Geographic Residence Research Articles

Trends of Exclusive Breastfeeding Practices and Its Determinants in Tanzania from 1999 to 2016.

Introduction: The benefits of exclusive breastfeeding (EBF) are widely reported. However, it is crucial to examine potential disparities in EBF practices across different regions of a country. Our study uses Tanzania demographic and health survey data to report on the trends of EBF across regions from 1999 to 2016, the patterns of the practice based on geographical location and socioeconomic status, and explores its determinants across the years. Methods: Descriptive statistics were used to establish the trends of EBF by geographical location and wealth quintile. A generalized linear mixed model was developed to incorporate both infant and maternal attributes as fixed covariates while considering enumeration areas and regions as clusters. The fitted model facilitated the estimation of EBF proportions at a regional level and identified key determinants influencing EBF practices across the survey periods. Moreover, we designed breastfeeding maps, visually depicting the performance of different regions throughout the surveys. Results: Across the various survey rounds, a notable regional variation in EBF practices was observed, with coastal regions generally exhibiting lower adherence to the practice. There was a linear trend between EBF and geographical residence (p < 0.05) and socioeconomic standing (p < 0.05) across the survey periods. Rural-dwelling women and those from the least affluent backgrounds consistently showcased a higher proportion of EBF. The prevalence of EBF declined as infants aged (p < 0.001), a trend consistent across all survey waves. The associations between maternal attributes and EBF practices displayed temporal variations. Furthermore, a correlation between exclusive breastfeeding and attributes linked to both regional disparities and enumeration areas was observed. The intra-cluster correlation ranged from 18% to 41.5% at the regional level and from 40% to 58.5% at the enumeration area level. Conclusions: While Tanzania's progress in EBF practices is laudable, regional disparities persist, demanding targeted interventions. Sustaining achievements while addressing wealth-based disparities and the decline in EBF with infant age is vital. The study highlights the need for broad national strategies and localized investigations to understand and enhance EBF practices across different regions and socioeconomic contexts.

Urban/rural Patterns of Healthcare Utilization among People with Rheumatoid Arthritis and Osteoarthritis in a large U.S. patient registry.

Rural residence has been associated with health disparities in rheumatic diseases and other chronic conditions in the United States. This study aimed to determine if a relationship exists between geographic residence and healthcare utilization outcomes for people with rheumatoid arthritis (RA) and osteoarthritis (OA) in a U.S.-wide rheumatic disease registry. Participants were in FORWARD, The National Databank for Rheumatic Diseases, a U.S.-wide rheumatic disease longitudinal cohort completing questionnaires between 1999 and 2019. Healthcare utilization variables (i.e., medical visits and diagnostic tests) from six-month questionnaires were analyzed by geographic categories (small rural/isolated, large rural, and urban). Double selection LASSO with Poisson regression was used to assess the best model when examining the association between healthcare utilization variables and geographic residence. Among 37,802 participants with RA, urban residents were more likely than small rural residents to utilize in-person healthcare by most measures including physician visits and diagnostic tests. Urban residents reported more rheumatologist visits [IRR=1.22 (95% CI 1.18-1.27)] but fewer primary care visits [IRR=0.90 (95% CI 0.85-0.94)]. Among 8,248 participants with OA, urban residents were also more likely than rural residents to report healthcare utilization by most measures. Individuals residing in urban areas were more likely than those in rural areas to report in-person healthcare utilization. Specifically, urban residents with RA were more likely to report rheumatologist visits, but less likely to report primary care visits. Less disparity existed in OA healthcare utilization, though an urban-rural disparity still existed by most measures.

