Lower Socioeconomic Groups Research Articles

Total elbow arthroplasty in England.

The aim of this study was to review the provision of total elbow arthroplasties (TEAs) in England, including the incidence, the characteristics of the patients and the service providers, the types of implant, and the outcomes. We analyzed the primary TEAs recorded in the National Joint Registry (NJR) between April 2012 and December 2022, with mortality data from the Civil Registration of Deaths dataset. Linkage with Hospital Episode Statistics-Admitted Patient Care (HES-APC) data provided further information not collected by the NJR. The incidences were calculated using estimations of the populations from the Office for National Statistics. The annual number of TEAs performed by surgeons and hospitals was analyzed on a national and regional basis. A total of 3,891 primary TEAs were included. The annual incidence of TEA was between 0.72 and 0.82 per 100,000 persons before 2020 and declined to 0.4 due to a decrease in elective TEAs during the COVID-19 pandemic, with a slight recovery in 2022. Older patients, those of white ethnicity and females, were more likely to undergo TEA. Those who underwent elective TEA had a median wait of between 89 (IQR 41 to 221) and 122 days (IQR 74 to 189) in the years before 2021, and this increased to 183 days (IQR 66 to 350) in 2021. The number of TEAs performed by surgeons per annum remained unchanged, with a median of two (IQR 1 to 3). The median annual number of TEAs per region was three to six times higher than the median annual case load of the highest volume hospital in a region. Patients in the lowest socioeconomic group had a higher rate of serious adverse events and mortality (11%) when undergoing TEA for acute trauma. In England, TEA is more common in older age groups, those of white ethnicity, and females. The COVID-19 pandemic affected the incidence of elective TEA and waiting times, and the provision of TEA has not yet recovered. The Getting it Right First Time recommendation of centralizing services to one centre per region could result in up to a six-fold increase in the number of TEAs being performed in some centres.

Improving breast cancer care post-pandemic from the patient perspective

Abstract Background Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on socio-economic status (SES). Methods 37 women were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SES was analysed within each sub-theme. Results Of the 28 women who participated in interviews, 39% were categorized as high-SES, while 61% were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient-priorities included: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included: improving the transition from active to post-treatment; enhancing support resources; and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which resulted in varied patient-priorities and recommendations. Conclusions As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic. Key messages • The pandemic has impacted BC services considerably and this study has identified a range of unmet needs, patient-centered priorities, and recommendations. • Particular consideration needs to be given to those women from lower socioeconomic groups, in order to reduce health inequalities, which have been further exacerbated by the pandemic.

11.F. Scientific session: If we build it, will they come? Evaluation of citywide park redesign and renovation in NYC

Abstract Urban environments, such as parks, play a crucial role in shaping the health of their residents. However, the relationship between parks and health remains inconclusive. This workshop will present findings from the Physical Activity and Redesigned Community Spaces (PARCS) Study that examined the community health impacts of the Community Parks Initiative (CPI), a citywide park equity initiative of the New York City Department of Parks and Recreation (NYC Parks) that led to citywide park redesign and renovation across 67 low-income neighborhoods in NYC. Using a quasi-experimental design with socio-demographically matched control parks, we evaluated longitudinal changes in park use, physical activity, and psychosocial well-being as a result of CPI. There will be a total of 3 presentations. The first presentation will focus on the impact of CPI on park use before and after park renovation, relative to control parks, using data collected from the System for Observing Play and Recreation in Communities (SOPARC). Results showed that CPI led to a significant net increase in park use, especially among adults. The second presentation will report on changes in perceived stress pre- and post-renovation among adults. Results showed that a greater decrease in perceived stress was associated with a sustained high or increased park use frequency in the context of high-quality CPI intervention parks. In contrast, the same association was not found in lower quality control parks. The third presentation will showcase a study that demonstrated a significant increase in children’s physical well-being, a dimension of quality of life, at CPI vs. control sites. The analysis also showed that children in the lowest socio-economic group might have benefited the greatest from CPI. PARCS is one of the largest intervention studies on the effects of park renovation on health. This workshop will engage participants in considering how these insights can be translated into actionable programs and policies in service of community health and health equity. Findings from PARCS will help inform future public health and urban planning interventions in the use of the built environment to promote population well-being. Key messages • Urban park renovations may contribute significantly to community health, demonstrating a vital link between the built environment and public health. • Investments in green spaces may enhance the physical and mental well-being of low-income urban communities, promoting social equity.

