Inequalities In Access Research Articles

Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre

Abstract Background Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access. Methods A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO. Results 167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96) Conclusion Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.

Right Care, Right Time, Right Place: Real-life Challenges in Delivering Sláintecare – A Multi-Centre Survey of Multidisciplinary Team Members

Abstract Background Sláintecare launched in 2018 seeks to reform the delivery of healthcare services in Ireland towards equity of access based on patient need1. However, delivering the right care, in the right place at the right time is, as yet an aspirational goal. We sought to identify the on-the ground challenges that exist in delivering Sláintecare in the day-to-day practice of multidisciplinary team members. Methods An online survey questionnaire was distributed to medical social workers, occupational therapists, and physiotherapists. Respondents were asked about their experience in applying for community-based care in their practice including home care packages, community occupational therapy and home equipment. Descriptive statistics were applied to numerical data and a thematic analysis was performed on free text responses. Results There were 31 respondents from 10 clinical sites including acute and rehabilitation settings. All nine community healthcare organisations (CHOs) were represented. 29/31 (94%) felt that access to community-based care differed based on the patient’s residential address. 23/31 (74%) stated the referral documentation and process for home care packages varied depending on the patients’ CHO. Qualitative analysis identified three core themes; Unfulfilled care hours due to dearth of carer availability differed across CHOs; inconsistencies in the application process that exists between CHO’s and incongruities in the availability of and accessibility to publicly funded services on hospital discharge. Conclusion Our survey highlights the practical challenges of delivering Sláintecare currently. It reinforces the health inequities that limits patients’ ability to access quality healthcare because of their geographical location.

Characterizing pulmonary rehabilitation referrals from primary care

BackgroundSupporting referral to pulmonary rehabilitation (PR) from primary care for people with chronic lung disease could improve equity of access. Understanding who is referred to PR from primary care, and by whom, could inform development of strategies to increase awareness of and referral to PR for people with chronic respiratory disease. We aimed to quantify the proportion of patients referred to PR from primary care in an Australian metropolitan setting; and to identify characteristic features of patients and referrers. MethodsA retrospective, single-site, audit of referrals was undertaken. Corresponding patient medical records were reviewed for referral details, patient demographics and baseline PR assessment measures. ResultsBetween January 2020 and December 2023 658 referrals to PR were received of which 6.2 % (n = 41) originated from a primary care source (98 % general practice; 2 % allied health). People referred to PR from primary care were typically diagnosed with COPD (71 %), were female (59 %), had moderate disease severity (mean(SD) forced expiratory volume in 1 s 70(26) %predicted) and had mild symptoms (53 % modified Medical Research Council dyspnoea score 0 or 1) and modest functional impairment (6-min walk distance 410(121) meters). Just 4 of 36 primary care practitioners referred more than one patient. ConclusionIn this audit the proportion of people referred to PR from primary care was very low. Processes to support the referral of more patients from primary care to PR, across the spectrum of chronic respiratory disease, remain a priority for improving access to this well-established treatment.

Population perinatal substance use and an environmental scan of health services in British Columbia, Canada

BackgroundSubstance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs. MethodsUsing linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016–2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region. ResultsThe population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60 % (N=1745) of people with perinatal substance use; however, these regions represented only 35 % of BC’s specialized acute care and supportive housing beds (N=140). ConclusionsExpanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.

Examining the effect of economic complexity on energy justice

A clean and healthy environment is necessary to achieve other Sustainable Development Goals. Policymakers must find ways to minimize carbon dioxide emissions and global warming before the Sustainable Development era expires. These ills are compounded by chronic inequalities in access to clean energy and the distribution of energy infrastructure, costs, and benefits. This underscores the importance of examining, addressing, and preventing various inequalities in the energy sector. Thus, this paper endeavours to examine probably for the first time the effect of economic complexity on energy justice in a panel of 62 countries over the past decade. The measure of energy justice in this study is a rarely used indicator constructed from a range of 21 sub indicators. We also use three sub-indices of energy justice: distributive justice, procedural justice, and restorative justice. The empirical analyses based on a range of robust estimation approaches consistently provide strong evidence that, on average, economic complexity improves energy justice and its three sub components. Finally, the results from the mediation analysis show that the positive effect of economic complexity on energy justice mediates through income, and human capital. Based on these results, some policy recommendations are made for the achievement of Sustainable Development Goals 7, 8, and 16.