Racial Disparities in End-Stage Kidney Disease Outcomes among Asians and Native Hawaiians and Other Pacific Islanders across Geographic Residence

Introduction: While Asian and Native Hawaiian and other Pacific Islander (NHOPI) patients have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asian and NHOPI individuals, we compared their ESKD outcomes based on residence in the mainland USA versus Hawaii/Pacific Islands (PIs). Materials and Methods: Using United States Renal Data System data, we examined the impact of geographic residence in the mainland versus Hawaii/PIs on race-mortality associations among incident ESKD patients transitioning to dialysis over January 1, 2000–December 31, 2016 using Cox regression. We examined likelihood of post-dialysis kidney transplantation using Cox models and cumulative incidence curves. Results: Compared with White patients in the mainland, Asian and NHOPI patients in the mainland had lower mortality: adjusted HRs (95% CIs) 0.67 (0.66–0.67) and 0.72 (0.70–0.73), respectively. When examining Asian and NHOPI patients in Hawaii/PIs, survival benefit was attenuated in Asian and diminished to the null in NHOPI patients (ref: mainland White patients). Cumulative incidence curves comparing Asian, NHOPI, and White patients showed Asian and NHOPI patients in the mainland had the highest likelihood of transplantation, whereas NHOPI and Asian patients in Hawaii/PIs had the lowest likelihood. Conclusion: In the mainland, Asian and NHOPI patients had lower mortality versus White patients, whereas in Hawaii/PIs, this survival benefit was diminished in Asian and mitigated in NHOPI patients. NHOPI and Asian patients in Hawaii/PIs had less transplantation versus those in the mainland. Further research is needed to uncover factors contributing to differential ESKD outcomes among Asian and NHOPI patients across geographic residence.

Investigating mobility and pastoralism in Kerma-period communities upstream of the fourth cataract, Sudan.

The Kingdom of Kush in today's northern Sudan and southern Egypt (ancient Nubia) is often depicted as a secondary state relative to ancient Egypt. More recent investigations have set aside Egyptocentric and western, colonialist perspectives of state development focused on control of land and agricultural surplus, examining Kushites through the lens of African-based models of mobile pastoralism in which power and authority were achieved through control of herds and alliance-building. Here, analyses of radiogenic strontium isotopes in human dental enamel are used to investigate diachronic shifts in mobility patterns linked to pastoralism and state development during the Kerma period (ca. 2500-1100 BCE). From five cemetery sites around al Qinifab, Sudan, upstream of the capital at Kerma, we analyzed the strontium isotope ratios of 50 teeth from 27 individuals dating from the Early through Late Kerma phases. Individuals from the Early and Middle Kerma phases demonstrated considerable 87 Sr/86 Sr ratio variability (mean = 0.70835 ± 0.00109), with 50% falling outside the locally bioavailable strontium range. Conversely, most Classic (0.70756 ± 0.00043) and Late Kerma (0.70755 ± 0.00036) individuals exhibited ratios consistent with the local region. These changes indicate a potential transformation in subsistence strategies and social organization as early communities engaged in a more mobile lifestyle than later groups, suggesting a greater degree of pastoralism followed by declining mobility with Kushite state coalescence and a shift to agropastoralism. Because 87 Sr/86 Sr ratios from enamel reflect childhood geographic residence, these findings indicate that mobility likely involved extended family groups, and not just transhumant adults.

Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study.

Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and conflicting. This study aims to explore the relationship between mental health status (specifically, depression and/or anxiety) and the uptake of CRC screening. To achieve this, a larger and nationally representative sample from the adult population of the United States was utilized. We employed a cross-sectional approach using data from the 2019-2020 edition of the Health Information National Trends Survey (HINTS). The study examined disparities in CRC screening between individuals with self-reported history of depression diagnosis and the general population. Chi-square tests were used for analysis. Multivariable logistic regression models were applied to adjust for variables such as gender, age, education level, race, comorbidities, healthcare access, smoking status, household income, geographical residence, and insurance status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. The findings of the study indicated that out of 5,398 eligible individuals, approximately 1,220 (weighted percentage: 22.8%) reported experiencing depression and/or anxiety, and approximately 4,154 (weighted percentage: 68.9%) reported adherence to colorectal cancer screening. In the bivariate analysis, there was no significant difference in participation in colorectal cancer screening between individuals with and without depression and/or anxiety (72.0% vs. 68.0%). Similarly, after adjusting for sociodemographic and health-related factors, the study found that the odds of participating in colorectal cancer screening did not vary based on an individual's depression status (OR 1.34, 95% CI 0.94-1.91, P = 0.05). Individuals with depression participate in colorectal cancer screening at comparable rates to the general population. The findings of this study suggest that factors beyond CRC screening may play significant roles in the higher CRC-associated mortality rate. Therefore, further research is needed to uncover the various mechanisms contributing to the increased cancer-related mortality rates among susceptible populations.

