High-income Groups Research Articles

Postpartum Care by Midwives: Socioeconomic Status has a Strong Influence on the Amount of Care Received An Analysis with Routine Data from BARMER Health Insurance

Socio-economic situation is associated with inequalities in access to health care and health-related resources. This also applies to pregnancy, birth and the postpartum period. Compared to other European countries, Germany has very good care options for the postpartum period. It has an unique system of postpartum care, which comprises home visits by midwives for 12 weeks after birth and beyond in problem cases and thus has structurally good care options. So far, however, there are hardly any studies based on routine data that show which mothers receive homevisits in postpartum care and to what extent. The study population comprised 199,978 women insured with BARMER who gave birth to at least one child in the years 2017-2020. Some women were pregnant several times in this period of time. The services billed by freelance midwives for outreach midwifery care in the puerperium were considered for 227,088 births, taking into account the socioeconomic situation of the mothers. According to the definition of the German Institute for Economic Research, 26% of the mothers belonged to a low income group, 46% to a medium income group and 29% to a high income group. Similar to what was shown for midwifery care during pregnancy, large differences were also found with regard to postpartum care: While 90.5% of the women with a high income received home visits, only 83.5% of women with a medium income did so, and only 67.9% of women with a low income. The groups did not differ with regard to other characteristics such as rate of caesarean section, preterm births, twins, age or concomitant diseases to an extent that could explain the differences in care. Women who had received midwifery services in pregnancy were much more likely to receive home visits by a midwife in the postpartum period. Furthermore, there was a correlation with the density of midwives in the respective region. The results suggest that access to home-based postpartum care by freelance midwives is significantly limited for low-income women. In contrast to antenatal care, women in the postpartum period cannot switch to other service providers, as outreach postpartum care is a reserved activity of midwives. Women with low incomes thus receive less midwifery care, although they have a higher need for support (Eickhorst et al. 2016).

Prevalence of maternal depression and anxiety symptoms and associations with child mental health outcomes in rural Nepal.

This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well-understood in rural, community-based settings in low- and middle-income countries (LMIC). A sample of 347 women with children under 5 years was recruited in September 2019 for a cross-sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1-3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02-5.84). In contrast, there was no association between maternal anxiety and child outcomes. Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low-resourced and community-based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post-infancy, emphasising the importance of improving maternal mental health in the early years of a child's life.

Ours to eat and own: assessing the feasibility of a cooperative meal-kit service to improve food access.

Although typically serving higher income and younger demographic groups, meal-kit subscription services have the potential to improve food availability and dietary quality in communities experiencing low food access due to systemic discrimination. This study describes the development and characteristics of a pilot community-led meal-kit service (SouthEats) and evaluates key implementation outcomes of adoption, acceptability, and feasibility among households experiencing less income. We utilised a mixed methods study design, including data from administrative records, customer surveys and worker interviews. Thematic qualitative analyses and descriptive quantitative analyses were conducted to illuminate the characteristics and extent the pilot meal-kit service was adopted, acceptable, and financially feasible among the target populations. The study took place in Washington DC, USA. Study participants included SouthEats consumers (n 35) and workers (n 3). During the pilot period, sixty-seven community members signed up for the meal-kit service, with 52 % making recurring purchases. Our results suggest that the meal-kit service is acceptable among people living in low food access areas. Our feasibility analysis indicates that, although not without challenges, the SouthEats model could be financially feasible. These preliminary insights can inform the scalability and potential replication of this service and provide foundational evidence for an approach that may be used to improve food access.

Oral COVID-19 Antiviral Uptake Among a Highly Vaccinated US Cohort of Adults With SARS-CoV-2 Infection Between December 2021 and October 2022.

