Fair Health Research Articles

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

Predictors of Receipt of Comprehensive Medication Reviews in Older Adults.

Polypharmacy is highly prevalent among older adults. This study's purpose was to provide nationally representative estimates of self-reported comprehensive medication review (CMR) receipt among older adults and describe factors associated with their receipt, as CMRs are available through the Medicare Part D program. This cross-sectional study used data from the National Poll on Healthy Aging (NPHA), a nationally representative online survey of community-dwelling adults aged 50-80, administered in December 2019. Participants included older adults aged 65-80 with any health insurance (n = 960). Outcomes were self-reported CMR receipt, awareness of CMR insurance coverage, and interest in a future CMR with a pharmacist. Sociodemographic and health-related variables were included. Descriptive statistics and multivariable logistic regression with NPHA population sampling weights were used. Among older adults on 2 or more prescription medications, only 20.8% had received a CMR while 34.3% were interested in a future CMR. Among individuals who had not received a CMR, most (83.4%) were unaware their insurance might cover a CMR. Factors associated with higher odds of receiving a CMR included taking 5 or more prescription medications (adjusted odds ratio [AOR] = 2.6, 95% CI: 1.59-4.38) and reporting food insecurity (AOR = 2.9, 95% CI: 1.07-7.93). Having fair or poor self-reported physical health was associated with lower odds of receiving a CMR (AOR = 0.49, 95% CI: 0.25-0.97). Most older adults on 2 or more prescription medications with health insurance had not received a CMR and many were interested in one. Targeted strategies to increase older adults' awareness and receipt of CMRs are warranted.

Racial trends in clinical preventive services use, chronic disease prevalence, and lack of insurance before and after the Affordable Care Act.

To compare the relative change in the use of clinical preventive services, prevalence of chronic disease, and share uninsured among White, Black, and Hispanic adults before and after the introduction of the Affordable Care Act (ACA). Retrospective analysis using the Medical Expenditure Panel Survey of adults aged 18 to 64 years. The regression relies on a fully interacted set of indicator variables of each racial group by 3 time periods: 2005-2009, 2010-2013, and 2014-2018. Outcomes included indicators of mammography, colonoscopy, and lipid panel use. Several chronic conditions were examined, including diabetes, hyperlipidemia, hypertension, coronary heart disease, and mental health status. The final outcome variables examined health insurance (uninsured or not) and out-of-pocket spending as a share of family income. Regression models were used controlling for patient characteristics (age, income, education) and for a set of fully interacted indicator variables of race and time period. We tested for relative changes in White adults vs minority adults for each outcome variable. We used the Wald test (test command in Stata) to test for relative changes over time. We found reductions in baseline (pre-ACA) disparities over time in several of the measures between minority adults and White adults. This included greater growth in the use of mammograms and colonoscopies among minority populations. The results also saw relative reductions in hypertension, coronary heart disease, and fair or poor mental health. Finally, the share uninsured among Hispanic adults decreased at a faster rate than among White adults pre-ACA compared with the ACA period examined. The ACA is associated with a reduction in baseline differences in the use of some clinical preventive services, chronic disease prevalence, health insurance coverage, and out-of-pocket spending. Continued efforts to promote prevention and further expansions of coverage would appear to pay dividends.

A Comparison of Patient Satisfaction When Using the Insured and Non-insured in Public Health Center (Puskesmas Kasihan 1) Bantul, Indonesia

