Important Social Determinant Of Health Research Articles

Association of Limited Health Literacy With Clinical and Patient-Reported Outcomes in Individuals With Systemic Lupus Erythematosus.

Health literacy is an important social determinant of health, with limited health literacy associated with worse health outcomes. This study examined the associations between limited health literacy with patient-reported outcomes and disease activity/damage among 267 Black women with active systemic lupus erythematosus (SLE) enrolled in the Peer Approaches to Lupus Self-Management (PALS) program. The three-item Chew Health Literacy Screening was used to dichotomize those reporting in the "limited" range on any item with outcomes compared via generalized linear models. Baseline surveys and assessments obtained at study entry as part of the PALS study were used. Primary outcomes included disease activity and lupus damage; other secondary outcomes included patient activation, self-efficacy, physician/patient communication, and quality of life. The study included 267 Black women with SLE. In covariate-adjusted analyses, participants with limited health literacy (88 [33%]) were more likely to have lower patient activation (Patient Activation Measure P < 0.0001), lower self-efficacy (Lupus Self-Efficacy P < 0.0001), higher lupus damage (self-administered Brief Index of Lupus Damage P=.016), higher disease activity (Systemic Lupus Activity Questionnaire symptom severity P=0.006), and worse physician/patient communication (patient-centered care P < 0.0001) compared to those with adequate health literacy. Those with limited health literacy also reported worse lupus quality of life (P=0.0004) and greater levels of stress (Perceived Stress Scale-4 P < 0.0001) and were 2.4 times more likely to have probable major depression (Patient Health Questionnaire Depression Scale-8 of ≥10 P=0.004) and probable anxiety disorder (General Anxiety Disorder-7 of ≥10 P=0.007) compared to those with adequate health literacy. Black women with SLE and limited health literacy have worse clinical outcomes and represent a particularly vulnerable population with significantly disparate health outcomes. These findings suggest health literacy and complexities of managing SLE may impair clinical care in multiple domains, ultimately contributing to higher disease activity and death/damage, and are important to address in clinical care and future interventions in patients with SLE.

Later Life Food Insecurity and Social Isolation in Ghana: The Importance of Psychological Factors.

Social isolation (SI) and food insecurity (FI) are important social determinants of health that can negatively impact well-being in old age. While research on the association between FI and SI is limited in LMICs, the mediators of this association are largely unknown. This cross-sectional study examined whether FI is associated with SI among older adults in Ghana and whether psychological factors (i.e., depression, anxiety, and sleep problems) mediated the association. Our study consisted of adults aged ≥50years in the Aging, Health, Well-being, and Health-seeking Behavior Study. SI was assessed with the Berkman-Syme Social Network Index, while FI was assessed with dietary inadequacy-related items. We used an ordinary least squares regression(OLS), logistic regressions, and bootstrapping modeling approach to examine our hypotheses with p<0.05. The analysis included 1201 individuals (Mage=66 [SD=12], women=63%). In the full sample (β=0.21; p<0.001) and in women (β=0.30, p<0.001) but not in men, FI was independently associated with SI. FI was comparably associated with increases in SI for the 50-64 age group (β=0.21, p<0.001) and ≥65 age cohort (β=0.19, p<0.01). Moreover, FI showed differential associations with specific domains of SI (OR=1.81 to 1.45, p<0.001). Finally, the FI-SI association was mediated by depressive symptoms (65.16%), anxiety symptoms (30.16%), and sleep problems (9.50%). Our data highlight the fundamental role of FI in SI among older adults, and the effect is explained by psychosocial factors. Interventions targeted toward strengthening interpersonal ties in old age should include addressing FI and older adults' psychosocial outcomes.

Dignity of Work and at Work: The Relationship between Workplace Dignity and Health among Latino Immigrants during the COVID-19 Pandemic.

