Lack Of Health Insurance Research Articles

Support Provided by Caregivers for Community-Dwelling Obesity Individuals: Focus on Elderly and Hispanics.

Obesity is a chronic disease marked by the buildup of extra adipose tissue and a higher chance of developing concomitant illnesses such as heart disease, diabetes, high blood pressure, and some malignancies. Over the past few decades, there has been a global increase in the prevalence of obesity, which now affects around one-third of the world's population. According to recent studies, a variety of factors, including genetics and biology as well as environmental, physiological, and psychosocial factors, may have a role in the development of obesity. The prevalence of obesity is often higher among Hispanic American groups than among White people in the U.S. Obesity is a widespread condition with a high risk of morbidity and death, and it is well-recognized that the prevalence of comorbidities rises with rising levels of obesity or body mass index. To combat the rising prevalence of obesity in the USA, especially among Hispanics, one of the fastest-growing racial/ethnic groups in the country, there is an urgent need for obesity therapies. The exact cause of this disparity is unclear, but some responsible factors are a lack of education, high unemployment rates, high levels of food insecurity, an unhealthy diet, inadequate access to physical activity resources, a lack of health insurance, and constricted access to culturally adequate healthcare. Additionally, managing obesity and giving needed/timely support to obese people is a difficult responsibility for medical professionals and their loved ones. The need for caregivers is increasing with the increased number of individuals with obesity, particularly Hispanics. Our article summarizes the status of obesity, focusing on Hispanic populations, and we also highlight specific factors that contribute to obesity, including genetics, epigenetics, biological, physiological, and psychosocial factors, medication and disease, environment, and socio-demographics. This article also reviews caregiver duties and challenges associated with caring for people with obesity.

Association Between the Affordable Care Act and Emergency Department Visits for Psychiatric Disease.

Emergency department (ED) utilization for psychiatric disease is increasing, and a lack of health insurance has been identified as a potential cause of preventable or avoidable ED use. Through the Affordable Care Act (ACA), more uninsured individuals gained health insurance; however, the effects of increased health insurance coverage on ED utilization for psychiatric disease have not been examined. We performed a longitudinal, cross-sectional analysis of data from the Nationwide Emergency Department Sample, the largest all-payer ED database in the US, which contains data on over 25 million ED visits each year. We examined ED utilization for psychiatric disease as the primary reason for visit among adults aged 18-64. We compared the proportion of ED visits with a psychiatric diagnosis during post-ACA years (2011-2016) to pre-ACA (2009) using logistic regression adjusted for age, gender, payer, and hospital region. The proportion of ED visits with psychiatric diagnosis increased from pre-ACA (4.9%) to post-ACA years (ranging from 5.0-5.5%). There was a significant difference in the proportion of ED visits with a psychiatric diagnosis when comparing each post-ACA year with pre-ACA, with adjusted odds ratios ranging from 1.01-1.09. Among ED visits with a psychiatric diagnosis, the most common age group was 26-49 years, and patients were more likely to be male than female and to have visited urban rather than rural hospitals. During post-ACA years (2014-2016), private and uninsured payers decreased, Medicaid payers increased, and Medicare payers increased in 2014 and decreased in 2015-2016 compared to pre-ACA. With the ACA more people gained health insurance, yet ED visits for psychiatric disease continued to increase. These results suggest that increasing access to health insurance alone is not sufficient to reduce ED utilization for patients with a psychiatric disease.

Insight into the Role of the Child Opportunity Index on Surgical Outcomes in Congenital Heart Disease