Diverse migration patterns and seasonal habitat use of Stone's sheep (Ovis dalli stonei).

We describe temporal and spatial patterns of seasonal space-use and migration by 16 GPS-collared Stone's sheep (Ovis dalli stonei) from nine bands in the Cassiar Mountains of northern British Columbia, Canada. Our objectives were to identify the timing of spring and fall migrations, characterize summer and winter ranges, map and describe migration routes and use of stopover sites, and document altitudinal change across seasons. Our last objective was to assess individual migration strategies based on patterns of geographic migration, altitudinal migration, or residency. Median start and end dates of the spring migration were 12 and 17 Jun (range: 20 May to 05 Aug), and of the fall migration were 30 Aug and 22 Sep (range: 21 Aug to 07 Jan). The median area of winter and summer ranges for geographic migrants were 630.8 ha and 2,829.0 ha, respectively, with a broad range from about 233.6 to 10,196.2 ha. Individuals showed high fidelity to winter ranges over the limited duration of the study. The winter and summer ranges of most individuals (n=15) were at moderate to high elevations with a median summer elevation of 1,709 m (1,563-1,827 m) and 1,673 m (1,478-1,751 m) that varied <150 m between ranges. Almost all collared females (n=14) exhibited changes in elevation use that coincide with abbreviated altitudinal migration. Specifically, these females descended to lower spring elevations from their winter range (Δ>150 m), and then gradually moved up to higher-elevation summer ranges (Δ>150 m). In the fall, they descended to lower elevations (Δ>100 m) before returning to their higher winter ranges. The median distance travelled along geographic migration routes was 16.3 km (range: 7.6-47.4 km). During the spring migration, most geographic migrants (n=8) used at least one stopover site (median = 1.5, range: 0-4), while almost all migrants (n=11) used stopover sites more frequently in the fall (median = 2.5, range: 0-6). Of the 13 migratory individuals that had at least one other collared individual in their band, most migrated at about the same time, occupied the same summer and winter ranges, used similar migration routes and stopover sites, and exhibited the same migration strategy. We found collared females exhibited four different migration strategies which mostly varied across bands. Migration strategies included long-distance geographic migrants (n=5), short-distance geographic migrants (n=5), vacillating migrants (n=2), and abbreviated altitudinal migrants (n=4). Different migratory strategies occurred within one band where one collared individual migrated and two did not. We conclude that female Stone's sheep in the Cassiar Mountains displayed a diverse assemblage of seasonal habitat use and migratory behaviors. By delineating seasonal ranges, migration routes and stopover sites, we identify potential areas of priority that can help inform land-use planning and preserve the native migrations of Stone's sheep in the region.

