Importance Of Social Determinants Research Articles

A pilot study of social and structural determinants of health (SSDOH) measures in an Alzheimer’s Disease Research Center (ADRC) cohort

AbstractBackgroundResearch shows that people have different experiences, opportunities, and challenges depending on their background and life circumstances. These circumstances can be important social and structural determinants of health (SSDoH) that may help explain heterogeneity in cognitive, functional, and interventional outcomes in Alzheimer’s disease and related dementias (ADRDs). The National Institute on Aging has set as a priority understanding the effects of SSDoH. This information may help elucidate disease mechanisms and modifiers as well as aid discovery of disease modifying treatments that are effective across diverse populations.MethodA battery of SSDoH measures was constructed based on instrument content relevance and psychometric properties. The battery is being pilot tested in a diverse cohort of older adults. We will report the results of that pilot testing.The battery consists of self‐report measures in 6 categories: (1) Education: highest grade or academic level completed, (2) Occupation: occupational cognitive requirements score (OCRS) and occupation description, (3) Economic Status and Strain: financial strain (2‐item mean index), total economic problems (7‐item inventory, range: 0–7) and Agency for Healthcare Research and Quality (AHRQ) socioeconomic status index, (4) Subjective Stress: Everyday Discrimination Scale (EDS), Perceived Stress Scale (PSS), self‐report primary caretaker well‐being, and the Social Deprivation Index (SDI), (5) Early Life Stressors: parental stressors (3‐item mean index), parental educational involvement (2‐item mean index), hunger (1 item), and parental/caregiver education, occupation and health status during participant’s childhood (3 items), (6) Subjective Social Support and Status: Social Network Index (SNI) and the MacArthur Scale of Subjective Social Status. Sociodemographic data collected includes self‐report of age, race, and sex, orientation, gender and identity (SOGI) questions. Collection of race data is based on National Institutes of Health (NIH) standards.ResultWe describe the results of pilot testing of SSDoH measures in the Penn ADRC UDS cohort, including return rates, participant experience, and other measures of feasibility and usefulness.ConclusionWe discuss the feasibility of routinely collecting SSDoH data in an ADRC research cohort. We describe factors to consider when selecting modules to implement in standing cohorts and options for adapting the SSDoH module‐based battery to a range of research cohorts.

Abstract 9992: Homelessness and Heart Failure

Background: Homelessness is an important social determinant of health. Since heart failure (HF) contributes to significant morbidity and mortality, we sought to investigate the association of homelessness with clinical outcomes in the patients hospitalized with HF. Methods: We analyzed the National Inpatient Sample (NIS) database between 2016 and 2018. Primary HF hospitalizations and homeless adults were identified through ICD codes. Multivariable adjusted logistic regression was used to assess the association of homelessness and clinical outcomes. Results: Of 3522459 weighted primary HF hospitalizations identified, only minority of patients were identified as homeless (n=28555; 0.81%). Homeless adults were younger (mean age: 56 vs. 72 years) and had lower prevalence of clinical comorbidities (diabetes, hypertension, obesity, dyslipidemia, renal failure, peripheral vascular disease, stroke) compared with non-homeless adults. However, homeless adults had higher prevalence of drug, tobacco, and alcohol abuse than non-homeless adults. Adjusted models showed lower odds of inpatient mortality and clinical complications among homeless adults. Conclusion: Homeless adults were younger and had higher prevalence of drug abuse, but lower burden of clinical comorbidities than non-homeless adults. While homeless adults had lower inpatient mortality and clinical complications, the interpretation of these results is limited by lower hospitalization rates among homeless. Majority of homeless adults may not seek medical attention due to poor social support. .

Exploring the outcomes and experiences of Black and White athletes following a sport-related concussion: a retrospective cohort study.