Excess mortality during COVID-19 pandemic in Bangladesh - evidence from a rural survey.

The coronavirus disease 2019 (COVID-19) had a profound impact worldwide. In Bangladesh, the official number of deaths for COVID-19 was around 29 000. However, many countries including Bangladesh experienced substantial underreporting of COVID-19 deaths due to lack of complete national civil registration system. This study aims to estimate excess mortality in 2020, identify risk factors, and determine leading causes of death in Bangladesh. In February 2021, we conducted a cross-sectional household survey in Sitakunda, a subdistrict of Chattogram, identifying deaths from January 2018 to December 2020. Excess mortality was quantified using the p-score and incidence rate ratio (IRR) utilising Poisson segmented regression. We employed the InterVA-5 algorithm to attribute causes of death. Proportional distribution and cause-specific mortality rates (CSMR) per 100 000 individuals were compared between pre-pandemic and pandemic periods. Among 1748 deaths from 25 669 households, we found 1.4 (95% confidence interval (CI) = 1.2-1.4) times excess mortality in 2020 compared to 2018-2019. Leading causes of death in 2020 included cardiac disease (CSMR = 121.0, CI = 115.8-127.3), stroke (CSMR = 108.0, CI = 102.6-114.0), and acute respiratory infection (CSMR = 61.0, CI = 55.1-66.5), all displaying significantly higher mortality rates than in previous years. Older age (IRR = 1.6), less education (IRR = 1.8), and lower socio-economic groups (IRR = 2.1) had higher mortality rates in 2020 compared to pre-pandemic years. Our study suggests high rural excess mortality during COVID-19 including cardiac disease, stroke and acute respiratory infection as the leading causes of deaths. We require targeted strategies to identify high-risk patients with comorbidity and social vulnerabilities that contribute to mortality to guide the preparedness strategy for future pandemics.

Investigation of the relationship between socioeconomic status and literacy in PISA Türkiye data

Previous researchers have identified socioeconomic status as a significant predictor of achievement/literacy. However, it is important to recognize that the influence of socioeconomic status on literacy may vary at different levels of socioeconomic status. Thus, this study analyzes the relationship between socioeconomic status and literacy scores for all domains in PISA Türkiye data from 2003 to 2022 through the Classification and Regression Trees and linear regression methods. Upon examining the results, separate investigations carried out for the lower and upper socioeconomic status groups indicate that R2 values were found to be equal to or greater than .80 in 37 out of the 42 analyses. From 2003 to 2009, the R2 values in both groups were considerably high; however, there has been a notable decline in subsequent periods. The year 2009 demonstrated particularly high R2 values by ESCS in all domains for both upper and lower groups. Consequently, socioeconomic status exhibited a greater predictive power on literacy scores across all domains in the lower socioeconomic group than upper socioeconomic group.

Trends in socioeconomic inequality in e-cigarette use among adolescents in South Korea.

The global rise in e-cigarette use among adolescents is alarming, with associated socioeconomic inequalities posing potential public health risks. This study examined trends in the socioeconomic inequality in e-cigarette use among South Korean adolescents to inform future regulatory directions. Socioeconomic inequalities in e-cigarette use among Korean adolescents were assessed using data from the Korea Youth Risk Behavior Web-based Survey (KYRBS) from 2011 to 2023. The Concentration Index, a well-established method for measuring health inequalities, was employed. Additionally, this study investigated how the smoking behaviors of family members and friends influence socioeconomic inequality in e-cigarette use among Korean adolescents, using a decomposition analysis. The Concentration Index values showed a clear, fluctuating downward trend over 13 years, from -0.12 (95% CI: -0.13 - -0.10) in 2011 to -0.24 (95% CI: -0.26 - -0.21) in 2023. Decomposition analysis revealed that smoking among peer groups, including friends and siblings, was the primary contributor to socioeconomic inequality in e-cigarette use, followed by maternal smoking. Socioeconomic inequalities in adolescent e-cigarette use in South Korea are widening, particularly among low socioeconomic status groups. The impact of peer groups on socioeconomic inequalities in e-cigarette use among adolescents is concerning.