Comparative characteristics of the body mass index of young persons in different regions of Russia

BACKGROUND: Being one of the aspects of the morphological constitution, the component composition of the body reflects the state of metabolic processes in the body and can serve as a kind of predictor of the development of various pathological conditions. One of the most accessible and widely used methods for researchers is the determination of the body mass index, which ensures the comparability of the results obtained by different authors.&#x0D; AIM: To systematize and compare the literature data of domestic and foreign authors on the body mass index of young people and its relationship with the degree of urbanization and geography of residence.&#x0D; MATERIALS AND METHODS: The original articles and reviews posted in the scientometric databases PubMed, Google Scholar and eLIBRARY.RU for the last 20 years are analyzed. An analysis of the results of a survey of medical students from Russian universities was carried out depending on the region of residence and the population of the city.&#x0D; RESULTS: It was revealed that the interest of the scientific community in the study of body composition is constantly growing: every next year the total number of publications on body composition increases by an average of 24% compared to the previous year. An increase in the proportion of students with a low body mass index was noted as the number of the city grew and its shift in the direction from the eastern regions of the Russian Federation to the western ones. The proportion of students with a normal body mass index decreases as the population of the city in which the medical school is located increases.&#x0D; CONCLUSION: According to our analysis of the results of a survey of medical students in Russia, body mass index is associated with the degree of urbanization and has geographical features.

(542) Socioeconomic Status is Not Associated with Complications or Patient Satisfaction Following Inflatable Penile Prosthesis Surgery

Abstract Introduction Prior studies have demonstrated that patient socioeconomic background and neighborhood status are associated with health care outcomes. Understanding how a patient’s environment and local community status affect clinical outcomes can vastly impact surgical care, patient education and counseling, as well as surgical outcomes. The Area Deprivation Index (ADI), is a validated measurement evaluating the differences in socioeconomic status between various neighborhoods both on a state and national level. ADI incorporates a composite score of patient income, education level, employment status, and housing quality. No prior studies have looked at how a patient’s socioeconomic status and geographic residence affect postoperative outcomes and patient satisfaction following implantation of inflatable penile prosthesis (IPP). Objective To understand how a patient’s socioeconomic status as measured by the ADI affects overall surgical outcomes and patient satisfaction following IPP placement. Methods Men that underwent a new IPP placement between 6/1/13 and 3/31/22 were included in the study. Using the Neighborhood Atlas National® (Madison, WI), national ADI percentiles (1-100) were calculated for each patient using their home address at the time of surgery. Higher ADIs represent a more disadvantaged socioeconomic status while lower ADIs represent a more advantaged socioeconomic status. Complications were defined as mechanical failure, urethral erosion, infection, intractable pain, or other (ex. hematoma, herniated reservoir, pump revision). A patient satisfaction phone questionnaire was administered measuring overall satisfaction (Likert scale). In order to reduce recall bias and allow for adequate follow-up, the phone questionnaire was limited to men who underwent IPP placement between the 2016-2020. Multivariable logistic regression and multivariable ordinal logistic regression were used to identify the association between ADI and surgical complications and patient satisfaction, respectively. Results A total of 430 men who underwent IPP implantation from 2013 to 2022 were identified and data were retrospectively collected. The final cohort consisted of 83% (n=355) Caucasian men with the median age of 65 (IQR 58-69). The overall complication rate was 11.2% (n=48). Of the 48 total complications, 22 (5.1%) required surgical intervention (mechanical problem n=7, urethral erosion n=1, infection n=9, pain n=1, other n=4). The median national ADI for patients with a complication was 57 (IQR 33-72) compared to 60 (IQR 42-76) in those patients without a complication (p=0.32). A total of 163 men completed the satisfaction phone questionnaire and 70% (n=114) of men stated that they were either very satisfied or satisfied with their IPP. The median ADI for patients who were satisfied was 64 (IQR 43-80) compared to 60 (IQR 42-76) in those patients who were not satisfied (p=0.45). On multivariable analysis, national ADI was not associated with postoperative complications (p=0.57) (Table 1) or with patient satisfaction (p=0.39) (Table 2). Conclusions While living in a disadvantaged neighborhood has been associated with poor health outcomes in other areas of medicine, we found no association between a patient’s socioeconomic status and complications or satisfaction following IPP placement. Regardless of a patient’s geographic residence, patients pursuing an IPP can expect comparable outcomes and overall satisfaction rates suggesting that implant consideration should not be influenced by socioeconomic status. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Social Support System and Old Age Vulnerability: An Investigation in India

