Lower Annual Household Income Research Articles

Domestic energy mapping to enable area-based whole house retrofits

A long-standing challenge for area-based mass retrofits has been the ability to rapidly and accurately target appropriate dwellings for energy improvements. This paper demonstrates the application of a data-driven localised Geographical Information System (GIS)-based domestic energy mapping approach to create house-by-house baseline energy models and predict the potential for whole house energy retrofits in a case study of 431 dwellings in Oxford (UK). Top-down spatial datasets on energy, housing, socioeconomics and fuel poverty are combined with bottom-up energy modelling underpinned by actual dwelling details gathered through questionnaire surveys by the local community group. Multiple routes to identify suitable dwellings were tested such as grouping dwellings with high energy use, those with high levels of fuel poverty and by common dwelling characteristics. About 300 dwellings were found to be suitable for a whole house retrofit package, equating to 89–94% mean energy reduction over baseline. While the most common dwelling typology, 1930s semi-detached had high retrofit need, it fell in an area with low annual household income. The second most common dwelling typology, 1930s terrace, was dominant in areas with median level of household income. Funding programmes will need to be customised for different household segments to increase the take-up of energy retrofits.

Prevalence and risk factors of low health literacy in residents of Anhui province: A cross-sectional survey.

This survey aimed to evaluate the prevalence of low health literacy and correlations of demographic characteristics with low health literacy risk in residents of Anhui province.A total of 5120 residents of Anhui province were interviewed in this cross-sectional survey, and 4816 (94.1%) gave valid responses. Sociodemographic characteristics were collected. Health literacy and its 3 subscales, including basic knowledge and concepts, lifestyle, and health-related skill, were assessed. Low health literacy was defined as <80.0% of the total score or score of each subscale.Mean total health literacy score was 62.7±17.2 (maximum 100 points), and was 31.5 ± 9.0 (maximum 47 points), 17.0 ± 4.8 (maximum 28 points), and 14.2 ± 4.1 (maximum 25 points) in terms of basic knowledge and concepts score, lifestyle score, and health-related skill score, respectively. The prevalence of low health literacy was 81.4%, and was 71.3% in terms of basic knowledge and concepts subscale, 87.9% with regard to lifestyle subscale, and 86.3% in view of health-related skill subscale. In addition, older age (P = .001), male (P < .001), decreased education level (P < .001), lower annual household income (P < .001), and location at rural area (P < .001) associated with increased risk of low health literacy. Moreover, multivariate logistic regression revealed that male, lower education level, and location at rural area were independent risk factors of low health literacy (all P < .05).The prevalence of low health literacy is high in residents of Anhui province, and male, lower education level, as well as location at rural area are independent risk factors of low health literacy.

Co-occurrence of decrements in physical and cognitive function is common in older oncology patients receiving chemotherapy.

Older adults receiving cancer chemotherapy are at increased risk for decrements in physical (PF) and cognitive (CF) function. Study identified subgroups of patients with distinct PF and CF profiles; risk factors associated with subgroup membership; and impact of subgroup membership on quality of life (QOL). In 366 older oncology patients, PF and CF were assessed using the Physical Component Summary (PCS) of the SF-12 and Attentional Function Index, respectively. Latent profile analysis was used to identify subgroups of older patients with distinct PF/CF profiles. Three distinct PF/CF profiles were identified (i.e., Very Low PF+Moderate CF (15.6%); Low PF+Low CF (39.3%), Normal PF+Normal CF (45.1%)). Compared to the both Normal class, patients in the other two classes had a lower functional status, a worse comorbidity profile, and were less likely to exercise on a regular basis. Compared to the Both Normal class, patients in the Both Low class were less likely to be married/partnered, more likely to live alone, less likely to be employed, and more likely to report depression and back pain. Compared to the other two classes, patients in the Both Low class had a lower annual household income and were receiving chemotherapy with a worse toxicity profile. First study to use a person-centered analytic approach to identify subgroups of older adults with distinct PF/CF profiles. Fifty-five percent of the older adults had statistically significant and clinically meaningful decrements in both PF AND CF that had negative effects on all aspects of QOL.

Multiple Vulnerabilities to Health Disparities and Incident Heart Failure Hospitalization in the REGARDS Study.

