Disparities In Health Status Research Articles

Health disparities in cirrhosis care and liver transplantation.

Morbidity and mortality from cirrhosis are substantial and increasing. Health disparities in cirrhosis and liver transplantation are reflective of inequities along the entire spectrum of chronic liver disease care, from screening and diagnosis to prevention and treatment of liver-related complications. The key populations experiencing disparities in health status and healthcare delivery include racial and ethnic minority groups, sexual and gender minorities, people of lower socioeconomic status and underserved rural communities. These disparities lead to delayed diagnosis of chronic liver disease and complications of cirrhosis (for example, hepatocellular carcinoma), to differences in treatment of chronic liver disease and its complications, and ultimately to unequal access to transplantation for those with end-stage liver disease. Calling out these disparities is only the first step towards implementing solutions that can improve health equity and clinical outcomes for everyone. Multi-level interventions along the care continuum for chronic liver disease are needed to mitigate these disparities and provide equitable access to care.

38 Disparities in health outcomes by the age of five among preterm children in rural versus urban communities in British Columbia

Abstract Background Health disparities exist between than urban and rural communities, as rates of preterm birth, severe maternal morbidity and severe neonatal morbidity are higher in rural areas. There are limited population-based studies on early childhood health outcomes among those born preterm by geographical area. Objectives To compare health service use, morbidity, and medication use for up to five years of age between preterm children in rural versus urban residences. Design/Methods The study included liveborn infants at 22-44 weeks’ gestational age (GA) in British Columbia (BC), Canada, 2004-2014. Follow-up data to December 2019 included linked health information from four provincial databases (perinatal database, outpatient visits, hospitalizations, and outpatient prescriptions). Urban-rural status was based on maternal residence at birth. Rate ratios (RR) of health service use, childhood morbidity and medication use were compared within GA categories (22-27, 28-33, 34-36, 37-44) by rural vs. urban region using Poisson regression. Results There were 49,555 (10.9%) rural and 406,149 (89.1%) urban children included in this study. 42,789 children were born at <37 weeks GA, and the preterm birth rate was 9.4%. Compared to urban areas, children in rural regions had more hospitalizations (28-33 weeks: RR 1.35, 95% CI: 1.19-1.51; 34-36 weeks: RR 1.35, 95% CI 1.27-1.44; 37-44 weeks: RR 1.32, 95% CI 1.29-1.34) by five years of age; and significantly fewer outpatient visits (22-27 weeks: RR 0.90, 95% CI: 0.87-0.93; 28-33 weeks: RR 0.81, 95% CI: 0.80-0.82; 34-36 weeks: RR 0.75, 95% CI 0.74-0.75; 37-44 weeks: RR 0.71, 95% CI 0.71-0.71). Rural children born at 34-36 weeks had significantly higher rates of bronchiolitis (RR: 1.35, 95% CI: 1.16-1.56) compared to urban children. They were prescribed more antibiotics and bronchodilators (RR: 1.15, 95% CI: 1.13-1.17, and RR: 1.12, 95% CI: 1.05-1.19, respectively). Conclusion Compared with urban areas, preterm children living in rural regions of BC had higher rates of hospitalization, higher rates of bronchiolitis and more frequent prescriptions of antibiotics and bronchodilators by five years of age. These disparities in health status and service use warrant further research and public health interventions.

Health and inequality

Abstract Poorer people tend to have worse health and shorter lives than richer ones, which raises the question of whether the relationship is causal. Does bad health lead to economic inequality or vice versa? And is increasing inequality responsible for widening socio-economic disparities in health status? What policies can break these links? This commentary takes the positive relationship between health and income as a given and explores what we know about these questions. I conclude that bad health causes economic inequality, but whether economic inequality harms health depends on the policy environment. There is much that governments can do and have done to improve the health of the poor and flatten the relationship between income, income inequality, and health.

