Important Social Determinant Of Health Research Articles

Association between Living with Children and the Health and Health Behavior of Women and Men. Are There Differences by Age? Results of the "German Health Update" (GEDA) Study.

Does the health of women and men living with and without minor children differ, and are age differences evident in the association? For self-rated general health, depression, back pain, overweight, smoking and sporting inactivity, the GEDA data 2009–2012 (18–54 years, n = 39,096) were used to calculate prevalence for women and men stratified by parental status (living with children: yes/no) and age. Moreover, we calculated odds ratios and predictive margins, performing logistic regressions with interaction terms of parental status and age. Women and men aged 45–54 living with children are healthier than those not living with children. Parents aged 18–24 smoke more frequently and do less sport; young mothers are also more likely to be overweight and suffer from back pain than women not living with children. In multivariable analysis, the interaction of living with children and age is significant for all outcomes (except depression and back pain in men). Living with children is an important social determinant of health, highly dependent on age. It is to be discussed whether the bio-psycho-social situation has an influence on becoming a parent, or whether parenthood in different phases of life strains or enhances health.

Gender, justice and empowerment: creating the world we want to see

Gender is one of the most important social determinants of health. Considerable research has shown that power imbalances due to gender and sexual orientation lead to numerous negative health outcom...

Incorporation of Information-Seeking Behavior Into Food Insecurity Research

Limited or uncertain availability of nutritionally adequate and safe foods affects the health of individuals. Because of its association with chronic health conditions, addressing food insecurity may improve health outcomes and decrease health-related costs. This study explores whether and how information seeking as captured by calls made to United Way 2-1-1 can be used to identify food-insecure areas and information deserts-communities with low proportions of residents accessing government food resources but with high rates of 2-1-1 calls for emergency food resources. Details regarding calls made to United Way of Salt Lake 2-1-1 for emergency food resources between 2014 and 2018 (n=63,221) were analyzed in 2019. Using GIS methods, areas with the highest number of calls for emergency food resources (hot spots) were identified; multinomial logistic regression was used to identify community-level sociodemographic predictors of food insecurity. Areas with a smaller proportion of the population aged <18 years, more female householders, and more African Americans are associated with higher odds of being food-insecure. Patterns of information seeking about emergency food resources suggest that, despite statewide access to federal means-tested food programs, significant food needs remain. This novel approach in food insecurity research can help public health officials and health systems address an important social determinant of health by identifying areas vulnerable to food insecurity. In addition, this work may be useful in benchmarking food needs, information seeking, and replicating analyses where similar data are available.

Abstract WP234: Association of Social Trust With Subsequent Stroke and Cardiovascular Disease Risk

Introduction: Although social capital has been shown to be one of the important social determinants of health, the association between social trust and the risk of stroke and cardiovascular disease (CVD) is not clear yet. We aimed to investigate the association of social trust with stroke and CVD risk using a large Asian population. Methods: The study data was derived from the Korean National Health Insurance Service database. Community-level social trust was determined from the Koran Community Health Survey. The study population consisted of 2,156,829 participations. According to social trust index measured in the area of residence during 2011, participants were followed-up from 1 January 2012 to 31 December 2016. Multivariate Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for stroke and CVD risk according to quintiles of social trust. Results: Compared to those with the lowest quintile of social trust, participants within the highest quintile had lower risk for stroke (aHR 0.90, 95% CI 0.87-0.93) and CVD (aHR 0.91, 95% CI 0.89-0.93), and the risk-reducing association of high social trust on CVD risk was preserved after additional adjustments for lifestyle behaviors including smoking, alcohol intake, and physical activity. Conclusion: Higher social trust was associated with reduced risk of stroke and CVD even after considering lifestyle behaviors. Social trust in a community level is an important determinant of stroke risk and enhancing social trust may lead to reduced risk of stroke and CVD.

Homelessness and Mental Illness: Views from Early Career Psychiatrists from Asian Countries

Homelessness is an important social determinant of health. The information has been sparse on the relationship between homelessness and mental illnesses in Asian countries. In this perspective paper, we present the synthesis of viewpoints of early career psychiatrists from several Asian countries on the relationship of homelessness and mental illnesses. An online questionnaire was used to gather responses. The definition of homelessness was kept broad and included both temporary and lasting homelessness. The responses were synthesized into paragraphs to describe the perspective for the country. Although difficulties were experienced in the estimation of homelessness, the numbers of homeless individuals varied from practically negligible in Jordan to about 1.77 million in India. Mental health issues were present in the homeless population and included affective disorders, psychotic disorders, and substance use disorders. The psychiatrists generally had a considerate viewpoint toward treating the mentally ill homeless people. There is a need for more literature on the interface of homelessness and mental illness from Asian countries, especially where the homeless populations are substantial.