Socially determined vulnerabilities (SDVs) to health disparities often cluster within the same individual. SDVs are separately associated with increased risk of heart failure (HF). The objective of this study was to determine the cumulative effect of SDVs to health disparities on incident HF hospitalization. Using the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort study, we studied 25 790 participants without known HF and followed them for 10+ years. Our primary outcome was an incident HF hospitalization through December 31, 2016. Guided by the Healthy People 2020 framework for social determinants of health, we examined 10 potential SDVs. We retained SDVs associated with incident HF hospitalization (P<0.10) and created an SDV count (0, 1, 2, 3+). Using the count, we estimated Cox proportional hazard models to examine associations with incident HF hospitalization, adjusting for potential confounders. Models were stratified by age (45-64, 65-74, and 75+ years) because past reports suggest greater disparities in HF incidence at younger ages. Participants were followed for a median of 10.1 years (interquartile range, 6.5-11.9). Black race, low educational attainment, low annual household income, zip code poverty, poor public health infrastructure, and lack of health insurance were associated with incident HF hospitalization. In adjusted models, among those 45 to 64 years, compared with having no SDV, having 1 SDV (hazard ratio, 1.85 [95% CI, 1.12-3.05]), 2 SDVs (hazard ratio, 2.12 [95% CI, 1.28-3.50]), and 3+ SDVs (hazard ratio, 2.45 [95% CI, 1.48-4.04]) were significantly associated with incident HF hospitalization (P for trend, 0.001). We observed no significant associations for older individuals. A greater number of SDVs significantly increased risk of incident HF hospitalization among adults <65 years, which persisted after adjustment for cardiovascular risk factors. Using a simple SDV count that could be obtained from a social history during clinical assessment may identify younger individuals at increased risk.

Economic Hardship, Ocular Complications, and Poor Self-reported Visual Function are Predictors of Mental Problems in Patients with Uveitis

ABSTRACT Purpose: To characterize the quality of life and mental health status of patients with uveitis and investigate predictors of psychological problems. Methods: A total of 245 patients and 105 controls were enrolled in this cross-sectional study. Quality of life, psychological status, socio-demographic and clinical data were obtained from questionnaires and medical records. Multivariate regression analyses and Receiver Operating Characteristic (ROC) were applied to obtain the model predicting psychological problems of patients. Results: Of 245 patients, 16.7% and 26.5% (P< .0001) screened positive for anxiety and depression, respectively. The model predicting anxiety was comprised of low annual household income and poor self-reported visual function (P= .029,P< .0001, respectively), with an AUC of ROC of 0.744. The model predicting depression was comprised of poor self-reported visual function and ocular complications (P< .0001, P= .012, respectively), with an AUC of 0.78. Conclusions: Economic hardship, ocular complications, and poor self-reported visual function are predictors of mental problems in patients with uveitis.

Rapid Emergence of SARS-CoV-2 in the Greater New York Metropolitan Area: Geolocation, Demographics, Positivity Rates, and Hospitalization for 46 793 Persons Tested by Northwell Health.

BackgroundIn March 2020, the greater New York metropolitan area became an epicenter for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The initial evolution of case incidence has not been well characterized.MethodsNorthwell Health Laboratories tested 46 793 persons for SARS-CoV-2 from 4 March through 10 April. The primary outcome measure was a positive reverse transcription–polymerase chain reaction test for SARS-CoV-2. The secondary outcomes included patient age, sex, and race, if stated; dates the specimen was obtained and the test result; clinical practice site sources; geolocation of patient residence; and hospitalization.ResultsFrom 8 March through 10 April, a total of 26 735 of 46 793 persons (57.1%) tested positive for SARS-CoV-2. Males of each race were disproportionally more affected than females above age 25, with a progressive male predominance as age increased. Of the positive persons, 7292 were hospitalized directly upon presentation; an additional 882 persons tested positive in an ambulatory setting before subsequent hospitalization, a median of 4.8 days later. Total hospitalization rate was thus 8174 persons (30.6% of positive persons). There was a broad range (>10-fold) in the cumulative number of positive cases across individual zip codes following documented first caseincidence. Test positivity was greater for persons living in zip codes with lower annual household income.ConclusionsOur data reveal that SARS-CoV-2 incidence emerged rapidly and almost simultaneously across a broad demographic population in the region. These findings support the premise that SARS-CoV-2 infection was widely distributed prior to virus testing availability.