Exploring challenges and innovation in memory assessment services in England and Wales – a national survey and case study approach

BackgroundTo explore the design, delivery models and identify good and innovative practices in Memory Assessment Services (MAS) in England and Wales.MethodsA two-stage service evaluation comprising (1) on-line survey of MAS providers to identify features of the commissioning models, service design, delivery, and challenges alongside examples of good/innovative practice; (2) qualitative case studies using video/telephone interviews with key staff and people who had used the service.ResultsThe 49 respondents to the survey reported a shift in delivery of MAS post COVID and identified key areas for improvement, including a need for specialist staff, support for MCI and rarer dementias, and capacity for post diagnostic support. The 15 case studies illustrated good practice and innovation focusing on post diagnostic support, equity of access, working with external services/service location, MCI and rarer dementia and involving specialist staff.ConclusionsThe evaluation speaks to the importance of (re)evaluation of services to identify local need and the importance of commissioning based on local need and innovative approaches that my sit outside of ‘typical’ MAS pathways.

The Healthcare Support Program and Healthcare Utilization of Older Adults in Ethnic Minority Areas in Vietnam

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55-74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008-2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes.

Reviewing the Pillars of Immunization: Essential Vaccines and Their Public Health Benefits.

Vaccination has lowered, across the globe, morbidity and mortality from infectious diseases. It is considered one of the basic principles of preventive health measures. The World Health Organization’s Expanded Programme on Immunization defined vaccinations that are required and their tremendous benefits to public health, which are discussed in this review article. These involve the vaccinations taken against most communicable diseases, such as COVID-19, polio, measles, rubella, pneumococcal diseases, rotavirus, human papillomavirus, tuberculosis, Haemophilus influenzae type B, diphtheria, pertussis, and tetanus. The article points out that quite a number of vaccinations have been proven effective and safe and if administered, could prevent serious disease, disability, and death. For example, vaccination against measles has been rated to be vital in the containment of outbreaks within nonimmune populations, while the DTP vaccine is paramount in decreasing the cases of pertussis, tetanus, and diphtheria. The effect of vaccination can be exemplified by the dramatic decrease in the occurrence of serious bacterial contagion in children since the introduction of conjugate vaccines against Hib and pneumococcus. Notwithstanding these successes, there are persistent obstacles, such as vaccine hesitancy, misinformation, and inequities in access to vaccines, all heightened by the COVID-19 pandemic. The article discusses the global impact of vaccination efforts under siege and appeals for further public health efforts toward the attainment of these goals.

Equity in education for migrant and racialized students in Southern Spain: From multilevel analysis to participatory recommendations

This paper aims to analyze equity in education policies and practices in Southern Spain that ensure cultural competence in services and the inclusion of migrant and racialized students. Our model for defining and analyzing equity in education was adapted from the Migrant Integration Policy Index (MIPEX) and includes five dimensions: (E1) equity in mission/goal, (E2) equity in access, (E3) quality/sensitivity of services, (E4) equity in participation, and (E5) development of partnerships and opportunities. Through transformative mixed methods (i.e., documental analysis of 13 policies, 15 interviews with professionals, one focus group with mothers of Afro-descendant students), the results showed that equity was 100% present in the mission/goal of the Andalusian education system, although there were gaps in its practical implementation, especially in participation and quality/responsiveness. These results were discussed and recommendations for improving equity in education policies and practices are proposed participatively.

Culturally safe community agency health promotion capacity for diverse equity-seeking women: a rapid theoretical review

ObjectivesImmigrant and sexually/gender-diverse women (henceforth, women) face inequities in access to and quality of care. As a result, many seek health information from community agencies perceived as culturally safe. We...

Stigma, Discrimination and Other Social-Structural Factors Associated with Barriers to Counselling or Therapy among Women Living with HIV Who have Experienced Violence in Metro Vancouver, Canada.

Women living with HIV face high social and structural inequities that place them at heightened risk for gender-based violence and mental health conditions, alongside health services access inequities, with almost no research done to better understand access to mental health services. This study therefore examined social and structural factors associated with barriers to counselling or therapy amongst women living with HIV who experienced lifetime physical and/or sexual violence in Metro Vancouver, Canada. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were used and adjusted odds ratios (AOR) and 95% Confidence Intervals ([95%CIs] are reported). From Sept/15-Aug/21, 1695 observations were collected among 279 participants. In multivariable analysis, with all variables measured in the last six months, experiencing any barriers to counselling or therapy was significantly associated with having thoughts or attempts of suicide (AOR:1.64 [1.02-2.66]), lacking coverage for health care (AOR:1.60 [1.17-2.18]), and everyday discrimination (AOR:1.02 [1.00-1.04]) and anticipated (AOR:1.57 [1.04-2.36]), enacted (AOR:1.48 [1.02-2.16]) or internalized (AOR:1.53 [1.07-2.20]) HIV stigma. Access to interdisciplinary mental health care services should be improved. Social and structural interventions to reduce HIV stigma and discrimination are urgently needed.