Health status based on EQ-5D-5L for the cancer patient population in Malaysia

The EQ-5D is a common generic tool used in clinical trials and economic evaluations to evaluate the health-related quality of life as a proxy of health outcomes. To date, studies using EQ-5D-5L to evaluate the health status of cancer patients remain scarce in Malaysia. In this study, EQ-5D-5L dimensions, EQ-5D-5L index, and EQ-VAS scores were applied to assess the health status of Malaysian cancer patients. A cross-sectional study was conducted March-December 2022 to collect data relevant to the EQ-5D-5L valuation of health status via the Research Electronic Data Capture (REDCap) platform. Respondents rated their health states using EQ-5D-5L and EQ-VAS. Among the 235 respondents, the mean EQ-5D-5L index and EQ-VAS score were 0.76 (SD 0.223) and 81.06 (SD 16.36). Most of the patients reported some problems in the pain/discomfort and anxiety/depression dimensions. The level of education, stage of cancer, and comorbidity were significantly associated with better health status on EQ-5D-5L (p < 0.05) but only the stage of cancer was significantly associated with EQ-VAS scores. This study highlighted the disparities in self-reported health status across patients of different sociodemographic and medical profiles with EQ-5D-5L valuation. Thus, future research should use EQ-5D norm scores as a benchmark of comparison among cancer patients.

Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program.

Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.

Decadal Descriptive Analysis of Health Status, Hospitalization, Intensive Care Admissions, and Mortality Rates Among the Elderly Population in Turkey (2012-2022)

Objective: This study aimed to analyse decadal changes in health status, hospitalisation, intensive care admissions, and mortality rates among the Turkish elderly population from 2012 to 2022, focusing on the impact of the COVID-19 pandemic. Material and Methods: A retrospective study obtained data from the Turkish Statistical Institute (TÜİK) and Health Statistics Yearbooks. Descriptive statistics were used to elucidate healthcare utilisation patterns and mortality profiles among individuals aged ≥ 65 years. Results: Analysis showed that self-reported "Very good/Good" health status peaked at 70.7% in 2012, decreased to 60.9% in 2019, and rebounded to 63.4% in 2022. The hospitalisation rates for the 65-74 age group increased from 17.5% in 2012 to 20.2% in 2021, with males (20.2%) having higher rates than females (16.0%) in 2021. ICU admission rates escalated during the pandemic, reaching 3.7% in 2021 for ages 65-74 and 4.7% for 75+ years, before declining in 2022 to 3.0% and 4.0%, respectively. The annual population growth rate has significantly decreased from 21.7 per thousand in 2012 to 5.5 per thousand in 2022, whereas the crude death rate has remained stable, dropping from 7.1 per thousand in 2012 to 5.1 per thousand in 2022. Conclusion: This study highlights fluctuating health perceptions among the elderly exacerbated by the pandemic. The enduring gender disparities in health status and healthcare utilisation underscore the need for gender-sensitive policies. The consistent yet stable mortality rates amidst demographic shifts emphasise the resilience of Turkey's healthcare system. These findings provide critical insights into geriatric care policies and post-pandemic health care strategies.

The assessment of national conduct in realizing the right to heath: using the framework of United Nations

Purpose Health is a human right and a fundamental building block of sustainable development, economic prosperity and poverty reduction. To realize people’s right to health, evaluating the situation of the right and its determinants is necessary. This paper aims to analyze Iran’s conduct in realizing its population’s right to health. Design/methodology/approach A qualitative case study design involving a structured review of relevant laws, policy documents, reports and academic literature was undertaken. The data were collected from electronic databases and the official Web pages of the United Nations (UN) and Iran’s Government and analyzed by a framework suggested by the UN. Findings Iran’s law and policies intend to combat health inequalities and to provide an adequate standard of living for everyone, particularly disadvantaged groups and individuals. However, not all laws and policies protecting disadvantaged groups are adequately implemented. There are disparities in health status and access to health care among different socio-economic groups. International economic sanctions and government policies decreased people’s ability to access the necessities of life including health care. Moreover, social determinants of health, such as cultural beliefs regarding women’s rights have not been addressed sufficiently in the country’s laws. Research limitations/implications This study includes a broad range of subjects and provides an overview of the health-care system of Iran. However, more detail is needed to describe every aspect of the right to health. It was not feasible to address them all in this paper and needs more research. In addition, as with the majority of qualitative studies, the design of the current study is subject to limitations. Firstly, the research quality of narrative reviews is dependent on the researcher’ skills and more easily can be influenced by his/her personal biases. Second, the rigor is more difficult to maintain, assess and demonstrate. Nevertheless, narrative studies often complement quantitative studies and are informative. Originality/value To fulfill the right to health, Iran should improve affordability and quality of care and the situation of the determinants of health. The gaps in people’s access to health care need to be identified, and all necessary means and scarce resources be allocated to remove access barriers and to improve the situation of disadvantaged people. The adoption of relatively low-cost targeted programs, the proper management of resources and the prevention of unnecessary costs are suggested.

