High Levels Of Social Deprivation Research Articles

Trends and Disparities in Ambulatory Follow-Up After Cardiovascular Hospitalizations : A Retrospective Cohort Study.

Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care. To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations. Retrospective cohort study. Medicare. Medicare fee-for-service beneficiaries hospitalized between 2010 and 2019. Receipt of a cardiology visit within 30 days of discharge. Multivariable logistic regression models were used to estimate changes over time overall and across 5 sociodemographic characteristics on the basis of known disparities in cardiovascular outcomes. The cohort included 1 678 088 AMI and 4 245 665 HF hospitalizations. Between 2010 and 2019, the rate of cardiology follow-up increased from 48.3% to 61.4% for AMI hospitalizations and from 35.2% to 48.3% for HF hospitalizations. For both conditions, follow-up rates increased for all subgroups, yet disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual eligible, and residents of counties with higher levels of social deprivation. By 2019, the largest disparities were between Black and White patients (AMI, 51.9% vs. 59.8%, difference, 7.9 percentage points [pp] [95% CI, 6.8 to 9.0 pp]; HF, 39.8% vs. 48.7%, difference, 8.9 pp [CI, 8.2 to 9.7 pp]) and Medicaid dual-eligible and non-dual-eligible patients (AMI, 52.8% vs. 60.4%, difference, 7.6 pp [CI, 6.9 to 8.4 pp]; HF, 39.7% vs. 49.4%, difference, 9.6 pp [CI, 9.2 to 10.1 pp]). Differences between hospitals explained 7.3 pp [CI, 6.7 to 7.9 pp] of the variation in follow-up for AMI and 7.7 pp [CI, 7.2 to 8.1 pp]) for HF. Generalizability to other payers. Equity-informed policy and health system strategies are needed to further reduce gaps in follow-up care for patients with AMI and patients with HF. National Institute on Aging.

The impacts of area-level social deprivation on overall survival in patients receiving immune-checkpoint inhibitors (ICI) treatments: A retrospective cohort study.

1613 Background: Despite recent advancements in ICI therapy, disparities in treatment outcomes persist, potentially influenced by social factors. We investigated the association between Area-level social deprivation (ALSD) and overall survival in patients treated with ICIs, aiming to uncover the potential socioeconomic barriers to effective cancer care. Methods: The study included newly diagnosed solid or liquid tumor patients treated with ICIs between 2012 and 2020 at the Ohio State University Comprehensive Cancer Center. Socioeconomic deprivation was defined using the Social Deprivation Index (SDI), a validated measure of disadvantage across small areas using seven components related to demographic and household characteristics. A high ALSD was defined as an SDI score above the sample’s third quartile. Crude and Adjusted Cox proportional models with robust variance to account for group clustering were used to examine the association between overall survival and ALSD. We also examined the relationship between all-cause mortality and each of the seven components of ALSD. Results: A total of 3,317 patients were included in the study with a median age of 62 years, 59.1% males and 89% White non-Hispanics. An estimated 30.7% of patients had lung cancer, 16.3% melanoma, and 10.8% head and neck cancer. Type of cancer was significantly associated with deprivation states (P <0.001). The median (interquartile range) survival time for all participants was 10.3 (3.7–22.3) months. The high ALSD group had 440/800 (55.0%) deaths over 10,999.0 person-years reported, while the low ALSD group had 1275/2517 (50.7%) deaths over 40,994.8 person-years reported – risk ratio of 1.29 (95% CI: 1.15–1.43). High ALSD was significantly associated with a higher risk of all-cause: the crude risk of all-cause mortality was 21% higher for patients in the high vs. low ALSD groups [HR: 1.21; 95% CI: 1.08–1.36]. In the fully adjusted models, high ALSD was associated with an 18% higher risk of all-cause mortality [adjusted HR: 1.18; 95% CI: 1.06–1.33] compared to low ALSD. In a sub-analysis, we limited our cohort to patients undergoing immunotherapy as first-line treatment, and low ALSD remained a significant predictor of increased risk of all-cause mortality. Area-level poverty and residing in areas with higher percentages of rented housing were the main drivers of the increased risk of all-cause mortality in patients residing in high ALSD areas. Conclusions: Patients from areas with higher levels of social deprivation had a significantly higher risk of all-cause mortality compared with their counterparts in less deprived areas. Addressing adverse social factors could expand the benefits of ICIs for everyone and help reduce disparities in cancer care. Future strategies should consider social interventions to advance equitable healthcare outcomes for all cancer patients.