Young American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race may influence the experience and outcome of SRC. The authors' objective was to compare White and Black athletes' recovery and subjective experiences after SRC. A retrospective study was performed using the Vanderbilt Sports Concussion registry. Self-reported White and Black young athletes (ages 12-23 years) who had been treated for SRC between 2012 and 2015 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data were collected by electronic medical record review and phone calls to athletes and parents or guardians. The primary outcomes were as follows: 1) days to symptom resolution (SR), 2) days to return to school, and changes in 3) any daily activity (binary) and 4) sport behavior (binary). Secondary outcomes were changes (more, unchanged, or less) in specific activities such as sleep, schoolwork, and television time, as well as equipment (binary) or playing style (more reckless, unchanged, or less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards models, and logistic regression were performed. The final cohort included 247 student-athletes (36 Black, 211 White). Black athletes were male (78% vs 58%) more often than White athletes, but both races were similar in age, sport, and medical/family histories. Black athletes more frequently had public insurance (33.3% vs 5.7%) and lived in areas with a low median income (41.2% vs 26.6%). After adjusting for age, sex, concussion history, insurance status, and zip code median income, Black athletes reached an asymptomatic status (HR 1.497, 95% CI 1.014-2.209, p = 0.042) and returned to school earlier (HR 1.522, 95% CI 1.020-2.270, p = 0.040). Black athletes were less likely to report a change in any daily activity than White athletes (OR 0.368, 95% CI 0.136-0.996, p = 0.049). Changes in sport behavior were comparable between the groups. Racial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached SR and return to school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

Biodiversity and Long-Term Nutrition Through A Food-Based Approach

At the beginning of the new millennium, we are still facing severe challenges. There are still 1 billion poor people suffering from hunger and malnutrition, while approximately 2 billion people suffer from malnutrition and micronutrient deficiencies. At the same time, approximately 2 billion people are overweight and/or obese, and this number is increasing in every country in the world. Food and diet are one of the important social determinants of health and well-being, but the current food system is deeply unfair and creates social injustice. Based on the experiences of the last half century and current trends, we are convinced that it has become very urgent to fundamentally change our nutrition strategy and to promote a fair, culturally appropriate and sustainable diet based on biodiversity. This is indeed a significant challenge for nutritionists

22 Housing Need Amongst Children with Medical Complexity: A Cross-Sectional Descriptive Study of Three Populations

Abstract Primary Subject area Complex Care Background Children with medical complexity (CMC) have medical fragility, complex chronic disease necessitating specialized care, functional disability, and/or high technology dependence. Housing is an important social determinant of health, yet research on prevalence and types of housing need in CMC is limited. Housing need encompasses unstable (frequent moves), inaccessible (lack of ramps/lifts), inadequate (major repairs needed), unsuitable (not enough bedrooms), or unaffordable housing. Given the association between housing and health, housing need may be an important consideration when caring for CMC. Objectives The primary objective was to describe the prevalence of and factors related to housing need in CMC. The secondary objective was to compare housing need between CMC, children with one chronic condition (Type 1 diabetes; CT1D) and healthy children (HC) to understand the relationship between chronic conditions and housing need. Design/Methods This was a cross-sectional descriptive study. Housing affordability, adequacy, suitability, stability, and accessibility were evaluated through surveys administered to caregivers of CMC, CT1D, and HC at a tertiary-care paediatric hospital using convenience sampling. The association of binary outcomes of housing need between groups was analyzed using logistic regression models, adjusting for sociodemographic factors (income, education, employment, geography, immigration status). Results 453 caregivers participated (Table 1). Compared to caregivers of HC, caregivers of CMC had higher odds of reporting one or more moves in the last two years (1.3 times), having safety concerns (3 times), using a common area as a bedroom (5.2 times), and experiencing housing stress (3.2 times), after sociodemographic factors were adjusted for (Table 2). Families of CT1D also had elevated odds of some indicators of housing need compared to HC, although to a lesser extent than CMC. 62.2% of CMC indicated they had to reduce spending on basics in order to afford their rent/mortgage, compared to 35.9% of CT1D and 25.2% of HC. Nearly two-thirds of CMC (60.2%) reported a need for accessibility accommodations in their home. Of those who installed accommodations, 62.9% felt the installations were a financial burden (cost ranged from $800-$80,000). Conclusion Families of CMC had higher odds of reporting unstable, inadequate, unsuitable, and stressful housing compared to HC even after sociodemographic factors were accounted for, suggesting an association between complexity of child health conditions and housing need. Access to appropriate housing may improve the health of CMC. Health care providers can screen for housing need, become familiar with housing interventions, and advocate for improved resources to address housing need in CMC.

Stress and perceived discrimination among Israeli Arabs: the mediation role of threat and trust

During pandemics, minorities may experience high stress levels, which could harm their health. This study explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to guidelines, and perceived discrimination. The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect=0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β=-0.52), which, in turn, was negatively associated with stress (β=-0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. Our findings could assist policymakers in developing fair policies, that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving their mental and physical health.Key messages The results highlight the relationships between discrimination, trust, perceived threat and stress.To reduce minorities’ stress, it is vital to create a credible and fair atmosphere during pandemics.