Population ageing is increasingly receiving attention in India. With economic development, a sustainable social support system during old age is essential to ensure life-long wellbeing. An accurate estimation of the problem and identification of appropriate vulnerable groups are indispensable for the success of any sustainable social support policy. However, such an attempt is lacking in the literature. Moreover, those, who tried to estimate the old-age vulnerability, mainly adopted the unidimensional vulnerability approach, and considered a single period. The present study, however, argues that vulnerability is a multi-dimensional phenomenon, and developed a comprehensive index. Furthermore, using quantitative and qualitative analyses, the study identified the extent of vulnerability among the elderly people across gender, socio-religion identity, household financial status, level of education and geographical residence. The findings have policy implications in presenting a comprehensive tool and identifying the vulnerable social groups to design a sustainable social support system for the older population. JEL Classifications: D69, I31, J12, Z18

Reassessing the level and implications of male involvement in family planning in Indonesia

BackgroundAlthough there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning.MethodsA mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying “dimensions” of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women’s and couple’s unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants.ResultsIndonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent “dimensions” of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings.ConclusionsIndonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.

The prevalence and variations in unintended pregnancy by socio-demographic and health-related factors in a population-based cohort of young Australian women

ObjectiveThe aim of this study is to estimate the prevalence of unintended pregnancy and associated socio-demographic and health-related factors among a national cohort of young Australian women. MethodsSecondary analysis of three waves (2013–2015) of the Australian Longitudinal Study on Women’s Health new young cohort. Women born between 1989 and 1995 were recruited through internet and traditional media, and peer referral. Respondents completed a baseline web-based survey in 2013 (n=17,010) on their health and healthcare use and were followed up annually. This analysis uses data from women reporting ever having vaginal sex in waves 2 (n=9,726/11,344) and 3 (n=6,848/8,961). We assessed correlates of lifetime and recent unintended pregnancy using multivariable regression models. ResultsAt wave 2, among women aged 19–24, lifetime prevalence of unintended pregnancy was 12.6%, rising to 81.0% among ever pregnant women. Pregnancy outcomes among women with a history of unintended pregnancy differed by geographical residence. Disparities in odds of unintended pregnancy were seen by relationship and educational status, contraceptive use, sexual coercion and risky alcohol use. ConclusionsUnintended pregnancy among young Australians is disproportionally experienced by women with structural disadvantages and exposure to sexual coercion. Public health implicationsService improvements to achieve equitable distribution of contraception and abortion services must be integrated with initiatives responding to sexual coercion.

The risk of post-polio syndrome among immigrant groups in Sweden

To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co-morbidities, and neighbourhood socioeconomic status. In total 5300 post-polio cases were registered, 2413 males and 2887 females. Fully adjusted HRs (99% CI) in immigrants versus Swedish-born were 1.77 in men (1.52–2.07) and 1.39 (1.19–1.62) in women. Statistically significant excess risks of post-polio were found in the following subgroups: men and women from Africa, HRs (with 99% CI) 7.40 (5.17–10.59) and 8.39 (5.44–12.95), respectively, and Asia, HRs 6.32 (5.11–7.81) and 4.36 (3.38–5.62) respectively, and in men from Latin America, HR 3.66 (2.17–6.18). It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.

Willingness and eligibility to donate blood under 12-month and 3-month deferral policies among gay, bisexual, and other men who have sex with men in Ontario, Canada.

