Areas Of High Deprivation Research Articles

Are individual-level risk factors for gastroschisis modified by neighborhood-level socioeconomic factors?

Two strong risk factors for gastroschisis are young maternal age (<20 years) and low/normal pre-pregnancy body mass index (BMI), yet the reasons remain unknown. We explored whether neighborhood-level socioeconomic position (nSEP) during pregnancy modified these associations. We analyzed data from 1269 gastroschisis cases and 10,217 controls in the National Birth Defects Prevention Study (1997-2011). To characterize nSEP, we applied the neighborhood deprivation index and used generalized estimating equations to calculate odds ratios and relative excess risk due to interaction. Elevated odds of gastroschisis were consistently associated with young maternal age and low/normal BMI, regardless of nSEP. High-deprivation neighborhoods modified the association with young maternal age. Infants of young mothers in high-deprivation areas had lower odds of gastroschisis (adjusted odds ratio [aOR]: 3.1, 95% confidence interval [CI]: 2.6, 3.8) than young mothers in low-deprivation areas (aOR: 6.6; 95% CI: 4.6, 9.4). Mothers of low/normal BMI had approximately twice the odds of having an infant with gastroschisis compared to mothers with overweight/obese BMI, regardless of nSEP (aOR range: 1.5-2.3). Our findings suggest nSEP modified the association between gastroschisis and maternal age, but not BMI. Further research could clarify whether the modification is due to unidentified biologic and/or non-biologic factors.

Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia.

Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia-based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood-level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. Of the 14,195 women with breast cancer, 54% were non-Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32-2.43; OR: 1.75, 95% CI: 1.43-2.13; OR: 1.27, 95% CI: 1.06-1.51). Among patients living in low-deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44-2.78; OR: 1.84, 95% CI: 1.48-2.30; OR: 1.26, 95% CI: 1.05-1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high-deprivation areas. Insurance status was associated with treatment delays for women living in low-deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status.

Hospital admissions linked to SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first ascertained infections in England

ObjectiveTo describe hospital admissions associated with SARS-CoV-2 infection in children and adolescents.DesignCohort study of 3.2 million first ascertained SARS-CoV-2 infections using electronic health care record data.SettingEngland, July 2020 to February...

Estimating quality of life: A spatial microsimulation model of well-being in Aotearoa New Zealand

Quality of life is a complex concept characterised by several dualities, it has many definitions depending on the field of research and an abundance of diverse objective and subjective measures. The latter often represents the extent of perceived (dis)satisfaction with various domains of life experienced by individuals or groups, and research is increasingly focusing on subjective measures of well-being to better understand personal drivers related to quality of life. A better understanding of these factors at a local level has potential to shed light on an often-overlooked aspect of the mental health landscape in Aotearoa New Zealand. Individual-level data on adults (15+ years) is sourced from the New Zealand Attitudes and Values Study 2018 (N = 47,949) and aggregate-level data from the Census 2018 (N = 3,775,854). Matching constraint variables include sex, age, ethnicity, highest qualification, and labour force status. Outcome variables include personal and national well-being scores from 0 to 10 (extremely dissatisfied–extremely satisfied). Spatial microsimulation is used to create a synthetic population based on the above data. Results show lower mean national well-being scores than personal well-being scores, with spatial variations that broadly reflect patterns of socioeconomic deprivation. Low mean values for both personal and national well-being scores are seen in rural areas of high socioeconomic deprivation, particularly those with large Māori populations. High mean values are associated with areas of low deprivation. Additionally, high national well-being scores are associated with areas of agricultural activity, particularly in the South Island. Consideration should be given to factors that influence responses in such topics however, including demographic profiles as well as economic and social conditions of individuals and their surrounding communities. This study demonstrates that spatial microsimulation can be used as a powerful tool to understand population well-being. It can help support future planning and resource allocation, aiding in achieving health equity.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Background: CAR T-cell therapy has revolutionised treatment of relapsed/refractory (r/r) large B-cell lymphoma (LBCL), but it is unclear whether access and clinical benefit is equal for ethnic minorities and deprived communities. We analysed outcomes of LBCL patients approved for CD19 CAR T at 2 UK centres serving a large and diverse population, according to ethnicity and socioeconomic deprivation. Methods: Consecutive patients with r/r LBCL approved for 3L axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) between January 2019 and December 2022 at King’s College Hospital London and University Hospital Birmingham were included. Data on deprivation was obtained through the Index of Multiple Deprivation (IMD) 2020 according to patients’ postcode. The IMD ranks between 1 and 10 and includes different factors relating to healthcare inequalities (e.g., income, employment, education). Patients were grouped into high (IMD 1–3) and low deprivation (8–10). Results: 245 patients were included, 193 approved for axi-cel, 52 for tisa-cel. Deprivation data were available for 218 patients. The product choice did not differ according to ethnic or deprivation groups. Patients’ median age was 61y. Ethnic groups were as follows: 214/245 (87%) White, 22 (9%) Asian, 7 (3%) Afro-Caribbean, 2 mixed race. 21% of patients were from areas of high deprivation. 53% of patients travelled >50 km to the CAR T centre, 25% >100 km. 82% patients were infused, with no significant difference according to ethnicity, deprivation or distance to the centre. Ethnic minority patients came from more deprived areas versus white patients (med. IMD 7 vs. 5 vs. 4 in White, Asian and Afro-Caribbean patients, respectively; p = 0.04). Distance to the CAR T centre was longer in white versus ethnic minority patients (med. 59 vs. 18 km, p = 0.03). There were more patients with ECOG PS 0 from low deprivation areas (46% vs. 31%; p = 0.04), otherwise no significant differences of baseline characteristics, i.e., LDH, bulk, stage, IPI, bridging response, or vein-to-vein time according to ethnicity or deprivation. No difference was observed in high-grade ICANS, incidence of CRS, ICU requirement, tocilizumab/steroid use or non-relapse mortality with respect to ethnicity or deprivation. CAR T response and progression-free survival were similar across ethnic and deprivation groups. Among patients who progressed after CAR T, those from areas of low deprivation were more likely to receive further therapies (79% vs. 48%, p = 0.02). Patients from low deprivation areas had better overall survival (OS; 1-y OS 61% vs. 45%, p = 0.04). Keywords: Cancer Health Disparities, Cellular therapies, Immunotherapy No conflicts of interests pertinent to the abstract.