We described the oral nirmatrelvir/ritonavir (NMV/r) and molnupiravir (MOV) uptake among a subgroup of highly vaccinated adults in a US national prospective cohort who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 12/2021 and 10/2022. We estimate antiviral uptake within 5 days of SARS-CoV-2 infection, as well as age- and gender-adjusted antiviral uptake prevalence ratios by antiviral eligibility (based on age and comorbidities), sociodemographic characteristics, and clinical characteristics including vaccination status and history of long coronavirus disease 2019 (COVID). NMV/r uptake was 13.6% (95% CI, 11.9%-15.2%) among 1594 participants, and MOV uptake was 1.4% (95% CI, 0.8%-2.1%) among 1398 participants. NMV/r uptake increased over time (1.9%; 95% CI, 1.0%-2.9%; between 12/2021 and 3/2022; 16.5%; 95% CI, 13.0%-20.0%; between 4/2022 and 7/2022; and 25.3%; 95% CI, 21.6%-29.0%; between 8/2022 and 10/2022). Participants age ≥65 and those who had comorbidities for severe COVID-19 had higher NMV/r uptake. There was lower NMV/r uptake among non-Hispanic Black participants (7.2%; 95% CI, 2.4%-12.0%; relative to other racial/ethnic groups) and among individuals in the lowest income groups (10.6%; 95% CI, 7.3%-13.8%; relative to higher income groups). Among a subset of 278 participants with SARS-CoV-2 infection after 12/2021 who also had a history of prior SARS-CoV-2 infection, those with (vs without) a history of long COVID reported greater NMV/r uptake (22.0% vs 7.9%; P = .001). Among those prescribed NMV/r (n = 216), 137 (63%; 95% CI, 57%-70%) reported that NMV/r was helpful for reducing COVID-19 symptoms. Despite proven effectiveness against severe outcomes, COVID-19 antiviral uptake remains low among those with SARS-CoV-2 infection in the United States. Further outreach to providers and patients to improve awareness of COVID-19 oral antivirals and indications is needed.

Costs of major depression covered / not covered in British Columbia, Canada

BackgroundMajor depressive disorder (MDD) is one of the world’s leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness.MethodsWe performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions.ResultsThere were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53–104 unless MDD was refractory to treatment ($125/week between week 12–52 and $101/week over weeks 53–104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached − 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII − 0.07 to 0.6).ConclusionsMDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.

Wage Differentials Among Reverse Migrants: Analyzing the Social Reproduction of Inequalities During the Post-COVID Recovery

Income inequalities that have traditionally been high in India, witnessed a widening of the wedge as the pandemic struck. Interestingly, this wedge widened further as the recovery began, those in high income groups reverted to their original income levels while those in low income groups were left struggling at decreased wages. This paper is an attempt to examine if the post pandemic economic recovery mirrored the existing pattern of inequalities amongst various social groups. The study is based on a case study of a small town in the Raebareli district of Uttar Pradesh, and the data is collected from a primary survey of the migrants who had returned back to their home town in the aftermath of pandemic. Hypothesis tested is that the rate of recovery from pandemic-induced income loss is consistent among similarly skilled workers, regardless of their social group affiliation.The results indicate that the loss of income is not uniform across categories, and that it is more severe in case of vulnerable groups. We argue that if there is no affirmative action, the inequalities will keep reproducing themselves and become more severe after every shock that the economy faces.

Disparities in Cancer Incidence across Income Levels in South Korea.

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.

Before dinner: The health value of gaseous fuels

In this paper, we study the impact of gaseous fuels used for cooking on the middle-aged and elderly's health in China. By using 2011, 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), we find that gaseous fuel use reduces the probability of respiratory disease in middle-aged and elderly adults. Health effects are stronger for the people aged between 45 and 79, female, high-income, urban, and gas-importing province groups. The quantification of health benefits allows to find that from 2010 to 2018, the reduction in the number of respiratory illnesses due to gaseous fuel use ranges from 22.905 to 23.721 million people, resulting in treatment cost savings of between 9.29 and 14.47 billion RMB ($26.4 - $34.2 billion). The monetary valuation of indoor clean air according to self-rated health find that for each additional unit of indoor clean air, middle-aged and elderly adults are willing to pay a price of 4.5 RMB ($1.06). We provide new evidence of the considerable health and welfare effects of gaseous fuels.

Payout Phase of Defined Contribution Systems: the Case of Slovakia

The paper aims to assess various aspects concerning the payment phase of the old-age pension scheme, the socalled second pillar of the pension system in Slovakia. However, the conclusions may also be useful for other pension systems. Using the Lee-Carter model and standard actuarial methods, we conclude that the second pillar is advantageous for the high-income groups or in case of high performance of pension funds. We also address the issue of deferring the purchase of a lifetime annuity. Deferral can be beneficial when the yield of the pension fund exceeds a certain threshold value. This threshold usually raises with increasing age. We argue that the temporary pension is a disadvantageous product and its recent cancellation is correct. The main contribution of the paper subsists in a three-state model of long-term care insurance, using which we calculate corresponding replacement rates. Combined with a lifetime annuity, long-term care insurance can be beneficial.