Abstract C080: A successful culturally tailored intervention to empower low-income Asian American women to conduct human papillomavirus self-sampling test

Abstract Background: Asian American women face disproportionate burden of cervical cancer (CC) than do non-Hispanic white women in the United States. Human papillomavirus (HPV) screening rates are still relative low among first-generation immigrant women and those with low socioeconomic status. Self-sampling for HPV is a convenient and cost-effective way to increase screening, especially among the low-income and underserved populations. This study aims to assess the impact of a culturally-tailored intervention to promote HPV self-sampling among low-income Asian American women. Methods: We adopted the community-based participatory research (CBPR) approach to conduct this efficacy study. A total of 156 female participants from three ethnic groups, Chinese (56), Korean (50), and Vietnamese (50) were recruited from community-based organizations (CBOs) such as churches and community centers in the greater Philadelphia metropolitan area. All participants received educations on HPV symptoms, transmissions, and screening, through workshops and group discussions at the CBOs. The workshops included handouts, lectures, and a demonstration on conducting a self-sampling HPV test in Chinese, Korean, and Vietnamese languages. Participants were also given self-sampling kits and were contacted 30 days post intervention (booster contact). Results: The majority of the sample was Asian American women with low annual household income (62.3% earned less than $20,000) and low educational attainment (61.3% without a college degree). We used paired sample t-tests to assess the differences between baseline and post-intervention for knowledge, social support, self-efficacy, and comfortability conducting a HPV self-sample test. We found significant increase in participants’ knowledge on HPV (baseline: 2.83, post: 4.89, p &amp;lt;0.001), social support (baseline: 3.91, post: 4.09, p &amp;lt;0.001), self-efficacy (baseline: 3.05, post: 3.59, p &amp;lt;0.001), and comfortability conducting a HPV self-sample test (baseline: 3.62, post: 4.06, p &amp;lt;0.001). Within 6 months post intervention, all (100%) participants completed the HPV self-sampling test and returned the kits, which were then sent to the lab for analysis. Conclusion: To the best of our knowledge, this is the first intervention to promoted HPV self-sampling among Asian American women. Our findings showed that culturally tailored messages and hands-on demonstrations of the self-sampling kits were highly effective in empowering low-income Asian immigrant women to conduct HPV self-sampling tests. Acknowledgement This study is partially supported by the faculty research funds under the Center for Asian Health, Temple University (PI: Grace X. Ma, PhD). It is also partially supported by the grant of U54 CA221704(5) funded by the National Cancer Institute (NCI) of NIH (Contact PIs: Grace X. Ma, PhD and Olorunseun O. Ogunwobi, MD, PhD). The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of NIMHD or the NCI, NIH. Citation Format: Grace X Ma, Shumenghui Zhai, Lin Zhu, TImmy Lin, Yin Tan, Carolyn Fang, Jerome L Belinson, Minqi Wang. A successful culturally tailored intervention to empower low-income Asian American women to conduct human papillomavirus self-sampling test [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C080.

Association of socioeconomic factors and prevalence of hypertension with sleep disorder among the elderly in rural southwest China

ObjectivesThis study examines the distribution of sleep disorder prevalence across socioeconomic status (SES) and investigates the relationship between sleep disorders and hypertension among southwest China's rural older adult population. MethodsA cross-sectional survey was conducted in rural Yunnan Province, China from 2017 to 2018, consisting of 4833 consenting participants aged ≥60 years. Each participant completed a structured interview and had their blood pressure measured. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression was used to model variations in prevalence of sleep disorders and hypertension. ResultsIn the study population, the prevalence rates of sleep disorders and hypertension were 46.5% and 50.3%, respectively. Women had higher prevalence of both chronic illnesses (53.4% vs. 38.7%, 53.1% vs. 47.6%, P < 0.01). After adjusting for age, sex, and residential status, older adults of minority ethnicity had a higher prevalence of sleep disorders than the Han ethnic majority (P < 0.01). Attainment of higher levels of education and lower annual household income were also associated with a greater risk of sleep disorders (P < 0.01). Further, logistic regression analysis indicated that older adults with sleep disorders had a greater risk of being hypertensive (P < 0.01). ConclusionsSleep disorders are highly prevalent in rural southwest China. Future interventions to improve sleep quality would benefit from tailoring to address individual SES. Improving sleep quality profoundly reduces prevalence of hypertension.