Adherence to surveillance guidelines in survivors of hodgkin lymphoma: A report from the Childhood Cancer Survivor Study (CCSS).

10047 Background: Pediatric Hodgkin lymphoma (HL) is a highly curable disease. However, survivors are at high risk for long-term complications of therapy. The impact of sociodemographic and clinical factors on adherence to late effects surveillance guidelines is unknown. Methods: The CCSS is a retrospective cohort with prospective follow-up of survivors diagnosed from 1970-1999. HL survivors enrolled in CCSS who responded to a 2017 questionnaire were included. We assessed adherence to the Children’s Oncology Group surveillance guidelines for cardiomyopathy, breast cancer, colorectal cancer, and skin cancer. Multivariate logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals (aOR [95% CI]) for sociodemographic and clinical risk factors associated with adherence. Estimates were adjusted for area deprivation index (ADI); chronic health conditions; recent (≤2 years) routine check-up, cancer center or survivorship clinic visit; and possession of a survivorship care plan (SCP). Results: 1,380 HL survivors (45.6% male; median age 43.6 years, range 21.6-65.9 years) responded, of whom 55.5% were at elevated risk for cardiac dysfunction, 71.0% for breast cancer, 83.5% for skin cancer, and 39.4% for colorectal cancer. Of those at elevated risk, 42.7%, 19.9%, 31.3% and 48.9% were adherent to the guidelines for cardiac, breast, skin, and colorectal screening, respectively. Predictors of adherence to cardiac dysfunction guidelines were male sex (aOR 1.7 [1.1-2.6]), having children (aOR 1.6 [1.1-2.4]), recent routine checkup (aOR 4.0 [1.3-13.1]), recent visit to a cancer center or survivorship clinic (aOR 6.2 [3.9-10.0]), and possession of a SCP (aOR 3.1 [1.9-5.0]). Adherence to breast cancer guidelines was higher in those who were unmarried (aOR 2.1 [1.0-4.1]), had a recent visit to a cancer center or survivorship clinic (aOR 3.7 [2.0-7.0]), and possessed a SCP (aOR 3.5 [1.5-8.3]). Adherence to skin cancer guidelines was higher in those &gt; 14 years at diagnosis (aOR 1.8 [1.3-2.4]), living in a low deprivation area (ADI 1-24.9) compared to a high deprivation area (ADI 75-100) (aOR 3.4 [1.9-5.9]), employed (aOR 1.8 [1.1-2.9]), &gt; 30 years from diagnosis (aOR 2.4 [1.6-3.6]), with a recent routine check-up (aOR 3.6 [1.1-12.5]), and recent cancer care (aOR 2.4 [1.6-3.5]). Adherence to colorectal cancer guidelines was higher in those with grade 3-4 chronic health conditions (aOR 1.9 [1.1-3.3]). Conclusions: Less than 50% of HL survivors are adherent to screening guidelines. Sociodemographic risk factors are significant predictors of non-adherence, particularly to skin cancer screening guidelines. This threatens to potentiate outcome disparities among HL survivors.

