Higher Income Brackets Research Articles

Patient access to precision medicine: Correlation of immune checkpoint inhibitor (ICI) usage in non-small cell lung cancer (NSCLC) with patient household income levels across multiple Asian markets.

e18629 Background: 1st line (1L) advanced/metastatic NSCLC patients wild-type (WT) for EGFR, ALK and ROS1 have been shown to benefit from treatment with ICIs, and these drugs have been incorporated into most treatment guidelines for this cancer. However, some patients cannot afford these costly treatment options, especially in countries where reimbursement coverage is partial/absent. This study uses real-world data to explore the correlation between monthly household income levels (MHHI) and ICI shares in Thailand, Indonesia, Vietnam, Taiwan and mainland China. Methods: Ipsos’ Oncology Monitor is a physician-reported syndicated patient record database. 532 cancer-treating physicians (Thailand = 37, Indonesia = 30, Vietnam = 80, Taiwan = 40, China = 345) were screened for specialty, role and caseload and submitted data on 1,134 1L WT stage IIIB/IV NSCLC patients (aggregate) with known MHHI. Data were collected (online + pen & paper) from July ’21 – June ’22. Results: In all 5 countries, a correlation was observed between MHHI and the percentage of WT patients in each cohort receiving an ICI as part of their current 1L therapy. In Thailand and Vietnam, share of ICIs was ≤10% for patients in the study earning < 39,999 THB and < 12,000,001 VND, respectively. This compared to an ICI share of 79% among the most affluent Thai patients ( > 1,000,000 THB) and 35% among the highest-income Vietnamese patients ( > 12,000,000 VND). In Indonesia, all 8 patients prescribed an ICI were in the highest income bracket ( > 10,000,000 IDR). In Taiwan, the correlation was less pronounced, but those earning < 40,000 NTD per household were still least likely to receive an ICI. In China, patients with a MHHI above 10,000 CNY were most likely to be given an ICI. Conclusions: Results from this study suggest that, among this cohort, there is a clear link between patient household income and likelihood to be prescribed an ICI across 5 different Asian markets. While all patients should have access to the most optimal treatment based on their diagnosis and molecular profile, this does not appear to be a reality in the clinical setting, based on data from this real-world evidence study in Asia. More must be done to ensure equal access to all, regardless of country of residence or income. [Table: see text]

Differential overall survival and treatment for non-dedifferentiated liposarcoma in academic and non-academic facilities: An NCDB analysis.

e23556 Background: Liposarcoma is a malignant soft tissue tumor sarcoma which most commonly arises in subcutaneous fat of the limbs and abdomen. Previous studies found overall survival and treatments to vary between patients treated at academic and non-academic facilities. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with non-dedifferentiated liposarcoma from 2004 to 2019 using the histology codes 8850, 8851, 8852, 8853, 8855, and 8857 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of the 15,256 patients queried, 72% were treated at an academic/research facility (AF). Patients treated at an AF had an improved median survival compared to a non-academic facility (NA) (184 months versus 154 months; p < 0.001). After controlling for stage, income, and therapy type, treatment at an AF was associated with an independent decrease in hazard (HR = .824; p < 0.001). AF patients disproportionately came from a higher income bracket and were more likely to carry private insurance. Additionally, AF patients were more likely to receive surgery, have margins with complete tumor resection, and receive adjuvant chemotherapy (p < 0.001). There were no significant differences in stage or metastasis at presentation between the two groups. Conclusions: Patients with non-dedifferentiated liposarcoma treated at an academic/research facility had improved overall survival, higher rates of surgery, higher rates of chemotherapy, and better surgical margins compared to patients treated at a non-academic facility.