Latino immigrants living in the United States were highly vulnerable to the health and economic consequences brought on by the COVID-19 pandemic. We use the conceptual framing of workplace dignity, worth that is acknowledged based on performance of job responsibilities, to explore Latino immigrants' experiences during the early months of the pandemic. A qualitative study was conducted with La Clínica del Pueblo (La Clínica), a community health center serving low-income Latino immigrants. From June to December 2020, we conducted in-depth video interviews with 29 Latino immigrant clients to explore pandemic-related challenges, including workplace changes, discriminatory experiences, and effects on health. We conducted thematic analysis using Dedoose software. Nearly half of participants were undocumented immigrants. Most participants were unemployed or underemployed due to the pandemic and 26-49 years of age; one-third were still working, and one-quarter were 50 years or older. About half were cisgender women and two were transgender women. Employed participants experienced a lack of dignity through being socially isolated and stigmatized at work; receiving no compensation for their extra labor or for sick leave; and experiencing discriminatory labor practices. Unemployed participants experienced a lack of dignity in being the first to lose their jobs without government support; losing self-esteem; and not being rehired. Participants associated denial of dignity with worsening health conditions and increased anxiety and depression. Our study suggests that denial of workplace dignity-through job loss, underemployment, and poor working conditions-is linked to adverse health outcomes for Latino immigrants. More research should recognize workplace dignity as an important social determinant of health.

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes.

Food access is an important social determinant of health and refers to geographical and infrastructural aspects of food availability. Using publicly available data on food access from the United States Department of Agriculture (USDA), geospatial analyses can identify regions with variable food access, which may impact acute pancreatitis (AP), an acute inflammatory condition characterized by unpredictable outcomes and substantial mortality. This study aimed to investigate the association of clinical outcomes in patients with AP with geospatial food access. We examined AP-related hospitalizations at a tertiary center from January 2008 to December 2018. The physical addresses were geocoded through ArcGIS Pro2.7.0 (ESRI, Redlands, CA). USDA Food Access Research Atlas defined low food access as urban areas with 33% or more of the population residing over one mile from the nearest food source. Regression analyses enabled assessment of the association between AP outcomes and food access. The study included 772 unique patients with AP residing in Massachusetts with 931 AP-related hospitalizations. One hundred and ninety-eight (25.6%) patients resided in census tracts with normalurban food access and 574 (74.4%) patients resided in tracts with low food access. AP severity per revised Atlanta classification [OR 1.88 (95%CI 1.21-2.92); p = 0.005], and 30-day AP-related readmission [OR 1.78(95%CI 1.11-2.86); p = 0.02] had significant association with food access, despite adjustment for demographics, healthcare behaviors, and comorbidities (Charlson Comorbidity Index). However, food access lacked significant association with AP-related mortality (p = 0.40) and length of stay (LOS: p = 0.99). Low food access had a significant association with 30-day AP-related readmissions and AP severity. However, mortality and LOS lacked significant association with food access. The association between nutrition, lifestyle, and AP outcomes warrants further prospective investigation.

Trajectories of job insecurity and the probability of poorer mental health among prime working-age Australian women and men

Precarious and insecure employment arrangements are important social determinants of health. Prior evidence has consistently found perceived job insecurity to be associated with poorer mental health. Nonetheless, several key under-researched areas remain in the existing evidence base. This study addresses some of these gaps by examining trajectories of job (in)security and assessing the effect of various persistent job security trajectories on subsequent mental health of both men and women. Utilising 15 waves of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we employed group-based trajectory modelling (GBTM) to identify trajectories of job (in)security through men and women's prime working years (from baseline age of 28–38yrs to 41–51yrs) across 14 years (waves 5–18), before subsequently examining the associations between these estimated trajectories and mental health at wave 19 (aged 42–52yrs). We identified four distinct trajectories of job (in)security for both men and women: persistently secure, becoming more secure, becoming less secure, and persistently insecure. Examining the association between these trajectories and mental health, we found that chronic exposure to any amount of persistent job insecurity (improving, worsening or persistently insecure) is detrimental to the mental health of both men and women. Furthermore, a somewhat incremental or dose dependant effect was found, with persistent job insecurity associated with the largest declines in mental health scores. Given mental health disorders are a substantial cause of disability globally, our study provides evidence that developing policy and practice interventions to reduce job insecurity (as an increasingly recognised and highly modifiable social determinant of mental health) has considerable potential to enact positive population health improvements.

Housing assistance among patients with cancer: SEER-Medicare US Department of Housing and Urban Development data linkage.