Inter-Generational Differences in Perinatal Health Behaviours: A Secondary Analysis of the Born in Bradford Cohort, Disentangling Ethnicity and Migration

ObjectivesThere exists a body of research regarding ethnic differences in perinatal health whereas this is not the case concerning the role of migration status and acculturation in attenuating these differences. This study aims to investigate determinants of health during pregnancy up to one-year postpartum by migration status.MethodsThe study utilises data collected by the Born in Bradford cohort. The focus of analysis was migration status groupings, based on self-reported country of birth of participants and their parents and grandparents. Chi-Square, one-way ANOVA and correlation coefficients examined relationships between variables.ResultsMigrant women were less likely to smoke (native: 34.4%, 1st generation: 2.8%, 2nd generation: 8.6%) or to be obese (native: 25.5%, 1st generation: 17.4%, 2nd generation: 21.3%) compared to native women. Migrants were less physically active at 6 months (Mean (SD) minutes/week: native 265 (245), 1st generation 113 (162), 2nd generation 147 (182)) with larger increases in BMI over time compared to native women. Migrant women were more likely to be suffering psychological distress at baseline and 6 months postpartum and migrant families were more likely to live in areas of high socio-economic deprivation, despite higher levels of educational attainment.Conclusions for PracticeThis study ethnicity and migration identifies some important differences between ethnic groups with different migration histories, therefore indicating that healthcare professionals should consider eliciting full migration histories to improve care. The impact of these differences on perinatal outcomes is a priority for future research.

P101 Understanding First Contact Physiotherapists experiences of remote consultations in primary care

Abstract Background/Aims First Contact Physiotherapists (FCPs) assess, diagnose and manage patients presenting with musculoskeletal disorders in primary care, without the need for prior GP consultation. Prior to COVID-19 almost every consultation was conducted in-person. Since the pandemic, many consultations are now undertaken remotely, a trend that is set to continue in line with the ‘Digital first’ strategy which seeks to enhance patient access to appointments. This aim of this study was to explore FCP views of remote consultations and how this impacted their role satisfaction and wellbeing. Methods This mixed methods two phase study consisted of an online survey investigating distributed via professional networks and through social media. The phase one survey explored consultation methods; levels of training; challenges and benefits; and a stress appraisal. Data were analysed descriptively. Respondents were invited to take part in phase two which included a semi-structured interview to gain an in-depth understanding of FCPs lived experience of remote consultation ways of working. Transcripts were thematically analysed. Results The online survey received n = 109 responses from UK-based FCPs. Data revealed that despite the ‘Digital First’ push for continued remote consultations, the majority of FCPs (62%) used them for less than a quarter of their appointment slots. Whilst recognising that many patients found this format convenient, FCPs highlighted their own stress levels, citing poor efficacy, anxiety of misdiagnosis, feelings of isolation and increased administrative workload. Nearly two thirds (66%) of respondents had not received any training in how to conduct effective remote consultations. Follow-up interviews with n = 16 FCPs highlighted coping strategies including following up with an in-person consultation and directing patients to other community health and wellbeing resources. In areas of high socioeconomic deprivation and poor health literacy additional problems associated with communication difficulties, poor IT access and capability, and digital poverty were all cited. Conclusion Remote consultations may offer a convenient alternative for some patients. FCP responses suggest that the continued offer of remote consultation is decreasing now pandemic restrictions have been lifted, despite the push for continued digital working practices. The perceived lack of efficacy, and fear of missing important diagnostic information means that many FCPs are either returning to in-person consultation or following up with a second face-to-face assessment resulting in potential service inefficiencies. Additional challenges were identified in areas of high deprivation and low health literacy, and the value of this consultation format needs to be considered in this context. Future work should focus on the training and support needs of FCP staff who are engaging with remote working to ensure clinical effectiveness and staff wellbeing. Disclosure N. Walsh: Grants/research support; Walsh is funded by NIHR. B.E. Jones: None. R. Thomas: None. Z. Anchors: None.