In Canada, gay, bisexual and other men who have sex with men (GBMSM) are a population that are willing to donate blood, if eligible, but have a history of ineligibility and deferrals due to concerns that their blood poses an increased risk of HIV entering the blood supply. Our objective was to examine the proportion of GBMSM who are willing and eligible to donate under the 12-month deferral policy (implemented in 2016) and the 3-month deferral policy (implemented in 2019). Data for this study comes from the #iCruise study, a mixed cohort study designed to examine sexual health outreach experiences through online services and mobile apps among GBMSM in Ontario. A total of 910 participants were recruited between July 2017 and January 2018. Eligibility criteria include identify as male (cisgender or transgender); at least 14 years old; having had sex with a man in the previous year or identifying as sexually/romantically attracted to other men or identifying as gay, bisexual, queer or two-spirit; and living or working in Ontario or having visited Ontario four or more times in the past year. Participants completed a baseline and a follow-up questionnaire. A subset of #iCruise participants (n = 447) further completed this questionnaire. Willingness and eligibility to donate blood were assessed under 12-month and 3-month deferral policies. Of the 447 GBMSM surveyed, 309 (69.1%) reported a general interest in donating blood. 109 (24.4%) GBMSM were willing, 75 (16.7%) were eligible, and 24 (5.4%) were both willing and eligible to donate blood under the 12-month deferral policy. Under the 3-month deferral policy, willingness and eligibility to donate blood increased significantly to 42.3% and 29.3%, respectively. The percent of GBMSM who were both willing and eligible to donate blood also increased significantly to 12.3% under the 3-month deferral policy. The increase in willingness to donate blood varied by age, ethnicity, and geographic residence of participants whereas the increase in eligibility to donate blood varied by education level of participants. Under the 3-month deferral policy, GBMSM who were 50 years or older, identified as bisexual or other, had a lower education level, and who were not 'out' to others were more likely to be eligible to donate. GBMSM who reported a general interest in donating blood were more likely to be willing to donate blood under both deferral policies. The most common reason for not being interested in donating blood was the MSM deferral policy itself; many participants interpreted the policy as discriminatory for 'singling out' GBMSM or self-assed themselves as ineligible. Among study participants, both willingness and eligibility to donate blood was significantly higher under the 3-month deferral policy. The results suggest that a time-based reduction to a 3-month deferral policy is impactful but limited. Future research should measure GBMSM's willingness and eligibility under the individual risk-based assessment (to be implemented in 2022).

Age, Benign Prostatic Hyperplasia, Geography of Residence, and Occupation are Predictors of Bladder Calculi in Men: A Three-Year Data Analysis.

The formation of bladder calculi is a complex multifactorial process. Our objective was to identify predictors of bladder calculi in men. This cross-sectional study was conducted at a regional public hospital. We used medical records from 2017 to 2019 for men diagnosed with urinary calculi or benign prostatic hyperplasia (BPH). The diagnosis of urinary calculi was based on urinalysis, plain x-ray, and ultrasonography (USG). The diagnosis of BPH was based on digital rectal examination (DRE), USG, and American Urological Association (AUA) Symptom Index to assess the severity of BPH. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, Chi-square tests, and binary logistic regression. Of 2010 study participants, 66.0% were men with urinary calculi, 39.7% had BPH, 21.0% were aged 70 years or more, 12.5% lived in limestone mountain areas, and 24.6% had occupations that were mainly outdoors. Urinary calculi in men with BPH were found in the urethra (3.0%), bladder (27.6%), ureter (2.2%), and kidney (1.1%). Of all men with urinary calculi, the odds of having bladder calculi in men aged 70 years or more was 13.484, 95% confidence interval (95% CI): 8.336-21.811; In men with BPH was 11.182, 95% CI: 6.440-19.416; In men who lived in limestone mountain area was 1.894, 95% CI: 1.242-2.887; In men whose occupation is mainly outdoor was 3.240, 95% CI: 1.954-5.375, compared to reference groups. Age, BPH, geography of residence, and occupation were predictors of bladder calculi in men.

Differences and Disparities in Ageism Affecting Older US Adults: A Review.