Abstract 60: Low-Income is a Negative Prognostic Factor in Patients With MPNST: An NCDB Analysis

Abstract Purpose: Malignant Peripheral Nerve Sheath Tumors (MPNST) are a form of soft tissue tumor that forms from the Schwann cell lineage. Previous studies have noted that treatment at income is generally associated with improved survival in cancer patients. Thus, the objective of this study was to investigate the influence of patient income level on overall survival for patients with MPNST. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with MPNST from 2004 to 2019 using the ICD-O-3 histology code 9540. Median Income Quartiles were identified as assigned by the Commission on Cancer Accreditation program and re-classified into three categorical variables: high (HI= >$46,000) middle (MI =$30,000 – $45,999) and low (LI =<$29,000). Descriptive statistics and Kaplan Meier curves were used to measure survival in these patients and Chi-square analyses were used to evaluate differences in demographics. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: Of the 2222 patients with MPNST queried, 2,023 met selection criteria for Kaplan-Meier analysis. Patients in the high-income bracket experienced the longest median survival (83.6 months) compared to 47 and 37 months for the median- and low-income groups, respectively. A Log-Rank test found the difference in survival by income groups to be statistically significant. A Cox Proportional Hazards Model revealed that increased income was not significantly associated with decreased hazard (death), however being in the lowest income bracket was associated with a 41% increase in the relative risk of death (HR 1.41; 95% CI 1.19-1.67). Low-income patients did not present with more advanced disease, however, they experienced a longer average delay in the onset of treatment and were significantly more likely to be uninsured and of Black or Native American) race. Conclusion: This retrospective cohort study found that for patients with MPNST, low income was independently associated with inferior survival. These patients were more likely to be a minority race and presented with less insurance coverage. They thus experienced a longer duration between diagnosis and the initiation of therapy compared to patients with higher incomes. Citation Format: Jared Kennard, Marco Braaten, Peter Silberstein. Low-Income is a Negative Prognostic Factor in Patients With MPNST: An NCDB Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 60.

Measuring long-run housing affordability for Malaysian millennial households: a geospatial and income distribution analysis

PurposeThe purpose of this study is to use a lifetime income measure to evaluate the long-run housing affordability for an understudied cohort of households in the literature – the millennials. The authors do this in the context of Malaysia, measuring long-run affordability for four housing types across geographic locations and income distributions.Design/methodology/approachThis study calculates a long-run housing affordability index (HAI) using data on house prices and household incomes. Essentially a ratio of predicted lifetime incomes to house prices, the HAI is computed for four common housing types in Malaysia from 2005 to 2016 and for six states in the country. The HAI is also compared across four income percentiles.FindingsThe analysis reveals varying patterns of housing affordability among different states in Malaysia. Housing affordability has declined since 2010, with most housing types being unaffordable for millennial-led households with the lowest income. Housing is most affordable for those in the highest income bracket, although even here, there are pockets of unaffordable housing as well.Practical implicationsBased on the findings, this study proposes three targeted interventions to improve housing affordability for Malaysian millennials.Originality/valueThis study fills a gap in the literature by examining the long-run housing affordability of Malaysian millennial-led households based on both geographic location and income distribution. The millennial population is understudied in the housing affordability literature, making this study a valuable contribution to the field.

The economic contribution of the cultural sector in Brazil: an input–output approach with different income groups

Brazil is characterized by strong income inequality, which is naturally reflected in the consumption of goods and services. Such disparities in access are also reproduced in the artistic and cultural activities sector. Thus, understanding the cultural sector as key to the development of society, the present article evaluates the intersectoral impact of the artistic and cultural activities sector on other sectors of the Brazilian economy. First, this analysis identifies the effects of COVID-19, which allows us to determine how the sector is affected by such a shock in terms of output, employment and income. Subsequently, the relevance of the cultural sector is evaluated by identifying different family income groups with the 2015 input–output matrix published by the Brazilian Institute of Geography and Statistics (IBGE) and information from the Family Budget Survey (POF). The main results indicate that the COVID-19 pandemic, specifically, its effect on the cultural sector, reduced the production of cultural activities by 31.8%, equating to a loss of 237,701 jobs. This result indicates the relevance of the cultural sector for the Brazilian economy. In addition, we show that low income families, a group representing more than 70% of households, are responsible for only 28% of all Brazilian household consumption in the cultural sector. However, families in the highest income bracket, i.e. less than 3% of households, account for 22% of this sector. This result underscores the importance of developing public policies to stimulate consumption among low income groups, given that in addition to the cultural sector’s economic benefits, there are intangible benefits of cultural activity for society.