Identifying Barriers to Effective Patient-Provider Communication About Food Insecurity Screenings in Outpatient Clinical Settings in Central Florida: A Mixed-Methods Study.

Screening for food insecurity in health care settings is inconsistently performed among health care providers. This study examined how patient-provider interactions influenced patient comfort discussing food insecurity, an important social determinant of health. We conducted a convergent mixed-methods study and surveyed patients on their experiences with patient-centered care when communicating and interacting with their providers, and their comfort level being screened for food insecurity. Telephone interviews were also conducted to better understand the concepts in the survey. Various clinical organizations in Central Florida, as well as food pantries affiliated with Second Harvest Food Bank. Forty-six patients in Central Florida completed the survey, 12 of whom completed qualitative portions of the study (7 completing the qualitative survey questions and 5 completing a telephone interview). Patient comfort discussing food insecurity with their health care providers. Quantitative findings show that patient involvement in care planning and cultural sensitivity of health care providers were 2 important factors associated with patient comfort being screened for food insecurity. Qualitative findings suggest that providers' effective communication and empathy are other factors that can influence patient comfort. To effectively address food insecurity of vulnerable patients and communities, it is important that providers conduct screenings within their practice. This study points to specific actions that providers may employ to increase patient comfort discussing this topic. Efficiently identifying food-insecure patients and connecting them to appropriate community resources would improve patient health and aid in efforts to eliminate health disparities.

LUNG TRANSPLANTATION AMONG UNDOCUMENTED IMMIGRANTS

TOPIC: Transplantation TYPE: Original Investigations PURPOSE: Legal status in the United States is an important social determinant of health. Undocumented immigrants face several obstacles in obtaining equivalent healthcare to United States citizens or resident aliens. Despite these obstacles, undocumented individuals are eligible to be listed for and receive organ transplant for advanced disease. We hypothesize that this population represents healthy workers, and has significantly different social and clinical needs pre-transplantation than the population of listed US Citizens or resident aliens. We sought to describe this population of undocumented patients, listed for lung transplantation, for the first time, to identify potential disparities in care and develop strategies to address the needs of this unique patient population. METHODS: Using the de-identified United Network for Organ Sharing (UNOS) Thoracic dataset we identified 64,585 individuals who had been listed for lung transplant between 1985 and 2020. We identified 232 undocumented individuals; non-resident aliens who did not travel to the US for the purpose of transplant evaluation or have their care paid for by a foreign healthcare system. We evaluated demographic, disease characteristic, and payer differences between documented and undocumented individuals using bivariate tests of difference. We report Cohen’s d statistics, when possible, to characterize the degree of difference between the two populations. RESULTS: The mean age of undocumented individuals listed for transplant was 41.1 years, which was significantly lower than that of documented individuals (p < 0.00001). The proportion of individuals with the listing diagnoses of idiopathic pulmonary fibrosis (IPF), pulmonary arterial hypertension (PAH), and bronchiectasis was significantly higher in the undocumented cohort of patients (p- values of 0.002, < 0.001, and <0.001 respectively). However, the proportion of undocumented individuals with a listing diagnosis of chronic obstructive pulmonary disease (COPD) was significantly lower (p < 0.001). Patients within the undocumented cohort also had a higher initial Lung Allocation Score (LAS) than documented individuals with an average score of 43.1 indicating more severe disease (p = 0.046). Undocumented individuals were less likely to have a history of tobacco use (p < 0.001). The majority of undocumented individuals were self-pay and there were no significant differences in Medicaid users between both cohorts. CONCLUSIONS: Undocumented patients listed for lung transplant represent a younger population of non-smokers who likely have very different medical and social needs than US citizens or resident aliens. Further evaluation of the specific needs of this population is warranted, particularly in areas with high populations of undocumented individuals. CLINICAL IMPLICATIONS: These patients are not more likely than US citizens or resident aliens to rely on public insurance programs (e.g. Medicare and Medicaid) indicating that the current practice of listing these individuals does not place an excessive burden on public health programs. DISCLOSURES: No relevant relationships by Lilia Cervantes, source=Web Response No relevant relationships by Daniel Colon Hidalgo, source=Web Response No relevant relationships by Matthew Griffith, source=Web Response No relevant relationships by Guillermo Jimenez, source=Web Response No relevant relationships by Matthew Rockstrom, source=Web Response