Abstract A075: Racial and ethnic inequities in receipt of degarelix among patients diagnosed with advanced prostate cancer in United States

Abstract Background: Prostate cancer (CaP) is the most commonly diagnosed non-cutaneous cancer among men in the United States (US). Limited data currently exists regarding inequities in access to androgen deprivation therapy (ADT) which is the backbone of systemic treatment in management of advanced CaP. Gonadotropin-releasing hormone (GnRH) antagonists, first approved in 2008, represent a novel class of ADT drugs with faster onset of action and without initial testosterone surge or symptom flare when compared to GnRH agonists. There is also some evidence that GnRH antagonists, compared to GnRH agonists, may be associated with lower cardiovascular complications. Thus, in this study, we assessed inequities in access to GnRH antagonist (degarelix) by examining the associations of race and ethnicity with initiation of this drug among patients diagnosed with distant CaP. Methods: Using the Surveillance, Epidemiology and End Results (SEER) data linked to Medicare fee-for-service (Parts A, B, and D), we identified a cohort of patients, at least 66 years of age, who were diagnosed with distant CaP between 2008 and 2019 with follow-up through 2020. We defined treatment initiation with a GnRH antagonist (degarelix) or GnRH agonists (leuprolide, goserelin, histrelin, or triptorelin) as starting treatment with the study drug within one year after diagnosis. Poisson regression models were used to estimate adjusted rate ratios (aRR) and 95% confidence intervals (CI) for the association between race and ethnicity and degarelix treatment initiation (vs GnRH agonists, no treatment). All models were adjusted for age and Gleason score and compared Non-Hispanic Black (NHB), Hispanic, Non-Hispanic Asian American and Pacific Islander (NHAAPI), and Non-Hispanic American Indian and Alaska Native (NHAIAN) with Non-Hispanic White (NHW) patients. Results: There were 25,277 patients diagnosed with CaP in our analytic cohort, 3,033 (12.0%) initiated degarelix, and 14,045 (55.6%) initiated GnRH agonists over the study period. Mean (SD) age in the study population was 77.8 (7.8). Among all patients, 19,231 (76.1%) were NHW, 3,013 (11.9%) were NHB, 2,075 (8.2%) were Hispanic, 770 (3.0%) were NHAAPI, and 119 (0.5%) were NHAIAN. In the primary analysis, NHB (aRR: 0.58, 95% CI: 0.51-0.66), Hispanic (aRR: 0.59, 95% CI: 0.51-0.69), NHAIAN (aRR: 0.85, 95% CI: 0.49-1.47), and NHAAPI (aRR: 0.75, 95% CI: 0.59-0.94) were less likely to initiate degarelix compared with NHW patients. Discussion: In this US population-based study of patients diagnosed with distant CaP, we observed lower rates of treatment initiation with degarelix among patients of all other racial and ethnic groups compared to NHW patients, which may suggest lower access to these new class of ADT in these groups. Additional research is needed to elucidate health systems, provider, and patient access barriers that contribute to these inequities. Citation Format: Farzin Khosrow-Khavar, Mingchao He, Elizabeth Handorf, Tina Mayer, Thomas Jang, Saum Ghodoussipour, David Golombos, Biren Saraiya, Elisa V. Bandera, Hari S. Iyer. Racial and ethnic inequities in receipt of degarelix among patients diagnosed with advanced prostate cancer in United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A075.

Abstract B159: Could cultural adaptation of nutrition education improve survivorship outcomes among African American/black women with reproductive cancers?