The Impact of Social Deprivation on Healthcare Utilization Patterns Following Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures

BackgroundDisparities in social determinants of health have been linked to worse patient reported outcomes, higher postoperative pain, and increased risk of revision surgery following orthopaedic procedures. Identification of perioperative predictors of healthcare utilization is of particular interest to mitigate cost and improve patient outcomes. The aim of this study is to elucidate the effect of social deprivation levels, using the Area Deprivation Index (ADI), on healthcare utilization following pinning of supracondylar humerus (SCH) fractures. Identifying risk factors for discrepancies in healthcare utilization following SCH fracture fixation can help mitigate unnecessary healthcare spending and improve care of vulnerable patient populations. MethodsThis is a retrospective review of a single institution’s experience with SCH fracture pinning between 2010 and 2023. Demographic variables and healthcare utilization data were recorded within 90 days of surgery. The ADI was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared. Results1186 patients from a single level one trauma center were included in this study. The upper, middle, and lower terciles of ADI consisted of 226, 458, and 502 patients, respectively. The most deprived tercile had greater emergency department visitation within 90 days of surgery relative to the least and intermediate deprived terciles (IRR 1.85, 95% CI 1.10-3.08). Identifying as White was an independent risk factor for increased outpatient clinic utilization (IRR 1.17, 95% CI 1.03-1.34). Higher levels of social deprivation were independent risk factors for increased ED visitation. There was no difference in 90-day inpatient readmission rates or telephone/telehealth calls made to the clinic between the least, intermediate, and most deprived patients. ConclusionsThis study begins to shed light on how social determinants of health impact the postoperative care of the pediatric orthopedic patient and which patient populations are the most at-risk for disproportionate resource utilization after pinning of SCH fractures. Understanding these differences may lead to improved patient outcomes while decreasing potentially unnecessary burden on the healthcare system. Level of EvidenceIII; retrospective comparative study Key Concepts1.Social determinants of health impact the postoperative care of the pediatric patient in the setting of supracondylar humerus fractures, more socially deprived patients are at higher risk of postoperative emergency department visits, patient race is shown to be a factor in postoperative clinic utilization.

The impact of social deprivation on healthcare utilization patterns following rotator cuff repair

BackgroundDisparities in social determinants of health have been linked to worse patient reported outcomes, higher pain, and increased risk of revision surgery following rotator cuff repair. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized. MethodsThis is a retrospective review of a single institution's experience with primary rotator cuff repair between 2012-2020. Demographic variables (age, race, gender, ASA score) and healthcare utilization (hospital readmission, emergency department visits, follow-up visits, telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index (ADI) was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared. ResultsA total of 1695 patients were included. The upper, middle, and lower terciles of ADI consisted of 410, 767, and 518 patients, respectively. The most deprived tercile had greater emergency department visitation and office visitation within 90 days of surgery relative to the least and intermediate deprived terciles. Higher levels of social deprivation were independent risk factors for increased ED visitation and follow-up visitation. There was no difference in 90-day readmission rates or telephone calls made between the least, intermediate, and most deprived patients. ConclusionsPatients with higher levels of deprivation demonstrated greater postoperative hospital utilization. We hope to use these results to identify risk factors for increased hospital use, guide clinical decision making, increase transparency, and manage patient outcomes following rotator cuff repair surgery.