Abstract P153: Multiple Vulnerabilities to Health Disparities and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke Study

Background: Multiple socially determined vulnerabilities (SDV) to health disparities often cluster within the same individual. Previous studies have shown that SDV are separately associated with increased risk of heart failure (HF). As there may be a cumulative effect of these SDVs in the same individual, understanding their joint impact on the incidence of HF is critical. Methods: REGARDS is a national prospective cohort study that recruited 30,239 adults &lt;45 years of age from 2003-2007 with ongoing follow-up. We followed participants free of HF at baseline for incident HF hospitalization through December 31, 2016. Guided by the Healthy People 2020 framework, we examined 10 potential SDVs, retaining those that were associated with incident HF (p&lt;0.10) and creating a count of SDV (0, 1, 2, 3+). We used Cox models to examine associations between the SDV count and incident HF, adjusting for potential confounders. Since disparities in HF have been shown to be greatest in younger individuals models were stratified by age. Results: The 25,790 participants were followed for a median of 10.1 years (IQR 6.5, 11.9); their mean age at baseline was 64.8, 55%% were women, and 40% were blacks. In age-adjusted models, Black race, low educational attainment, low annual household income, zip code poverty, poor public health infrastructure, and lack of health insurance were significantly associated with incident HF. In fully adjusted models, among those 45-64 years, compared to having no SDV, having a SDV was significantly associated with incident HF, with a trend toward a higher count conferring greater risk (Fig. 1). There was no association in other age groups. Conclusions: An increased number of SDVs was associated with risk of incident HF hospitalization among adults &lt;65 years, even after adjustment for cardiovascular risk factors. Using a simple count of SDVs that could be incorporated into the social history during clinical assessment may identify younger individuals at increased risk of incident HF.

Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital

While lung cancer screening improves cancer-specific mortality and is recommended for high-risk patients, barriers to screening still exist. We sought to determine our institution's (an urban safety net hospital) screening rate and to identify socioeconomic barriers to lung cancer screening. We identified 8935 smokers 55 to 80 years of age evaluated by a primary care physician between March 2015 and March 2017 at our institution. We randomly selected one-third of these (n= 2978) to review for eligibility using the U.S. Preventive Services Task Force criteria for lung cancer screening. Using our institution's Lung Cancer Screening Program clinical tracking database, we identified patients who were screened from March 2015 to March 2017. We collected demographic information (race, primary language, education status, and median income) and evaluated possible associations with screening. Among our institution population, 99 patients meeting U.S. Preventive Services Task Force screening criteria underwent screening computed tomography, whereas 516 eligible patients were not screened, making our institution's estimated screening rate 16.1%. Comparing the unscreened population with those who received screening at our institution, the unscreened population was significantly older (median age of screened patients was 63 years, of unscreened patients was 66 years; P < .001). African Americans had a lower screening rate (37.6% of the screened population and 47.5% of the unscreened population; P < .001). Unscreened patients had a lower annual household income. The lung cancer screening rate at our hospital is 16.1%. Unscreened patients were older, were more likely to be African American, and had a lower median income. These findings highlight possible screening barriers and potential areas for targeted strategies to decrease disparities in lung cancer screening.

Dietary patterns of adults and their associations with Sami ethnicity, sociodemographic factors, and lifestyle factors in a rural multiethnic population of northern Norway - the SAMINOR 2 clinical survey

BackgroundFew population-based studies have assessed dietary behaviors in the rural multiethnic population of Northern Norway. The present study determined dietary patterns and investigated their association with Sami ethnicity, sociodemographic factors, and lifestyle factors in a multiethnic population in rural Northern Norway.MethodsThis cross-sectional study included 4504 participants of the SAMINOR 2 Clinical Survey (2012–2014) aged 40–69 years. All participants completed a lifestyle and food frequency questionnaire. Dietary patterns were determined using principal component analysis. Associations between food patterns and ethnicity, sociodemographic factors, and lifestyle factors were examined by multiple linear regression.ResultsSix dietary patterns were identified that accounted for 28% of the variability in food intake in the study sample: ‘processed meat/westernized’, ‘fish/traditional’, ‘fruit/vegetables’, ‘reindeer/traditional’, ‘bread and sandwich spreads’, and ‘sweets and bakery goods’. The ‘reindeer/traditional’ pattern was most common among the inland Sami population. The ‘fish/traditional’ pattern was most common among costal multiethnic Sami and least common among inland Sami and among women independent of ethnicity. The ‘fish/traditional’ pattern was also positively associated with older age, high education level, small household size, and smoking. Adherence to the ‘processed meat/westernized’ pattern was lower among inland Sami than inland/coastal non-Sami; no ethnic differences in adherence to this pattern were found between costal multiethnic Sami and inland/coastal non-Sami. Unhealthy lifestyle factors, like low physical activity level and smoking, and younger age were mainly associated with the ‘processed meat/westernized’ pattern, whereas socioeconomic factors like low education, low gross annual household income, and large household size were related to the ‘sweets and bakery goods’ pattern. Male gender, low education level, and smoking were associated with the ‘bread and sandwich spreads’ pattern. The ‘fruit/vegetables’ pattern was characterized by healthy dietary choices and a health-conscious lifestyle, and was more common in women with a high education level and income.ConclusionsAdherence to the six identified dietary patterns was characterized by different sociodemographic and lifestyle factors. Ethnicity, in combination with geographical region of residence, was associated with dietary behaviors. This study provides knowledge that will be useful in future studies on dietary patterns related to chronic diseases in the rural population of Northern Norway.