Abstract Background/Significance: Cancer epidemiological data suggest African American/Black women experience the lowest relative survival rate for reproductive cancers compared to other racial/ethnic groups, despite these cancers being most prevalent among White women. Findings from recent studies suggest contributors to these adverse outcomes include socio-cultural and lifestyle factors, including diet, physical activity, and smoking. As an intervention strategy, it has been recommended dietary changes may enhance overall health and survival among AA/B women with reproductive cancers. However, inequalities in access to nutritious foods and culturally and linguistically appropriate nutrition information may serve as an impediment to making healthy food choices. Methods: An environmental scan was conducted by reviewing peer reviewed literature and online nutrition information sources to identify available, easily accessible, culturally adapted nutrition education for AA/B reproductive cancer survivors. Focus groups with breast and endometrial cancer survivors will ensure to inform the development of culturally targeted nutritional programs for cancer survivors. Results: Our literature review reveals a growing body of evidence indicating the potential benefits of culturally adapted dietary modifications post-diagnosis for African American/Black women with reproductive cancers, suggesting improved outcomes. Notably, the review underscores the critical role of culturally relevant nutrition information, disseminated by culturally affiliated individuals, with technology playing a pivotal role in accessibility facilitation. This research study aims to clarify the barriers and facilitators encountered by African American/Black women in accessing culturally and linguistically appropriate information, thereby enhancing understanding of factors influencing cancer survivorship outcomes. Conclusion and Implications/Discussion: Seeking to improve the survivorship of reproductive cancers in AA/B women through enhanced dietary patterns, this study merges insights from a systematic literature review and an environmental scan. Offering a comprehensive understanding of available nutritional information for AA/B women. Recognizing both strengths and gaps in existing resources, our research serves as a foundation for developing or adapting culturally specific nutritional programs to improve survivorship outcomes for reproductive cancers. Anticipating that our findings will contribute to understanding barriers and facilitators in accessing culturally and linguistically appropriate information, we aim to enhance cancer survivorship outcomes for AA/B women. Acknowledgement of Funding: The project described was supported by Award Number CHERC-MSI-21-166-01-CHERC-MSI. from the American Cancer Society (ACS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the ACS. Citation Format: Desiree Rivers, Zakirah L Abdul-Hameed. Could cultural adaptation of nutrition education improve survivorship outcomes among African American/black women with reproductive cancers? [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B159.

Abstract B102: Impact of previous genetic counseling and reaction to genetic test results among Hispanic/Latino colorectal cancer patients in ENLACE: A cancer Moonshot study

Abstract Background: Inequities in access to genetic testing exist among Hispanic/Latino (H/L) individuals, a population disproportionately affected by colorectal cancer (CRC) burden. Past studies demonstrate the value of genetic counseling (GC) on improving patient understanding of genetic testing utility, but few studies have focused on H/L individuals. Therefore, we assessed the impact of having prior-GC on genetic testing knowledge among patients enrolled in the ENLACE study, a NCI-Moonshot-funded study of participant engagement in genomic characterization among H/L CRC patients. Methods: The ENLACE study enrolled participants from two healthcare facilities since 2022: Los Angeles General Medical Center (LA Gen, a safety-net hospital) and USC Norris Comprehensive Cancer Center (Norris, a university medical center). Baseline surveys to assess sociodemographic characteristics, genetic literacy and comprehension (GLAC), and genetic knowledge (KnowGene) were evaluated. Following somatic and germline return-of-results (ROR), Feelings About genomiC Testing Results (FACToR) for germline sequencing, the impact of somatic testing on cancer patient knowledge, attitudes, and expectations, and Decisional Regret for genomics research participation were evaluated. Results: A total of 105 H/L CRC participants completed surveys at baseline, and 39 post ROR. Most were recruited at LA Gen (n = 72), are male (n = 56), and Mexico-born (n = 55). Fifty participants (33, LA Gen; 17, Norris) had GC prior to study enrollment. No difference was found in the sociodemographic characteristics of participants with prior-GC by facility (p = 0.24). When stratified by prior-GC and facility there were no differences in GLAC and KnowGene scores, using univariate analysis (all p-values > 0.05). Post-ROR total FACToR score, which ranges from 0-48 with higher scores indicating greater functional impairment, was low with a median of 11 (IQR = 5.0-23.0) and no differences were seen for prior-GC or without (p = 0.2). Participants had low decisional regret with a median score of 2.5 (IQR = 0-25.0), on a 0-100 scale. When examining opinions about genetic testing in cancer care, 84% (n = 33) of patients agreed or strongly agreed that genetic testing based on today’s technology would significantly improve their cancer treatment and care. Conclusion: There was no association with prior-GC and baseline genetic knowledge scores. Post-ROR, the cohort had low functional impairment and decisional regret from genetic testing, suggesting that these H/L patients have a favorable reaction to their genetic test results. A limitation of this evaluation is that it does not consider the effect of GC during ROR, completed for some patients, on post-ROR responses. As the study progresses, larger numbers will allow us to stratify by germline test results and dosage of GC. These findings support the need for impactful genetics education tools and communication methods to ensure greater understanding of genetics for H/L individuals to maximize genetic testing utility. Citation Format: Natalia Gutierrez, Joel Sanchez Mendez, Julie O. Culver, Charite R. Ricker, Carmen Chavez, Lucia Enriquez, Sandra Algaze, John D. Carpten, Heinz-Josef Lenz, Mariana C. Stern. Impact of previous genetic counseling and reaction to genetic test results among Hispanic/Latino colorectal cancer patients in ENLACE: A cancer Moonshot study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B102.