To use neighborhood-level Child Opportunity Index (COI) measures to investigate disparities in congenital heart surgery postoperative outcomes and identify potential targets for intervention. In this single-institution retrospective cohort study, children <18years old who underwent cardiac surgery between 2010 and 2020 were included. Patient-level demographics and neighborhood-level COI were used as predictor variables. COI-a composite US census tract-based score measuring educational, health/environmental, and social/economic opportunities-was dichotomized as lower (<40th percentile) vs higher (≥40th percentile). Cumulative incidence of hospital discharge was compared between groups using death as a competing risk, adjusting for clinical characteristics associated with outcomes. Secondary outcomes included hospital readmission and death within 30days. Among 6247 patients (55% male) with a median age of 0.8years (IQR, 0.2-4.3), 26% had lower COI. Lower COI was associated with longer hospital lengths of stay (adjusted HR, 1.2; 95% CI, 1.1-1.2; P<.001) and an increased risk of death (adjusted OR, 2.0; 95% CI. 1.4-2.8; P<.001), but not hospital readmission (P=.6). At the neighborhood level, lacking health insurance coverage, food/housing insecurity, lower parental literacy and college attainment, and lower socioeconomic status were associated with longer hospital length of stay and increased risk of death. At the patient-level, public insurance (adjusted OR, 1.4; 95% CI, 1.0-2.0; P=.03) and caretaker Spanish language (adjusted OR 2.4; 95% CI, 1.2-4.3; P<.01) were associated with an increased risk of death. Lower COI is associated with longer length of stay and higher early postoperative mortality. Risk factors identified including Spanish language, food/housing insecurity, and parental literacy serve as potential intervention targets.

Disparities in lung cancer

Lung cancer is the second most common cancer and the leading cause of cancer death among men and women in the United States. Despite a substantial decline in lung cancer incidence and mortality across all races in the last few decades, medically underserved racial and ethnic minority populations continue to carry the greatest burden of disease throughout the lung cancer continuum. Black individuals experience a higher incidence of lung cancer due to lower rates of low-dose computed tomography screening, which translate into advanced disease stage at diagnosis and poorer survival outcomes compared with White individuals. With respect to treatment, Black patients are less likely to receive gold standard surgery, have access to biomarker testing or high-quality treatment compared with White patients. The reasons for those disparities are multifactorial and include socioeconomic (eg, poverty, lack of health insurance, and inadequate education), and geographic inequalities. The objective of this article is to review the sources of racial and ethnic disparities in lung cancer, and to propose recommendations to help address them.

Food insecurity, SNAP participation and glycemic control in low-income adults with predominantly type 2 diabetes: a cross-sectional analysis using NHANES 2007–2018 data

IntroductionDiabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are...

Antibiotic use without a Prescription: A multi-site Survey of Patient, Health System, and Encounter Characteristics.

Use of antibiotics without a prescription is potentially unsafe and may increase the risk of antimicrobial resistance. We evaluated the effect of patient, health system, and clinical encounter factors on intention to use antibiotics without a prescription: (1) purchased in the United States (U.S.), (2) obtained from friends or relatives, (3) purchased abroad, or 4) from any of these sources. Survey was performed January 2020 - June 2021 in six publicly-funded primary care clinics and two private emergency departments in Texas, U.S. Participants included adult patients visiting one of the clinical settings. Non-prescription use was defined as use of antibiotics without a prescription, and intended use was professed intention for future non-prescription antibiotic use. Of 564 survey respondents (33% Black and 47% Hispanic or Latino), 246 (43.6%) reported prior use of antibiotics without a prescription, and 177 (31.4%) reported intent to use antibiotics without a prescription. If feeling sick, respondents endorsed that they would take antibiotics: obtained from friends/relatives (22.3% of 564), purchased in the U.S. without a prescription (19.1%), or purchased abroad without a prescription (17.9%). Younger age, lack of health insurance and a perceived high cost of doctor visits were predictors of intended use of non-prescription antibiotics from any of the source. Other predictors of intended use were lack of transportation for medical appointments, language barrier to medical care, Hispanic or Latino ethnicity and being interviewed in Spanish. Patients without health insurance who report a financial barrier to care are likely to pursue more dangerous non-prescription antimicrobials. This is a harm of the fragmented, expensive healthcare system that may drive increasing antimicrobial resistance and patient harm.