Lifetime healthcare expenditures across socioeconomic groups

BackgroundA socioeconomic gradient affects healthcare expenditures and longevity in opposite directions as less affluent individuals have higher current healthcare expenditures but simultaneously enjoy shorter lives. Yet, it is unclear whether this cross-sectional healthcare expenditure gradient persists from a lifetime perspective. This paper analyzes lifetime healthcare expenditures across socioeconomic groups using detailed individual-level healthcare expenditure data for the entire Danish population.MethodUsing full population healthcare expenditures from Danish registries, we estimate lifetime healthcare expenditures as age-specific mean healthcare expenditures times the probability of being alive at each age. Our data enables the estimation of lifetime healthcare expenditures by sex, socioeconomic status, and by various types of healthcare expenditure.ResultsOnce we account for mortality differences and all types of healthcare expenditures, all socioeconomic groups spend an almost equal amount on healthcare throughout a lifetime. Lower socioeconomic groups incur the lowest lifetime hospital expenditures, whereas higher socioeconomic groups experience the highest lifetime expenditures on long-term care services. Our findings remain robust across various socioeconomic measures and alternative estimation methodologies.ConclusionImproving the health status of lower socioeconomic groups to align with that of higher socioeconomic groups is costly but may ultimately reduce current healthcare expenditures. Enhanced health outcomes likely increase lifespan, leading to extended periods of healthcare consumption. However, since all socioeconomic groups tend to have similar lifetime healthcare expenditures, this prolonged consumption has limited impact on overall lifetime healthcare costs. Additionally, a significant benefit is the deferment of healthcare expenditures into the future. Overall, our results diminish concerns about socially inequitable utilization of healthcare resources while socioeconomic differences in health and longevity persist, even in a universal healthcare system.

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta-analysis.

Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random-effects model. Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] -9.85years and 95% confidence intervals [CI] -9.99 to -9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14-1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97-3.13), length of stay (WMD 1.15days and 95% CI -0.32-2.62), and mortality (OR 1.04 and 95% CI 0.95-1.14) regardless of background. Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation.

A preventive integrated eHealth approach for individuals with a low socioeconomic position: protocol for a realist evaluation

BackgroundAdoption of standalone eHealth tools is low among persons in lower socioeconomic groups. The preventive integrated eHealth approach combines blended care with an active and personal approach to facilitate access to local care, tailored to the needs of the participant. We describe the four step preventive integrated eHealth approach for individuals with a low socioeconomic position and the realist evaluation protocol of the intervention and implementation. The realist evaluation centers around the question, ‘what works for whom in what circumstances and why’.MethodsThe study population will consist of adult individuals with a low socioeconomic position, who participate in the preventive integrated eHealth approach in one of the participating locations in the Netherlands. The four-step intervention consists of: (1) a proactive invitation of participants by care professionals, (2) the use of an eHealth tool that produces a personalized health report, (3) a personal consultation with a care professional to discuss the personalized health report and set a goal to work on, and (4) active referral to local social and health care. An initial program theory theorized from literature and stakeholder involvement is presented. Qualitative and quantitative data collection and analysis with participants (survey at zero, three and twelve months and focus groups at six months) and professionals (interviews at three months) will inform the realist evaluation and serves to test and refine the initial program theory.DiscussionOur mixed-methods realist evaluation on the effect and implementation of a personal and active blended care approach will elucidate what elements trigger the mechanisms and responses of how individuals with a low socioeconomic position experience the preventive integrated eHealth approach. This will inform the way a preventative health check incorporating eHealth can be used to its full potential for low socioeconomic positioned groups to help close the digital divide and contribute to reduce health disparities.

Oral health of Dutch primary school children in relation to social and health aspects.

This research investigated the oral health status of Dutch primary school children aged 10-12 years in Utrecht and its association with demographic characteristics, lifestyle factors, general psychosocial health, and dental treatment, to guide targeted interventions to improve children's oral and overall well-being. A cross-sectional survey was conducted at 49 primary schools in Utrecht in 2017 and 42 schools in 2019. The questionnaire covered background characteristics (7 questions), psychosocial health (14 questions), nutrition and exercise (20 questions), school and leisure time (26 questions), home situation (23 questions), and oral health (4 questions). Associations were analyzed using multivariate logistic regression. Data from 5,426 children were analyzed. Prior to the survey, 11% did not visit a dentist, 23% had a toothache, 22% had a cavity filled, and 8% had a tooth extracted. Independent predictors for increased odds of oral health problems were migration background, poor general health, drinking more than two glasses of soft drinks per day, having ever drunk alcohol, having fear of failure, experiencing problems at home and/or coming from average or low socioeconomic position group. Factors associated with increased odds of dental treatment, such as cavity filled and tooth extracted, were migration background, fear of failure and home problems. These findings emphasize the need for targeted prevention to improve the oral health of children with a migration background, average or low socioeconomic position and/or with poorer general and psychosocial health, unhealthy diets and problems in the home situation, within a community-based and transdisciplinary approach.