Cancer-Related Distress and Unmet Needs Among Acute Myeloid Leukemia Survivors

Background: Individuals with acute myeloid leukemia (AML) are at risk for significant physical and psychological burden related to their illness. While overall survival rates are improving, treatments may be associated with lengthy hospitalizations, and the risk of relapse remains substantial. This study explores cancer-related distress and concerns among AML survivors, as well as supportive care received from their healthcare team. Methods: 58 AML patients and survivors enrolled in the Cancer Support Community's online Cancer Experience Registry; 38 completed CancerSupportSource® (CSS) questions, a 25-item distress screening tool in which they rated their level of concern (0=Not at all; 4=Very seriously) about emotional well-being, symptom burden and impact, body image and healthy lifestyle, healthcare team communication, and relationships and intimacy. CSS includes validated subscales that identify individuals at risk for clinically significant depression and anxiety. Participants also completed questions about their unmet needs and desired help. Pearson's correlation coefficients were used to explore bivariate associations between socio-demographic variables and clinical history with overall distress (sum of CSS ratings) in AML respondents. Results: Mean (SD) age was 50 (14) years (range: 18-77); mean time since diagnosis was 5.6 years. Participants were 87% White and 64% female. 33% were receiving treatment at the time of taking the survey; 23% had ever experienced a recurrence of their cancer. Participants' greatest concerns (% rated Moderately to Very seriously) included: eating and nutrition (61%); exercising (57%); fatigue (53%); worry about the future and what lies ahead (51%); feeling irritable (51%); health insurance or money worries (49%); sleep problems (47%); changes or disruptions in work, school, or home life (46%); and feeling sad or depressed (45%). Based on responses to CSS risk screening subscales, more than half of participants (54%) were at risk for clinically significant level of anxiety; 42% were at risk for clinically significant levels of depression. Over half of respondents indicated their healthcare team asked about emotional concerns (58%); half said they were asked about lifestyle concerns such as diet and exercise (50%) and about financial concerns (e.g., out-of-pocket costs) (50%); roughly two-out-of-five had a health professional talk to them about employment concerns (40%) or family (42%). A majority of participants wished they had received more help with managing emotions related to cancer (67%), managing short-term (50%) and long-term (61%) side effects and symptoms, changing lifestyle behaviors (53%), and financial advice/assistance (47%). In bivariate analysis, greater overall distress was associated with younger age (r=-.49; p&lt;.01), less education (r=-.44; p&lt;.01), and lower annual household income (r=-.74; p&lt;.001). Conclusions: This exploratory study demonstrates that substantial proportions of AML survivors express concerns about emotional distress, symptom burden and impact, and practical matters including finances. Yet, many report they are not counseled about these concerns, and the majority wish for more help to address these needs. Efforts are needed to enhance social and emotional support and improve access to integrated supportive care for individuals with AML, to reduce the potential impact of illness burden and distress on quality of life, treatment adherence, and other illness outcomes. Future research will examine multivariate predictors of distress and unmet needs. Disclosures Zaleta: Pfizer: Research Funding; Gilead: Research Funding; Athenex: Research Funding. Albrecht:Cancer Support Community: Membership on an entity's Board of Directors or advisory committees; Oncology Nursing Society: Honoraria; Carevive: Research Funding. LeBlanc:Medtronic: Membership on an entity's Board of Directors or advisory committees; NINR/NIH: Research Funding; Astra Zeneca: Consultancy, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; CareVive: Consultancy; Celgene: Honoraria; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy; Heron: Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Otsuka: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Research Funding; American Cancer Society: Research Funding; Duke University: Research Funding; Jazz Pharmaceuticals: Research Funding; Flatiron: Consultancy; AbbVie: Membership on an entity's Board of Directors or advisory committees; Pfizer Inc: Consultancy. Liesveld:Abbvie: Membership on an entity's Board of Directors or advisory committees; Onconova: Other: Data safety monitoring board. Rogers:Teva: Speakers Bureau; Takeda: Honoraria; Genentech: Speakers Bureau; Seattle Genetics: Speakers Bureau; Abbvie: Speakers Bureau; Cardinal Health: Honoraria; Genentech: Honoraria; Mylan: Honoraria; Coherus: Speakers Bureau.