Effects of Covid-19 Vaccines on Mental Health of an Individual A Cross-Sectional Clinical Study

Objective: The mains and objectives of the study was to evaluate the impact of Covid’19 vaccination on mental health status. Study Design: A Cross-Sectional Clinical Study. Place and Duration: It is a cross-sectional study which was conducted by the house officers and the faculty of Dow International Dental College from june2022 to January 2023. Methodology: This study was conducted by distributing the questionnaire among the patients coming to the Outpatient Department at Dow International Dental College. A total of 280 Questionnaires were filled among the Vaccinated Patients coming to the OPD. Questions were inquired related to demographics, dosage, history, last dose, and benefit of vaccine, depression, sleep deprivation, feeling low, trouble concentrating and suicidal thoughts. The consent to fill this questionnaire by the patient was taken by 'Implied Consent'. It was in English language but was translated in Urdu by the house officers whenever it was needed to ensure the comprehension of the questions to the patients. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of which 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. Practical Implications: The results of this cross-sectional clinical study have practical implications for the wider community. Encouraging Covid-19 vaccination can have a positive impact on both physical and mental health, and promoting vaccine uptake may lead to improved mental health outcomes for individuals. Such benefits can reduce the overall burden of mental health issues during the pandemic, which is beneficial to the community. Thus, public health campaigns should focus on the potential positive effects of Covid-19 vaccines on mental health to improve community well-being and promote vaccine acceptance. Results: Approximately 48% women and 52% male have anxiety, depression or either disorder, respectively. Adults with anxiety and depression were more likely to have low educational attainment, low household income, lack of health insurance and either lack or delay medical care. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of whom 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. There was a common mental impact that was noticed and brought about people's mental health at stake. Conclusion: Forceful vaccination has a potential to affect mental health of an individual. Further studies are required to extrapolate the findings of the present study. Keywords: vaccination, Mental health, Anxiety, Depression

Factors Associated with the Low Facilities Visit: The Real Expectations of Patients in Cameroonian’s Context

The health district of Mfou is one of the 29 health districts for the Central region of Cameroon. In 2014, the attendance rate of its facilities was 41%, lower than the 80% norm of the Togolese Ministry of Health in 2013. Questioning the factors associated with this low attendance necessitated the identification of links and associations between it and social demographic factors, health satisfaction, and the perception of facilities by the population. To identify factors associated with low attendance in the Mfou Health District. This is a quanti-qualitative, descriptive cross-sectional study that took place from June 15 to September 22, 2018, in the 32 health facilities in the Mfou Health District. The data collection was based on medical consultation records for 84231 enrolled persons, 372 questionnaires administered to patients in health facilities, and 5 patients who underwent interviews. The data analysis was carried out using CSPro 6.2, Survey CTO Collect v2.41, and SPSS 21 software and the manual operation of the audio content of the interviews. This study shows that the attendance rate of health facilities in the health district of Mfou remains low: 39% in 2015 and 42% in 2017. The factors associated with low attendance at health facilities are the lack of health insurance, the rural environment, the poor quality of reception, the low dynamism of community health workers, the high cost of care and services, the need to have a family relative or an acquaintance working in the Hospital and going to the Hospital only when the illness seems serious with a (P˂ 5%). The low attendance of health facilities in the Mfou health district remains a major public health concern. This is associated with many factors for which the involvement of communities is necessary and their inclusion in the development of health policies. Keywords: Factors Associated with Low Attendance of Health Facilities, Health Facilities, and Health Districts.

Invited commentary: Mediation analysis and cancer screening, identifying areas to target to improve cancer disparities.