A whole system approach to childhood obesity: how a supportive environment was created in the city of Brighton and Hove, United Kingdom

Childhood obesity is a growing global challenge, and no country has yet reversed the upward trend in prevalence. The causes are multifaceted, spanning individual, societal, environmental, and political spheres. This makes finding solutions complex as traditional linear models of treatment and effect have proven only minimally successful or unfeasible at the population level. There is also a paucity of evidence of what works, and few examples of intervention that operate on a ‘whole systems’ level. The city of Brighton in the United Kingdom has experienced a downward trend in child obesity rates compared to national figures. The aim of this study was to explore what has led to successful change in the city. This was done through a review of local data, policy and programs, and thirteen key informant interviews with key stakeholders involved in the local food and healthy weight agenda. Our findings highlight key mechanisms that have plausibly contributed to a supportive environment for obesity reduction in Brighton according to key local policy and civil society actors. These mechanisms include; a commitment to early years intervention such as breastfeeding promotion; a supportive local political context; the ability to tailor interventions to community needs; governance structures and capacity that enable cross-sectoral collaboration; and a citywide framing of obesity solutions in the context of a ‘whole system’ approach. However, substantial inequalities persist in the city. Engaging families in areas of high deprivation and operating in an increasingly difficult context of national austerity are persistent challenges. This case study sheds light on some mechanisms of what a whole systems approach to obesity looks like in practice in a local context. This is of relevance to both policymakers and healthy weight practitioners across a spectrum of sectors who need to be engaged to tackle child obesity.

Comparing primary caregivers’ reported injury data with routinely recorded injury data to assess predictors of childhood injury

BackgroundLinking self-reported data collected from longitudinal studies with administrative health records is timely and cost-effective, provides the opportunity to augment information contained in each and can offset some of the limitations of both data sources. The aim of this study was to compare maternal-reported child injury data with administrative injury records and assess the level of agreement.MethodsA deterministic linkage was undertaken to link injury-related data from the Growing up in New Zealand (GUiNZ) study to routinely collected injury records from New Zealand’s Accident Compensation Corporation (ACC) for preschool children. The analyses compared: (i) the characteristics of mothers with linked data vs. those without, (ii) injury incidences from maternal recall with those recorded in ACC injury claims, and (iii) the demographic characteristics of concordant and discordant injury reports, including the validity and reliability of injury records from both data sources.ResultsOf all mothers who responded to the injury questions in the GUiNZ study (n = 5836), more than 95% (n = 5637) agreed to have their child’s record linked to routine administrative health records. The overall discordance in injury reports showed an increasing trend as children grew older (9% at 9 M to 29% at 54 M). The mothers of children with discordance between maternal injury reports and ACC records were more likely to be younger, of Pacific ethnicity, with lower educational attainment, and live in areas of high deprivation (p < 0.001). The level of agreement between maternal injury recall and ACC injury record decreased (κ = 0.83 to κ = 0.42) as the cohort moved through their preschool years.ConclusionsIn general, the findings of this study identified that there was underreporting and discordance of the maternal injury recall, which varied by the demographic characteristics of mothers and their child’s age. Therefore, linking the routinely gathered injury data with maternal self-report child injury data has the potential to augment longitudinal birth cohort study data to investigate risk or protective factors associated with childhood injury.

Abstract P4-07-47: Real-world practice patterns in the management of metastatic breast cancer in Washington State