Financial Inclusion in Tanzania Determinants, Barriers, and Impact

Financial inclusion is vital in economic development as it empowers families and communities to meet basic needs, such as nutritious food, clean water, housing, education, and healthcare. Financial inclusion is also a tool for hedging against extreme weather events, disasters, and health crises such as the COVID-19 pandemic. Moreover, access to financial services has the potential to alleviate poverty, reduce income inequality, and stimulate economic growth and development. However, there is limited literature regarding the impact of financial inclusion at the household level. According to the latest World Bank Global Findex, the number of financially included adults has risen substantially in Tanzania due to the introduction of mobile money and baking financial inclusion. Based on Tanzania World Bank's Global Findex micro-data set for 2011, 2014, and 2017 surveys, this study uses the ordered probit regression model with endogenous treatment assignment to evaluate factors influencing financial inclusion and estimate the impact of financial inclusion on income in Tanzania. The available literature guided us in selecting the independent variables to include in the financial inclusion and impact models. The applied model allows for correcting for self-selection bias and endogenous effects associated with financial inclusion and income. Self-selection bias can occur when individuals choose whether to participate in a program based on their socioeconomic and demographic circumstances. Due to self-selection, participants often differ from nonparticipants in ways significant to the research, leading to a biased sample, which affects the generalizability of the research results. The results show that formal education and lack of money are the most crucial factor influencing financial inclusion and exclusion. Moving from financial exclusion to inclusion increased the probability of being in the higher income brackets. Personal finance education programs geared towards the most vulnerable groups would improve financial inclusion and income in Tanzania. Results from this study indicate that financial inclusion has a positive impact on income, and thus, it is crucial to enhance the scope coverage via more extensive and swift channels, such as mobile money and baking. Enhanced financial inclusion in Tanzania will lead to higher and quicker integration of the excluded community members into formal financial systems, thereby maximizing the effects of financial inclusion on the poor and the country's economic growth.

Internet-Based Germline Genetic Testing for Men With Metastatic Prostate Cancer.

Germline mutations in DNA repair genes are present in approximately 10% of men with metastatic prostate cancer (mPC), and guidelines recommend genetic germline testing. Notable barriers exist, including access to genetic counseling, insurance coverage, and out-of-pocket costs. The GENTleMEN study was designed to determine the feasibility of an Internet-based, patient-driven germline genetic testing approach for men with mPC. In this prospective cohort study, men with mPC provided informed consent via an Internet-based platform and completed a questionnaire including demographics and family cancer history. Supporting medical data were also collected. Genetic testing was performed using the Color Genomics 30-gene targeted panel of cancer predisposition genes on a mailed saliva sample. Men whose test results identified a germline pathogenic or likely pathogenic variant received results by phone or telehealth genetic counseling; other participants received results by email with an option for phone-based or telehealth genetic counseling. As of August 18, 2021, 816 eligible men were consented, of whom 68% (551) completed genetic testing, and 8.7% (48 of 551) were found to carry a pathogenic or likely pathogenic variant in a germline DNA repair gene: CHEK2 (17), BRCA2 (15), ATM (6), NBN1 (3), BRCA1 (2), PALB2 (2), PMS2 (2), and MSH6 (1). Participants were more likely to complete the testing process if they were non-Hispanic White, married, highly educated, or from a higher-income bracket. Here, we show the feasibility of delivering germline (inherited) genetic testing by a voluntary, patient-driven, Internet-based platform to men with mPC. Preliminary results show rates of germline DNA repair mutations, consistent with other cohorts. Although feasible for some, reduced steps for participation, more dedicated diverse outreach and participant support, and identification and addressing of additional barriers is needed to ensure equitable access and optimization.

A DYNAMIC PROFILE OF GREEN CONSUMERS

Consumers are showing a growing awareness of the environmental impact of their consumption choices and in response to this trend firms are increasingly including environmentally friendly options in their product portfolios. To develop marketing strategies that increase demand for these products, it is important for firms to have a good understanding of who green customers are and how the green consumer profile is evolving. This study uses household-level purchase data from the years 2013 and 2018 to examine the household characteristics that predict the preference for environmentally friendly products and provide insight into how this profile is changing over time. The results highlight younger, more educated households in high income brackets to be more likely to prefer green products. In terms of dynamics, the findings suggest a widening of the age gap in green consumption, with younger consumers increasingly adopting eco-friendly options, while consumers above the age of 45 appear reluctant in green product adoption.