Surgical health services research has traditionally focused on reporting “associations” between specific risk factors and healthcare outcomes. Fewer studies have sought to address the underlying “how” or “in what way” the risk factors/exposures affect the outcome in question. Mediation analysis is a statistical approach that attempts to define underlying mechanisms through which an exposure influences an outcome. Mediation analysis differs from classic multivariable regression analysis in that it aims to understand the factors involved in the pathways between the exposure and the outcome. In particular, mediation models seek to identify and explain the mechanism or process that underlies an observed relationship between an independent variable and a dependent variable via the inclusion of a third hypothetical variable, known as a mediator variable.1 In essence, the effect of the exposure (X) on the outcome (Y) is decomposed into the indirect effect (X → M → Y) of the exposure (X) through which other factors act as mediators (M) versus the direct effect (X → Y) that denotes the impact of the exposure not explained by these mediators (Figure 1).2 Mediation analysis can help deconstruct how various factors may be driving outcomes of interest and help identify both indirect and direct factors to target for intervention. In turn, this analytic tool may help delineate the various contributions of different mediators associated with social determinants and health outcome inequities. Determining which variables may function as mediators can be difficult to discern, however, as there are multiple ways that factors in the causal pathway may interact with each other. Unmeasured confounders may cause an opposite directional effect or, in certain cases, entirely nullify the total effect; even true opposite direct and indirect effects may coexist.3 In turn, variable selection for mediation analysis should be informed relative to the possible directionality of associations based on prior knowledge, experience, and existing data in the literature. In addition, sensitivity analyses may be helpful to examine the strength of unmeasured confounders and interaction effects, as well as estimate whether these factors might alter the conclusions drawn from the analysis.2 The current study examined the role of structural factors that underlie racial/ethnic and economic disparities related to cancer screening using mediation analysis.4 Specifically, we utilized mixed-effect beta distribution models to assess direct and indirect effects of race/ethnicity and economic disparities on county-level cancer screening rates. Mediation analysis was conducted using generalized structural equation models, which is a validated methodologic approach.5 Mediators were assessed as continuous variables and standardized (mean centered) before inclusion into the final model. A Gaussian distribution with an identity link for all mediators was used and the random intercept was assumed to have a normal distribution, which was appropriate for our dataset yet needs to be tailored based on the specific data being analyzed. In the current study, we noted an association between racial/ethnic and economic privilege on USPSTF-recommended cancer screening. Perhaps more importantly, mediation analysis revealed that the observed disparities between county-level privilege and cancer screening were explained by mediators such as poverty status, lack of health insurance or employment, urban-rural location and access to primary care physicians that accounted for 64% (95% confidence interval [CI]: 61%–67%), 85% (95% CI: 80%–89%), and 74% (95% CI: 71%–77%) of the effect on breast, colorectal and cervical cancer screening, respectively. The combination of more rigorous statistical approaches such as mediation analysis with the use of publicly available datasets such as the Center for Disease Control and Prevention (CDC)'s PLACES dataset and the American Community Survey can help better elucidate area-level social determinants of health that mediate disparities in cancer prevention strategies. In turn, rather than simply identifying and describing disparities, these analyses may hopefully inform which specific disparities need to be addressed to improve health equity. Over the last decades, disparities in surgical outcomes have been well described. A new era of surgical health services research should now focus on more “mechanistic” analyses that identify which specific direct and indirect factors should be targeted by healthcare institutions, payers, policymakers, and professional organizations to improve access to quality healthcare and enhance health equity through state and national policies. NA.

Mediators of county‐level racial and economic privilege in cancer screening

Area-level social determinants of health (SDoH) impact access to cancer care and prevention. Little is known about the factors that underlie the impact of residential privilege on county-level cancer screening uptake. Population-based cross-sectional study examining county-level data was obtained from the Centers for Disease Control and Prevention's PLACES database, American Community Survey and the County Health Rankings and Roadmap database. The Index of Concentration of Extremes (ICE), a validated measure of racial and economic privilege, was examined relative to county-level rates of US Preventive Services Task Force (USPSTF) guideline-concordant screening for breast, cervical, and colorectal cancers. Generalized structural equation modeling was used to determine the indirect and direct effects of ICE on cancer screening uptake. Across 3142 counties, county-level cancer screening rates demonstrated geographical variation ranging from 54.0% to 81.8% for breast cancer screening, from 39.8% to 74.4% for colorectal cancer screening, and from 69.9% to 89.7% for cervical cancer screening. Of note, cancer screening rates for breast, colorectal, and cervical cancer all increased from lower (ICE-Q1) to higher (ICE-Q4) privileged areas (breast: Q1 = 71.0% vs. Q4 = 72.2%; colorectal: Q1 = 59.4% vs. Q4 = 65.0%; cervical: Q1 = 83.3% vs. Q4 = 85.2%; all p < 0.001). Mediation analysis revealed that the observed disparities between ICE and cancer screening uptake were explained by mediators such as poverty status, lack of health insurance or employment, urban-rural location and access to primary care physicians that accounted for 64% (95% confidence interval [CI]: 61%-67%), 85% (95% CI: 80%-89%), and 74% (95% CI: 71%-77%) of the effect on breast, colorectal, and cervical cancer screening, respectively. In this cross-sectional study, the association between racial and economic privilege on USPSTF-recommended cancer screening was complex and influenced by an interplay of sociodemographic, geographical, and structural factors. Understanding the underlying area-level SDoH that mediate disparities in cancer prevention strategies can help focus interventions to improve equity in cancer prevention.