Covid-19 and pathways to health inequities for families in a socioeconomically disadvantaged area of Sweden \u2013 qualitative analysis of home visitors\u2019 observations

BackgroundLack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic.MethodsSemi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis.ResultsThe analysis resulted in five pathways on two explanatory levels, affecting parents’ health and parenting capacity and children’s health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families’ access to resources and increases isolation for parents with already limited social support.ConclusionsThe diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity.Trial registrationThe study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097).

Community and Social Context: An Important Social Determinant of Cardiovascular Disease.

Disease prevention frameworks and clinical practice guidelines in the United States (US) have traditionally ignored upstream social determinants of health (SDOH), which are critical for reducing disparities in cardiovascular disease (CVD)—the leading cause of death in the US. Existing evidence demonstrates a protective effect of social support, social cohesion, and community engagement on overall health and wellbeing. Increasing community and social support is a major objective of the Healthy People 2030 initiative, with special provisions for vulnerable populations. However, to date, existing evidence of the association between community and social context (CSC)—an integral SDOH domain—and CVD has not been reviewed extensively. In particular, the individual and cumulative impact of CSC on CVD risk and the pathways linking CSC to cardiovascular outcomes are not well understood. In this review, we critically appraise current knowledge of the association between CSC and CVD, describe potential pathways linking CSC to CVD, and identify opportunities for evidence-based policy and practice interventions to improve CVD outcomes.

Social and Demographic Associates of School Bully Behavior in Indian Pupils

Bully activities at school have a long-term detrimental effect. Though the types and manifests of this damaging behavior are studied, there is a paucity of evidence on its social determinants. Aim and Objective: This study explored the socio-demographic determinants of school-bullying in a central India district. Methods: Cross-sectional data were compiled over one year from 480 participants by simple random method from urban and rural schools. The bully Prevalence Questionnaire (BPQ) and socio-demographic information questionnaire were used. Questionnaires in English and Hindi language were commissioned to cater to the participants’ need. SPSS Vs. 21 was used for data analysis at P ≤ 0.05. Results: The urban vs. rural divide was noticable (ꭓ2; p -0.033). Boys involvement was dominant (66.2% vs, 30.4% and ꭓ2; p -0.00). Father’s occupation and family income were the important social determinants (ꭓ2 value p -0.00, ANOVA p - 0.02, and 0.05). Victimization per se was noticed more among girls as compared to boy’s (r .310** vs. .144*). Children of unskilled workers were more often a party to school bullying (r .317**). Father and mother’s educational levels were strong players in deciding students’ prosocial skills (ANOVA p -0.014 and 0.00). Participants’ self-esteem score was influenced by family income (ANOVA p -0.00). Conclusion: Involvement of boys at high number was a matter of concern. The skewed number in favour of children from unskilled working families necessitates the attention of social reformists and policymakers. Improved education of parents is also vital in curbing this social evil.

Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes

Health literacy is considered an important social determinant of health that may underlie many health disparities, but it is unclear whether inadequate health literacy among pregnant individuals is associated with adverse maternal and neonatal outcomes. To assess the association between maternal health literacy and maternal and neonatal outcomes among nulliparous individuals. This was a secondary analysis of a large, multicenter cohort study of 10 038 nulliparous individuals in the US (2010-2013). Participants underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted. Data analysis was performed from July to December 2019. Between 16 and 21 weeks of gestation, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Short Form, a validated 7-item word recognition test. In accordance with standard scoring, results were dichotomized as inadequate vs adequate health literacy. On the basis of theoretical causal pathways between health literacy and health outcomes, a priori maternal and neonatal outcomes (determined via medical records) were selected for this analysis. Multivariable Poisson regression models were constructed to estimate the associations between health literacy and outcomes. Sensitivity analyses in which education was removed from models and that excluded individuals who spoke English as a second language were performed. Of 9341 participants who completed the Rapid Estimate of Adult Literacy in Medicine-Short Form, the mean (SD) age was 27.0 (5.6) years, and 2540 (27.4%) had publicly funded prenatal care. Overall, 1638 participants (17.5%) had scores indicative of inadequate health literacy. Participants with inadequate health literacy were more likely to be younger (mean [SD] age, 22.9 [5.0] vs 27.9 [5.3] years), have less educational attainment (some college education or greater, 1149 participants [73.9%] vs 5279 participants [94.5%]), have publicly funded insurance (1008 participants [62.2%] vs 1532 participants [20.0%]), and report they were a member of an underrepresented racial or ethnic group (non-Hispanic Black, 506 participants [30.9%] vs 780 participants [10.1%]; Hispanic, 516 participants [31.5%] vs 948 participants [12.3%]) compared with those with adequate health literacy. Participants who had inadequate health literacy had greater risk of cesarean delivery (adjusted risk ratio [aRR], 1.11; 95% CI, 1.01-1.23) and major perineal laceration (aRR, 1.44; 95% CI, 1.03-2.01). The adjusted risks of small-for-gestational-age status (aRR, 1.34; 95% CI, 1.14-1.58), low birth weight (aRR, 1.33; 95% CI, 1.07-1.65), and 5-minute Apgar score less than 4 (aRR, 2.78; 95% CI, 1.16-6.65) were greater for neonates born to participants with inadequate health literacy. Sensitivity analyses confirmed these findings. These findings suggest that inadequate maternal health literacy is associated with a variety of adverse maternal and neonatal outcomes.

Importance of Social Determinants in Screening for Depression

ImportanceThe most common screening tool for depression is the Patient Health Questionnaire-9 (PHQ-9). Despite extensive research on the clinical and behavioral implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and social determinants of health and disease.ObjectiveTo assess the relationship between the PHQ-9 at intake and other measurements intended to assess social determinants of health.Design, Setting, and ParticipantsCross-sectional analyses of 2502 participants from the Baseline Health Study (BHS), a prospective cohort of adults selected to represent major demographic groups in the US; participants underwent deep phenotyping on demographic, socioeconomic, clinical, laboratory, functional, and imaging findings.InterventionsNone.Main Outcomes and MeasuresCross-sectional measures of clinical and socioeconomic status (SES).ResultsIn addition to a host of clinical and biological factors, higher PHQ-9 scores were associated with female sex, younger participants, people of color, and Hispanic ethnicity. Multiple measures of low SES, including less education, being unmarried, not currently working, and lack of insurance, were also associated with higher PHQ-9 scores across the entire spectrum of PHQ-9 scores. A summative score of SES, which was the 6th most predictive factor, was associated with higher PHQ-9 score after adjusting for 150 clinical, lab testing, and symptomatic characteristics.Conclusions and RelevanceOur findings underscore that depression should be considered a comorbidity when social determinants of health are addressed, and both elements should be considered when designing appropriate interventions.

Estimated Incidence and Factors Associated With Risk of Elder Mistreatment in New York State

IMPORTANCEElder mistreatment is associated with major health and psychosocial consequences and is recognized by clinicians, policy makers, and researchers as a pervasive problem affecting a rapidly aging global population.OBJECTIVETo estimate the incidence of elder mistreatment and identify factors associated with the risk of new cases.DESIGN, SETTING, AND PARTICIPANTSThis research is a 10-year, longitudinal, population-based, cohort study of the incidence of elder mistreatment in New York State households conducted between 2009 (wave 1) and 2019 (wave 2). At wave 1, random digit-dial (landline and cellular telephones) stratified sampling was done to recruit English-speaking and/or Spanish-speaking, cognitively intact, community-dwelling older adults (aged ≥60 years) across New York State. The current study conducted computer-assisted telephone interviews with older adults who participated in wave 1 and gave permission to be contacted again for wave 2 interviews (response rate, 60.7%). Data analysis was performed from October 2020 to January 2021.EXPOSURESPhysical factors (health status, functional capacity, and age), living arrangement (coresidence), and sociocultural characteristics (sex, race/ethnicity, geocultural context, and household income).MAIN OUTCOMES AND MEASURESTen-year incidence for overall elder mistreatment and subtypes (financial abuse, emotional or psychological abuse, physical abuse, and neglect) were measured using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale, and the New York State Elder Mistreatment Prevalence Study financial abuse tool.RESULTSThe analytical sample included 628 older adults (mean [SD] age at wave 1, 69.20 [6.95] years; age at wave 2, 79.40 [6.93] years; 504 non-Hispanic White individuals [80.9%]; 406 women [64.6%]). Ten-year incidence rates were 11.4% (95% CI, 8.8%−14.3%) for overall elder mistreatment, 8.5% (95% CI, 6.3%–10.9%) for financial abuse, 4.1% (95% CI, 2.6%–5.7%) for emotional abuse, 2.3% (95% CI, 1.2%–3.6%) for physical abuse, and 1.0% (95% CI, 0.3%–1.8%) for neglect. Poor self-rated health at wave 1 was associated with increased risk at wave 2 of new overall mistreatment (odds ratio [OR], 2.86; 95% CI, 1.35–5.84), emotional abuse (OR, 3.67; 95% CI, 1.15–11.15), physical abuse (OR, 4.21; 95% CI, 1.14–13.70), and financial abuse (OR, 2.80; 95% CI, 1.16–6.38). Compared with non-Hispanic White participants, Black participants were at heightened risk of overall mistreatment (OR, 2.61; 95% CI, 1.16–5.70) and financial abuse (OR, 2.80; 95% CI, 1.09–6.91). A change from coresidence to living alone was associated with increased risk of financial abuse (OR, 2.74; 95% CI, 1.01–7.21).CONCLUSIONS AND RELEVANCEThese findings suggest that health care visits may be important opportunities to detect older adults who are at risk of mistreatment. Race is highlighted as an important social determinant for elder mistreatment requiring urgent attention.