Lack of stable, affordable housing is an important social determinant of health. Federal housing assistance may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of Surveillance, Epidemiology, and End Results (SEER) program-Medicare and US Department of Housing and Urban Development (HUD) administrative data. Individuals enrolled in HUD public and assisted housing programs between 2006 and 2021 were linked with cancer diagnoses between 2006 and 2019 identified in the SEER-Medicare data from 16 states using Match*Pro (National Institutes of Health, Bethesda, MD) probabilistic linkage software. HUD administrative data include timing and type of housing assistance as well as verified household income. Medicare administrative data are available through 2020. A total of 335 490 unique individuals who received housing assistance at any time point, including 156 794 who received housing assistance around the time of their diagnosis (at least 6 months before diagnosis until 6 months after diagnosis or death), were matched to SEER-Medicare data. A total of 63 251 individuals receiving housing assistance at the time of their diagnosis were aged 66 years and older and continuously enrolled in Medicare parts A and B fee for service; 12 035 had a diagnosis of lung cancer, 8866 of breast cancer, 7261 of colorectal cancer, and 4703 of prostate cancer. This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis, care, and outcomes, including the role of housing assistance status in potentially reducing or contributing to inequities across racialized and ethnic groups.

Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic

BackgroundFood insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people.MethodsIn partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences.ResultsAmong 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders.ConclusionsHigh rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.

Cross-sectional analysis of primary care clinics’ policies, practices, and availability of patient support services during the COVID-19 pandemic

BackgroundHealthcare accessibility and utilization are important social determinants of health. Lack of access to healthcare, including missed or no-show appointments, can have negative health effects and be costly to patients and providers. Various office-based approaches and community partnerships can address patient access barriers.Objectives(1) To understand provider perceptions of patient barriers; (2) to describe the policies and practices used to address late or missed appointments, and (3) to evaluate access to patient support services, both in-clinic and with community partners.MethodsMailed cross-sectional survey with online response option, sent to all Nebraska primary care clinics (n = 577) conducted April 2020 and January through April 2021. Chi-square tests compared rural-urban differences; logistic regression of clinical factors associated with policies and support services computed odds ratios (OR) and 95% confidence intervals (CI).ResultsResponse rate was 20.3% (n = 117), with 49 returns in 2020. Perceived patient barriers included finances, higher among rural versus urban clinics (81.6% vs. 56.1%, p =.009), and time (overall 52.3%). Welcoming environment (95.5%), telephone appointment reminders (74.8%) and streamlined admissions (69.4%) were the top three clinic practices to reduce missed appointments. Telehealth was the most commonly available patient support service in rural (79.6%) and urban (81.8%, p =.90) clinics. Number of providers was positively associated with having a patient navigator/care coordinator (OR = 1.20, CI = 1.02–1.40). For each percent increase in the number of privately insured patients, the odds of providing legal aid decreased by 4% (OR = 0.96, CI = 0.92-1.00). Urban clinics were less likely than rural clinics to provide social work services (OR = 0.16, CI = 0.04–0.67) or assist with applications for government aid (OR = 0.22, CI = 0.06–0.90).ConclusionsPractices to reduce missed appointments included a variety of reminders. Although finances and inability to take time off work were the most frequently reported perceived barriers for patients’ access to timely healthcare, most clinics did not directly address them. Rural clinics appeared to have more community partnerships to address underlying social determinants of health, such as transportation and assistance applying for government aid. Taking such a wholistic partnership approach is an area for future study to improve patient access.

A theoretical conceptualisation of connection to culture in Australian First Peoples children

Connection to culture in Australian First Peoples children is an important social determinant of health in child development and wellbeing. The current study draws upon the collective knowledge of Australian First Peoples Elders and community leaders to collaboratively develop the first theoretical conceptualisation of connection to culture in Australian First Peoples children. Through participatory action research, we integrated both Western and Indigenist methodologies. One-on-one qualitative narrative interviews were conducted with six Australian First Peoples Elders and community leaders. Their knowledge was summarised through a process of Western thematic analysis and Indigenist arts-based participatory analysis to identify core concepts and mechanisms of connection to culture in First Peoples children. The outcome was a theory of connection to culture in Australian First Peoples children. By better understanding how children connect to culture, we can better support children in connecting to culture, targeting an important factor of health and wellbeing.

Student Health Services at Historically Black Colleges and Universities and Predominantly Black Institutions in the United States.