A Study of Respiratory Hygiene Among Patients With Respiratory Manifestations in a Selected Primary Healthcare Setting in India.

Tuberculosis is the second leading infectious killer disease, mainly transmitted through undiagnosed presumptive and inadequately treated pulmonary tuberculosis (PTB) cases in the community. This study was conducted to assess the knowledge, attitude, and practices (KAP) related to respiratory hygiene and sputum disposal methods and to estimate the proportion of presumptive PTB cases among patients with clinical features of respiratory manifestations. A hospital-based cross-sectional study was conducted among 80 adult patients with respiratory manifestations at an urban health centre in Goa using a validated, pre-tested, semi-structured questionnaire by interview method. Among 80 study participants, 10 (12.5%) presumptive PTB cases were found. The knowledge regarding the exact cause and transmission of tuberculosis was 55% (44) and 72.4% (58), respectively. Around 32.5% (26) of participants were not following cough etiquette and they studied only up to middle school. Regarding the attitude towards ideal sputum disposal methods, more than three-fourths (81.3%, 65) of the responses were towards unsafe sputum disposal methods. There is a need for health education regarding proper respiratory hygiene and sputum disposal methods, especially among patients with low educational and socio-economic groups.

Medicine Compliance Among Hypertensive Patients with Known Diabetes Mellitus in Sindh, Pakistan

Background: Hypertension and diabetes mellitus are prevalent chronic conditions, requiring long-term medication adherence for effective management. Non-compliance can lead to severe health complications and increased healthcare costs.Objective: To evaluate medication compliance among hypertensive patients with known diabetes mellitus in Sindh, Pakistan, and identify key factors contributing to non-compliance.Methods: This cross-sectional study included 381 participants from various cities in Sindh, selected through convenience sampling. Data were collected using a structured questionnaire covering demographic characteristics, socioeconomic status, and factors influencing medication compliance. Blood pressure was recorded using a sphygmomanometer. Ethical approval was obtained, and data were analyzed using SPSS version 25, with a p-value < 0.05 considered statistically significant.Results: Of the 381 participants, 67.98% were fully compliant with their medication regimen, while 32.02% were non-compliant. The most common reasons for non-compliance were complex medication regimens (17.21%), side effects (16.39%), and financial constraints (13.93%). Socioeconomic status significantly influenced compliance, with lower compliance observed in the lower socioeconomic group (p < 0.05).Conclusion: Despite a high compliance rate, a substantial portion of patients remain non-compliant due to regimen complexity and financial barriers. Targeted interventions, including simplified treatment plans and improved patient education, are necessary.

Quality of life, capability well-being, financial strain and physical activity in the short- and medium-term COVID-19 post-lockdown phases in the UK: a repeated cross-sectional study.

The COVID-19 lockdowns had negative effects on children's and adults' mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being. Cross-sectional data were collected in May-December 2021 (Wave 1) and January-July 2022 (Wave 2). Children (aged 10-11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults - EQ-5D-5L, children - CHU9D), capability well-being (adults - ICECAP-A) and family financial strain (adults - Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored. Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA. Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL. There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the UK's 'cost of living crisis'. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

Consumer Locus of Control Scale: Validity, and Measurement Invariance Evidence in Low and High Socioeconomic Status Groups

Consumer locus of control is a key factor in purchase decisions, where consumers perceive outcomes as either dependent on or external to their own actions. These beliefs vary among individuals from different socioeconomic backgrounds, except when it comes to consumption. However, the assumption of measurement invariance across all socioeconomic groups has not been proven. To address this, a study was conducted to develop, validate, and test the invariance of the Consumer Locus of Control Scale. The first study (n = 300) involved exploratory factor analysis and reliability testing. The second study (n = 309) examined confirmatory factor analysis, convergent and discriminant validity, and measurement invariance. Results showed high explained variance and internal consistency. The five-factor structure demonstrated a good fit, supporting the scale's structural validity. Furthermore, the scale was invariant between high and low socioeconomic groups. This study provides valuable evidence for the reliability and validity of the Consumer Locus of Control Scale.