Impact of changes in housing tenure and affordability status on depressive symptoms: Evidence from a longitudinal study

IntroductionHousing is an important social determinant of health. We investigated effects of changes in housing tenure and affordability on depressive symptoms. MethodsData of 9,956 individuals aged >20 years from the Korea Welfare Panel Study (2015–2020) were analyzed. Housing tenure was categorized as homeowners or tenants. Individuals with housing-related expenditures exceeding 30% of household income were defined as having housing unaffordability. Analyses using generalized estimating equations were conducted to evaluate the relationship between changes in housing tenure and affordability on depressive symptoms measured with the Center for Epidemiologic Studies Depression Scale. ResultsIndividuals who became tenants (β = 0.326, p = 0.027) or were persistent tenants (β = 0.542, p<0.001) demonstrated significantly more severe depressive symptoms than persistent homeowners. Individuals with new (β = 0.562, p < 0.001) or consistent housing unaffordability (β = 1.032, p = 0.036) showed increased depressive symptoms compared with those with persistent housing affordability. Depressive symptoms were reduced in new homeowners and those who left housing unaffordability status (β = -0.807, p = 0.031). The interaction between housing tenure and affordability on depressive symptoms differed by age and household composition. Housing tenure at post-retirement age and single-person households were associated with a decrease in depressive symptoms, respectively. LimitationsAll housing-related factors, especially different domains of housing insecurity including unstable neighborhoods or reasons for moving, have not been identified. ConclusionsChanges in housing tenure, affordability, and the two combined were significantly associated with depressive symptoms. Furthermore, the degree of interactive effect varied among age groups and household composition. Housing welfare policies that can stabilize housing tenure and affordability might help prevent depression.

Energy, Data, and Decision-Making: a Scoping Review-the 3D Commission.

Access to energy is an important social determinant of health, and expanding the availability of affordable, clean energy is one of the Sustainable Development Goals. It has been argued that climate mitigation policies can, if well-designed in response to contextual factors, also achieve environmental, economic, and social progress, but otherwise pose risks to economic inequity generally and health inequity specifically. Decisions around such policies are hampered by data gaps, particularly in low- and middle-income countries (LMICs) and among vulnerable populations in high-income countries (HICs). The rise of "big data" offers the potential to address some of these gaps. This scoping review sought to explore the literature linking energy, big data, health, and decision-making.Literature searches in PubMed, Embase, and Web of Science were conducted. English language articles up to April 1, 2020, were included. Pre-agreed study characteristics including geographic location, data collected, and study design were extracted and presented descriptively, and a qualitative thematic analysis was performed on the articles using NVivo.Thirty-nine articles fulfilled eligibility criteria. These included a combination of review articles and research articles using primary or secondary data sources. The articles described health and economic effects of a wide range of energy types and uses, and attempted to model effects of a range of technological and policy innovations, in a variety of geographic contexts. Key themes identified in our analysis included the link between energy consumption and economic development, the role of inequality in understanding and predicting harms and benefits associated with energy production and use, the lack of available data on LMICs in general, and on the local contexts within them in particular. Examples of using "big data," and areas in which the articles themselves described challenges with data limitations, were identified.The findings of this scoping review demonstrate the challenges decision-makers face in achieving energy efficiency gains and reducing emissions, while avoiding the exacerbation of existing inequities. Understanding how to maximize gains in energy efficiency and uptake of new technologies requires a deeper understanding of how work and life is shaped by socioeconomic inequalities between and within countries. This is particularly the case for LMICs and in local contexts where few data are currently available, and for whom existing evidence may not be directly applicable. Big data approaches may offer some value in tracking the uptake of new approaches, provide greater data granularity, and help compensate for evidence gaps in low resource settings.