Sex/Gender Differences in the Association between Residential Green Space and Self-Rated Health-A Sex/Gender-Focused Systematic Review.

Though sex/gender is an important social determinant of health, sex/gender inequalities have not been considered comprehensively in environmental health research thus far. The aim of this systematic review was to clarify whether sex/gender theoretical concepts were addressed in studies on the impact of residential green space on self-rated health and whether effect modification by sex/gender was observed. Three electronic databases were searched to identify epidemiological studies on perceived or objective residential green/blue space and self-rated health. Necessary for study inclusion was mentioning at least one keyword for sex/gender in title or abstract, adult study participants and data on self-rated health and on availability and/or use of green/blue spaces. Decisive for study inclusion was consideration of sex/gender differences in the impact of perceived or objective residential green/blue spaces on self-rated health in the analysis and presentation of results. Seven studies were included. They presented an overall positive impact of green space on self-rated health. No consistent sex/gender differences in the impact of green space on self-rated health were found in these studies. However, all studies used a binary operationalization male/female without further theoretical foundation. Research quality could be enhanced by integrating sex/gender-theoretical concepts into study design and interpretation of results.

Usefulness of Social Support in Older Adults After Hospitalization for Acute Myocardial Infarction (from the SILVER-AMI Study)

The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support - emotional support, informational support, tangible support, positive social interaction, and affectionate support - with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.

Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database

Given the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates. Our analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES. 15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p < 0.0001). We found that Asian Americans compared to whites had better overall survival (HR 0.75; 95% CI [0.58-0.95]). Black patients had improved survival compared to whites on univariate (HR 0.71; 95% CI [0.64-0.79]); but not multivariate analysis. Hispanic ethnicity and higher education level were protective (HR 0.76 95% CI [0.63-0.91] and HR 0.84 95% CI [0.74-0.96], respectively). We found no significant survival association based on income level. In this national sample of patients with parotid malignancy, a rare form of cancer, we found a significant correlation between important social determinants of health and overall survival rate. Females, Asian-Americans, Hispanics, and patients with higher education level have better overall survival.

Gender differences in the impact of perceived or objectively measured residential green or blue space on self-rated health – a systematic review

TPS 702: Green space and population health, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background/Aim. Though gender is an important social determinant of health, gender inequalities have not been considered comprehensively in environmental health research so far. The project INGER intends to develop innovative methods for integration of gender in environmental health research. The aim of this systematic review was to clarify whether gender-theoretical concepts were addressed in studies on gender differences in the impact of residential green/blue space on self-rated health. Methods. Three electronic databases were searched to identify studies on residential green/blue space and self-rated health. Inclusion criteria were publication in 2000-2018, at least one keyword for gender/sex in title/abstract, adult study participants, and providing data on green or blue spaces and self-rated health. Green/blue spaces could be measured subjectively (e.g. perceived amount of or access to green space) or objectively (Normalized Difference Vegetation Index, landcover map). Sufficient for study inclusion were consideration of gender differences in the impact of green/blue space on self-rated health in the analysis and presentation of results on potential gender differences. Results. Out of 4230 potential eligible articles identified by the search seven cross-sectional studies met the inclusion criteria. Quality assessment gave fair results. All studies had a reasonable sample size and valid data collection. They presented an overall positive impact of green space on self-rated health. Only two studies reported on quality characteristics of green space. No or only weak evidence for gender differences in the impact of green space on self-rated health were found. However, all studies used a binary operationalisation male/female without further theoretical foundation. Interchangeable use of the terms ‘gender’ and ‘sex’ indicated a conceptual muddle. Due to the heterogeneity in approaches to assess green/blue spaces no meta-analysis was possible. Conclusion. Research quality could be enhanced by integrating gender-theoretical concepts into study design and interpretation of results.

Relevance of Gender and Social Support in Self-Rated Health and Life Satisfaction in Elderly Spanish People.

Background: Gender and social support are important social determinants of health, but the relevance of such variables in older people’s health has raised less scholarly attention than in younger age groups. This study examines the relevance of gender and social support in the self-rated health and life satisfaction of elderly Spanish people. A cross-sectional study with a sample of 702 men and 754 women aged between 60 and 94 years was conducted. All participants were evaluated through questionnaires that assess gender role traits, social support, and life satisfaction. Results: Men scored higher than women in masculine/instrumental trait and in life satisfaction whereas women scored higher than men in feminine/expressive trait. Results from multiple regression analyses indicated that women and men presenting higher social support had better self-rated health and higher life satisfaction. High scores in masculine/instrumental trait also proved to be an important predictor of men’s and women’s high life satisfaction and of women’s better self-rated health, whereas the high feminine/expressive trait predicted better self-rated health in the men group. A high educational level was associated in the women’s group with better self-rated health and higher life satisfaction. Conclusions: We conclude that gender and social support are important social determinants of health among older people.