Journalism and Journalists’ Vulnerability during COVID-19 Pandemic in Indonesia

Journalists are among the workers who continue to engage in journalism activities like news covering despite the COVID-19 pandemic. Journalists facing paradoxical conditions between being productive in news covering and the dangers of virus transmission that can infect at any time. In other hand, journalists need support equipment facilities to avoid virus transmission during news covering process. Moreover, various media companies announce layoffs and salary cuts by asserting business uncertainty. This study aims to describe journalists’ vulnerability within journalism activity and journalist as occupation during the COVID-19 pandemic in 2020. This study was conducted with a qualitative method by analyzing the primer data from 50 journalist various region and representatives of journalist’s association in Indonesia. Furthermore, we analyze secondary data that provided officially by Alliance of Independent Journalists Indonesia. Authors found that the lack of health insurance, support for preventing the spread of COVID-19, unilateral dismissals by media institutions, and salary cuts place journalists in a difficult position. Aspects of journalism activities that run normally without institutional or structural support legitimize the vulnerabilities experienced by journalists in Indonesia.

Predictors of COVID-19 vaccine uptake among people who inject drugs.

We studied characteristics of COVID-19 vaccination uptake among people who inject drugs (PWID). Participants aged ≥18years who injected drugs ≤1month ago were recruited into a community-based cohort from October 2020 to September 2021 in San Diego, California Poisson regression identified correlates of having had ≥1 COVID-19 vaccine dose based on semi-annual follow-up interviews through March 15, 2022. Of 360 participants, 74.7% were male, mean age was 42years; 63.1% were Hispanic/Mexican/Latinx. More than one-third had ≥1 co-morbidity. HIV and HCV seroprevalence were 4.2% and 50.6% respectively; 41.1% lacked health insurance. Only 37.8% reported having ≥1 COVID-19 vaccine dose. None received ≥3 doses. However, of those vaccinated, 37.5% were previously unwilling/unsure about COVID-19 vaccines. Believing COVID-19 vaccines include tracking devices (adjusted incidence rate ratio [aIRR]: 0.62; 95% CI: 0.42,0.92) and lacking health insurance (aIRR: 0.60; 95% CI: 0.40,0.91) were associated with approximately 40% lower COVID-19 vaccination rates). Ever receiving influenza vaccines (aIRR: 2.16; 95%CI: 1.46, 3.20) and testing HIV-seropositive (aIRR: 2.51; 95% CI: 1.03, 6.10) or SARS-CoV-2 RNA-positive (aIRR: 1.82; 95% CI: 1.05, 3.16) independently predicted higher COVID-19 vaccination rates. Older age, knowing more vaccinated people, and recent incarceration were also independently associated with higher COVID-19 vaccination rates. One year after COVID-19 vaccines became available to U.S. adults, only one third of PWID had received ≥1 COVID-19 vaccine dose. Multi-faceted approaches that dispel disinformation, integrate public health and social services and increase access to free, community-based COVID-19 vaccines are urgently needed.

Abstract P6-08-14: Breast Cancer Treatment Choices and Results in Hispanic Women Without Funding for Radiation