Student health services are associated with improved health outcomes and academic success, particularly among under-resourced college populations. This study compared student health services at Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs) and identified factors associated with the availability of comprehensive health services (CHS). We conducted a secondary analysis of 2022 data from the Integrated Postsecondary Education Data System (IPEDS), the Minority Serving Institutions (MSIs) Directory, and the websites of HBCUs and PBIs (n=167). Bivariate and multivariate logistic regression analyses were undertaken to identify institutional variables associated with providing CHS. Institutional variables included college type (public vs. private), MSI category (HBCU vs. PBI), undergraduate enrollment, location, and proportion of Pell grant recipients. Approximately 13% of HBCUs and 26% of PBIs offered no student health services; 65% of HBCUs and 39% of PBIs offered on-campus CHS with prescribing providers. Four-year HBCUs were five times more likely than 4-year PBIs to have CHS (p=0.014). Institutions with more Pell Grant recipients were less likely to offer CHS. Access to health care is an important social determinant of health, academic persistence, and achievement for college students. HBCUs were significantly more likely than PBIs to offer CHS. HBCUs are more likely than PBIs to have resources from federal funding, donors, and endowments that may support the development of student health centers and services. Increased funding for PBI health centers could improve access and promote health equity among the most vulnerable student populations.

An Exploration of Rural Housing Insecurity as a Public Health Problem in California's Rural Northern Counties.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

Time poverty, health and health-related behaviours in a Southern European city: a gender issue

BackgroundDespite its growing interest, time poverty is a neglected issue in public health analysis and policies. The objectives of this study were: (1) to analyse gender differences in paid, unpaid...

First, Seek to Understand: Deconstructing the Concept of Poverty for Nursing Education

Poverty, an important social determinant of health, is a multifaceted issue that impacts the health of individuals, families, and communities. People who live in impoverished communities have limited access to many necessary resources. This deficit often results in increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy and greater need for healthcare services. There is a call for nurse educators to provide multiple opportunities throughout curricula for students at all levels to develop competencies to assess and intervene in outcomes impacted by social determinants of health. Doing so requires a perspective of empathy, grounded in cultural humility, to advance health equity and advocate for persons facing challenges, such as those who experience poverty. This article provides an overview of poverty in the context of the social determinants and discusses strategically designed experiential learning experiences, such as simulations and community-academic partnerships. An exemplar of an interprofessional community-academic partnership is provided to illustrate an ongoing successful effort that has fostered a deeper understanding of the lived experience of poverty for students of nursing and other professions.

Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage.

Mortality after intracerebral hemorrhage (ICH) is common. Neighborhood socioeconomic status (nSES) is an important social determinant of health (SDoH) that can affect clinical outcome. We hypothesize that SDoH, including nSES, contribute to differences in withdrawal of life-sustaining therapies (WLSTs) and mortality in patients with ICH. We performed a retrospective study of patients with ICH at 3 tertiary care hospitals between January 2017 and December 2022 identified through the Get with the Guidelines Database. We collected data on age, clinical severity, race/ethnicity, median household income, insurance, marital status, religion, mortality before discharge, and WLST from the electronic medical record. We assessed for associations between SDoH and WLST, mortality, and poor discharge mRS using Mann-Whitney U tests and χ2 tests. We performed multivariable analysis using backward stepwise logistic regression. We identified 868 patients (median age 67 [interquartile range (IQR) 55-78] years; 43% female) with ICH. Of them, 16% were Black non-Hispanic, 17% were Asian, and 15% were of Hispanic ethnicity; 50% were on Medicare and 22% on Medicaid, and the median (IQR) household income was $81,857 ($58,669-$122,078). Mortality occurred in 17% of patients, and of them, 84% of patients had WLST. Patients from zip codes with higher median household incomes had higher incidence of WLST and mortality (p < 0.01). Black non-Hispanic race was associated with lower WLST and discharge mortality (p ≤ 0.01 for both). In multivariable analysis adjusting for age and clinical severity scores, patients who lived in zip codes with high-income levels were more likely to have WLST (adjusted odds ratio [aOR] 1.88; 95% CI 1.29-2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06-2.13). SDoH, including nSES, are associated with WLST after ICH. This has important implications for the care and management of patients with ICH.

Poverty and cancers: A brief review

Poverty has been an important social determinant of health, including cancer. The poverty trap of cancer diagnosis and treatment owing to catastrophic expenditure and subsequent poor outcomes is well documented in the literature. This article aims to explore the role of poverty, leading to biological changes responsible for an increased risk of carcinogenesis. The role of poverty-causing cancers could open the avenues for more comprehensive prevention and control strategies, and subsequent policy implications, in high-burden and poverty-stricken regions in the country.

Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs

ObjectivePrevious studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA. MethodsAdministrative claims data were linked to objective PAP therapy usage. Inverse probability treatment weighting was used to compare outcomes over 2 years across PAP adherence levels. The predicted numbers of emergency room (ER) visits and hospitalizations by adherence level were assessed using risk-adjusted generalized linear models. Results37,459 patients were included. Relative to non-adherent patients, consistently adherent patients had fewer self-harm events (0.04 vs 0.05, p < 0.001) after 1 year, and significantly (all p < 0.001) fewer ER visits (0.66 vs 0.86) and all-cause hospitalizations (0.13 vs 0.17), and lower total ($11,847 vs $11,955), inpatient hospitalization ($1634 vs $2274), and ER visit ($760 vs $1006) costs per patient in the second year of PAP therapy. Consistently adherent patients showed lower risk for hospitalizations and ER visits. LimitationsUsing observational claims data, we were unable to assess clinical characteristics including sleep, sleepiness, and daytime symptoms, or important social determinants of health. We were limited in assessing care received outside of the included health plans. ConclusionConsistent adherence to PAP therapy over 2 years was associated with improved HCRU outcomes for patients with pre-existing depression newly diagnosed with comorbid OSA.

UNDERSTANDING THE RELATIONSHIP BETWEEN AIR QUALITY AND FIVE-YEAR SURVIVAL OF PATIENTS IN THE AMERICAN FAMILY COHORT

Abstract Air pollution is an important social determinant of health and associated with cardiopulmonary disease, cancer, diabetes, and cognitive impairment. This study examined the impact of air pollution on the mortality of patients in the American Family Cohort (AFC), a national dataset of 6.6 million Americans, derived from the American Board of Family Medicine PRIME Registry electronic health record data. The AFC data were merged with the Environmental Protection Agency’s Air Quality Index (AQI) measures for the study period (2016-2022). Two Cox-Regression-Models were performed to determine how (1) baseline air quality and (2) air quality measures over time would affect patients’ five-year survival. Fixed covariates of interest--gender, race, age, location, and year of entry into the study--were studied as well. The adjusted hazard of death in the group with baseline AQI greater than 50 was 4.02 times higher than that of the group with AQI less than or equal to 50 (95% CI: 3.36, 4.82, p &amp;lt; 0.05). Compared to younger patients, the hazard of death was 6.73 times higher in persons older than 80 years of age (95% CI: 5.47, 8.28; p &amp;lt; 0.05). Black/African American patients had a 4.27 times higher hazard of death (95%CI: 3.47, 5.26; p &amp;lt; 0.05) compared to other races. Our study shows that vulnerable populations (older adults and persons from minority communities) are disproportionately burdened by poor air quality. Public health initiatives that focus on improving air quality for minority communities will improve their longevity.

Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China

BackgroundBehavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults.MethodsData were extracted from China’s Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors.ResultsA total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (β = -0.78, P < 0.001) or mixed habitation (β = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone.ConclusionsThis study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Introducing the SEER-Medicare-Housing and Urban Development data linkage: A novel resource for examining the association of housing assistance and cancer care and outcomes.

200 Background: Lack of stable and affordable housing is an important social determinant of health. Federal housing assistance—through housing choice vouchers, public housing, and other programs—may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of SEER-Medicare and Housing and Urban Development (HUD) administrative data that can be used to examine housing assistance and cancer care and patient outcomes to inform efforts to reduce inequities. Methods: Individuals enrolled in HUD programs 2006-2021 were linked with cancer diagnoses 2006-2019 identified in the SEER-Medicare data from 16 states using Match*Pro probabilistic linkage software. HUD administrative data include timing and type of housing assistance and verified household income. Medicare administrative data are available through 2020. We describe the cohort aged ≥66 years with continuous Medicare fee-for-service Parts A/B coverage surrounding diagnosis who had episodes of housing assistance: 1) at diagnosis or 2) starting within 3 years after diagnosis. Because supply of housing assistance is limited, eligible, low-income families are frequently wait-listed; individuals who receive housing assistance after diagnosis can serve as controls for individuals with housing assistance at diagnosis. Results: Among 42,197 individuals aged ≥66 years diagnosed with cancer and with housing assistance, the most common diagnoses were female breast (n=8,108), lung (n=5,400), colorectal (n=5,197), and prostate (4,548) cancers. Sociodemographic characteristics were similar among the 35,873 individuals with HUD assistance at diagnosis and 6,334 who received it later (Table). Both groups were majority female and non-Hispanic white and with median household income &lt;$14,000. Private multifamily housing programs were the most common form of assistance, followed by housing choice vouchers, and public housing. Conclusions: This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis and outcomes, including the role of housing assistance in potentially reducing or contributing to inequities across racialized and ethnic groups.[Table: see text]

Supporting Solidarity

Supporting Solidarity