BACKGROUND: In Indonesia, the health sector has experienced a very significant development. Fair and equitable health care is one way to fulfill the health rights of each individual. Therefore, puskesmas are required to provide good service quality through conformity to standards with customer needs. The creation of service quality will certainly create customer satisfaction for service users when using health assurance and non-assurance. AIM: This study was to know a comparison of patient satisfaction when using the insured and non-insured in Public Health Center (Puskesmas Kasihan 1) Bantul, Indonesia. METHODS: This study was a cross-sectional study, with 222 samples with 111 respondents using health assurance and 111 non-assurance. Samples were collected with a cluster sampling technique taken from nine service polyclinics in Puskesmas Kasihan 1 Bantul. Data were analyzed using independent sample t-test. RESULTS: The study found that the average patient satisfaction with health insurance was 34.76 more than the average patient satisfaction with non-health insurance was 29.10. Based on the results of the analysis, the mean ± sd of patient satisfaction with health insurance was 29.10 ± 3.04 compared to the satisfaction of non-health insurance patients, namely, 34.76 ± 3.61 with a Sig value of 0.000, which means that there is a significant difference between patient satisfaction using the insured and non-insured. CONCLUSIONS: Patients when using the health insured are more satisfied than patient’s non-insured.

Avoidance of primary healthcare among transgender and non-binary people in Canada during the COVID-19 pandemic

Transgender (trans) and non-binary people experience barriers to culturally competent healthcare and many have reported avoiding care. COVID-19 and related mitigation strategies may have exacerbated avoidance, and poor mental health may be bidirectionally related to avoiding care. This study estimated the prevalence of primary care avoidance during the pandemic in a national sample of trans and non-binary people in Canada with a primary care provider and examined the association between poorer self-rated mental health and avoidance. In Fall 2019, Trans PULSE Canada collected multi-mode survey data from trans and non-binary people. In September to October 2020, 820 participants completed a COVID-19-focused survey. In this cross-sectional analysis, multivariable logistic regression models estimated odds ratios adjusted for confounders and weighted to the 2019 sample. The analysis included 689 individuals with a primary healthcare provider, of whom 61.2% (95% CI: 57.2, 65.2) reported fair or poor mental health and 25.7% (95% CI: 22.3, 29.2) reported care avoidance during the pandemic. The most common reason for avoidance was having a non-urgent health concern (72.7%, 95% CI: 65.9, 79.5). In adjusted analyses, those with fair or poor mental health had higher odds of avoiding primary care as compared to those with good to excellent mental health (adjusted odds ratio [AOR] = 2.37; 95% CI: 1.50, 3.77). This relationship was similar when excluding COVID-related reasons for avoidance (AOR = 2.52; 95% CI: 1.52, 4.17). Expansion of virtual communication may enhance primary care accessibility, and proactively assessing mental health symptoms may facilitate connections to gender-affirming mental health services.

The Relative Contribution of Social Determinants of Health Among Health Resources and Services Administration-Funded Health Centers.

Frameworks for identifying and assessing social determinants of health (SDOH) are effective for developing long-term societal policies to promote health and well-being, but may be less applicable in clinical settings. The authors compared the relative contribution of a specific set of SDOH indicators with several measures of health status among patients served by health centers (HCs). The 2014 Health Center Patient Survey was used to identify a sample of HC patient adults 18 years and older that reported the HC as their usual source of care (n = 5024). The authors examined the relationship between SDOH indicators organized in categories (health behaviors, access and utilization, social factors, economic factors, quality of care, physical environment) with health status measures (fair or poor health, diabetes, hypertension, cardiovascular disease, depression, or anxiety) using logistic regressions and predicted probabilities. Findings indicated that access to care and utilization indicators had the greatest relative contribution to all health status measures, but the relative contribution of other SDOH indicators varied. For example, access indicators had the highest predicted probability in the model with fair or poor health as the dependent variable (72.4%) and the model with hypertension as the dependent variable (47.4%). However, the second highest predicted probability was for social indicators (54.1%) in the former model and physical environment (44.7%) indicators in the latter model. These findings have implications for HCs that serve as the primary point of access to medical care in underserved communities and to mitigate SDOH particularly for patients with diabetes, depression, or anxiety.

Oral health-related interdisciplinary practices among healthcare professionals in Saudi Arabia: Does integrated care exist?