Abstract Background: Although the survival rates for breast cancer have improved, there is still a disparity gap between Hispanic women and non-Hispanic women. Hispanic women in the US are vulnerable to cancer inequalities due to a plethora of barriers including disproportionate poverty, lack of health insurance, and citizenship status. A Surveillance, Epidemiology, and End Results analysis found that Hispanic women had lower rates of both early-stage breast cancer and receipts of radiation therapy (RT) after breast-conserving surgery than White women. For patients without private or government health insurance, charity and county indigent programs have variable levels of coverage, and some patients cannot access radiation services. The aim of this study is to identify disparities in breast cancer treatment for patients referred to the Travis County indigent cancer treatment program. Methods: We analyzed new referrals to the Ascension Seton Breast Clinic from April 2020 to January 2022. Demographics, disease stage, funding and treatments were extracted from medical records. We compared funding status at the time of referral vs time of surgery. We also analyzed the type of surgery elected and if RT was indicated and received. Results: We found that out of 242 referrals, 116 were diagnosed with a new malignancy. Of the 116, a total of 76 underwent breast surgery and RT was considered in 64 of these patients. 61% received RT. Of the remaining 25 patients, 16 patients elected simple mastectomies and 9 did not have funding to cover radiation (income was not low enough to qualify for RT benefit under the health district). Of the 9 women who did not have funding about 78% identified as Hispanic or Latino. 4 opted for simple mastectomies thus no longer needing RT, 3 received modified radical mastectomies without RT, 1 accessed charity funding for RT and 1 had lumpectomy without radiation and had recurrence of her breast cancer. Overall, the rate of breast conserving surgery was 43%. Discussion: The safety net system for patients in the US without access to private or government funding for healthcare is inherently limited. Costs of radiation treatment for cancer can be prohibitive for charity and indigent programs, but patients are forced to choose between mastectomy or risk a higher rate of recurrence. This data will be used to advocate for health district funding for this patient population. Citation Format: Maria De Los Leon-Camarena, Neha Reddy, Kimberly Ellison, Boone Goodgame. Breast Cancer Treatment Choices and Results in Hispanic Women Without Funding for Radiation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-14.

Abstract P6-03-06: Determining prognostic factors and optimal surgical intervention for young patients with triple-negative breast cancer

Abstract Background Triple-negative breast cancer (TNBC) is more frequently diagnosed in young patients, with an incidence of 26% of this population compared to 12% overall, and is characterized by high malignancy and poor prognosis. Limited data are available that contribute to a comprehensive summarization of the prognostic factors and the determination of surgical strategy that are associated with young patients with TNBC. We aimed to determine the optimal surgical approach (breast-conserving versus mastectomy) for patients aged &amp;lt; 40 years with TNBC and establish a prognostic model. Methods We performed a cohort study with a median follow-up of 31 months using the Surveillance, Epidemiology, and End Results (SEER) data of young patients &amp;lt; 40 years diagnosed with stage I–III TNBC between 2010 and 2016. A Cox proportional hazards model was used to investigate the effects of baseline characteristics on breast cancer-specific survival (BCSS) and overall survival (OS). To ensure that differences in outcomes were not based on baseline differences in demographic and clinical characteristics, we performed Kaplan–Meier analysis before and after propensity score matching (1:1). Subgroup analyses stratified by TNM stage as well as further propensity score matching analyses were performed. A nomogram was constructed from the multivariate logistic regression to incorporate all the prognostic factors to predict the BCSS rates of patients at 3 years and 5 years. Young patients &amp;lt; 40 years diagnosed with stage I–III TNBC between 2006 and 2016 in Shenzhen Second People’s Hospital (SSPH) were enrolled as external validation. Results A total of 2,854 patients from SEER dataset and 250 from SSPH were included in this study. On multivariable analysis, unmarried status, lack of health insurance, advanced T stage, advanced N stage, invasive lobular carcinoma or mixed histologic type, were all significantly associated with poor BCSS and OS. Young patients with TNBC were more likely to undergo mastectomy than breast-conserving surgery. Notably, patients with T1N0M0 or T2-4N+M0 tumors who underwent breast-conserving surgery achieved longer BCSS and OS than those who underwent mastectomy; however, the type of surgery did not influence survival rates among patients with T1N+M0 or T2-4N0M0 tumors. The nomogram was constructed by the five variables and passed the calibration and validation steps (C-index: 0.774 for training cohort and 0.768 for validation cohort). The area under the receiver operating characteristic curves (AUCs) predicting the 3-year and 5-year BCSS rates were calculated (0.783 and 0.774 in training cohort; 0.786 and 0.772 in validating cohort). Conclusions A localized surgical approach may be a superior option for young patients with TNBC, especially those with T1N0M0 and T2-4N+M0 tumors. Marital status, health insurance status, T stage, N stage, and histological type were independent prognostic factors, and a nomogram established based on these variables successfully predicted the 3- and 5-year survival probabilities among these patients. Citation Format: Yi-Zi Zheng, Yan Liu, Zhen-Han Deng, Guo-Wen Liu, Ni Xie. Determining prognostic factors and optimal surgical intervention for young patients with triple-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-03-06.