Factors associated with meeting physical activity guidelines during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic impacted individual physical activity levels. Less is known regarding how factors such as sociodemographic and built environment were associated with physical activity engagement during the pandemic. Understanding these factors is critical to informing future infectious disease mitigation policies that promote, rather than hinder physical activity. The purpose of this study was to assess predictors of physical activity levels during the beginning of the pandemic (April-June 2020), including Stay-at-Home length and orders, neighborhood safety, and sociodemographic characteristics.MethodsData included 517 participants who responded to an anonymous online survey. Physical activity was assessed with a modified Godin Leisure-time exercise questionnaire. We used logistic regression models to estimate unadjusted and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) for the associations between independent variables (e.g., demographic variables, neighborhood safety, COVID Stay-at-Home order and length of time) and physical activity levels that did not meet (i.e., < 600 metabolic equivalents of task [MET]-minutes/week) or met guidelines (i.e., ≥ 600 MET-minutes/week). We used R-Studio open-source edition to clean and code data and SAS V9.4 for analyses. ResultsMost participants were 18–45 years old (58%), female (79%), Hispanic (58%), and college/post-graduates (76%). Most (70%) reported meeting physical activity guidelines. In multivariate-adjusted analyses stratified by income, in the highest income bracket (≥ $70,000) pet ownership was associated with higher odds of meeting physical activity guidelines (aOR = 2.37, 95% CI: 1.23, 4.55), but this association did not persist for other income groups. We also found lower perceived neighborhood safety was associated with significantly lower odds of meeting physical activity guidelines (aOR = 0.15, 95% CI:0.04–0.61), but only among individuals in the lowest income bracket (< $40,000). Within this lowest income bracket, we also found that a lower level of education was associated with reduced odds of meeting physical activity guidelines.DiscussionWe found that perceived neighborhood safety, education and pet ownership were associated with meeting physical activity guidelines during the early months of the COVID-19 pandemic, but associations differed by income. These findings can inform targeted approaches to promoting physical activity during subsequent waves of COVID-19 or future pandemics.

The relationship between lower extremity amputation and body mass index.

Non-traumatic lower extremity amputation (LEA) is associated with significant morbidity and mortality. Diabetes mellitus (DM) and peripheral vascular disease (PVD) are associated with increased risk for LEA. As such, DM and PVD account for 54% of all LEA's, performed in the United States annually. As obesity is highly associated with both DM and PVD, our study sought to explore the relationship between LEA and obesity defined by BMI. Using the National Inpatient Sample (NIS) database, a retrospective review of patients who underwent non-traumatic LEA (LEA) between 2008 and 2014 was performed. The International Classification of Diseases 9th edition (ICD-9) codes were utilized to determine the diagnoses, comorbidities, and procedures. Patient BMIs were classified as follows: Non-obese [BMI <30], Obesity class I [BMI 30-34.9], Obesity class II [BMI 35-39.9], and Obesity class III [BMI ≥40]. Predictors for LEA were compared between groups using chi-square test and binary logistic regression to identify possible underlying factors associated with LEA. We also conducted a multivariate analysis to measure the effect of multiple variables on LEA. We identified 16,259 patients with non-traumatic LEA and a mean age of 59.9 years. Rate of amputation in females was lower than males at 0.35% vs 0.87% respectively (p < 0.001). Of patients that underwent amputation there was a V-shape trend based on BMI, with 30.4% in non-obese patients, 18.2% in obesity class I, 17.3% in obesity class II, and 34.1% in obesity class III. The incidence of diabetes increased with obesity class, while the incidence of PVD decreased. Interestingly, of those with DM there was an inverse relationship between amputation rate and BMI class, with LEA rates in non-obese versus obesity class III patients were 1.63% vs 0.98% respectively (p < 0.001). Similarly, patients who had both diabetes and PVD showed a downward trend in LEA rate as obesity class increased; non-obese patients had a LEA rate of 8.01%, while obesity class III had 4.65% (p < 0.001). Patients in higher income bracket have lower odds of LEA (OR 0.77, p < 0.001) compared to the lowest income patients. Also, patients with comorbidities such as PVD (OR 10.78), diabetes (OR 5.02), renal failure (OR 1.41), and hypertension (OR 1.36) had higher odds to get an LEA (p < 0.001). Individuals with obesity class III are almost at half the odds (OR 0.52) to get an LEA compared to non-obese (p < 0.001). Higher BMI and female gender are protective factors against lower extremity amputation. Factors that predisposing to LEA include lower household income and certain comorbidities such as PVD, diabetes, renal failure, and hypertension. These findings warrant further research to identify patients at high risk for LEA and help develop management guidelines for targeted populations.