Abstract Background: Evidence-based recommendations for the management of metastatic breast cancer (MBC) endorse confirmation of recurrence with biopsy and reassessment of biomarker status. National guidelines support numerous treatment options and do not capture the nuances of real-world practice. Real world data may demonstrate disparities in adherence to guidelines. Methods: We collaborated with Hutchinson Institute for Cancer Outcomes Research (HICOR) to link enrollment and insurance claims records with Washington State cancer registries from 2008-2017. Our cohort comprised of women &amp;gt; 18 years old with MBC who met enrollment criteria in one of four payors (Premara, Regence, Medicare, or Medicaid). We identified receipt of biopsy and biomarker re-assessment at time of recurrence, receipt of first line treatment, categorized as CDK4/6 inhibitors (CDKi), chemotherapy (CT), or hormone therapy (HT) and examined factors influencing these practice patterns. Results: We identified 1,101 patients with MBC (recurrent MBC, N = 715; de novo MBC, N = 386) with a median age of 66 (range 54 – 74). Of the patients with MBC, there were a total of 677 patients with ER+/HER2- MBC. Table 1 shows demographic data. Most of the cohort were White (89%). Approximately 15% of patients lived in areas of high deprivation (area of deprivation index, ADI, 8-10). Patients had either Commercial (47%), Medicaid (4%), Medicare (35%) or multiple (13%) insurance. Of the patients with recurrent MBC, 49.5% received a biopsy to confirm metastatic diagnosis. Similarly, 48.7% of recurrent MBC patients underwent biomarker reassessment. Patients with highest co-morbidity index (2) were more likely to undergo biopsy confirmation (20.3% vs 13.0%, p = 0.02). Biopsy was more often performed at recurrence in patients receiving care at a high-volume center (74.3% vs 67.6%, p = 0.03) compared to low volume center (18.6% vs 26.6%, p = 0.03). First line treatment selection was directly associated with receipt of biopsy and biomarker testing. Hormone therapy only was more common in patients who did not undergo biopsy (62.3% vs 37.7%, p &amp;lt; 0.001) or biomarker reassessment (62.7% vs 37.3%, p &amp;lt; 0.001). Of the patients with ER+/HER2- MBC, the majority of patients received ET alone (69%), followed by chemotherapy (22%), and CDK4/6i + ET (9%). Dual agent CT was the more commonly prescribed compared to single agent in those who received CT (56% vs 44%). The majority of patients who received CDKi + ET were &amp;lt; 65 years old (65.2%, p &amp;lt; 0.02). Insurance influenced first line therapy selection and patients with commercial insurance were more likely to receive CDK4/6i + ET compared to those with Medicare/Medicaid. (60.9% vs 26.1%, p = 0.10). Patients with de novo MBC were more likely to receive CT (43.1% vs 13.4%, p &amp;lt; 0.001) and less likely to receive ET alone (47.9% vs 78.0%, p &amp;lt; 0.001). Almost all patients treated with CDK4/6i + ET received care a high-volume center (91.3%, p = 0.11). Conclusion:Our findings highlight key gaps for future investigations in the management of MBC and serve as a launching point for new patient-centered and quality-promoting research initiatives. Table 1: Baseline Demographics 1# of patients treated annually, high = &amp;gt;100, medium 25-100, low &amp;lt;25. Citation Format: Poorni Manohar, Hannah Linden, Veena Shankaran, Catherine Fedorenko, Jenna Voutsinas, Qin Sun, Vicky Wu. Real-world practice patterns in the management of metastatic breast cancer in Washington State [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-47.

Geographic Variation in Disease Burden and Mismatch in Care of Patients With Rheumatoid Arthritis in the United States.

Our objective was to evaluate the factors associated with regional variation of rheumatoid arthritis (RA) disease burden in the US. In a retrospective cohort analysis of Rheumatology Informatics System for Effectiveness (RISE) registry data, seropositivity, RA disease activity (Clinical Disease Activity Index [CDAI], Routine Assessment of Patient Index Data-version 3 [RAPID3]), socioeconomic status (SES), geographic region, health insurance type, and comorbidity burden were recorded. An Area Deprivation Index score of more than 80 defined low SES. Median travel distance to practice sites' zip codes was calculated. Linear regression was used to analyze associations between RA disease activity and comorbidity adjusting for age, sex, geographic region, race, and insurance type. Enrollment data for 184,722 patients with RA from 182 RISE sites were analyzed. Disease activity was higher in African American patients, in those from Southern regions, and in those with Medicaid or Medicare coverage. Greater comorbidity was prevalent in patients in the South and those with Medicare or Medicaid coverage. There was moderate correlation between comorbidity and disease activity (Pearson coefficient: RAPID3 0.28, CDAI 0.15). High-deprivation areas were mainly in the South. Less than 10% of all participating practices cared for more than 50% of all Medicaid recipients. Patients living more than 200 miles away from specialist care were located mainly in Southern and Western regions. A disproportionately large portion of socially deprived, high comorbidity, and Medicaid-covered patients with RA were cared for by a minority of rheumatology practices. Studies are needed in high-deprivation areas to establish more equitable distribution of specialty care for patients with RA.