Segregated by whom? Examining triple neighbourhood disadvantages and activity spaces in Seoul, South Korea

This study explores the potential mechanisms by which neighbourhood isolation is created and reinforced in non-home activity locations. The existing discussion on neighbourhood isolation, its consequences, and the subsequent reproduction of interactions between individuals and their environment has focused on their residential locations. However, the vitality of a neighbourhood depends not only on its own socioeconomic conditions but also on the conditions of the other neighbourhoods its residents visit and are visited by. Residential locations are only one of the many spaces in which individuals engage in their activities; therefore, to fully comprehend people’s everyday experiences of integration and isolation, it is imperative to look at interactions within both home and non-home activity spaces. Building on this extended perspective, we examine: (1) whether residential neighbourhood isolation is intensified by socioeconomic conditions individuals’ encounter in consumption and commuting activity spaces; and (2) which socioeconomic group drives the association between residential neighbourhood isolation and activity spaces—whether both disadvantaged and privileged groups contribute to isolation through the differential use of urban space or either group predominantly leads this association. We use Seoul as a case study, characterised as a city that is highly populated, contains multiple economic centres, functions with a highly affordable and efficient public transportation system, and suffers from increasing socioeconomic segregation. The results suggest that mobility patterns in activity spaces tend to reinforce neighbourhood isolation through potential forces driven by neighbourhood homophily. Isolation in the use of urban spaces appears to be driven mainly by the self-seclusion of the most advantaged neighbourhood group, while neighbourhoods in the lower socioeconomic status groups indicate broader cross-interactions across status groups, probably because of Seoul’s transit-friendly environment. Our study contributes to enhancing the understanding of spatial-societal inequalities in Korea and beyond and could assist in formulating policies for a more balanced provision of diverse urban social services and infrastructure.

Trends in COPD severe exacerbations, and all-cause and respiratory mortality, before and after implementation of newer long-acting bronchodilators in a large population-based cohort

BackgroundLittle is known about the trends in morbidity and mortality at the population level that followed the introduction of newer once-daily long-acting bronchodilators for COPD. The purpose of the study was to evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across sex and socioeconomic status classes.MethodsWe used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e., trend effect) in monthly severe exacerbation and mortality rates after 03/2013 and 02/2015 compared to the tiotropium period (04/2007 to 02/2013). Cohorts of individuals > 65 years with COPD were created from the nationally representative database of the Quebec Integrated Chronic Disease Surveillance System in the province of Quebec, Canada. Whether these trends were similar for men and women and across different socioeconomic status classes was also assessed.ResultsThere were 130,750 hospitalizations for severe exacerbation and 104,460 deaths, including 24,457 (23.4%) respiratory-related deaths, over the study period (928,934 person-years). Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.14%/month;95%CI -1.90% to -0.38%), which further decreased after 02/2015 (-1.78%/month;95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%/month;95%CI -4.38% to -0.47%) and severe exacerbation (-1,90%/month;95%CI -3.04% to -0.75%) rates were only observed after 02/2015. These observations tended to be more pronounced in women than in men and in higher socioeconomic status groups (less deprived) than in lower socioeconomic status groups (more deprived).ConclusionsThe arrival of newer bronchodilators was chronologically associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD > 65 years. Our findings document population benefits on key patient-relevant outcomes in the years following the introduction of newer once-daily long-acting bronchodilators and their combinations, which were likely multifactorial. Public health efforts should focus on closing the gap between lower and higher socioeconomic status groups.

Inequalities in Ambulatory Care Sensitive Conditions: An International Comparison of High-Income Countries

ObjectiveTo examine the differences in inequalities in Ambulatory Care Sensitive Conditions (ACSC) hospitalizations relative to socioeconomic status across nine countries, namely Australia, Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). ApproachThe International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) research collaborative developed national data sets with hospitalization and sociodemographic data aggregated to small-area levels and pooled across countries using a common data model. Inequalities were assessed using both the slope index of inequality and the relative index of inequality. ResultsThis study developed a common definition and set of codes for ACSC hospitalizations that proved to be comparable across countries and regions. Consistent socioeconomic gradients were observed in all countries with higher ACSC hospitalization rates for individuals in most disadvantaged areas. The greatest difference in hospitalizations between the highest and lowest income quintiles were observed in New Zealand (1603 per 100,000), Finland (1802 per 100,000) and England (1955 per 100,000). ConclusionsThe high-income countries included in this study displayed many commonalities in inequalities in ACSC hospitalizations. As a proxy measure of primary care access and quality, the observed inequalities may implicate disparities in health care quality and access for the lowest socioeconomic status groups. ImplicationsBarriers to health care access in low socioeconomic groups remain a complex and multifaceted issue. Future research should investigate the underlying contributing factors to the observed ACSC hospitalization equity gradients, including primary care delivery model, remuneration approach, and population structure.