Nationwide disparities in transportation related delays to care experienced by children with frequent ear infections

BackgroundAcute otitis media (AOM), or ear infection, is the most common reason for pediatric medical visits in the United States [1]. Additionally, transportation barriers are a significant driver of missed and delayed care across medical specialties [2,3]. Yet, the role of transportation barriers in impeding access for children with frequent ear infections (FEI) has not been investigated. Assessing the prevalence of transportation barriers across sociodemographic groups may help clinicians improve outcomes for children with FEI. MethodsA retrospective analysis of the U.S. National Health Interview Survey was completed to examine associations between sociodemographic characteristics among children with FEI and transportations barriers to seeking care between 2011 and 2018. ResultsMultivariable logistic regression found that income level, insurance status, and health status were linked to disparities in transportation barriers among children with FEI. Those in the middle (aOR 3.00, 95% CI 1.77–5.08, p < 0.001) and lowest income brackets (aOR 6.33, 95% CI 3.80, p < 0.001), who were publicly insured (aOR 3.24, 95% CI 2.00–5.23, p < 0.001) or uninsured (aOR 3.46, 95% CI 1.84–6.51, p < 0.001), and with Poor to Fair health status were more likely to face transportation delays than patients who were in the highest income bracket, privately insured, or had Good to Excellent health status. ConclusionChildren with FEI from families that were lower-income, less insured, and less healthy faced more transportation barriers when accessing care than their counterparts. Future interventions to improve health-related transportation should be targeted toward these patient subgroups to reduce gaps in outcomes.

Self-reported cultural competency measures among patients with diabetes: A nationwide cross-sectional study in the United States

Culturally tailored interventions may reduce disparities in diabetes care. We conducted a nationally representative assessment of self-reported cultural competency measures of care among patients with diabetes in the United States. The 2017 National Health Interview Survey was queried for adults with self-reported diabetes. Sample weight-adjusted multivariable logistic regressions defined adjusted odds ratios and 95% confidence intervals of a positive response to each of the cultural competency measures while controlling for relevant sociodemographic variables. 2,448 adults were included in the analyses. Black, Latinx, and Asian respondents had greater odds of and individuals with the highest income level had lower odds of placing greater importance in sharing cultures with their provider. Black and Latinx individuals had lower odds of reporting encountering providers who shared or understood their cultures. Asians had lower odds of and respondents aged 40-64 and 65 years and older had greater odds of reporting frequently being treated with respect by their providers. Non-English speakers had lower odds of and individuals from higher income brackets had greater odds of reporting frequently receiving easy-to-understand information about their care. Blacks and respondents not part of the workforce had greater odds of reporting frequently being asked about their opinions or beliefs in care. Disparities in self-reported provider cultural competency measures exist among cultural minorities in the United States. Our findings may inform efforts to reduce disparities and improve care among minorities with diabetes. No funding was used in the preparation of this work.

Scrutiny of income related drivers of energy poverty: A global perspective

This paper intends to explore the roles of a variety of income-related attributes of the problem of energy poverty which should be considered in the policy-making for alleviating various constraints for essential access of the people to useable energy. This inquiry scrutinizes the drivers of energy poverty in the settings of development stages by using the data of 190 countries grouped under low-income, middle-income, and high-income brackets from 1991 to 2019. For being a multifaceted issue, this study adopts the definition of access to modern energy facilities in the form of electricity consumption as a popular proxy for energy poverty. The empirical model conducts advanced panel cointegration methods i.e., panel ARDL based on pooled mean group and panel quantile regression. The findings of the study illustrate that the influence of different factors on access to electricity is heterogeneous along with the three panels of countries. The derived heterogeneity of employment, inflation, GDP, education, stock market returns and liquid liabilities over energy poverty is due to the diversified demographics of the low-income, middle-income, and high-income countries. The study found that the stage of economic development is a key factor in the determination of energy poverty, and this has important policy implications at the global level while accounting for the income attributes of the relevant countries.