BackgroundThere is a bidirectional relation between oral and general health, therefore collaboration between healthcare providers is needed. This study investigated current interdisciplinary practices (IDP) and the associated factors among healthcare professionals in Saudi Arabia.MethodsA cross-sectional study was conducted in the Eastern Saudi Arabia recruiting four groups of health professionals (nurses, physicians, pediatricians and Ear-Nose and Throat (ENT) specialists). A validated, self-administered questionnaire was distributed online and shared through social media platforms. The questionnaire explored predisposing factors (demographics) and facilitating factors (knowledge, attitudes, attendance of oral health training and source of knowledge) associated with IDP.ResultsA total of 1398 health professionals were recruited. Participants showed fair oral health knowledge (7.1 ± 2.1) and attitudes (22.2 ± 3). Three-fourths (74.6%) reported always providing oral health education (OHE) to their patients, more than half (59.6%) reported always conducting an oral health screening (OHS), two-thirds (66.7%) reported responding to patients’ questions about oral health or conditions and 58.7% reported referring patients to dentists. Pediatricians and physicians had greater odds of IDP compared to other health professionals. Source of oral health knowledge (Ministry of Health (MOH) and formal education) was significantly associated with increased odds of IDP. Participants with good oral health knowledge had greater odds of responding to patients’ oral health question as well as have more referral practices.ConclusionThe results reveal a discrepancy between participants' IDP, knowledge, and attitudes. Incorporating dental component to medical curricula, continuous education and training programs targeting health professionals through Ministry of Health should be considered.

Geriatric Psychiatry and Palliative Care: Not-So-Strange Bedfellows

More Americans are living longer and entering old age than ever before. The number of adults age 65 years and older in the United States (US) is projected to grow to more than 83.7 million by 2050. Today's 65-year-olds can expect to live, on average, another 19.4 years. However, the outcomes of extending longevity have not kept pace with the outcomes of prolonging physical, mental, and cognitive wellness. The 2012 Institute of Medicine (IOM) report estimates that 14%–20% of the elderly population is afflicted by a mental health or substance use condition, including dementia-related behavioral and psychiatric symptoms, while the CDC estimates that 22.2% of those over 65 are in fair or poor overall health. Despite this clear growing demographic need, the number of physicians formally trained in geriatric psychiatry and geriatric medicine is shrinking while those pursuing training in hospice/palliative care medicine is increasing.This session will cover several aspects of how geriatric psychiatry and palliative care may overlap in meeting the growing needs of the geriatric population through discussion of the direct clinical utility of applying palliative care concepts and techniques when caring for individuals with neurocognitive disorders and their families/caregivers, how early referrals to palliative care specialists may improve patient care/outcomes while alleviating some of the workforce burden that geriatric psychiatry and geriatric medicine providers face, and how the construction of a dedicated palliative care rotation for geriatric psychiatry fellows may better facilitate collaboration between specialties while also filling a current gap in training for geriatric psychiatrists.

Changing Care Settings for Injuries.

Tracking injury rates is important for surveillance purposes but little data exist for injuries outside of emergency department visits. We assess the share and type of injuries reported in urgent care centers (UCCs) compared with other settings. We used FAIR Health claims data from 2016 through the first quarter of 2019 to calculate the percent of claims and most common types of injuries. Of the 197 million injury claims, 62% occurred in office settings and 17% in hospital outpatient departments (HOPDs), 5% in inpatient and in ED settings, and less than 2% in UCCs. Injury claims in UCCs increased 6% from 2016 to 2018, whereas injury claims in EDs declined 24%. Overall, physician offices and HOPDs accounted for the largest share of injury care, but UCCs represented the fastest growing setting to treat injuries.

Dental health status, use, and insurance coverage among adults with chronic conditions: Implications for medical-dental integration in the United States