The impact of remote consultations on the health and wellbeing of first contact physiotherapists in primary care: Amixed methods study.

First Contact Physiotherapists (FCPs)were introduced to reduce demands on GPs by providing improving access to expert musculoskeletal care. FCPs experience similar workplace stressors to GPs and there is an emerging concern that remote consultations are causing further impacts to their wellbeing. To explore the impact of remote consultations on FCPs. A mixed methods sequential explanatory study with FCPs was conducted. An online survey measured the usage and impact of remote consultations. Semi-structured interviews explored the lived experiences of using remote consultations. The online survey was completed by 109 FCPs. A key benefit of remote consultations was patient convenience; perceived challenges included IT issues, poor efficacy, FCP anxiety, isolation, and increased workload. FCPs viewed remote consultations as a 'challenge' rather than a 'threat'. Nearly two thirds of the FCPs had not received relevant training, yet over half were interested. Follow-up interviews with 16 FCPs revealed 4 themes: (1) Remote consultations provide logistical benefits to the patient; (2) Compromised efficacy is the key challenge of remote consultations; (3) Challenges for FCPs working in areas of high deprivation; and (4) Remote consultations impact the health, wellbeing and work satisfaction of FCPs. Remote consultations offer a convenient alternative for patients, but may add to FCP stress particularly in areas of high socioeconomic deprivation. Further research is required to understand how remote consultations can be enhanced when communication barriers and lower levels of digital literacy exist. Continued monitoring of job satisfaction and resilience levels is important to ensure FCPs remain in their role.

Abstract 87: Area Deprivation And Race Synergistically Contribute To Undiagnosed Hypertension Leading To Acute Ischemic Stroke

Background: Area deprivation is one of the leading social determinants of health and is associated with lower access to clinical care. We hypothesize that undiagnosed hypertension is more prevalent in highly deprived areas as well as in people from black race and that undiagnosed hypertension is associated with a higher risk of incident stroke. Methods: We conducted an observational study analyzing participants from the All of Us study (AoU). We identified people who meet the criteria for hypertension based on blood pressure measurements at the time of enrollment but were not known to have the condition according to EHR or survey data. We evaluated area deprivation using the Deprivation Index (DI), an aggregate variable derived from six metrics of the American Community Survey. We used multivariable logistic regression to test for interaction between tertiles of DI and race in a model predicting undiagnosed hypertension adjusting for age, sex, income, and education. Results: Out of 372,397 participants enrolled in AoU, 269,063 had data for area deprivation and blood pressure, including 6,690 (2.5%) who sustained a stroke. Compared to low area deprivation, intermediate and high deprivation were associated with 3.4% (OR 1.034, 95%CI 1.00-1.07) and 17.4% (OR 1.174, 95%CI 1.14-1.21) higher risk of undiagnosed hypertension (test-for-trend p&lt;0.0001). Compared to White participants, Black participants had a 67.4% (OR 1.674, 95%CI 1.62-1.73, p&lt;0.0001) higher risk of undiagnosed hypertension. There was significant synergy between DI and race (interaction p&lt;0.0001): compared to White participants living in areas of low deprivation, Black participants living in areas of high deprivation had 106% (OR 2.06, 95%CI 1.96-2.16, p&lt;0.0001) higher risk of undiagnosed hypertension. In the whole cohort, undiagnosed hypertension was associated with a 34% (OR 1.34, 95%CI 1.12-1.62, p=0.002) higher risk of incident stroke when adjusting for prevalent hypertension and the remaining socioeconomic factors. Conclusion: High area deprivation and Black race are associated with a higher risk of undiagnosed hypertension. Undiagnosed hypertension is associated with a higher risk of ischemic stroke after accounting for prevalent hypertension diagnosis.