Household income and contraceptive methods among female youth: a cross-sectional study using the Canadian Community Health Survey (2009-2010 and 2013-2014).

Low socioeconomic status is one of many barriers that may limit access to family planning services. We aimed to examine the relation between household income and contraceptive methods among female youth in Canada. Our study population included sexually active females aged 15-24 who were trying to avoid pregnancy. We used cross-sectional data from the 2009-2010 and 2013-2014 cycles of the Canadian Community Health Survey to compare household income and other sociodemographic covariates for those using oral contraceptives, injectable contraceptives, condoms or a dual method (condoms plus oral or injectable contraceptives). Of female youth at risk for unintended pregnancy, 59.2% reported using oral contraceptives, 29.0% used dual methods, 16.8% used condoms only, 2.5% used injectable contraceptives and 13.6% did not use contraception. In multiple regression models, lower annual household income (< $80 000) was associated with decreased use of oral contraceptives (relative risk [RR] 0.85, 95% confidence interval [CI] 0.80-0.91) and dual methods (RR 0.81, 95% CI 0.71-0.91), increased use of condoms (RR 1.36, 95% CI 1.11-1.67) and injectable contraceptives (RR 1.69, 95% CI 0.98-2.92), and a greater risk of contraceptive nonuse (RR 1.19, 95% CI 0.94-1.50). We found that lower household income was associated with decreased use of oral contraceptives and increased reliance on injectable contraceptives and condoms only. Young, low-income females may face barriers to accessing the full range of contraceptive methods available in Canada. Easier access to affordable contraception may decrease the number of female youth at risk for unintended pregnancy due to financial barriers.

Ethnic disparities in prevalence and clustering of cardiovascular disease risk factors in rural Southwest China

BackgroundThis study examines how prevalence and clustering of cardiovascular disease (CVD) risk factors differ by ethnicity and socioeconomic status (SES) among rural southwest Chinese adults.MethodsA cross-sectional survey of 7027 adults aged ≥35 years of Han and four ethnic minority group descent (Na Xi, Li Shu, Dai, and Jing Po) was used to derive prevalence of tobacco smoking and exposure to secondhand smoke (SHS) as well as alcohol consumption and physical activity data. Anthropometric measurements were also taken, including height, weight, and waist and hip circumference, as well as blood pressure (BP) and fasting blood glucose (FBG) measurements.ResultsCurrent smoking and drinking status were the top two CVD risk factors in the study population. Dai ethnic minority participants had the highest prevalence of hypertension, obesity, and central obesity, whereas Jing Po ethnic minority participants had the highest prevalence of current smoking status, SHS exposure, and current drinking status (P < 0.01). Han participants had the highest prevalence of diabetes and physical inactivity (P < 0.01). 11.1% of all participants did not have any of the studied CVD risk factors, while 68.6% of Han, 60.2% of Na Xi, 50.7% of Li Shu, 82.2% of Dai, and 73.0% of Jing Po participants had clustering of two or more CVD risk factors. Prevalence of CVD risk factor clusters increased with age (P < 0.01). Males and individuals with lower education levels and lower annual household income were more likely to have CVD risk factors than their counterparts (P < 0.01).ConclusionClustering of CVD risk factors is common in rural southwest China. Ethnicity and individual SES significantly impact prevalence of CVD risk factors and their clustering.

Co-occurring Gastrointestinal Symptoms Are Associated With Taste Changes in Oncology Patients Receiving Chemotherapy