The geography of Medicare's hospital value-based purchasing in relation to market demographics.

To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing (HVBP) scores. This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015-2019. This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables. We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file. Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19-64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS (ß=-12.79, p < 0.0001), followed by the percent of the population coded to "non-Hispanic, some other race" (ß=-2.59, p < 0.0023), and the percent of families in poverty (ß=-0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native (ß=0.35, p < 0.0001) and percent non-Hispanic Asian (ß=0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores. The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent-that is, structural-association between market sociodemographics and HVBP scores.

Neighborhood Ecological Models of Alcohol Outlet Density and Male–on–Female Domestic Violence: Accounting for Adjacent Place and Neighborhood Characteristics

Alcohol availability is a consistent predictor of domestic violence, including intimate partner violence. Less is known about the effects of alcohol availability in neighboring units of analysis on domestic violence. This study examined whether alcohol outlet density in Milwaukee, Wisconsin is associated with Male-on-Female domestic violence (MFDV). Using block groups as the unit of analysis ( N = 571), spatial regression models were estimated to model the relationship between the density of total, on-premise, and off-premise alcohol outlets on MFDV, while accounting for the spatial spillover effect (i.e., alcohol availability and neighborhood characteristics in focal and surrounding block groups). At the focal level, off-premise alcohol outlets are associated with MFDV, net of concentrated disadvantage, lack of health insurance, MFDV lag and total population. Additionally, off-premise alcohol outlet density in surrounding units of analysis is a significant predictor of MFDV. However, total and on-premise densities did not demonstrate a relationship with MFDV.

Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults, (c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.

Alopecia areata in underrepresented groups: preliminary analysis of the all of us research program.

Alopecia areata (AA) is an autoimmune condition characterized by patchy, nonscarring hair loss. Few studies of AA have adequately included participants from underrepresented groups when evaluating the burden of AA in the United States. We conducted a cross-sectional study of personal/demographic factors and AA using the ongoing All of Us (AoU) Research Program. AoU enrolls adults over 18years either as direct volunteers or through participating Health Care Provider Organizations by prioritizing recruiting underrepresented groups. We linked data from surveys and electronic health records (EHRs) to estimate the prevalence of AA by race/ethnicity, physical disability, sexual orientation/gender identity (LGBTQIA +), income, and education. The latest AoU release (version 5) includes 329,038 participants. Average age was 51.8years (standard deviation, SD 16.7), and 60.2% of participants were female. Of these, 251,597 (76.5%) had EHR data and 752 were diagnosed with AA (prevalence, 0.30%; 95% CI 0.28-0.32). We used multivariate logistic regression adjusted for age and other factors to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for prevalence of AA. Compared to Whites, Blacks and Hispanics had higher odds of AA (OR, 1.72; 95% CI 1.39-2.11 and OR, 2.13; 95% CI 1.74-2.59, respectively). Lower odds of AA were observed in participants with less than a high school degree (OR, 0.80; 95% CI 0.59-1.08), household income ≤ $35,000 (OR, 0.67; 95% CI 0.54-0.83), and no health insurance (OR 0.35; 95% CI 0.20-0.56). In this diverse population of US adults, participants with skin of color had higher prevalence of AA. Lower prevalence of AA among individuals with lower education and income levels and those lacking health insurance may reflect limited access to dermatologic care and potentially higher levels of undiagnosed AA in these groups.