BackgroundThe authors examined potential benefits and difficulties in integrating oral health care and medical care for adults with chronic conditions (CCs). MethodsThe authors used National Health and Nutrition Examination Survey 2009-2016 data to estimate crude (age- and sex-standardized) and model-adjusted estimates to examine the association between dental disease (severe tooth loss, untreated caries) and chronic disease (≥ 3 CCs, fair or poor health) and Medical Expenditure Panel Survey 2014-2016 data to estimate crude estimates of past-year medical and dental use and financial access according to CC status. Reported differences are significant at P < .05. ResultsNational prevalences of reporting fair or poor health and 3 or more CCs were both approximately 15%. Standardized prevalence of dental disease was notably higher among adults reporting CCs than those not reporting. After controlling for covariates, the magnitude of the association was substantially lower, although the association remained significant. Adults with CCs were approximately 50% more likely to report having a past-year medical visit and no dental visit than those not reporting CCs. Among adults reporting CCs, prevalence of having no private dental insurance and low income was approximately 20% and 60% higher, respectively, than that among adults not reporting CCs. ConclusionsAdults with CCs had higher prevalence of dental disease, past-year medical visit and no dental visit, and limited financial access. Practical ImplicationsMedical visits may be the only opportunity to provide dental education and referrals to adults with CCs. Improved medical-dental integration could improve oral health care access and oral health among these adults who are at higher risk of dental disease.

Economic Hardship, Sleep, and Self-Rated Health

The Supplemental Nutrition Assistance Program (SNAP) distributes vouchers for grocery shopping to around 43 million individuals across the United States to counteract food insecurity. In this study, we take advantage of the random interview day assignment of the American Time Use Survey (ATUS) and the variation in voucher issuance dates across states to identify changes in self-rated health and sleep over the monthly SNAP payment cycle. We find that the economic hardship experienced at the end of the payout period causes a significant and sizable negative effect on self-assessed physical health and sleep quality. SNAP recipients were 18 percent more likely to report fair or poor physical health at the end of the payment cycle compared with the rest of the month. During this period of scarcity, recipients were also 50 percent more likely to report sleeplessness, with the number of minutes being sleepless more than doubling while total sleep duration remained unchanged. Drawing upon information on time use in the ATUS, we discuss evidence suggesting that higher levels of stress, changed eating patterns, and reduced sleep quality may be potential mechanisms of the adverse health effects. Our findings extend the literature on sleep quality as a mediator between low socioeconomic status and self-rated health in the short run.

Equity of health financing in Indonesia: A 5-year financing incidence analysis (2015–2019)

SummaryBackgroundIn 2014, Indonesia launched a single payer national health insurance scheme with the aim of covering the entire population by 2024. The objective of this paper is to assess the equity with which contributions to the health financing system were distributed in Indonesia over 2015 – 2019.MethodsThis study is a secondary analysis of nationally representative data from the National Socioeconomic Survey of Indonesia (2015 – 2019). The relative progressivity of each health financing source and overall health financing was determined using a summary score, the Kakwani index.FindingsAround a third of health financing was sourced from out-of-pocket (OOP) payments each year, with direct taxes, indirect taxes and social health insurance (SHI) each taking up 15 – 20%. Direct taxes and OOP payments were progressive sources of health financing, and indirect tax payments regressive, for all of 2015 – 2019. SHI contributions were regressive except in 2017 and 2018. The overall health financing system was progressive from 2015 to 2018, but this declined year by year and became mildly regressive in 2019.InterpretationThe declining progressivity of the overall health financing system between 2015 – 2019 suggests that Indonesia still has a way to go in developing a fair and equitable health financing system that ensures the poor are financially protected.FundingThis study is supported through the Health Systems Research Initiative in the UK, and is jointly funded by the Department of International Development, the Economic and Social Research Council, the Medical Research Council and the Wellcome Trust.

Social Life Cycle Assessment of Green and Burnt Manual Sugarcane Harvesting in the Northeastern Thailand

