporary situation for brucellosis in the Republic of Tajikistan is characterized by a pronounced non-welfare and determined by acting social-economic conditions. The main factors are changes in the conditions of conducting agricultural activity against the background of high level of unemployment and external work migration.

Cumulative social risk exposure and risk of cancer mortality in adulthood.

BackgroundAdults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults.MethodsThe study included 8745 adults (aged ≥ 40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers.ResultsDeaths from all-cancers combined (P for trend = 0.001), tobacco-related cancers (P for trend = <0.001), and lung cancer (P for trend = 0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR = 1.8, 95 % CI = 1.3-2.4), tobacco-related cancers (HR = 2.6, 95 % CI: 1.6-4.0), and lung cancer (HR = 2.3, 95 % CI = 1.3-4.1).ConclusionsU.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.

Cumulative Social Risk Exposure, Infant Birth Weight, and Cognitive Delay in Infancy

ObjectiveTo determine the effect of exposure to multiple social risks on cognitive delay at 9 months of age; and whether obstetric factors mediate the relationship between cumulative social risk and cognitive delay. MethodsData were from 8950 mother–child dyads participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort. Cognitive delay was defined as falling in the lowest 10% of mental scale scores from the Bayley Short Form–Research Edition. Five social risk factors were combined and categorized into a social risk index. Staged multivariable logistic regressions were used to investigate whether obstetric factors mediated the impact of social risk on the odds of cognitive delay. ResultsInfants with cognitive delay were more likely to live with social risks than infants without cognitive delay. The percentage of infants with cognitive delay increased with the number of social risks. In adjusted analyses, exposure to multiple social risk factors was associated with higher odds of cognitive delay at 9 months of age (adjusted odds ratio 2.11; 95% confidence interval 1.18–3.78 for 4 or more risks vs no risks). Accounting for birth weight attenuated this relationship (P < .001). ConclusionsThis population-based study investigated the independent and cumulative effects of social risk factors on cognitive delay in infancy. Findings revealed a significant cumulative relationship between exposure to social risk and cognitive delay, which was partly mediated by birth weight. Programs that address the social context of US infants are needed to improve their developmental trajectories.

Effects of stress and social support on recurrence in bipolar disorder

Background: Limited research has examined the impact of social support on the course of bipolar disorder, although results suggest a probable link. This study examines prospectively the effects of stressful events and social support on episode recurrence in bipolar I disorder. Methods: Fifty-two outpatients with bipolar I disorder recruited from an urban community were followed every 3 months for up to 1 year. At the initial interview, individuals reported separately on perceived social support from a best friend, parent, and romantic partner, combined to form a total network support score. Ongoing prospective assessments of stressful life events, symptomatology, and medication compliance were completed over 1 year. Logistic regressions were utilized to predict episode recurrence. Results: As predicted, both higher levels of stress and lower levels of social support from the total network independently predicted depressive recurrence over a 1-year follow-up, after controlling for clinical history and compliance. Social support did not moderate the impact of stress. Limitations: Only a 1-year follow-up was obtained, and sample sizes may have been insufficient to detect prediction of manic episodes. Direction of causality between support and recurrence is hypothesized but cannot be definitively determined. Conclusions: Higher levels of stress and perceptions of less available and poorer quality close relationships are associated with recurrence. Interventions that target these psychosocial vulnerabilities may help alter the course of bipolar I disorder. Research with larger samples should further examine the possible polarity-specific effects of social risk factors.

Social risk factors: impact on elders' perceived health status.

Face-to-face interviews were conducted with 379 community-based elders to determine the relationship of income, education, and social isolation (objective and subjective) to perceived health status. Significant associations were found between the size of the elder's social network, health status, and perceived loneliness. The elder's friends, relatives (excluding offspring), and church activities were the most significant of the social network components in predicting health status. Finally, a path model was developed that illustrated the direct and indirect effects of social risk factors on elders' perceived health status. This study represents a beginning effort to empirically justify specific interventions directed at reducing elders' social risk factors.