Abstract A029: Characterization of an aging Puerto Rican cohort with cancer: Analyzing sociodemographic factors and concomitant comorbidities. [R

Abstract Background: Incidence of cancer is constantly increasing in the United States, and Puerto Rico is no exception. The island is currently experiencing low birth rates, signifying that its population is primarily composed of aging citizens that experience a growing need for access to healthcare and medical literature, especially in those with cancer. In this study, we aimed to characterize an aging Puerto Rican cohort with a diagnosis of cancer. Methods: A questionnaire with sociodemographic and medical inquiries was administered to participants receiving an mRNA vaccine at a COVID-19 vaccination clinic between December 2020 and June 2021. Participants of age 60+ with a diagnosis of cancer, along with their comorbidities, were identified. Multivariate analyses were executed. This study is IRB approved. Results: A total of 100 aging participants with a diagnosis of cancer were included: 55 were female and 45 were male, with a mean age of 72.70±8.07 (age range: 61-95). When assessing race, participants identified as follows: 68% White, 23% Black or African American, 8% other race, and 1% American Indian or Alaska Native. Concerning ethnicity, 97% identified as Hispanic or Latino, while 3% did not regard themselves as such. When evaluating the cancer diagnoses provided, 27% of female participants had breast cancer and 7% had some form of gynecologic malignancy. Whereas, in males, 42% indicated a diagnosis of prostate cancer. Regarding concomitant comorbidities, 45% of participants had hypertension, 30% had diabetes mellitus, 18% had hypothyroidism, 15% had asthma, and 3% had chronic obstructive pulmonary disease. There was no statistically significant difference when comparing sex and prevalence of concomitant diabetes mellitus or hypertension (p=0.2125). There was also no statistically significant difference when assessing racial identity and presence of concomitant diabetes mellitus or hypertension (p=0.7373). Out of 91 participants who answered the health insurance inquiry, 82% possessed private insurance, 13% had public insurance, and 4% did not have insurance. There was no statistically significant difference when assessing private, public, or no health insurance status and the presence of concomitant diabetes mellitus or hypertension (p=0.9086). Conclusion: Data evidenced a diverse aging Puerto Rican cohort with cancer, showing a predominance in prostate cancer in men and breast cancer in women. Analysis suggested that the presence of concomitant diabetes mellitus or hypertension in an aging population with cancer was not linked to sex or racial identity. Additionally, the type or lack of health insurance did not influence the prevalence of concomitant diabetes mellitus or hypertension. Characterizing the aging Hispanic population in Puerto Rico and the United States is important, as these studies could be beneficial in the future approach, understanding and treatment of this population with historically limited medical data available. Citation Format: Humberto R. Nieves-Jimenez, Andrea Firpo-Pabon, Jean Carlos G. Martinez-Izquierdo, Manuel A. Colon-Terron, Rafael E. Morales-Grimany, Javier A. Velez-Martinez, Eric M. Gonzalez-Morales. Characterization of an aging Puerto Rican cohort with cancer: Analyzing sociodemographic factors and concomitant comorbidities. [R] [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A029.

Main problems and aspects of HIV prevention

Migration processes affect not only public health issues, but also public health ethics. The migration policy of the host country should take into account ethical issues at all stages of migration and be based on the principles of humanity, respect for human rights and that adequate public health should not be limited to the borders and citizens of the host country. The UNAIDS Report "On the Global AIDS Epidemic, 2022" reports on the growth of the HIV epidemic in Eastern Europe and Central Asia. And at the same time, regional coverage of HIV prevention and treatment services is assessed as insufficient. The adherence of HIV-infected persons to taking antiretroviral drugs determines the effective suppression of the human immunodeficiency virus and, thereby, reduces the risk of progression of the clinical picture and the risk of HIV transmission. The problems faced by migrants are untimely provision or inability to obtain drugs, low medical and legal literacy, the presence of elements of discrimination and lack of social support in the country of arrival, which become much more acute for migrants with HIV. The presence of a symbiosis of an epidemic of infectious and non-communicable diseases among migrants increases the negative consequences for health, which causes an increase in the number of new cases among migrants. The lack of health insurance is an additional source of difficulties in obtaining medical care for uninsured migrants and has a huge impact on sick patients with chronic diseases. Creating access for migrants to HIV prevention and treatment services in the destination country will not only improve the quality of life of migrants, but also improve public health in general. Currently, issues related to the COVID-19 pandemic are likely to remain a priority, and therefore it is necessary that responses to other infectious diseases, in particular HIV, are not jeopardized. One of the ways to solve this issue is the need to take a step towards the harmonization of legislation between neighboring countries in relation to HIV-positive migrants.Keywords: HIV infection, рrevention, migration, migrant.