Linkage, sectoral productivity, and employment spread

This study demonstrates how differences in the prefectural input–output (IO) multiplier and sectoral total factor productivity (TFP) translate into aggregate income differences across prefectures within a country. Furthermore, this study investigates the job creation generated from the IO multiplier and TFP relationship and considers expenditure in the high-income group.Our results show that aggregate multipliers substantially amplify average sectoral TFP by propagating through the IO network. However, as log TFP levels and multipliers are negatively correlated, sectors with high multipliers have below-average productivity levels, which reduces income per worker because key inputs to downstream sectors are expensive. The overall effect of the IO structure is dampened relative to the aggregate multiplier effect. For example, the commerce sector has large multipliers in many prefectures and is thus amplified through the IO network, but their TFPs are lower and do not significantly contribute to the increase in income. The TFPs of the information and communication equipment sector in certain prefectures are higher than those in Tokyo, but the benefits are not amplified well within the prefecture because their multipliers are low.Furthermore, sectors with high productivity generate fewer jobs than other sectors do. The sectors with a large influence on job creation in other sectors are not amplified well through the IO network because of the small multiplier. From the expenditure viewpoint, the high-income group increases their education consumption exponentially, but the multiplier is low and not widespread within the prefecture. The construction sector has a significant influence on job creation in other sectors. However, their economic activities do not spread widely within a prefecture, and the high-income group does not increase housing consumption in proportion to their income. Residents in prefectures with high multipliers tend to spend more money outside their residential prefectures, such as online shopping. Thus, expenditure outside residential prefectures reduces the effect of the multiplier that amplifies the average sectoral TFP and the difference in income across prefectures.This study contributes to the existing literature by providing an explicit understanding of these relationships. Our findings make people realize that promoting the industry alone is not enough to increase income and generate highly productive jobs. A spillover perspective is required.

Analysis of the Phenomenon of Star Tax Evasion and Countermeasures for Governance

Against the backdrop of steady economic development in China, the quality of life of the people is constantly improving, and their spiritual needs are gradually increasing. The film and television industry has ushered in unprecedented development opportunities and produced superstars, forming a fan economy. Therefore, industry practitioners, especially film and television stars, have a relatively high-income level. However, due to the development of the film and television industry, there has been a mismatch in the personal income tax collection and management system, resulting in a significant loss of tax revenue. The frequent occurrence of high-income celebrities evading huge taxes indicates that there are certain loopholes in the personal income tax collection and management of high-income groups in China's film and television industry. This article is based on the problems discovered in the Zheng Shuang tax evasion case, delving into the issue of personal income tax collection and management, and proposing beneficial solutions. In response to the current issue of personal income tax collection and management in China's film and television industry, the following suggestions are proposed: optimizing the tax system, strengthening tax collection and management, and improving the tax related environment. Through the research in this article, we hope to provide some ideas for the tax authorities to strengthen the personal income tax collection and management of the film and television industry, and reduce the loss of personal income tax.

Switch or continue to use? An empirical investigation into mobile payment applications

ABSTRACT Using a push-pull mooring framework, this study investigates the diverse factors that influence users’ intention to switch and continue using mobile payment applications (apps). A survey comprising 180 respondents based in Hong Kong was conducted. The results demonstrate that users’ intention to switch is influenced by their dissatisfaction with system quality, perceived benefits, and social influence. Conversely, their intention to continue using their current mobile payment apps is associated with inertia. Furthermore, users who have used their current mobile payment app for three years or more comprise an active switching group, whereas those in the high-income group show the highest inertia and willingness to continue using it. These findings enrich the push-pull mooring framework by incorporating switching and continued use intentions, thus providing a more comprehensive understanding of the impact of social influence and other factors on user behaviors. Furthermore, this study provides insights into the impact of user characteristics on mobile payment app usage, which can benefit application providers in developing tailored promotions, referrals, and retention campaigns to meet the needs and expectations of different user groups.

Longitudinal associations between socioeconomic position and overall health of children with chronic kidney disease and their carers.

Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown. This prospective longitudinal study included 377 children, aged 6-18years with CKD (stages I-V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up. Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8-6.0), employed status of primary carers (1.7, 0.9-3.0), higher carer-perceived financial status (2.6, 1.4-4.8), and carer home ownership (2.2, 1.2-4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer's self-rated health over time (p = 0.005). The predicted probabilities for carers' overall health being 'very good' among lower income groups at 0, 2, and 4years were 0.43 (0.28-0.60), 0.34 (0.20-0.51), and 0.25 (0.12-0.44), respectively, and 0.81 (0.69-0.88), 0.84 (0.74-0.91), and 0.88 (0.76-0.94) for carers within the higher income group. Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

The effect of the COVID-19 pandemic on Malaysian residential customers’ energy-saving appliance purchasing behaviour

PurposeThe COVID-19 pandemic has caused a dramatic impact on energy supply and demand. It is vital to understand households’ behaviour with regard to energy, particularly during the pandemic, to deploy future sustainable energy systems. This study aims to investigate the nexus of Malaysian households’ energy consumption behaviour in relation to various electrical appliances, their energy-saving appliance purchasing behaviour and their current possession of energy-saving appliances during the pandemic, especially during the lockdown period, from the perspective of the energy cultures framework.Design/methodology/approachThe partial least squares structural equation modelling technique was used to test hypothesised relationships based on the 1,485 pieces of household data collected using an online and physical survey during the lockdown period in Malaysia.FindingsThe energy-saving behaviour cultivated due to the impact of the COVID-19 pandemic led to residential customers’ intentions to purchase energy-saving appliances which subsequently led to their current possession of energy-saving appliances. Indeed, energy-saving behaviours in the kitchen, entertainment, office, home lighting and cooling appliances have more than 77.4% influence on their purchasing behaviour. The consumer’s purchase behaviour for energy-saving appliances has a significant, partially mediating influence on the energy-saving behaviour of various electrical appliances and the consumers’ current possession of energy-saving appliances.Research limitations/implicationsThis study could be enhanced by improving the sample using a higher-income group and involving other parts of Malaysia such as the southern region. The findings do extend the energy cultures framework by demonstrating the mediating role of households’ energy-saving appliance purchasing behaviour on the relationship between their energy consumption behaviour in relation to various electrical appliances and their current possession of energy-saving appliances.Practical implicationsThe results of this study will help develop future action plans for transitioning to energy-saving appliance practices.Originality/valueThis paper examines the effects of the COVID-19 pandemic on future energy efficiency practices in developing countries from the perspective of the energy cultures framework.

Does environmental regulation limit the income growth of Chinese migrant population? Empirical evidence from the CHIPS

It is a controversial question of whether environmental regulation can achieve the double dividend of improving environmental quality and increasing employment and income. This paper takes Chinese migrant population as the main research object and uses the Chinese Household Income Projects data (CHIPS) and the emission data of major pollutants at the prefecture-level city jointly. Based on the classic Mincer wage equation, we investigate the impact and mechanisms of environmental regulation on the income of Chinese migrant population. The results show that: (1) The intensity of environmental regulation significantly improves the income level of the migrant population, and for every 1% increase in the intensity of environmental regulation, the wage income of the mobile population will rise by 4.96%. (2) The documented positive effect of environmental regulation is more significant in non-public firms, the eastern regions and high-skilled workers. Conversely, for the female and elderly group, 1% increase in environmental regulations will restrain their income growth by 4.95% and 0.37%, respectively. (3) The influencing mechanisms include both the direct effect of labor demand and the indirect effects of firm performance and technological innovation. (4) we find that 1% increase in environmental regulations respectively raise the income of the low- and moderate-income migrant population by 10.834% and 3.579%, while having no significant impact on the high-income group, thus reducing the income gap of the migrant population. The findings of this paper provide theoretical support and practical evidence for achieving a coordinated development of ecological environmental protection and income improvement for socially disadvantaged groups in China.