ContextOver 80% of patients with cancer report taste changes. Despite the high prevalence of this symptom and its negative effects on health, few studies have assessed its association with other gastrointestinal (GI) symptoms. ObjectivesDetermine the occurrence, frequency, severity, and distress of patient-reported “change in the way food tastes” (CFT) and identify phenotypic and GI symptoms characteristics associated with its occurrence. MethodsPatients receiving chemotherapy for breast, GI, gynecological, or lung cancer completed demographic and symptom questionnaires prior to their second or third cycle of chemotherapy. CFT was assessed using the Memorial Symptom Assessment Scale. Differences in demographic, clinical, and GI symptom characteristics were evaluated using parametric and nonparametric tests. ResultsOf the 1329 patients, 49.4% reported experiencing CFT in the week prior to their second or third cycle of chemotherapy. In the univariate analysis, patients who reported CFT had fewer years of education; were more likely to be black or Hispanic, mixed race, or other; and had a lower annual household income. A higher percentage of patients with CFT reported the occurrence of 13 GI symptoms (e.g., constipation, diarrhea, abdominal cramps, feeling bloated). In a multivariable logistic regression analysis, compared with patients with breast cancer, patients with lung cancer (odds ratio = 0.55; P = 0.004) had a decrease in the odds of being in the CFT group. Patients who received a neurokinin-1 receptor antagonist and two other antiemetics were at an increased odds of being in the CFT group (odds ratio = 2.51; P = 0.001). Eight of the 13 GI symptoms evaluated were associated with an increased odds of being in the CFT group. ConclusionsThis study provides new evidence on the frequency, severity, and distress of CFT in oncology patients undergoing chemotherapy. These findings suggest that CFT is an important problem that warrants ongoing assessments and nutritional interventions.

Why is the recognition rate of psychological distress under-estimated in general hospitals? A cross-sectional observational study in China.

This study aimed to investigate the recognition rate of psychological distress in general hospitals in China and to examine the main associated factors.Using a cross-sectional study design, the questionnaires were administered to a total of 1329 inpatients from a tertiary hospital. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire (PHQ-15) and the Whiteley-7 (WI-7) were used to assess patients’ mental health status. Two subjective questions were used to identify the awareness of psychological distress in patients and doctors.The frequency of psychological distress measured by the questionnaires was high in our sample (53.4%). However, the recognition rates of both patients (34.9%) and by doctors (39.1%) was low. The concordance rate between patients and doctors of whether the patient had psychological distress or not was extremely poor (Kappa = 0.089, P = .001). Factors associated with the poor concordance rate included patients’ annual household income and clinically significant self-reported symptoms of anxiety and hypochondriasis.The recognition rate of psychological distress was underestimated and this may be related to a lack of awareness of mental disturbances and patients’ low annual household income.

Demographic factors associated with financial toxicity: Results from the multisite cost study.

e18362 Background: Financial toxicity (FT) is a major cause of distress for cancer patients. We have previously reported that FT was high among patients at a county hospital and a tertiary academic center. In this study, we sought to compare factors associated with FT at these institutions. Methods: Patients with clinic visits were asked to fill out an 11-item validated FT survey, the COST tool, and demographic questions from 10/2017 - 2/2018 at the county hospital and 7/2015 - 10/2018 at the academic center. We used a logistic regression model to analyze demographic factors associated with FT. Results: Mean COST score was significantly higher at the county hospital (28.7) compared to the academic center (20.4) (p &lt; 0.001). Distribution of cancer stage was similar between the institutions. Patients at the county hospital were more likely to have an annual household income (AHI) &lt; $25K (p &lt; 0.001), and be insured by Medi-cal (p &lt; 0.001). Patients at the academic center were more likely to be White (p &lt; 0.001). Monthly OOP spending was more likely to be &gt; $500 at the academic center (p &lt; 0.001). Conclusions: Overall, FT was higher at the county hospital as compared to the academic center. FT at both institutions was associated with higher OOP spending and lower AHI. However, variations in FT among other demographic factors may reflect differences in care delivery systems and patient populations. Our study demonstrates that demographic groups at risk for FT differs between institutions suggesting the factors that contribute financial toxicity are complex and variable. Thus local assessments of FT may be necessary for individual health systems to develop targeted interventions to improve FT among their patients.[Table: see text]

PCN175 DEPRESSIVE SYMPTOMS AND RISK OF CANCER-SPECIFIC MORTALITY AMONG OLDER PATIENTS WITH NON-HODGKIN LYMPHOMA: ANALYSES FROM THE SURVEILLANCE, EPIDEMIOLOGY AND END RESULTS (SEER) MEDICARE HEALTH OUTCOMES SURVEY (MHOS)