Effect of the Affordable Care Act's Medicaid Expansions on Food Security, 2010-2016.

Objectives. To examine whether the expansion of Medicaid under the Affordable Care Act (ACA) decreased the prevalence of severe food insecurity.Methods. With data on adult respondents to the Food Security Supplement to the Current Population Survey in US states for the years 2010 to 2013 and 2015 to 2016, I used a difference-in-difference design to compare trends in very low food security (VLFS) among low-income childless adults in states that did and did not expand Medicaid in 2014 under the ACA.Results. Among low-income, nonelderly childless adults, VLFS rose from 17.4% before ACA to 17.5% after ACA in nonexpansion states, and fell from 17.6% to 15.9% in expansion states. In difference-in-difference analysis, Medicaid expansion was associated with a significant adjusted 2.2-percentage-point decline in rates of VLFS, equivalent to a 12.5% relative reduction.Conclusions. The improvement in food security after the ACA's health insurance expansion suggests that health insurance provision has spillover effects that reduce other dimensions of poverty.Public Health Implications. Providing free or low-cost health insurance coverage may free up household funds, reducing food insecurity and improving this important social determinant of health.

Alcohol Outlet Clusters and Population Disparities.

Alcohol outlet clusters are an important social determinant of health in cities, but little is known about the populations exposed to them. If outlets cluster in neighborhoods comprised of specific racial/ethnic or economic groups, then they may function as a root cause of urban health disparities. This study used 2016 liquor license data (n = 1204) from Baltimore City, Maryland, and demographic data from the American Community Survey. We defined alcohol outlet clusters by combining SaTScan moving window methods and distances between outlets. We used multiple logistic regression to compare census block groups (CBGs) (n = 537) inside and outside of four types of outlet clusters: total, on-premise, off-premise, and LBD-7 (combined on-/off-premise). The most robust predictor of alcohol outlet cluster membership was a history of redlining, i.e., racially discriminatory lending policies. CBGs that were redlined had 7.32 times the odds of being in an off-premise cluster, 8.07 times the odds of being in an on-premise cluster, and 8.60 times the odds of being in a LBD-7 cluster. In addition, level of economic investment (marked by vacant properties) appears to be a key characteristic that separates CBGs in on- and off-premise outlet clusters. CBGs with racial/ethnic or socioeconomic advantage had higher odds of being in on-premise clusters and CBGs marked by disinvestment had higher odds of being in off-premise clusters. Off-premise clusters deserve closer examination from a policy perspective, to mitigate their potential role in creating and perpetuating social and health disparities. In addition to addressing redlining and disinvestment, the current negative effects of alcohol outlet clusters that have grown up in redlined and disinvested areas must be addressed if inequities in these neighborhoods are to be reversed.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support.

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

How do Latino Immigrants Perceive the Current Sociopolitical Context? Identifying Opportunities to Improve Immigrant Health in the United States

AbstractMigration is an important social determinant of health for immigrants in the United States. Increased attention on Latino immigrants in recent years has sparked interest in policies that affect this population. While prior research has assessed the potential health impact of specific immigration policies, there is limited understanding of how the overall sociopolitical context shapes the health of Latino immigrants. This study examines the potential mechanisms that link the sociopolitical context and health among Latino immigrants. Specifically, we explore how perceptions of the sociopolitical context are implicated in this relationship. Qualitative interviews with community gatekeepers (n=13) and Latino immigrants (n=34) in New York City revealed general perceptions about the overall sociopolitical context, which were characterized by discrimination towards immigrants, unpredictable and mercurial circumstances, and confusion and lack of information. These perceptions influenced participants’ psycho-emotional health and health-related behaviors. Findings suggest the importance of integrating immigrants’ perceptions of the sociopolitical context into health promotion efforts. Furthermore, findings demonstrate the need for paradigm shifts in developing policy-related actions to integrate immigrants’ perspectives. We propose an integrated, multi-level framework to guide future research and practice regarding social determinants of immigrant health.

The association of self-reported discrimination to all-cause mortality: A population-based prospective cohort study.

Discrimination has is an important social determinant of health and though some research has been carried out on this it is mostly from the United States, which may not be generalisable to Europe and Sweden. This study investigated the association between self-reported experiences of repeated discrimination and all-cause mortality in Scania, Sweden. The Scania Public Health survey was sent out in 2008 with a follow-up in 2013 through the Swedish national cause of death register (N=28,062). The exposure variable under investigation was self-reported discrimination and the outcome variable was all-cause mortality. Additional variables included demographics (age, sex, marital status, immigrant status), health behaviours (smoking, alcohol consumption, physical exercise), BMI, social participation, economic stress, and mental health. Time was measured as total number of days. Statistical analysis included association of the different variables to discrimination (ORs) and to all-cause mortality (HRs) adjusting for different covariates. Effect modification was tested for social participation, economic stress and mental health. The odds of discrimination was higher among the most vulnerable groups in society. All-cause mortality was strongly associated to age and sex, with a much higher risk among men than women. The association of repeated discrimination to all-cause mortality remained significant after adjusting for demographic variables, health behaviours and either social participation or economic stress, but not both. The association was non-significant after adjusting for demographic variables and mental health. Social participation was found to be an effect modifier with low participation strengthening the effect of the association of repeated discrimination to all-cause mortality. Repeated discrimination clearly has a strong impact on mental health but also on economic stress and social participation which in turn have a strong impact on mortality.