Effect of health literacy and socioeconomic deprivation on outcomes after lower limb surgical revascularisation for chronic limb-threatening ischaemia: the HeaLTHI study

Introduction: Research has suggested a relationship between health literacy, socioeconomic status and health-related outcomes. The aim of the study was to study the association between health literacy, socioeconomic status and outcomes following infra-inguinal bypass surgery for chronic limb-threatening ischaemia (CLTI). Methods: Patients with CLTI undergoing lower limb surgical bypass graft operations between January 2016 and December 2018 were included in a cross-sectional observational study. The HLS19-Q12 questionnaire categorised participant’s health literacy as inadequate, problematic, sufficient or excellent. Socioeconomic status was assessed using the Index of Multiple Deprivation (IMD). Primary outcomes were major lower limb amputation (MLLA) and adverse cardiovascular events. Secondary outcomes included length of hospital stay, and early postoperative complications including pneumonia, surgical site and graft infection. Kaplan– Meier survival curves were used to compare health literacy and amputation, and Cox proportional regression analysis was conducted to identify differences in limb loss risk against health literacy and social deprivation levels. Results: The study consisted of 50 patients with an average age of 70±8.7 years. The participants' levels of health literacy were classified as inadequate (28%), problematic (38%), sufficient (24%) or excellent (10%). Approximately 40% of the patients lived in the most deprived areas. While all health literacy groups had similar postoperative outcomes, low health literacy was connected with lower socioeconomic status (r=0.308, p=0.029). IMD (p=0.017, HR 0.502 (95% CI 0.285 to 0.883)) and haemoglobin (p=0.001, HR 0.919 (95% CI 0.872 to 0.968)) were significant predictors of MLLA. Conclusion: Patients with lower health literacy are more likely to face higher levels of social deprivation, which may predict amputation following bypass surgery. Enhancing health literacy could play a role in reducing health disparities caused by social deprivation, thereby potentially addressing a vascular James Lind Alliance priority.

Measuring the impact of deprivation on learning difficulties and behaviour among infants born preterm: A cohort study.

Preterm birth and social deprivation are known risk factors for learning difficulties. However there has been little work looking into the interaction between these two risks. We aimed to identify if children born preterm to families with higher levels of social deprivation are disproportionately more likely to have learning difficulties than those with lower levels of social deprivation. Data from the RANOPS (Respiratory And Neurological Outcomes in children born Preterm Study) was used to assess prevalence of learning difficulties. The effects of preterm birth and deprivation were reviewed. Multi-level logistic regression models were used to examine if gestational age and deprivation impacts interacted after adjustment for possible confounders. Primary outcome measure was parent-reported learning difficulties. Secondary outcome measures were parent-reported behavioural problems and a statement of special educational need. We investigated the developmental outcomes of 6,691 infants with a median age of 5 years at time of survey (IQR 5). Deprivation decile (OR 1.08 (1.03,1.12)) and preterm birth (OR 2.67 (2.02,3.53)) were both associated with increased risk of learning difficulties. There was little evidence for any interaction between preterm birth and deprivation (p = 0.298) and the risk of learning difficulties. Deprivation and preterm birth have significant associations with learning difficulties. While deprivation does not appear to have potentiated the impact of preterm birth, preterm infants in the most deprived areas have the highest risk of learning difficulties with almost 1 in 3 extremely premature infants with a learning difficulty in the most deprived areas.

Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand.

Māori have three times the mortality from lung cancer compared with non-Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics. To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non-Māori. Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non-Māori were compared. The analysis used Χ2 tests and logistic models for categorical variables and Student t tests for continuous variables. A total of 4933 patients were included, with 1575 Māori and 3358 non-Māori. The age-standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non-Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers. The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke-free New Zealand.

Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Indication for Carpal Tunnel Release.