The Most Important Social Determinants of Slum Dwellers' Health: A Scoping Review.

ObjectivesGiven the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants.MethodsThis scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness.ResultsThirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers.ConclusionsThis framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.

Value-based chronic care model approach for vulnerable older patients with multiple chronic conditions.

"Old age, itself, is not a disease" (Suborne 2007). The rising rate of the global aging population is predicted to create a health care crisis within the next three decades. Vulnerable older adults suffer from multiple chronic conditions (MCCs) in addition to cognitive and physical decline during the process of aging resulting in an inability to optimally achieve self-management. In terms of resource utilization, complex inpatient, and outpatient care results in higher physician visits, polypharmacy, and higher prescription costs. Health literacy has become known as an important social determinant of health affecting the older population. Both reductions in health literacy and self-management are associated with poorer health outcomes. The patient activation measure (PAM) has been coined "a vital sign" to ascertain a patient activation level throughout the continuum of care with the introduction of an intervention's progress. In this review, we conceptualize a systematic approach of the development of a "tailored" integrated community and care team to develop a partnership in assisting senior adults with MCCs. Through this intervention the value-based chronic care model (CCM) and PAM allows for an adaptable integration between the activated patient, their caregivers, and the community. The Model for Improvement (MFI) serves as a well-recognized technique for developing and executing quality improvement strategies in this "tailored" engaged and activated individual and community care team approach in achieving health outcomes and quality of life among the vulnerable older adult population worldwide.

A Content Analysis Of US Sanctuary Immigration Policies: Implications For Research In Social Determinants Of Health.

Restrictive immigration policies are important social determinants of health, but less is known about the health implications and health-related content of protective immigration policies, which may also represent critical determinants of health. We conducted a content analysis of types, themes, and health-related language in 328 "sanctuary" policies enacted between 2009 and 2017 in the United States. Sanctuary policies were introduced in thirty-two states and Washington, D.C., most frequently in 2014 and 2017. More than two-thirds of policies (67.6percent) contained language related to health, including direct references to access to services. Health-related themes commonly co-occurred with language related to supporting immigrants in communities, including themes of antidiscrimination, inclusion, trust, and privacy. Our work provides foundational, nuanced data about the scope and nature of sanctuary policies that can inform future research exploring the impacts of these policies on health and health care.

Reemployment Needs and Barriers of Users of Workforce Development Programs: A Mixed-Methods Study.

Employment is an important social determinant of health, and supporting individuals' return to the workforce is likely to have robust impacts on their health and well-being. The aim of this study was to identify (a) the self-perceived employment needs and expectations of users of community employment services; (b) the assets, needs, and barriers to reemployment among users of community employment services; and (c) areas of priority for programmatic development, including implications for patient-worker needs assessment and care coordination in clinical settings. We conducted structured interviews with 71 adults recruited from three workforce development programs located in the Chicago metropolitan area serving vulnerable workers. Topics of discussion included job histories, financial and social assets, and the respondents' motivation and expectations for their return to the workforce. We used descriptive statistics to analyze quantitative responses and performed content analysis for qualitative data. Users reported discrimination, legal barriers, family responsibilities, physical or mental health concerns, and needs related to transportation and housing as common challenges to reemployment. Concerns regarding navigating complex social support programs to meet individual and family needs, as well as uncertainty regarding what would qualify as sufficient employment in order to not be reliant on these programs in the future, were expressed. Health care providers have opportunities to identify those that may benefit from comprehensive referrals to reemployment programs and social services. Occupational health providers are also in a unique position to enhance workforce development programs through collaborations to better educate and support workers.