Impact of Social Determinants of Health on Healthcare Disparities in Florida

Healthcare disparities disproportionately affect underserved and marginalized communities due to social determinants of health (SDoH), contributing to significant differences in health outcomes and life expectancy within different communities in Florida. This observational study aimed to understand the impact of SDoH, such as race/ethnicity, income level, and education attainment on healthcare access in Florida. Methods Self-reported data from the 2020 Behavioral Risk Factor Surveillance System were pooled to evaluate disparities in healthcare access by race/ethnicity, income, and education level in Florida. Results Health status and healthcare access vary based on characteristics related to SDoH, including race/ethnicity, income level, and educational attainment. Health status and healthcare access increased with income and education attainment. There were no significant disparities in health status and healthcare access among racial and ethnic groups. Conclusion While race and ethnicity were not significant predictors of health status nor healthcare access, income level and education were positively correlated which may be related to policy including Florida's lack of Medicaid expansion or population characteristics such as health-seeking behaviors. Understanding the prevalence of healthcare disparities based on SDoH can inform and support the implementation of evidence-based strategies for improving the accessibility and affordability of culturally competent care for underserved populations.

Racial and ethnic disparities in self-reported general and mental health status among colorectal cancer survivors: impact of sociodemographic factors and implications for mortality—a SEER-CAHPS study

PurposePatient-reported outcomes are recognized as strong predictors of cancer prognosis. This study examines racial and ethnic differences in self-reported general health status (GHS) and mental health status (MHS) among patients with colorectal cancer (CRC).MethodsA retrospective analysis of Medicare beneficiaries between 1998 and 2011 with non-distant CRC who underwent curative resection and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey within 6–36 months of CRC diagnosis. Analysis included a stepwise logistic regression to examine the relationship between race and ethnicity and fair or poor health status, and a proportional hazards model to determine the mortality risk associated with fair or poor health status.ResultsOf 1867 patients, Non-Hispanic Black (OR 1.56, 95% CI 1.06–2.28) and Hispanic (OR 1.48, 95% CI 1.04–2.11) patients had higher unadjusted odds for fair or poor GHS compared to Non-Hispanic White patients, also Hispanic patients had higher unadjusted odds for fair or poor MHS (OR 1.92, 95% CI 1.23–3.01). These relationships persisted after adjusting for clinical factors but were attenuated after subsequently adjusting for sociodemographic factors. Compared to those reporting good to excellent health status, patients reporting fair or poor GHS or MHS had an increased mortality risk (OR 1.52, 95% CI 1.31–1.76 and OR 1.63, 95% CI 1.34–1.99, respectively).ConclusionRacial and ethnic differences in GHS and MHS reported after CRC diagnosis are mainly driven by sociodemographic factors and reflect a higher risk of mortality. Identifying unmet biopsychosocial needs is necessary to promote equitable care.

A machine learning approach using migration-related cultural stress to classify depression and post-traumatic stress disorder among hurricane survivors

BackgroundData science approaches have increasingly been used in behavioral health research and may be useful for addressing social factors contributing to disparities in health status. This study evaluated the importance of cultural stress-related factors in classifying depression and post-traumatic stress disorder (PTSD) among adult survivors (N = 319) of Hurricane Maria who migrated from Puerto Rico to the United States mainland. MethodsWe evaluated the performance of random forests (RF) and logistic regression (LR) for classifying PTSD and depression. Models included demographic, hurricane exposure, and migration-related cultural stress variables. We inspected area under the receiver operating characteristic curve (AUC), accuracy, balanced accuracy, F1 score, precision, recall, and specificity. ResultsNegative context of reception and language-related stressors were moderately important for accurately classifying depression and PTSD. For classifying depression, RF showed higher accuracy, balanced accuracy, specificity, precision, and F1. For classifying PTSD, RF showed higher accuracy, specificity, precision, and F1. LimitationsA more thorough classification model would also include biomarkers (e.g., of allostatic load), family, community, or neighborhood-level attributes. Findings may not generalize to other groups who have experienced crisis-related migration. ConclusionsFindings underscore the importance of culturally and linguistically appropriate and trauma-informed clinical services for recent migrants. Use of assessments to identify pre-migration and post-migration stressors could inform clinical practice with migrants presenting with behavioral health-related difficulties.