Disparities in the utilization of orthopaedic surgery based on race and ethnicity continue to be reported. We examined the impact of sociodemographic factors on treatment recommendation by hand surgeons for carpal tunnel syndrome (CTS) of similar disease severity. Patients with electrodiagnostic study (EDS)-confirmed CTS were evaluated at a single institution between 2016 and 2020. Data including patient age, sex, race/ethnicity, ZIP Code, and EDS severity were collected. The primary outcome was the recommended treatment by the hand surgeon at the first clinic visit according to patient race/ethnicity and the Social Deprivation Index (SDI). Secondary outcomes included the treatment selected by patients (nonsurgical or surgical) and the time to surgery. The 949 patients had a mean age of 58 years (range, 18 to 80 years); 60.5% (n = 574) were women. The race/ethnicity of the patient cohort was 9.8% (n = 93) Black non-Hispanic, 11.2% (n = 106) Hispanic/Latino, 70.3% (n = 667) White non-Hispanic, and 8.7% (n = 83) "other." Overall, Black non-Hispanic patients (38.7%; odds ratio, [OR] 0.62; 95% confidence interval [CI], 0.40 to 0.96) and Hispanic/Latino patients (35.8%; OR, 0.55; 95% CI, 0.36 to 0.84) were less likely to have surgery recommended at their first visit compared with White non-Hispanic patients (50.5%). This was no longer apparent after adjusting for demographic and clinical variables including EDS severity and SDI (Black non-Hispanic patients: adjusted odds ratio [aOR], 0.67; 95% CI, 0.4 to 1.11; Hispanic/Latino patients: aOR, 0.69: 95% CI, 0.41 to 1.14). Across all categories of EDS severity, surgeons were less likely to recommend surgery to patients with a higher SDI (aOR: 0.66, 0.64, and 0.54 for quintiles 2, 3 and 4, respectively). When surgery was recommended, patients in the highest SDI quintile were less likely to proceed with surgery (p = 0.032). There was no association between patient race/ethnicity and the treatment selected by the patient or time to surgery (p = 0.303 and p = 0.725, respectively). Patients experiencing higher levels of social deprivation were less likely to be recommended for CTS surgery and were less likely to proceed with surgery, regardless of patient race/ethnicity. Additional investigation into the social factors influencing both surgeon and patient selection of treatment for CTS, including the impact of patient socioeconomic background, is warranted. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis.

We previously identified 3 latent classes of healthcare utilization among people with human immunodeficiency virus (PWH): adherent, nonadherent, and sick. Although membership in the "nonadherent" group was associated with subsequent disengagement from human immunodeficiency virus (HIV) care, socioeconomic predictors of class membership remain unexplored. We validated our healthcare utilization-based latent class model of PWH receiving care at Duke University (Durham, North Carolina) using patient-level data from 2015 to 2018. SDI scores were assigned to cohort members based on residential addresses. Associations of patient-level covariates with class membership were estimated using multivariable logistic regression and movement between classes was estimated using latent transition analysis. A total of 1443 unique patients (median age of 50 years, 28% female sex at birth, 57% Black) were included in the analysis. PWH in the most disadvantaged (highest) SDI decile were more likely to be in the "nonadherent" class than the remainder of the cohort (odds ratio [OR], 1.58 [95% confidence interval {CI}, .95-2.63]) and were significantly more likely to be in the "sick" class (OR, 2.65 [95% CI, 2.13-3.30]). PWH in the highest SDI decile were also more likely to transition into and less likely to transition out of the "sick" class. PWH who resided in neighborhoods with high levels of social deprivation were more likely to have latent class membership in suboptimal healthcare utilization groupings, and membership persisted over time. Risk stratification models based on healthcare utilization may be useful tools in the early identification of persons at risk for suboptimal HIV care engagement.

The Association of Mobility, Social Deprivation, and Pediatric Primary Care Outcomes in Community Health Centers

To examine how social deprivation and residential mobility are associated with primary care use in children seeking care at community health centers (CHCs) overall and stratified by race and ethnicity. We used electronic health record open cohort data from 152 896 children receiving care from 15 US CHCs belonging to the OCHIN network. Patients were aged 3-17years, with ≥2 primary care visits during 2012-2017 and had geocoded address data. We used negative binomial regression to calculate adjusted rates of primary care encounters and influenza vaccinations relative to neighborhood-level social deprivation. Higher rates of clinic utilization were observed for children who always lived in highly deprived neighborhoods (RR=1.11, 95% CI=1.05-1.17) and those who moved from low-to-high deprivation neighborhoods (RR=1.05, 95% CI=1.01-1.09) experienced higher rates of CHC encounters compared with children who always lived in the low-deprivation neighborhoods. This trend was similar for influenza vaccinations. When analyses were stratified by race and ethnicity, we found these relationships were similar for Latino children and non-Latino White children who always lived in highly deprived neighborhoods. Residential mobility was associated with lower rates of primary care. These findings suggest that children living in or moving to neighborhoods with high levels of social deprivation used more primary care CHC services than children who lived in areas with low deprivation, but moving itself was associated with less care. Clinician and delivery system awareness of patient mobility and its impacts are important to addressing equity in primary care.