Parental Income Level and Risk of Developing Type 2 Diabetes in Youth

In recent years, the global incidence of type 2 diabetes in young people has increased, especially among minoritized, Indigenous, or financially disadvantaged populations. However, few studies have examined whether poverty is associated with increased risk of youth-onset type 2 diabetes. To examine the association of family income level with the risk of youth-onset type 2 diabetes. This nationwide, population-based retrospective cohort study used data from the 2008 National Health Insurance Research Database of Taiwan, with follow-up through December 31, 2019. Participants included children and adolescents aged 0 to 19 years. Data analysis was performed from June 9, 2022, to January 16, 2023. Family income, classified as very low, low, middle, and high. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the risks of youth-onset type 2 diabetes and all-cause mortality for all income groups vs the high-income group. The cohort included a total of 5 182 893 children and adolescents (mean [SD] age, 11.2 [5.2] years; 2 477 807 girls [48.3%]). The mean (SD) follow-up duration was 9.0 (0.3) years. The incidence rates of youth-onset type 2 diabetes were 0.52 cases per 1000 person-years for the very-low-income group, 0.40 cases per 1000 person-years for the low-income group, 0.35 cases per 1000 person-years for the middle-income group, and 0.28 cases per 1000 person-years for the high-income group. Children and adolescents from very-low-income (aHR, 1.55; 95% CI, 1.41-1.71), low-income (aHR, 1.34; 95% CI, 1.27-1.41), and middle-income (aHR, 1.27; 95% CI, 1.20-1.34) families had a significantly higher hazard of youth-onset type 2 diabetes than those from high-income families. Children and adolescents from very-low-income (aHR, 2.18; 95% CI, 1.97-2.41), low-income (aHR, 1.51; 95% CI, 1.42-1.60), and middle-income (aHR, 1.22; 95% CI, 1.14-1.31) families also had a significantly higher hazard of all-cause mortality than those from high-income families. Children and adolescents who were older, female, and obese and had dyslipidemia, gout, or psychiatric disorders had a significantly higher risk of youth-onset type 2 diabetes than children without those characteristics. This population-based cohort study showed that children and adolescents from very-low-income to middle-income families had a higher hazard of youth-onset type 2 diabetes and mortality than those from high-income families. Further research to reveal the factors underlying this association may improve the accuracy of identifying individuals at greatest risk for developing type 2 diabetes in youth.

문화복지의 쟁점과 문화의 복지적 역할

This paper aims at examining the significance and limitations of culture in welfare from the perspective of welfare, focusing on 2022 National Culture and Arts Activity Survey [abbreviated as 2022 Survey]. 2022 Survey shows that low-income group show more interest in improving the quality of works than cost, and that it is the high-income group that brings up the cost. The fact that low-income people have a high participation rate in cultural volunteering and clubs, showing their will and passion for culture and arts means that nostalgia for culture and arts is universal regardless of income. The welfare role of culture includes helping vulnerable group reflect on their lives, provide emotional comfort, discover hidden creativity, raise their intellectual level, and strengthen their sense of community integration. In this regard, this study is significant in that it has made it possible to supplement the weakening of welfare in cultural welfare and to rethink the quality of life based on the results of the 2022 Survey that expanded the cultural entertainment rate by income level.

The Impact Mechanism of Work Experience on the Income of Flexible Workers: Evidence from China

Numerous workers have adopted the flexible working approach due to its accommodating and job-sharing features, which play a key role in easing the employment pressure and maintaining socio-economic sustainability in China. This paper will study the impact of work experience on the income of flexible workers and the characteristics of impact mechanism. We use micro survey data from CFPS2020 to analyze flexible workers in China. This study found that, firstly, while the feature of flexible employment may be very different from formal employment, its relationship with work experience and income is as significantly correlated as it is for formal employment with a rise–fall, inverted U-shaped trend, but the return on work experience is lower than the employment level in the labor market. Secondly, there is an income gap between genders, especially in physical labor-intensive forms of flexible work; women can gradually narrow the gender income gap through continuous learning. Thirdly, the return on work experience in the older age group is lower than that in the youth group of flexible workers, and this may be due to the dynamic evolution of the elimination of existing work experience and the accumulation of new work experience. Fourthly, in contrast with the findings of the labor market as a whole, the trend of work experience return in flexible employment is reversed; the low-income group’s return rate of work experience is higher than that of the high-income group, and it can be seen that flexible employment is conducive to the development of new and young workers.