Abstract A151: Examining the influence of health insurance, socioeconomic factors, and rurality on breast cancer screening behaviors in Ohio

Abstract Background: Among Ohio women, breast cancer (BC) is the most common cancer and the second leading cause of cancer death. Inequalities in BC screening are associated with poverty, social injustice, environmental factors, as well as late-state diagnosis, treatment delays, and mortality. The main objective of this study is to examine how BC screening rates differ by rurality and socioeconomic status. Methods: The Ohio State University Comprehensive Cancer Center conducted a population health assessment survey of Ohioans. The Community Initiative Towards Improving Equity and Health Statues (CITIES) project included two waves of data collection 2017-2018 (Wave 1) and 2023-2024 (Wave 2). Participants self-reported various sociodemographic factors (i.e., race, ethnicity, education level, marital status, and insurance coverage), health insurance status, geographic setting, and BC screening adherence. Adherence with BC screening guidelines was defined as having a mammogram every 2 years after age 50. Baseline demographic characteristics were described using counts and percentages stratified by geographic setting. Adherence with BC screening guidelines was summarized with counts and percentages. The relationship between education, marital status[EP1] , insurance status, rurality, and BC screening adherence were assessed with chi-square tests. Results: A total of 300 women were included in this study. Most women (n=210, 70%) resided in urban counties, while 30% (n=90) lived in rural counties. Among rural residents, 96.7% were White, whereas urban residents were 37.6% White, 35.2% African American, 11.9% Hispanic, 9.1% Somali, and 6.2% Asian. Health care coverage was held by 97.8% of rural and 87.6% of urban residents. Over 67.8% of rural residents and over 65.3% of urban residents had at least some post-high school education. Most rural residents (68.7%) were married, compared to 46.7% of urban residents. Among rural residents, 78.9% (n=71) were within mammogram guidelines. Of the women residing in urban areas, 73.8% (n=155) were within mammogram guidelines and 26.2% (n=55) were not. Individuals with health insurance were over 4 times as likely to adhere to BC screening guidelines than those without health insurance (OR: 4.54, p<0.0001). High school graduates were nearly 5 times as likely to adhere to BC screening guidelines compared to those who did not complete high school (OR: 4.88, p<0.0001). White women were twice as likely to be adherent to BC screening guidelines compared to non-White women (OR: 2.07, p=0.007). Marital status (p=0.219) and rurality (p=0.350) were not significantly associated with adherence to BC screening guidelines. Conclusion: Understanding access to cancer care by education, health insurance status, and race, and how these factors influence BC screening is crucial for knowing the challenges that Ohioans may face in BC care. These findings may lead to future development of interventions targeted at population needs, as identified in this study, and improve equity in BC screening access and BC outcomes. Citation Format: Ruvarashe P. Rumano, Chloe M. Hery, Mohamed I Elsaid, Chasity Washington,, Cecilia R. Degraffinreid,, Electra D. Paskett. Examining the influence of health insurance, socioeconomic factors, and rurality on breast cancer screening behaviors in Ohio [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A151.