Depressive symptoms and quality of life may adversely affect cancer treatment and survival in patients’ diagnosed with cancer. Co-morbid depression in older adults may contribute to lower initiation or adherence to treatment, leading to increased mortality. We evaluated the association between pre-cancer depressive symptoms and mortality in older patients diagnosed with non-Hodgkin lymphoma. A retrospective cohort study was conducted using the SEER-MHOS linked database. The study included adults ≥65 years diagnosed with first primary NHL between 1998 and 2014 that completed one survey within 5-years prior to diagnosis. A positive screen for depressive symptoms was determined using MHOS responses. Depressive symptoms were defined as a positive response to at least 1 of 3 depression screening questions and a mental health component summary score £42. We used multi-variable Cox-proportional hazards models to estimate risk of cancer-specific mortality in adults with baseline depressive symptoms relative to adults without depressive symptoms. In a cohort of 1,308 patients, 81% were non-Hispanic white and 51% were female with a mean age of 76 years, consisting of primarily diffuse large B-cell lymphomas (75%). Prior to cancer diagnosis, 135 (10%) subjects reported depressive symptoms. Compared to patients without baseline depressive symptoms, patients with depressive symptoms reported lower education (less than high school: 39% vs. 25%, p <0.01), lower annual household income (less than $30,000: 81% vs. 62%, p<0.01) and had a higher number of co-morbidities (mean of 3 vs. 2, p<0.01). In multi-variable analyses, depressive symptoms were not associated with cancer-specific mortality risk (HR 1.09, 95% 0.80-1.38, p=0.60). Our findings provide little evidence to support the hypothesis that depressive symptoms adversely affect cancer-specific survival in older patients with NHL. However, the high prevalence of depressive symptoms among older lymphoma patients is consistent with that of other critically ill older adults and deserves clinical attention.

Indicators of Risk for Dental Caries in Children: A Holistic Approach.

Dental caries in children is a major public health problem worldwide, with a multitude of determinants acting upon children to different degrees in different communities. The objective of this study was to determine maternal, environmental, and intraoral indicators of dental caries experience in a sample of 6- to 7-y-old children in South East Queensland, Australia. A total of 174 mother-child dyads were recruited for this cross-sectional study from the Griffith University Environments for Healthy Living birth cohort study. Maternal education, employment status, and prepregnancy body mass index were maternal indicators, and annual household income was taken as a proxy for environmental indicators. These were collected as baseline data of the study. Clinical data on children's dental caries experience, saliva characteristics of buffering capacity, stimulated flow rate, and colony-forming units per milliliter of salivary mutans streptococci were collected for the oral health substudy. Univariate analysis was performed with 1-way analysis of variance and chi-square tests. Caries experience was the outcome, which was classified into 4 categories based on the number of carious tooth surfaces. Ordinal logistic regression was used to explore the association of risk indicators with caries experience. Age (P = 0.021), low salivary buffering capacity (P = 0.001), reduced levels of salivary flow rate (P = 0.011), past caries experience (P = 0.001), low annual household income; <$30,000 (P = 0.050) and <$60,000 (P = 0.033) and maternal employment status (P = 0.043) were associated with high levels of dental caries. These data support the evidence of associations between maternal, environmental, and children's intraoral characteristics and caries experience among children in a typical Western industrialized country. All of these need to be considered in preventative strategies within families and communities. The results of this study can be used by clinicians, epidemiologists, and policy makers to identify children who are at risk of developing dental caries. With consideration of costs for treatment for the disease, this information could be used to plan cost-effective and patient-centered preventive care.

Twelve-Year Temporal Trends in Ambulance Use for Patients Hospitalized With a Primary Diagnosis of Syncope in Canada

BackgroundAmbulance use is a costly mode of transportation to the emergency department (ED). Syncope is a frequent presentation to the ED; however, no data exist regarding the proportion of hospitalized patients with syncope arriving by ambulance and their outcomes compared with self-presenters. MethodsThe Canadian Institute for Health Information database was used to identify patients aged > 20 years hospitalized with a primary diagnosis of syncope (International Classification of Diseases 10th Revision code R55) in Canada, except Quebec, between April 2004 and March 2016. Logistic regression models (odds ratio and 95% confidence interval) were used to identify demographics, clinical factors, and province associated with ambulance use and whether ambulance use was associated with in-hospital mortality. ResultsAmong 108,967 syncope hospitalizations, 64% of patients arrived by ambulance, and use increased from 58.8% to 66.1% over 12 years (P for trend < 0.01). Significant variations existed in ambulance use across provinces (P < 0.01). Predictors associated with higher odds of ambulance use were increasing age, male sex, urban residence, residing in areas with lower annual household income, and higher comorbidity burden. In multivariable-adjusted analysis, ambulance use was associated with a 1.7-fold higher odds of in-hospital mortality. ConclusionsApproximately two-thirds of patients hospitalized for syncope presented by ambulance, and use has increased over time. Hospitalized patients in syncope who are transported by ambulance have a worse prognosis. Further research on emergency medical services’ risk stratification of patients who are transported by ambulance may help to identify a low-risk population who may obviate the need for transport.