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Engaging Children in Music-Making: A Feasibility Study Using Disabled Musicians as Mentors in Primary Schools

The place of music in the school curriculum is under increasing threat, yet this is contrary to the growing evidence base of music’s value to pupils’ social and psychological development. A contributory factor is that many teachers report a lack of training, skill, confidence, or resources for excluding music in their classroom. An innovative project used young adults with disabilities as music mentors to improve children’s access to creative music-making, while also providing non-threatening models to the children’s teachers and providing them practical tools to embed music in their classrooms. An evaluation was undertaken of the project’s impact. Eight classes from four schools in a city with high levels of social deprivation received 16 hours of music sessions over a four-week period, usually in the form of a four-hour workshop. Information was gathered from 171 children, the parents of 54 pupils; 8 class teachers; and 2 head teachers. The pupils’ knowledge and appreciation of music showed significant improvements and their enthusiasm for music making had increased, which parents also confirmed. The teachers and head teachers identified five ways in which they had gained from Project Sparks with an increased appreciation of the potential value of music in the school curriculum. Further research is needed to identify how innovative projects can be sustained and extended to many more teachers and schools.

THE IMPACT OF SOCIAL DEPRIVATION ON COVID-19 INFECTIONS IN NURSING HOMES

Abstract Health inequities vary along social and economic gradients. The COVID-19 pandemic and nursing home infections have highlighted this fact. Using the Centers for Medicare and Medicaid Services’ Nursing Home COVID-19 Public File, Brown University’s LTCFocus, Robert Graham Center’s Social Deprivation Index, and CMS Nursing Home Payroll Based Journal Staffing Data. We examined the relationship between community resource scarcity, as conceptualized by the Social Deprivation Index (SD) and COVID-19 incidence rates in nursing homes. After controlling for interstate differences, organizational enabling factors, as well as, facility-level resident and community-level characteristics, nursing homes located in communities with medium levels of social deprivation had 4.4% more COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.04; p < 0.05) and communities with high levels of social deprivation had 7.5% higher COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.07; p < 0.01) as compared to nursing facilities located in areas of low social deprivation. From a policy perspective, nursing homes, that are located in socially deprived communities, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.