Greater Stress Level Fluctuation in Lower Income Earners since onset of Coronavirus Pandemic

Natural disasters, mental illnesses, injuries, and crime are all known factors that lead to stress (Casarella 2020). People were in various levels of confinement due to Coronavirus all over the world, leading to job loss and inability to finance basic living expenses. This study evaluated the relationship between stress and income by surveying different socioeconomic groups. All the participants took anonymous PSS (Perceived Stress Scale) and SRRS (Social Readjustment Rating Scale) test that included questions about race, age range, income range, and the number of times they think about Coronavirus each day. Dr.Cohen's 2009 PSS score samples of the American population were used as a baseline measurement for the pre-Coronavirus stress score levels. The stress level fluctuation was calculated by subtracting participants' survey scores from Cohen's scores to determine the overall stress level change. A p-value of 0.00000001196 for the lower-income group (&lt;$30k/yr) and a p-value of 0.01214 for the higher income group (&gt;$91k/yr) was obtained using the independent-t-test. These p-values supported the alternative hypothesis proposed in this study that there is a more significant change in the stress levels spanning the onset and duration of the Coronavirus pandemic in members of a lower socioeconomic bracket (&lt;$30,000/yr) than of people in a higher income bracket (&gt;$91,000/yr). The results revealed that the PSS score of the 65 years and older group had increased the most and no significant difference in stress scores between racial groups. Additionally, people who think about Coronavirus more frequently have higher PSS scores.

Investigating the decrease in participation in the Dutch cervical cancer screening programme: The role of personal and organisational characteristics.

Declining attendance in the Dutch cervical cancer screening programme was recently observed, coinciding with preparations for implementing primary hrHPV-based screening, which was implemented in January 2017. We aimed to investigate which factors were related to decreased attendance. We conducted a population-based cohort study including all women aged 30 to 60years who were eligible for screening between 2014 and 2018. Attendance was defined as participation in the screening programme within 15months of the start of the invitation-eligible year. We used data from the Dutch pathology archive (PALGA) linked with data from Statistics Netherlands to investigate population characteristics (position in the household, household income, socio-economic status, number of people in the household, migration background, age) and data from the five Dutch screening organisations (SO) to investigate the effect of cessing self-inviting GP's ('inviting organisation'). SO's were termed SO 1 to 5. Higher attendance rates were observed in women who were employed (60.8%), married (62.9%), Dutch (61.2%), in the highest income bracket (63.4%), living in households with four persons (65.3%) and women who were invited by their GP (69.8%). Differences in personal characteristics did not explain the decline in attendance rates. By adjusting for whether the GP or the SO sent the invitation, the differences in attendance rates between 2014 and 2015 and 2016 and between 2014 and 2015 and 2017-2018 were explained in some screening organisations. Removing the possibility for GPs to send invitations explains some of the decline in participation, although this did not account for the total change in attendance.

Race, Income, and the Timeliness of Cleft Palate Repair in the United States.

ObjectiveTo determine if differences exist in the timing of cleft palate repair with respect to sex, race, income, and geographical location within the United States.DesignRetrospective cross-sectional study using the Kids’ Inpatient Database (KID) from 1997 to 2009.SettingInpatient.PatientsChildren with cleft palate with or without cleft lip undergoing inpatient cleft palate repair.Main outcome measuresAge at the time of palatoplasty (in months) by sex, race, income quartile, and geographic location.ResultsA total of 7,218 children with cleft palate underwent repair at a mean age of 12.1 months (95% CI 12.0-12.3). Females underwent palatoplasty at an older age (13.6 months) than males (13.2 months), a difference of 0.47 months (SE: 0.19, p=0.015). White children underwent surgery at an earlier age (12.1 months) than Black (12.9 months) (difference: 0.73 months, SE: 0.37, p=0.045), Hispanic (12.7 months) (difference: 0.57 months, SE 0.25, p=0.025), and Asian children (15.7 months) (difference: 3.60 months, SE 0.49, p<0.0001). Asian children were also found to undergo repair later than Hispanic (difference 3.03 months, SE 0.51, p<0.0001) and Black (difference: 2.87 months, SE 0.59, p<0.0001) children. Patients born into the highest income brackets were repaired 0.75 months earlier than those in the lowest bracket (SE: 0.26, p=0.005). Patients in the Midwest underwent palatoplasty later (14.3 months) than in the Northeast (12.9 months) (difference: 1.36 months, SE: 0.31, p<0.0001), South (13.2 months) (difference: 1.05 months, SE: 0.36, p=0.004), and West (13.2 months) (difference: 1.09 months, SE: 0.32, p=0.0007).ConclusionsAfter controlling for confounding factors, our results suggest that in recent history, Black, Hispanic, and Asian children with cleft palate were repaired later than their White counterparts. In addition, children of affluent families were repaired earliest, and economically disadvantaged children were repaired later than their peers.