Food Insecurity and Health-Related Quality of Life: A Cross-Sectional Analysis of Older Adults in Florida, U.S.

ABSTRACTIndividuals 65 years or older will comprise an estimated 20.0% of the U.S. population by 2030. This study investigated the association between food insecurity and health-related quality of life (HRQoL) among an older adult population (n = 234). HRQoL was measured using Healthy Days, a validated survey tool developed by the Centers of Disease Control and Prevention. Food-insecure individuals were more likely to report ≥14 physically unhealthy days (OR = 1.49, 95% CI 0.47–4.78) and ≥14 days with activity limitations (OR = 4.07, 95% CI 0.68–24.1). Although nonsignificant, the findings highlight food insecurity as a potentially important social determinant of health throughout the life course, including at an older age.

Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada

BackgroundAccess to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists.MethodsA cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients’ socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs.ResultsPatients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas.ConclusionOur findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.

Education system stratification and health complaints among school-aged children

Research shows that the school environment is an important social determinant of health among children and adolescents. However, we know virtually nothing of the health consequences of national education systems and policies, for example the stratification of pupils by academic ability. This study aimed to investigate if education system stratification is related to self-reported psychological and somatic health complaints of pupils aged 11 to 15, and social inequalities in such health complaints.Survey data from the Health Behaviors of School-aged Children (HBSC) survey, covering 33 countries and more than 180 000 pupils in primary and lower secondary school, were used. Multilevel models showed that education system stratification was not associated with the average levels of health complaints of pupils, but cross-level interaction effects showed that stratification moderated the relationship between social background and health complaints, such that inequalities in health complaints were smaller in countries with more stratified systems. Moreover, this moderating effect was mediated by the school learning environment and social relations in school. Specifically, social inequalities in school pressure, academic self-concept, school climate, and school satisfaction were smaller in more stratified education systems, which in turn accounted for smaller inequalities in health complaints in these countries.

Inequities in Genetic Testing for Hereditary Breast Cancer: Implications for Public Health Practice

Background and context: The Ontario Breast Screening Program for women with a genetic predisposition to breast cancer is 1 of the first international models of a government-funded public health service that offers systematic genetic screening to women at a high-risk of breast cancer. However, since the implementation of the program in 2011, enrolment rates have been lower than anticipated. While there may be several reasons for this to happen, it does call into consideration the 'inverse equity law', whereby the more advantaged in society are the first to participate and benefit from universal health services. An outcome of this phenomenon is an increase in the health divide between those that are at a social advantage vs those that are not. Aim: Using an intersectionality lens this review illuminates the role of the social determinants of health and social identity in creating possible barriers in the access to genetic screening for hereditary breast cancer, and the implications for public health practice in recognizing and ameliorating these differences. Strategy/Tactics: Although it remains too early to understand the exact cause for underenrolment in the OBSP high-risk screening program, this review serves to illuminate how screening programs that are used as targeted interventions to improve health outcomes must take into consideration the complexities associated with utilization and need across the entire population. A failure to do so may further disenfranchise socially disadvantaged individuals and widen the health equity gap that currently exists between population groups based on social location. Program/Policy process: The Ontario Breast Screening Program (OBSP) for High Risk Women is funded by the government; therefore, financial barriers in terms of access to care do not exist for individuals seeking screening. Despite this, the program has had low levels of enrolment based on their population targets (Cancer Care Ontario, 2012). Outcomes: While access to health care services is an important social determinant of health (Whitehead, 1992), the structure and design of health services can render them structurally unavailable and socially inacceptable to certain population groups (Gilson et al., 2007). Indeed, recent studies clearly demonstrate how socially disadvantaged individuals, such as those with lower levels of education, and those from ethnic minority groups consistently underuse health services despite the lack of a financial barrier to care (Maddison, 2011). What was learned: The way in which genetic testing is both accessed and used follow similar trends, such that higher levels of both income and education correlate with an increased awareness of genetic testing, a greater likely hood of receiving referrals for genetic testing, appropriateness of genetic counseling and the final decision to proceed with genetic testing.

A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases.

Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases-PubMed, EMBASE, and CINAHL-along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.