This review summarizes findings from quantitative research studies published between 2010 and 2022 providing insight on sociodemographic differences and disparities in ageism among US adults ages 50 and older. Across 21 studies, disparities in ageism were more consistently found such that those who were older (57% of studies), with less education (64%), and of lower socioeconomic status (100%) reported more ageism than their counterparts. Amount of ageism did not differ by sex in the majority (71%) of studies. Findings regarding race/ethnicity were mixed. Other possible differences in ageism, assessed in a small number of studies, were patterned by employment characteristics, geographic residence, religiosity, and political affiliation but not by marital or employment status. Given that ageism is both common and associated with poor health outcomes, identifying disproportionately affected segments of the older adult population is a necessary prerequisite for developing targeted interventions to reduce negative outcomes linked to ageism and associated health disparities. Evidence within this review suggests that the patterning of ageism may deviate from that typically documented for other social and structural disadvantages. Some groups traditionally considered to be socially marginalized were found to report more ageism while others did not.

SOCIAL ENGAGEMENT AND SUBJECTIVE COGNITIVE FUNCTION AMONG OLDER ADULTS: RURAL-URBAN DIFFERENCES

Abstract Increasing age significantly relates with a decline in subjective cognitive function, while age and cognitive function decline strongly links with a diagnosis under the umbrella of Alzheimer’s disease and related dementias (ADRD). Recent literature points to social engagement as a potential mitigator to cognitive function decline. Social engagement often differs by geography of residence, with typically higher engagement among those in urban areas compared to rural counterparts. The purpose of this study was twofold: (a) to explore the relationship between social engagement and subjective cognitive function among community-dwelling older adults; and (b) to examine any disparity in social engagement apropos to rural vs. urban residency within this population. The theoretical framework, combining activity theory and cognitive reserve theory, guided the understanding of the relationship between social engagement and subjective cognitive function. A functionalist lens was included to explain rural-urban differences. Secondary data of community-dwelling older adults from AARP’s 2016 Social Engagement and Brain Health Survey (Nf746) were utilized. Results from descriptive analyses, correlations, and several regression models were reported. Bivariate regression models examined primary predictor variables – social engagement and geography of residence. Multivariate models examined sample characteristics, engagement, and geography of residence. Neither social engagement nor rural vs. urban residence achieved statistical significance in the models. Physical health, emotional wellbeing, marital status (identifying as married), and ethnicity (identifying as Black or African American) were positively, significantly associated with subjective cognitive function. Implications for community-dwelling older adults are discussed.

SOCIAL DETERMINANTS OF HEALTH UNDERLIE RACIAL/ETHNIC DISPARITIES IN PSYCHOLOGICAL HEALTH AND WELL-BEING

Abstract This study sought to determine the impact of selected social determinants of health on psychological health and well-being (defined as depression, cognition, self-rated health) among Black and Hispanic/Latinx adults relative to White adults aged 51 to 89. We measured disparities in depression, cognition, and self-rated health among 2,306 Non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 Non-Hispanic/Latinx White adults from the Health and Retirement Study (n=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected social determinants of health explained a larger share of the disparities than age, sex, measures of health, health behaviors, and healthcare utilization. Selected social determinants included education, parents’ education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage. Black and Hispanic/Latinx adults reported worse depression, cognition, and self-rated health compared to White adults. Selected social determinants of health explained a larger proportion of the Black-White disparities in depression (51%), cognition (39%), and self-rated health (37%) than did age, sex, measures of health, health behaviors, and healthcare utilization. Social determinants of health explained a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and functional status primarily drove the disparity in depression (28%). Education, parents’ education, years worked, income, and insurance parity were social determinants associated with the disparities.In conclusion, differences in social determinants of health underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key social determinants of health.

Examining the cognitive performance of older adults in urban and rural regions of India.