Despite green sugarcane harvesting being promoted in Thailand, with some limitations on the use of harvesting machines, green sugarcane harvesting is practiced manually in many sugarcane fields. Although the environmental benefit seems clear, this harvesting practice’s social implications are yet unknown. This study assessed social performances of green and burnt manual sugarcane harvesting in North-Eastern Thailand, the region hosting the largest sugarcane plantation area, using the Social Life Cycle Assessment technique. Data collection was undertaken by surveys. The performance reference points method was applied to assess the different stakeholder’s social performances. Key stakeholder groups examined were workers, local community, and farm owners. The main social issues included in this study are fair wages, working conditions, health and safety, local employment, economic development, social responsibility, and satisfaction of occupation. The results showed that the social performances of green and burnt sugarcane harvesting were generally similar except for the local community group. This is mainly due to the health impact of sugarcane burning on the local community. Different issues cause the farmers to harvest the burnt sugarcane; for example, labor shortage in the harvesting season and the difficult working conditions for green harvesting, causing the farm owners to bear higher costs. For these reasons, mechanized harvesting is suggested to help promote green harvesting to reduce local air pollution. However, technology development is in urgent need to make the harvesting machines more affordable and applicable to all geographical conditions.

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies.

ABSTRACTOBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas.METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI).RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86).CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.

Trends in gender and socioeconomic inequalities in adolescent health over 16 years (2002-2018): findings from the Canadian Health Behaviour in School-aged Children study.

Monitoring health inequalities in adolescents informs policy approaches to reducing these inequalities early in the life course. The purpose of this study was to investigate trends in gender and socioeconomic inequalities in six health domains. Data were from five quadrennial survey cycles of the Health Behaviour in School-aged Children (HBSC) study in Canada (pooled n = 94 887 participants). Differences in health between socioeconomic groups (based on material deprivation) and between genders were assessed using slope and relative indices of inequality in six health domains: daily physical activity, excess body weight, frequent physical symptoms, frequent psychological symptoms, low life satisfaction, and fair or poor self-rated health. Over a 16-year period, adolescents in Canada reported progressively worse health in four health domains, with those at the lowest socioeconomic position showing the steepest declines. Socioeconomic differences increased in excess body weight, physical symptoms, low life satisfaction, and fair or poor health. Gender differences also increased. Females showed poorer health than males in all domains except excess body weight, and gender differences increased over time in physical symptoms, psychological symptoms and low life satisfaction. Socioeconomic and gender inequalities in health are persistent and widening among adolescents in Canada. Policies that address material and social factors that contribute to health disparities in adolescence are warranted.

Assessment of Aquatic Ecosystem Health with Indices of Biotic Integrity (IBIs) in the Ganjiang River System, China

Indices of biotic integrity (IBIs) are widely used to assess aquatic ecosystem health. However, there are few studies on their relationships. Based on fish, macroinvertebrate and plankton survey data collected in the Ganjiang River system from 2016 to 2017, redundancy analysis (RDA) and canonical correspondence analysis (CCA) were used to analyze how the community structures of these organisms respond to environmental variables. The fish IBI (F-IBI), benthic macroinvertebrate IBI (B-IBI), and phytoplankton IBI (P-IBI) were applied to evaluate the health status of the aquatic ecosystem. A Kruskal–Wallis test (p &lt; 0.05) and Spearman’s correlation coefficient analysis were performed to evaluate the spatiotemporal heterogeneity of the results. Our results suggested that the F-IBI-, B-IBI-, and P-IBI-based assessments indicated good, fair, and healthy Ganjiang River system ecosystem health statuses, respectively, and significant differences existed among these indices (p &lt; 0.05). The main environmental factors affecting F-IBI, B-IBI, and P-IBI were different. At the temporal scale, the F-IBI and B-IBI were stable, while the P-IBI fluctuated obviously. The consistency between the F-IBI and B-IBI results was better than that between each of these indices and the P-IBI results, and the consistency was better on a larger scale. These research results show that comprehensive assessments based on multiple groups rather than a single group can better characterize the impacts of environmental pressures on water ecosystems.

Preconception Health and Disability Status Among Women of Reproductive Age Participating in the National Health and Nutrition Examination Surveys, 2013-2018.