Is the Health of Older Americans With a GED Equivalent to Their Peers With a High School Diploma?

The aim of this study was to identify differences in the prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, General Educational Development (GED) recipients, and high school graduates. This study used secondary analysis of the nationally representative 2017 American Community Survey. The sample included 20,489 GED recipients, 154,892 high school graduates, and 49,912 high school dropouts. Our findings indicate that there is a gradient in health outcomes among older Americans, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations among high school dropouts, followed by GED recipients, and the lowest among high school graduates. Although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.

Oral health literacy, knowledge and perceptions in a socially and culturally diverse population: a mixed methods study

BackgroundPoor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse population of Australian adults visiting a public dental clinic in Western Sydney.MethodsA mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach.ResultsA sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL.ConclusionsStrategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.

Frailty Among Sexual and Gender Minority Older Adults: The All of Us Database.

Despite known disparities in health status among older sexual and gender minority adults (OSGM), the prevalence of frailty is unknown. The aim of this study was to develop and validate a deficit-accumulation frailty index (AoU-FI) for the All of Us database to describe and compare frailty between OSGM and non-OSGM participants. Developed using a standardized approach, the AoU-FI consists of 33 deficits from baseline survey responses of adults aged 50+. OSGM were self-reported as "not straight" or as having discordant gender and sex assigned at birth. Descriptive statistics characterized the AoU-FI. Regression was used to assess the association between frailty, age, and gender. Validation of the AoU-FI used Cox proportional hazard models to test the association between frailty categories (robust <0.15, 0.15 ≤ pre-frail ≤ 0.25, frail >0.25) and mortality. There were 9 110 OSGM and 67 420 non-OSGM with sufficient data to calculate AoU-FI; 41% OSGM versus 50% non-OSGM were robust, whereas 34% versus 32% were pre-frail, and 26% versus 19% were frail. Mean AoU-FI was 0.19 (95% confidence interval [CI]: 0.187, 0.191) for OSGM and 0.168 (95% CI: 0.167, 0.169) for non-OSGM. Compared to robust, odds of mortality were higher among frail OSGM (odds ratio [OR] 6.40; 95% CI: 1.84, 22.23) and non-OSGM (OR 3.96; 95% CI: 2.96, 5.29). The AoU-FI identified a higher burden of frailty, increased risk of mortality, and an attenuated impact of age on frailty among OSGM compared to non-OSGM. Future work is needed to understand how frailty affects the OSGM population.

Oral health of adolescents in West Africa: prioritizing its social determinants

Oral health is a major public health issue in West Africa, yet it has gotten little attention. Individual and group disparities in health status are influenced by social determinants of health (SDH), which also affect oral health. Adolescence is a significant transition into adulthood, a time when the SDH can contribute to lifelong health status. This article explored the SDH associated with oral health behaviour, perception, and oral health development amongst adolescents in West Africa. This article engaged articles published in peer-reviewed journals relating to adolescents' oral health and West Africa. The authors undertook this desk review to determine the social determinants of adolescents' oral health in West Africa. The literacy levels and oral health awareness of adolescents, family and social circle influences, socioeconomic status, nutritional levels, and cultural and environmental factors have been identified as important social determinants. Adequate policy implementation with the integration of oral health in schools' curriculum, health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Costs of (In)visibility: Issues of Disclosure and Data for Health Equity Research with Sexual and Gender Minority Veterans.

Sexual and gender minority (SGM) veterans experience numerous disparities in health conditions, behavioral risks, and social adversities compared with non-SGM veterans. Although survey data have illuminated these differences, SGM veterans remain largely invisible in administrative data such as electronic health records due to lack of sexual orientation and gender identity information. Administrative data hold promise for propelling SGM health equity research, but several issues must be addressed, including weighing the benefits and threats of visibility for SGM people in data sets that are tied to receipt of services.

Spatial disparities in health status and access to health-related interventions in Madhya Pradesh

Spatial disparities in health status and access to health-related interventions in Madhya Pradesh

Quality of life in 13-year-olds depending on health status, residential neighbourhood deprivation and social capital - results from the Polish HBSC Study 2010-2018.