Treatment Outcomes with Hypomethylating Agents and Venetoclax for AML in the Community Compared to an Academic Setting

Background: The treatment of acute myeloid leukemia (AML) in older and/or unfit patients consists of a combination of a hypomethylating agent (HMA), such as decitabine and azacitidine, with venetoclax, which can be safely administered in the ambulatory setting. In this study, we aimed to compare the outcomes of the treatment of patients with AML who received chemotherapy with venetoclax and an HMA in an ambulatory setting at an academic center or at a community practice with academic center support. Methods: This was a retrospective review of patients with de novo or relapsed/refractory AML treated with a combination of venetoclax and either decitabine or azacitidine between February 2018 and June 2023. Patients were included if they received treatment at an academic center or if they received their treatment at a community practice with ongoing consultation at an academic center. Drugs were administered per the standard of care and local practice. The primary objective was to evaluate the overall response rate (ORR). Secondary objectives were to evaluate differences in chemotherapy management between locations, potential socioeconomic disparities, and to identify adverse events that affect the dosing or administration of therapy. Results: A total of 129 patients received venetoclax plus HMA for AML for a minimum of one cycle as seen in table 1. Of these patients, 77 (60%) received treatment at an academic center, and 52 (40%) received treatment in the community setting. The average age at treatment initiation was 67 years. Disease risk was stratified according to the 2022 European LeukemiaNet (ELN) guidelines. While not statistically significant, there was a tendency for more patients at the academic center to have adverse risk disease (77.9% vs. 69.2%, p=0.364). They were also more likely to have had exposure to a previous HMA (n=10 vs. n=7, p=1) and prior AML treatment (n=20 vs. n=17, p=0.529). Additionally, patients were more likely to have been diagnosed with secondary AML in an academic setting (n=29 vs. n=18, p=0.868). In a multivariate Cox regression model, patients in the middle- and high-income groups, defined as a median household income greater than $52,000, had a 17% lower relative risk regarding survival probability than those in the lower-income group (HR=0.83, 95% CI 0.39-1.73, p=0.622). Overall, patients in the academic setting had a 33% higher relative risk regarding survival probabilities than the community-treated with covariate consideration of performance status, ELN risk, poverty status and exposure to prior-treatments (HR=1.33, 95% CI 0.78-2.26, p=0.285). The OS of all patients was 9.67 months (95% CI 8.33-12.7), with no significant difference between the groups as seen in figure 1. Additionally, the overall response rates (ORR) of the two groups were similar at 38.5% (n=20) and 35.1% (n=27) in community and academic settings, respectively. The complete remission (CR) rate in the community was 11%, while there was an increase of 18% in the academic setting. There were also increased CR rates in the academic compared to the community setting after cycle 1 (4.7 vs. 2.9%, p=0.33), cycle 2 (11.1 vs. 4.8%, p=0.858), and cycle 3 (18.2 vs. 0%, p=0.27). Adverse events in the study were similar except for increased rates of fatigue in the academic setting (76.6% vs. 55.8%, p=0.021). Only 67% of patients underwent a bone marrow biopsy after cycle 1 in the community versus 83% in the academic setting (p=0.101). Lastly, 67% of patients underwent dose reduction with the decitabine with venetoclax regimen in the community setting versus 31% in the academic setting (p=0.012). Conclusion: This study shows that the use of venetoclax plus HMA allows patients to safely receive AML treatment in the community with support from an academic center. Although there are some significant differences in management, such as increased rates of dose reduction in the community setting, the OS and ORR are similar. However, CR rates remain lower in the community setting. It is important to note that the patients in our study, who were treated at an academic center, had disease characteristics that were more resistant to treatment. Ultimately, this study identifies our efforts in creating community partnerships. Our goal is to further evaluate this partnership with quality improvement projects to bridge the gap in AML care between the community and academic practices.

Incidence trend and epidemiology of tic disorders among youths and adults in Korea from 2003 to 2020: A national population-based study

Tic disorder is a highly prevalent neurodevelopmental disorder; however, research on its incidence trends is still rare. We aimed to investigate its annual incidence rates and the characteristics of incident cases in the general Korean population using data from the National Health Insurance Service-National Health Information Database as a proxy measurement for true incidence in the community. The total number of incident cases and incidence rates of tic disorders from 2003 to 2020 were compared between youths and adults. Both the number of incident cases and the annual incidence rates of tic disorders significantly increased from 2003 to 2020. The overall increasing trend in the incidence rates was significantly greater in youths than in adults; however, the incidence rates in adults showed a relatively recent increase. The male predominance regarding the newly diagnosed case number in youths was no longer observed in adults. Tic disorders occurred more commonly in the low-income group than in the high-income group. Neurodevelopmental comorbidities in youths and mood or anxiety disorders and schizophrenia in adults were more frequently observed. Antipsychotic medication adherence was higher in youths than in adults. Efforts are required to raise awareness and promote expert education for adult patients with tic disorders.