AbstractBackgroundAging population is rapidly growing in India, with the majority of the older adult population residing in rural regions. Studies globally show a higher prevalence of cognitive impairment in rural regions than urban. With the lack of research on aging in India, there is an urgent need to evaluate the cognitive health of older adults in India to allow for their care needs to be met appropriately and promote healthy aging.MethodThis study used data from Harmonized Longitudinal Aging Study of India, Diagnostic Assessment of Dementia (LASI DAD), which was developed by the Gateway to Global Aging Data. The sample size was nationally representative (n = 4096) of older adults aged 60 years and above in India (urban community = 1561, rural village = 2535). Given the heterogeneity of the population, adapted cognitive instruments were used. This study assessed if geographical residency (urban vs. rural) of older adults influenced their cognitive performance above and beyond demographic factors (i.e., age and gender) and education using a hierarchical regression in SPSS.Result18% of the variance in cognitive performance was accounted for by age and gender. 37% of the variance in cognitive performance was accounted for by the addition of education. Finally, geographic residency accounted for 1.2% of the variance in cognitive performance of older adults. Older adults living in rural villages had statistically significantly lower cognitive performance than older adults living in urban communities (B = ‐.218, p &lt; 0.01). Women’s cognitive performance was lower than men’s (B = ‐.229, p &lt;0.01).ConclusionThe geographic residency only accounted for a small proportion of variance in the cognitive performance of older adults in India. The majority of the disparity was accounted for by education, with older adults with higher education performing better. Despite that, older adults living in rural villages performed worse on cognitive measures than older adults living in urban communities. Older women performed worse than men. The contribution of factors such as depression, socioeconomic status, and cardiovascular health to the cognitive health of older adults in India should be explored further.

Geographic heterogeneity in Black-white infant mortality disparities.

Despite recent decreases in Black infant mortality, racial disparities persist, motivating continued research into factors related to these inequalities. While the inverse association between education and infant mortality has been documented across races, less is known about its geographic heterogeneity. Using vital statistics from the National Center for Health Statistics, this study considers Black-white disparities in infant mortality for births occurring between 2011 and 2015 across regions and metropolitan status of maternal residence. With logistic regressions, we investigate heterogeneity in maternal educational gradients of infant mortality by geographic residence both within and between races. Beyond confirming the well-known relationship between education and infant mortality, our findings document a slight metropolitan advantage for infants born to white mothers as well as lower returns to education for infants born to Black mothers residing in nonmetropolitan counties. We observe a metropolitan advantage for infants born to Black mothers with at least a bachelor's degree, but a metropolitan disadvantage for infants born to Black mothers with less than a high school degree. The South is driving this divergence, pointing to particular mechanisms limiting returns to education for Southern Black mothers in nonmetropolitan areas. This paper's geographic perspective emphasizes that racial infant health disparities are not uniform across the country and cannot be fully understood through individual and household characteristics.

Similarities and differences across the underlying dimensions of social functioning in rural and nonrural cancer survivors: A mixed-methods study.

For cancer survivors, social functioning greatly influences other quality of life dimensions. While there is potential for differences in social functioning to vary as a function of geographic residence, few studies examine the social functioning of rural cancer survivors specifically. This study aims to help fill this gap. This was an embedded mixed-methods study where all participants completed a questionnaire, and some were purposively selected to complete an interview to gather more information about social functioning (ie, social roles, activities, network, support, and constraint). Participants (n = 93; 63% rural) were recruited through a state cancer registry and cancer care facility. Participants were predominately White, non-Hispanic (92.47%), roughly half female (54.84%), and on average, diagnosed in the past two years (SD = 1.68), and 61.45 (SD = 10.87) years old. Few differences in the social functioning of rural and nonrural participants were found on questionnaires, though rural participants reported larger networks and more overall support. Across groups, common themes in the interview data were the experience of both social support (eg, instrumental support) and social constraint (eg, others minimizing participants' problems or sharing their own negative experiences). This was the first cancer survivorship study to thoroughly examine social functioning by geographic residence. Rural cancer survivors described some unique strengths, but major group differences were not apparent. All participants highlighted situations when others, even with good intentions, were unhelpful to them. Future interventions to improve social functioning could work to dispel the belief that cancer survivors should handle their cancer on their own.