Review on techno-socio-economic studies of electric vehicles in electrical energy systems

Transportation electrification is a practical solution for the world's environmental, economic, and technical challenges. During the last decades, numerous studies have focused on electric vehicles (EVs) as one of the essential energy fields due to the growth rate of EV penetration into energy systems. Researchers have investigated different operation and long-term planning models of EV charging infrastructure and prediction and uncertainty-handling approaches for EV drivers’ behavior (i.e., the arrival/departure time to/from charging stations and the associated state-of-charge) as well as fixed and mobile charging stations (MCSs) and social equity access to EV charging infrastructure. This study provides a detailed analysis and discussion of the daily operation and long-term planning of EV charging stations with economic and technical aspects. Also, the prediction of EV drivers’ behavior and approaches to dealing with uncertain EV parameters are studied. Furthermore, the role of MCSs and social equity access in planning EVs’ charging station placement is investigated. The authors also assess the applications of permanent and MCSs and the social equity access to EV infrastructure. Finally, the current study discusses EVs future trends and their effect on electrical systems as future subjects of research studies.

Impact of agricultural land ownership on child nutrition in rural Sudan: an investigation across gender

Purpose In light of the inequality in access to farming land and the high prevalence of child malnutrition in Sudan, there is a lack of empirical research on the relationship between land ownership and child nutritional status. This study aims to examine the influence of agricultural landholding on the nutritional status of children under the age of five in rural Sudan.Design/methodology/approachThe study utilizes data from Sudan’s 2014 Multiple Indicator Cluster Survey (MICS), covering a sample of 10,753 rural children. The empirical analysis uses the two-stage least squares (2SLS) approach, adopting various estimation methods and model specifications for robustness check and comparison.Findings The results demonstrate that agricultural land has a positive and significant effect on reducing child malnutrition, signifying that children from families with agricultural land are less susceptible to malnutrition in Sudan. When examining the male and female sub-samples separately, the findings indicate a positive influence of land ownership on child malnutrition in the female sub-sample, while no significant impact is observed in the male sub-sample. This indicates a gender disparity in the effects of land ownership on child nutrition, with girls benefiting more from access to agricultural land compared to boys.Originality/value The study has several significant contributions. First, this is the sole study that examines the impact of agricultural land ownership on child malnutrition in Sudan. Second, considering the gender variations in nutritional status, investigating the influence of land ownership on child nutrition across genders addresses a significant gap in the current literature. Finally, the findings resulting from this study can contribute to achieving the United Nations Sustainable Development Goals (SDGs) to be achieved by 2030, precisely focusing on SDG2 Goal 2: Zero hunger and SDG 10: Goal 10: Reduced inequalities.

Inferred attractiveness gravity-based models for estimating realized access at rural hospitals

Operating obstetric units in rural America is financially challenging in part due to low birth volume. Birth volume at a hospital decreases when birthers bypass it to go to a farther hospital. Beyond financial considerations, it is important from a healthcare equity perspective for hospitals to know whether certain subgroups of birthers avoid utilizing the hospital’s services. This can better inform resource allocation decisions targeting those subgroups. In this paper, we use a nonlinear programming optimization model, inferred attractiveness gravity-based model (GBM), to estimate realized access to obstetric care at hospitals in Montana. We compare three variations of GBM and benchmark our results to a regression-based conditional logit model. Results indicate that hospital attractiveness varies across the level of obstetric care provided and depends on the subgroup of birthers considered. While all GBMs produced smaller errors for hospitals with higher birth volumes, our novel variant was more accurate for low-volume hospitals. Bootstrapping analyses and resolving the models for population subgroups indicated large variations in hospital attractiveness. Research findings contribute to new knowledge about equity in access to obstetric care, the importance of considering population heterogeneity in GBMs, and the benefit of using hospital demand-based thresholds for GBMs in rural settings.

Language ability and virtual mental healthcare utilisation among immigrant and refugee youth: a population-based cohort study

Background and objectivesThe widespread adoption of virtual care during the pandemic may not have been uniform across populations, including among paediatric immigrants and refugees. We sought to examine the association...

Patient navigation in reproductive healthcare.

This review summarizes evidence about barriers to abortion care pre-Dobbs and post-Dobbs, inequities in abortion access, and approaches to improving access to abortion care with use of patient navigators. The Dobbs decision and resulting state-level restrictions exacerbated economic, knowledge, and logistic barriers to abortion care. Abortion funds and emotional support are two main resources to help address these barriers; however, only with coordination can patients and clinics fully benefit from the resources. Patient navigation provides that coordination. Evidence shows it improves reproductive outcomes, is acceptable to patients and providers, and engages community health workers and community-based organizations. Increasing legal restrictions and barriers to abortion care have motivated advocates to identify effective interventions to facilitate patient-centered and culturally competent care. Navigators have improved postpartum care by increasing attendance, education and helping coordinate overall care. They have improved referrals and access to abortion care in statewide programs.