Health-related quality of life (HRQL) should be used more extensively in monitoring the health of school-aged children. The presented study aimed to evaluate trends in KIDSCREEN-10 indices, considering mean scores and the level of social inequalities. 3,937 children aged 13 participated in three Health Behavior in School-aged Children (HBSC) cross-sectional surveys conducted in Poland between 2010-2018. Subgroups were distinguished according to gender, health status, and three social factors (family affluence, neighbourhood social capital, and local deprivation). The average KIDSCREEN-10 index value was equal to: 22.36±4.54; 25.41±6.75; and 24.74±6.53 in 2010, 2014, and 2018,respectively. However, in 2018 no deterioration was recorded in boys, in poorer families or in regions with high social capital. The improvement in HRQL in 2014 was accompanied by an increase in disparities in health status and family wealth, as well as a decrease in disparities in local deprivation. An especially high increase in Glass index values was recorded for neighbourhood social capital (increasing from 0.542 in 2010 to 0.938 in 2018). The multivariate general linear model revealed the main effect of the year of the study, gender, chronic disease status, and the three social factors, as well as six significant 2-way interactions. Changes in the well-being of adolescents should be tracked over time using HRQL indices with proven psychometric properties. The level of social inequalities faced by young people should be included in policies and when designing interventions. The relevant initiatives should be targeted at different populations in order to properly address the needs of different groups of children and adolescents.

Community-level exposomics: a population-centered approach to address public health concerns.

Environmental factors affecting health and vulnerability far outweigh genetics in accounting for disparities in health status and longevity in US communities. The concept of the exposome, the totality of exposure from conception onwards, provides a paradigm for researchers to investigate the complex role of the environment on the health of individuals. We propose a complementary framework, community-level exposomics, for population-level exposome assessment. The goal is to bring the exposome paradigm to research and practice on the health of populations, defined by various axes including geographic, social, and occupational. This framework includes the integration of community-level measures of the built, natural and social environments, environmental pollution-derived from conventional and community science approaches, internal markers of exposure that can be measured at the population-level and early responses associated with health status that can be tracked using population-based monitoring. Primary challenges to the implementation of the proposed framework include needed advancements in population-level measurement, lack of existing models with the capability to produce interpretable and actionable evidence and the ethical considerations of labeling geographically-bound populations by exposomic profiles. To address these challenges, we propose a set of recommendations that begin with greater engagement with and empowerment of affected communities and targeted investment in community-based solutions. Applications to urban settings and disaster epidemiology are discussed as examples for implementation.

IS THE HEALTH OF OLDER AMERICANS WITH A GED EQUIVALENT TO THEIR PEERS WITH A HIGH SCHOOL DIPLOMA?

Abstract Previous research has found higher levels of educational attainment to be strongly associated with better health outcomes in later life, such as better cognitive functioning and fewer functional and sensory impairments. However, most studies have grouped General Educational Development (GED) recipients with high school graduates, neglecting potential differences in socioeconomic status, health behaviours, and health outcomes among these two groups. The aim of the current study is to identify differences in the age-sex-race-poverty adjusted prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, GED recipients, and high school graduates with no post-secondary education. The present study uses secondary analysis of the 2017 American Community Survey, a nationally representative survey of community-dwelling and institutionalized older adults aged 65 years and older, of whom 20,489 were GED recipients, 154,892 had a high school diploma and 49,912 had finished grade 8 but had not completed high school. Our findings indicate that there is a gradient in health outcomes among Americans aged 65-84, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations occurring among high school dropouts, followed by GED recipients, and the lowest prevalence among high school graduates. These findings suggestion that although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.

IS THE HEALTH OF OLDER AMERICANS WITH A GED EQUIVALENT TO THEIR PEERS WITH A HIGH SCHOOL DIPLOMA?

Abstract Previous research has found higher levels of educational attainment to be strongly associated with better health outcomes in later life, such as better cognitive functioning and fewer functional and sensory impairments. However, most studies have grouped General Educational Development (GED) recipients with high school graduates, neglecting potential differences in socioeconomic status, health behaviours, and health outcomes among these two groups. The aim of the current study is to identify differences in the age-sex-race-poverty adjusted prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, GED recipients, and high school graduates with no post-secondary education. The present study uses secondary analysis of the 2017 American Community Survey, a nationally representative survey of community-dwelling and institutionalized older adults aged 65 years and older, of whom 20,489 were GED recipients, 154,892 had a high school diploma and 49,912 had finished grade 8 but had not completed high school. Our findings indicate that there is a gradient in health outcomes among Americans aged 65-84, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations occurring among high school dropouts, followed by GED recipients, and the lowest prevalence among high school graduates. These findings suggestion that although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.