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Background:To study the role of social disparities on the effect of risk factors on suicidal ideation (SI) and suicide attempt (SA) among commercially insured youth and adults in the US.Methods:A national level retrospective cohort study was conducted using health insurance claims data from four major insurance companies in the US. The cohort was defined by patients having a mental health or substance use disorder (MH/SUD) related outpatient encounter (index encounter). We used Cox proportional hazards models to evaluate the impact of social disparities on the effect of risk factors on patients’ future SI and SA. Risk factors considered in the models consist of a mix of long-, mid-, and short-term prior comorbidities and prescriptions that are identified as important factors for predicting SA by Simon et al. 2018. Social disparities were summarized by the social deprivation index (SDI) at patients’ zip code level, and then categorized into five quintiles; higher SDI quintiles indicated higher levels of social deprivation. Patients were censored if they did not have an SI or SA diagnosis before 9/30/2015 (ICD-9 to ICD-10 switch date) or until the last day of the insurance plan enrollment, whichever came first.Results:Between 2014-2015, we identified 317,383 patients <65 years old with an index encounter. Among them, 124,424 aged <25 (youth and young adults; hereinafter youth) and 192,959 aged between 25-64 (other adults; hereinafter adults). Prevalence of SI and SA were both higher in youth (7.09% and 1.86%, respectively, vs. 3.00% and 0.79% in adults). Survival analysis showed that SDI impacted the behaviors of SI and SA differently for youth and adults. Among youth, SDI impacted the effects of risk factors for both SI and SA after controlling for demographic variables. For SI, SDI impacted the effects of age, alcohol use disorder diagnosis in the past 3 years, SA in the past year, and MH emergency department (ED) visits in the past 3 months. Overall, the effect of age on SI decreased as SDI quintile increased. Alcohol use disorder diagnosis in the past 3 years had a positive impact on SI for patients from neighborhoods in the 2nd SDI quintile (HR=1.25). SA in the past year had a negative impact on SI for patients from neighborhoods in the 3rd SDI quintile (HR=0.55). MH ED visits in the past 3 months had a positive impact on SI for patients from neighborhoods in the 2nd and 4th SDI quintiles (HR=1.30 and 1.63, respectively). For SA, SDI impacted the effects of SA in the past 3 years, SA and schizophrenia in the past 3 years, MH ED visits in the past year, and Benzodiazepine prescription in the past 3 months. Overall, the effect of SA in the past 3 years on SA increased as SDI increased. SA and schizophrenia in the past 3 years had a positive impact on SA for patients from neighborhoods in the 2nd SDI quintile (HR=3.09). MH ED visits in the past year had a positive impact on SA for patients from neighborhoods of 1st SDI quintile (HR=1.60). Benzodiazepine prescription in the past 3 months had a positive impact on SA for patients from neighborhoods in the 2nd SDI quintile (HR=1.91). Among adults, patients in poorer neighborhoods were positively associated with having SI (HRs=1.09, 1.13, 1.19, and 1.25 for SDI quintiles 2nd, 3rd, 4th, 5th vs. 1st), however having SA was not affected by the social deprivation level of patients’ neighborhoods (p=0.21).Discussion:Among commercially insured patients in the US, youth had higher prevalence of SI and SA when compared to adults. Neighborhood level social disparities impacted the behaviors of SI and SA differently for youth and adults. Among youth, social disparities nonlinearly impacted the effects of risk factors for both SI and SA. Among adults, social disparities were significantly associated with SI, but not with SA.Table:Comparison of data: Olanzepine Vs Olanzepine + Acetyl L carnitine.Scales1st Visit (T0), Score Mean2nd Visit (T1), Score MeanP value of OLZ group1st Visit (T0), Score Mean2nd Visit (T1), Score Meanp value of OLZ+ALC GROUPComparison of OLZ vs OLZ + ALC groupPositive Symptoms27.4621.9< .001 (1.5995E-15)28.7321.76< .001 (9.551E-15)> .05 (0.452407)Negative Symptoms19.7614.8< .001 (1.1478E-12)14.816.1< .001 (4.9443E-17)> .05 (0.094423)GP Score53.9635.86< .001 (1.9421E-11)58.6639.13< .001 (4.9998E-14)> .05 (0.250954)Total PANSS Score101.272.56< .001 (3.2389E-17)108.4377< .001 (1.9657E-20)> .05 (0.23467)MoCA Score18.921.7< .001 (4.7181E-10)1921.86< .001 (1.5028E-07)> .05 (0.452272)

Demographics and incidence of anal squamous cell carcinoma in people living in high HIV prevalence geographical areas

ObjectivesAnal squamous cell carcinoma (ASCC) is an uncommon cancer that is rapidly increasing in incidence. HIV is a risk factor in the development of ASCC, and it is thought that...

Functional Outcome After Nonoperative Treatment of a Proximal Humeral Fracture in Adults.

The functional outcome following nonoperative treatment of a proximal humeral fracture and the factors that influence it are poorly defined. We aimed to prospectively assess patient-reported outcome measures (PROMs) in a patient cohort at 1 year after the injury. In this study, 774 adult patients sustaining a proximal humeral fracture completed PROM assessments, including the Oxford Shoulder Score (OSS), the EuroQol-5 Dimensions-3 Levels (EQ-5D-3L), and visual analog scale (VAS) assessments of pain, health, and overall treatment satisfaction at 1 year. The mean patient age was 65.6 years, and 73.8% of patients were female. The influences of demographic and fracture measurements and complications on the OSS and EQ-5D-3L were assessed. The 1-year mean scores were 33.2 points (95% confidence interval [CI], 32.1 to 34.2 points) for the OSS and 0.58 (95% CI, 0.55 to 0.61) for the EQ-5D-3L. There was considerable heterogeneity in the reported scores, and the 3 demographic variables of higher levels of dependency, higher levels of social deprivation, and a history of affective (mood) disorder were most consistently associated with poorer outcomes, accounting for between 37% and 43% of the score variation. The initial fracture translation potentially leading to nonunion accounted for 9% to 15% of the variation, and a displaced tuberosity fracture was also predictive of 1% to 4% of the outcome variation. There was evidence of a ceiling effect for the OSS, with 238 patients (30.8%) having a score of ≥47 points but a mean outcome satisfaction of only 72.9 points, and this effect was more pronounced in younger, active individuals. At the other end of the spectrum, 239 patients (30.9%) reported an OSS of ≤24 points, and 120 patients (15.5%) had a "worse-than-death" EQ-5D-3L score. Nonoperative treatment of proximal humeral fractures produces considerable variation in shoulder-specific and general health outcomes at 1 year, and a substantial proportion of patients have poor perceived functional outcomes. The outcome for the majority of less-displaced fractures is mainly influenced by preexisting patient-related psychosocial factors, although the fracture-related factors of displacement, nonunion, and tuberosity displacement account for a small but measurable proportion of the variation and the poorer outcomes in the minority with more severe injuries. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a...