Maternal Care Utilization in Primary Healthcare Centers in Nigerian Communities.

This study investigated maternal care utilization in Primary Healthcare Centers (PHCs) in four rural communities in Ughelli North LGA, Delta State, Nigeria. The study is a cross-sectional household survey that used a structured questionnaire to elicit information from 398 women within the reproductive ages. The data were analyzed with descriptive and multivariate statistical methods. The data revealed that 67.1% of currently pregnant women utilized ANC in PHCs, 55.7% of women who reported recent birth delivered in PHCs and 30.9% delivered outside health institutions. The odds for delivery care utilization in PHCs were significantly lower for women who reported at least secondary education [aOR: 0.50; 95% CI: 0.221.16] and those on the highest income bracket N(15,000-99,000) [aOR: 0.08; 95% CI: 0.000.82]. Poor quality of care accounts for the highest proportion of the reasons why some women refrained from utilizing maternal care in PHCs despite proximity. Delta State government should put in place measures to upgrade PHCs in the rural part of the State.

Socio-Demographic Factor and Selected Buying Behavioral Attributes of Purchasing Convenience Food: Multiple Correspondence Analyses to Explore the Relationship

The objective of the study is to establish the relationship between socio demographic factors and buying behavior attributes towards convenience food. The present study is cross sectional in nature. Correspondence analysis method has been used to explore the relationship between socio- demographic factor and attribute associated with packaged food buying behavior. The correspondence analysis helps in evaluating the consumer preference of numerous qualitative parameters. The socio- demographic characteristics includes education, occupation, household size, age and income. The study was conducted in Bhubaneswar and the primary data was extracted from 711 respondents. The data is nominal in nature. The respondents are student, service people, businessmen and few housewives. The entire data was collected through Google form. The results of correspondence analysis suggest that there is significant relationship between socio-demographic factor and food preference attributes towards convenience food depicted through correspondence map. The young and less educated people prefer taste n flavor, variants, convenience, affordability, quick preparation and higher shelf life in packaged food item. On the contrary people with high age and in high income bracket prefer healthiness, food safety and strictly observe food labeling while purchasing. Such people prefer home cooked meal.

Social trust as an individual characteristic or societal property?

ABSTRACT This study aimed to predict individual social trust with both individual- and country-level characteristics. We hypothesized that individual social trust will be affected by human values at the individual level and cultural characteristics at the national level. The hypotheses were verified by a multilevel analysis of data from the World Values Survey Wave 5 (2005–2009) and Wave 6 (2010–2014) covering 64,548 individuals in 45 countries. It was found that among individual values, universalism, stimulation, power, and self-direction were positively related to individual social trust. Factors that were negatively associated were security and achievement. Among the cultural dimensions, individualism was positively related to social trust, whereas uncertainty avoidance was negatively associated. Among the respondents, those who were older, more educated, and in higher income brackets showed higher levels of social trust. The findings here indicate that social trust is not only an individual property but also a property of society.

Who Participates in Urban Agriculture? An Empirical Analysis†

AbstractA few highly publicized food supply chain disruptions early in the COVID‐19 pandemic were interpreted by some as evidence of a “broken” food system. One solution often brought in response to that perceived brokenness is urban agriculture. The literature, however, has sidestepped a key question: Who practices urban agriculture? Using survey data on 882 Montreal residents, we find that those who practice urban agriculture are more educated, and more likely to be homeowners and to report an income in the highest income bracket. This is consistent with urban agriculture being a luxury good.