Association of Socioeconomic Status and Reasons for Companion Animal Relinquishment.

It is important to understand the reasons for companion animal relinquishment to help reduce the financial and ethical problems arising from too many dogs and cats in shelters. This study investigates the socioeconomic factors and reasons behind companion animal relinquishment in Australia, utilizing data from five animal shelters, over a five-year period (Financial Year 2018/19 to 2022/23). Descriptive statistics reveal that the median Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) decile of companion animal guardians who relinquished their companion animal was decile 4 out of 10, indicating that they live in areas of lower-than-average socioeconomic status. Cats accounted for 59.4% and dogs for 40.6% of all relinquishments, with more relinquishments from lower socioeconomic deciles (1-5) (cats: 62.6%, dogs: 65.8%). The median age of relinquished cats was 5 months and dogs 16 months, with human factor-related issues (e.g., Housing, Financial Constraints, Human Healthcare) cited in 86% of cases. Descriptive analysis for the five financial years shows a declining trend in numbers of relinquishments, with housing issues (31.2%) identified as the primary reason, followed by ownership decisions (16.2%), financial constraints (11.2%), and human health issues (10.4%). Comparing the reasons for relinquishment between lower (decile 1-5) and higher (decile 6-10) socioeconomic status demonstrated that financial difficulties were a more common reason in lower vs. higher socioeconomic groups, while human health and family-related issues are more common in higher vs. lower socioeconomic groups. These findings highlight the critical role of socioeconomic factors in understanding why people relinquish their companion animals, which can inform targeted interventions to support companion animal welfare across different socioeconomic backgrounds.

Associations between risk factors, including approximal contact types and dental caries in children from low-income families. Pilot study.

The present cross-sectional study was conducted to evaluate various caries risk factors in children from low socio-economic groups and to assess if children with broad contacts between one or more primary molars (type I and S) should be categorized as at high caries risk. Clinical examinations were performed on 107, 3- to 10-year-old children from low socio-economic settings. Contact types along with other caries risk factors (insurance, diet, plaque, and fluoride use, and diet habits) were analyzed for effect on presence of caries lesions (prevalence) and caries experience (decayed, missing, filled teeth). 78% of the study population had dental caries lesions, with an average dmft of 5.6. Of the 277 evaluated contacts, 88% were categorized as broad contacts. Multivariate analyses failed to validate that broad contacts were a predictor of dental caries lesions. However, the analysis showed an association of insurance status, plaque index with dmft. In conclusion, the present study could not implicate broad contacts as a factor that increased caries risk in the studied population; however, it validates the importance of insurance status, plaque index, as well as diet frequency as predictors of dental caries lesions.

Identifying optimum implementation for human papillomavirus self-sampling in underserved communities: A systematic review.

To review the existing evidence to identify the optimum methods for implementing human papillomavirus self-sampling to increase screening uptake for underserved groups. Specific groups are less likely to participate in cervical screening. These include individuals from low socioeconomic status groups, ethnic minority groups, younger age groups (25-29), older age groups (≥50), with a physical disability, with a learning disability and with an LGBTQ+ identity. The advent of human papillomavirus self-sampling for cervical screening presents an opportunity to promote equitable access to screening. Implementation for human papillomavirus self-sampling can vary, for example, opt-out or opt-in approaches. However, it is unclear which of these is the best method of offering human papillomavirus self-sampling to underserved groups. Six databases were searched through May 2023. Studies comparing cervico-vaginal human papillomavirus self-sampling provision using different implementation strategies with the standard screening pathway in underserved groups were identified. A narrative synthesis was conducted. In total, 4574 studies were identified; 25 studies were included, of which 22 were from high-income countries. Greater uptake was found for offering human papillomavirus self-sampling compared to standard clinician-based sampling. Directly mailing human papillomavirus self-sampling kits to participants resulted in higher uptake of screening than using an 'opt-in' approach or standard recall in low socioeconomic status and ethnic minority groups, and older women. Strategies that used community health workers or educational materials increased uptake in ethnic minority and low socioeconomic status groups. Directly mailing human papillomavirus self-sampling kits to low socioeconomic status groups, ethnic minority groups and older women has the potential to increase uptake of human papillomavirus self-sampling. Using community health workers to offer human papillomavirus self-sampling should be considered for ethnic minority and low socioeconomic status groups. Further research exploring the preferences of younger women is needed.