Abstract HUP1: Neighborhood Deprivation And Polygenic Contribution To Acute Ischemic Stroke: Results From The All Of Us Research Program

Background: The interaction between social determinants of health and genetic risk factors in causing acute ischemic stroke (AIS) is poorly understood. We hypothesize that community deprivation, a geographic metric that captures several social determinants of health, modifies the effect of genetic variation on risk of AIS. Methods: We analyzed data from All of Us , a large population study that aims to enroll one million Americans. We ascertained AIS cases using Observational Medical Outcomes Partnership codes. We evaluated community deprivation using the deprivation index, an aggregate variable derived from six metrics of the American Community Survey that was divided into tertiles. We modeled the polygenic contribution to AIS through a polygenic risk score that included 530 known genetic risk variants for cardiometabolic risk factors. We used multivariable logistic regression to model AIS risk as a function of community deprivation and polygenic risk, using product terms to test for interaction. Results: Out of 372,397 participants currently enrolled in All of Us , 147,492 had available genetic and deprivation index data, including 3,201 (2.2%) strokes. Both community deprivation and the polygenic risk score were independently associated with AIS risk (both p&lt;0.05). We found a significant interaction between community deprivation and polygenic risk (interaction p=0.02, Figure): the polygenic risk score was significantly associated with AIS risk in areas with low community deprivation (OR 1.08, 95%CI 1.02-1.15; p=0.01) but was not associated with this risk in areas of intermediate and high deprivation (both p&gt;0.05). Conclusion: Among study participants enrolled in All of Us, those living in areas of low community deprivation were more susceptible to the effects of polygenic variation. We speculate that in areas with high deprivation, several social determinants of health known to lead to higher risk of AIS dilute the contribution of genetic risk factors.

The August 2020 COVID-19 outbreak in Aotearoa, New Zealand: Delayed contact tracing for Pacific people contributes to widening health disparities

BackgroundAfter COVID-19 arrived in New Zealand, a national system was developed to improve the efficiency of contact tracing. The first outbreak was followed by a period of ‘COVID-19 elimination’, until a community outbreak occurred in August 2020. We describe the characteristics of cases and their contacts during this outbreak, focused on the results of contact tracing. MethodsCOVID-19 case data from the national surveillance database were linked to contacts from the national contact tracing database. Demographic and clinical characteristics of cases, number of contacts, and timeliness of contact tracing were analysed by ethnicity. FindingsMost of the 179 cases were Pacific people (59%) or Māori (25%), living in areas of high socioeconomic deprivation, who had higher rates of comorbidity and accounted for almost all (21/22) hospitalisations, all 8 ICU admissions and all 3 deaths. Only 6% belonged to the European majority ethnic group. Of 2,528 registered contacts, 46% were Pacific, 14% Māori and 19% European. Only contacts that were reached were registered. Overall, 41% of contacts were reached within 4 days of onset of disease of the case, which was significantly lower for Pacific (31%) than for other ethnic groups. InterpretationOur findings confirm the greater health burden that ethnic minorities face from COVID-19. The significant delay in the timeliness of care for Pacific people shows that the public health response was inequitable for those at highest risk. Tailored public health responses and better registration of marginalised groups are necessary to provide better access to services and to improve insights for optimal future outbreak management.

Abstract 32: Neighborhood Deprivation And Polygenic Contribution To Acute Ischemic Stroke: Results From The All Of Us Research Program

Background: The interaction between social determinants of health and genetic risk factors in causing acute ischemic stroke (AIS) is poorly understood. We hypothesize that community deprivation, a geographic metric that captures several social determinants of health, modifies the effect of genetic variation on risk of AIS. Methods: We analyzed data from All of Us , a large population study that aims to enroll one million Americans. We ascertained AIS cases using Observational Medical Outcomes Partnership codes. We evaluated community deprivation using the deprivation index, an aggregate variable derived from six metrics of the American Community Survey that was divided into tertiles. We modeled the polygenic contribution to AIS through a polygenic risk score that included 530 known genetic risk variants for cardiometabolic risk factors. We used multivariable logistic regression to model AIS risk as a function of community deprivation and polygenic risk, using product terms to test for interaction. Results: Out of 372,397 participants currently enrolled in All of Us , 147,492 had available genetic and deprivation index data, including 3,201 (2.2%) strokes. Both community deprivation and the polygenic risk score were independently associated with AIS risk (both p&lt;0.05). We found a significant interaction between community deprivation and polygenic risk (interaction p=0.02, Figure): the polygenic risk score was significantly associated with AIS risk in areas with low community deprivation (OR 1.08, 95%CI 1.02-1.15; p=0.01) but was not associated with this risk in areas of intermediate and high deprivation (both p&gt;0.05). Conclusion: Among study participants enrolled in All of Us, those living in areas of low community deprivation were more susceptible to the effects of polygenic variation. We speculate that in areas with high deprivation, several social determinants of health known to lead to higher risk of AIS dilute the contribution of genetic risk factors.