Background: Preconception health is a critical determinant of health outcomes for women and their offspring. Given higher rates of prenatal and postpartum complications among women with disabilities, it is important to investigate a range of preconception health indicators in this population. Materials and Methods: Data were from women of reproductive age (18-44 years) who participated in the National Health and Nutrition Examination Surveys, 2013-2018. Disability was self-reported as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. Preconception health indicators were adapted from those developed by the Core State Preconception Health Indicators Working Group. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals of preconception health indicators among women with disabilities compared with those without disabilities. Results: Of 4055 women, 601 (15%, weighted) reported having any disabilities, and of these women, 220 (6%) reported having 2 or more types of disabilities. Women with any disabilities were more likely to have suboptimal preconception health indicators compared with women without disabilities, including low education and household income, no recent dental visit, difficulty getting pregnant, current smoking, binge drinking, drug use, obesity, no multivitamin use, physical inactivity, long sleep durations, asthma, hypertension, and sexually transmitted infections (aPRs from 1.1 to 2.0). The greatest disparities between women with and without disabilities were for indicators of self-rated poor or fair general health, depression, and diabetes, with aPRs ranging from 2.4 to 3.8. Conclusions: Disparities in preconception health indicators are modifiable and may be addressed through adequate access to health care, interventions targeting lifestyle and health behaviors, and education and training for all health practitioners.

Assessment of Oral Health-Related Quality of Life and Its Associated Factors among the Young Adults of Saudi Arabia: A Multicenter Study.

Oral health-related quality of life (OHRQoL) is an essential indicator of people's overall health and health-related quality of life. Poor oral health and OHRQoL among young adults lead to numerous negative consequences and an increased burden on the healthcare system. The present study is aimed at assessing the OHRQoL among the young adults of Saudi Arabia, identifying self-rated oral health, and determining the relationship between sociodemographic and lifestyle factors with the OHRQoL. The present analytical cross-sectional survey was conducted among 1152 health and non-health-related college university students from three randomly selected universities. The OHRQoL was evaluated using the validated Arabic version of the oral health impact profile-14 questionnaire (OHIP-14). Of the population studied, one-fourth of the participants (24.9%) reported poor or fair oral health, and the highest OHIP-14 score was found in the domains of physical pain (4.14), followed by psychological discomfort (4.07). Logistic regression analysis revealed that the poor oral health category was significantly associated with male gender (ref: female: adjusted OR (AOR) = 1.89, 95%CI = 1.23–2.94, p = 0.004), daily smokers (ref: nonsmokers: AOR = 3.47, 95%CI = 1.97–4.82, p < 0.001), chocolate and candies intake more than once a day (ref: never; AOR = 1.54, 95%CI = 1.10–2.19, p = 0.034), and did not seek periodical dental care (ref: periodic dental care received: AOR = 2.23, 95%CI = 1.53‐2.86, p = 0.002). The present study revealed the factors associated with poor OHRQoL. The concerned authorities should consider the implementation of periodic dental checkups for university students, especially for the high-risk group. Furthermore, it is recommended to have regular health education programs that will help to change the student's lifestyle and poor oral health behaviors.

Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972-2018.

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972-2018 National Health Interview Survey (n = 795,239 aged 40-64; n = 357,974 aged 65-84). Results: Between 1972-1974 and 2015-2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972-1974 and 2015-2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

Physical Activity and Quality of Life in People With Visual Impairments: A Systematic Review

Objective This systematic review aimed to investigate the relationship between physical activity and quality of life (QOL) in people with visual impairments. Methods: Electronic searches were performed in PubMed, SPORTdiscus, CINAHL, Embase, and Web of Science. Observational studies describing the relationship between physical activity and QOL in adults with visual impairments were included. The Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies was used to assess the quality of the studies. Results: Overall, 327 studies were identified, and eight met the inclusion criteria. All studies had cross-sectional designs and seven were performed in developed countries. Physical activity was assessed objectively by one study, and five studies used the International Physical Activity Questionnaire. The World Health Organization Quality of Life Questionnaire was the most used instrument to measure QOL. Six studies reported a positive relationship between physical activity and QOL domains, as follows: life satisfaction, activity limitation, fair or poor health, physically and mentally unhealthy days, psychological health, and overall QOL. Conclusion: People with visual impairments who are engaged in physical activity are more likely to have better QOL outcomes.