Abstract PO-167: Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina

Abstract Background: Cancer incidence, staging and mortality rates differ across geographic areas; however, there is a need for a better understanding of how neighborhood level socioeconomic and access to care factors impact cancer burden to tailor cancer control interventions in ways that appropriately target geographic determinants of cancer health disparities. The purpose of this study was to characterize the distribution of neighborhood deprivation in a cohort of breast cancer patients and examine the effect of social deprivation, healthcare professional shortage Area (HPSA) designation, and individual-level characteristics on breast cancer staging. Methods: We established a retrospective cohort of breast cancer patients diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center’s Social Deprivation Index (SDI) and the Health Resources and Services Administration primary care HPSA designation. Bivariate analyses and multivariate regression analyses were used to examine associations. Results: The sample included 54,501 female breast cancer patients. Overall, the mean for SDI was 54.2 (+18.1) and the range was 76 (19-95). Approximately 44.4% of women lived in areas with high levels of social deprivation (e.g., SDI score of 52 to 95). In the logistic regression model, living in a geographic area with high social deprivation was significantly associated with African American race (OR=2.3, 95% C.I. 2.2-2.4), being unmarried (OR=1.2, 95% C.I. 1.1-1.3), and HPSA designation (OR=14.0, 95% C.I. 13.5- 14.6). Higher tumor grade (OR=1.2; 95% CI.1.2-1.3) and later stage (OR=1.1, 95% C.I. 1.1-1.2) were also significantly associated with neighborhood deprivation. Conclusion: This study shows that SDI differs by race and clinical characteristics among breast cancer patients. The SDI could be integrated into tumor registries and cancer research to understand the effects of neighborhood level variables on cancer health disparities to improve the precision of cancer control interventions that are developed to address geographic determinants. Citation Format: Andrew B. Lawson, Chanita Hughes-Halbert, Oluwole A. Babatunde, Whitney E. Zahnd, Jan M. Eberth. Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-167.

Evaluating the Impact of Patient Social Deprivation on the Level of Symptom Severity at Carpal Tunnel Syndrome Presentation.

Background: There is a paucity of research examining the impact of social deprivation on the level of symptom severity at presentation, including in common hand conditions like carpal tunnel syndrome. We aimed to determine whether patient deprivation is associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores. Methods: Patients presenting to an academic hand clinic from December 2016 to December 2018 for a new patient visit for carpal tunnel syndrome completed PROMIS UE, PF, PI, and Depression Computer Adaptive Tests. Bivariate analyses were done to compare patient variables between the least and most deprived thirds, as measured by Area Deprivation Index (ADI), at the state (New York) and national levels. Multivariable linear regression was used to determine whether there was an association between social deprivation and PROMIS UE, PF, PI, and Depression scores. Results: All PROMIS domain scores were significantly worse in the most deprived cohort at the national level (P < .05) but not at the state level (P > .05). In multivariable regression at the national level, ADI values were associated with PROMIS UE (β = -0.06, P < .01) and PROMIS PI (β = .05, P < .01) but not PROMIS PF or PROMIS Depression. In multivariable regression at the state level, ADI values were associated with PROMIS UE (β = -0.79, P = .03) and PROMIS PI (β = 0.58, P < .05) but not PROMIS PF or PROMIS Depression. Conclusions: Higher levels of social deprivation are associated with worse PROMIS UE and PROMIS PI scores on both the state and national levels when initially seeking care for carpal tunnel syndrome.

To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation?

BackgroundDepression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR.MethodsAn observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic.ResultsThe analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male.ConclusionThe research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.