How do people who smoke perceive a tobacco retail outlet reduction policy in Aotearoa New Zealand? A qualitative analysis

BackgroundAotearoa New Zealand plans to greatly reduce tobacco retail outlets, which are concentrated in areas of higher deprivation and perpetuate health inequities caused by smoking and borne particularly by Māori....

Differences in physical activity participation among young adults in Aotearoa New Zealand

BackgroundThe purpose of this study was to examine socio-demographic differences in physical activity (aerobic and muscle-strengthening) among young adults (18–24 years).MethodsData collected between 2017–2019 as a part of Sport New Zealand’s Active NZ survey were examined using logistic regression analyses to determine the odds of participants meeting aerobic, muscle-strengthening and combined physical activity recommendations. Gender, ethnicity, employment/student status, disability status, and socio-economic deprivation were included as explanatory variables in analyses.ResultsThe proportion of young adults meeting recommendations varied according to physical activity type (aerobic:63.2%; strength:40.1%; combined:37.2%). Young adults not employed/studying had lower odds of meeting recommendations than those full-time employed (OR = 0.43 [0.34–0.54]). Physical activity levels differ according to gender and this intersects with ethnicity, employment/student status, and social deprivation. For example, the odds of Pasifika young adults meeting combined physical activity recommendations compared to Europeans were not different (OR = 0.95 [0.76–1.19]), but when stratified by gender the odds were significantly higher for men (OR = 1.55 [1.11–2.16]) and significantly lower for women (OR = 0.64 [0.47–0.89]. Similarly, young adults in high deprivation areas had lower odds of meeting combined physical activity recommendations than those in low deprivation areas (OR = 0.81 [0.68–0.95]), but this was mainly due to the difference among women (OR = 0.68 [0.54–0.85]) as there was no difference among men (OR = 0.97 [0.76–1.25]).ConclusionsIntersections between socio-demographic characteristics should be considered when promoting physical activity among young adults in Aotearoa New Zealand, particularly young adults not employed/studying, and young women who live in deprived areas or identify as Asian or Pasifika. Tailored approaches according to activity type for each of these groups are required.

Impact of removing prescription co-payments on the use of costly health services: a pragmatic randomised controlled trial

ObjectivesTo determine whether exempting people (with high health needs and living in areas of high deprivation) from a $5 prescription charge reduces hospital use.DesignTwo-group parallel prospective randomised controlled trial.SettingPeople living in the community in various regions of New Zealand.ParticipantsOne thousand sixty one people who lived in areas of high socioeconomic deprivation, and either took medicines for diabetes, took antipsychotic medicines, or had chronic obstructive pulmonary disease (COPD). Of the 1053 who completed the study, just under half (49%) were Māori. InterventionsParticipants were individually randomized (1–1 ratio) to either be exempted from the standard $5 charge per prescription item for one year (2020-2021) (n = 591) or usual care (n = 469). Those in the intervention group did not pay the standard NZ$5 charge, and pharmacies billed the study for these. Participants continued to pay any other costs for prescription medicines. Those in the control group continued to pay all prescription charges for the year although they may have received one-off assistance from other agencies.Main outcome measuresThe primary outcome was length of stay (hospital bed-days). Secondary outcomes presented in this paper included: all-cause hospitalisations, hospitalisations for diabetes/mental health problems/COPD, deaths, and emergency department visits.ResultsThe trial was under-powered because the recruitment target was not met. There was no statistically significant reduction in the primary outcome, hospital bed-days (IRR = 0.68, CI: 0.54 to 1.05). Participants in the intervention group were significantly less likely to be hospitalised during the study year than those in the control group (OR = 0.70, CI: 0.54 to 0.90). There were statistically significant reductions in the number of hospital admissions for mental health problems (IRR = 0.39, CI: 0.17 to 0.92), the number of admissions for COPD (IRR = 0.37, CI: 0.16 to 0.85), and length of stay for COPD (IRR 0.20, CI: 0.07 to 0.60). Apart from all-cause mortality and diabetes length of stay, all measures were better for the intervention group than the control group.ConclusionsEliminating a small co-payment appears to have had a substantial effect on patients’ risk of being hospitalised. Given the small amount of revenue gathered from the charges, and the comparative large costs of hospitalisations, the results suggest that these charges are likely to increase the overall cost of healthcare, as well as exacerbate ethnic inequalities.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001486213 registered on 04/09/2018.