Low-income Households Research Articles

Profiles and predictors of child neurodevelopment and anthropometry: The maternal-infant research on environmental chemicals study.

Evaluating individual health outcomes does not capture co-morbidities children experience. We aimed to describe profiles of child neurodevelopment and anthropometry and identify their predictors. Using data from 501 mother-child pairs (age 3-years) in the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a prospective cohort study, we developed phenotypic profiles by applying latent profile analysis to twelve neurodevelopmental and anthropometric traits. Using multinomial regression, we evaluated odds of phenotypic profiles based on maternal, sociodemographic, and child level characteristics. For neurodevelopmental outcomes, we identified three profiles characterized by Non-optimal (9%), Typical (49%), and Optimal neurodevelopment (42%). For anthropometric outcomes, we observed three profiles of Low (12%), Average (61%), and Excess Adiposity (27%). When examining joint profiles, few children had both Non-optimal neurodevelopment and Excess Adiposity (2%). Lower household income, lower birthweight, younger gestational age, decreased caregiving environment, greater maternal depressive symptoms, and male sex were associated with increased odds of being in the Non-optimal neurodevelopment profile. Higher pre-pregnancy body mass index was associated with increased odds of being in the Excess Adiposity profile. Phenotypic profiles of child neurodevelopment and adiposity were associated with maternal, sociodemographic, and child level characteristics. Few children had both non-optimal neurodevelopment and excess adiposity.

Work Participation of Autistic Adolescents.

This study sought to compare frequency of paid work by autistic adolescents to paid work by adolescents with other neurodevelopmental disorders and typically developing adolescents, and to examine whether demographic and clinical characteristics were associated with autistic adolescent employment with data from 2016-2019 National Survey of Children's Health. Rate of paid work was significantly lower in the autistic group (22.01%) than typically developing (49.38%) and other neurodevelopmental disorders (44.27%) groups. Younger age, lower household income, co-occurring intellectual disability, and more severe autism were associated with lower odds of an autistic adolescent having worked. This study indicates that work disparities impacting autistic individuals begin in youth and highlights the need for improved vocational support to address employment barriers for autistic youth.

Correlates of School-Home Communication From Caregivers of Children With Autism.

School-home communication may be especially critical for families of children with autism given their tenuous partnerships with school professionals. In this study, we explored the child, caregiver, and family-professional partnership correlates of school-home communication. Data were collected from 179 caregivers of children with autism (age 3-21) via a national survey. Participants overwhelmingly reported having less than monthly communication with educators (i.e., general and special education teachers) despite wanting at least weekly communication. A preference for email communication negatively correlated with participants who were Black and/or from lower-income households, but this should be met with caution due to limited sample diversity. These findings indicate that it is necessary to attain a nuanced understanding of school-home communication and identify other potential correlates.

Climate Crisis on Energy Bills: Who Bears the Greater Burden of Extreme Weather Events?

The increasing frequency of extreme weather events driven by global climate change poses a critical threat to energy system vulnerability and household energy security. Using meteorological data from NOAA and Chinese weather stations (2012-2022), this study examines the impact of extreme climate risks on household energy poverty. Our findings reveal two significant transmission channels: infrastructure disruption and price fluctuation. Extreme weather events compromise energy infrastructure stability and cause supply interruptions, while temperature extremes trigger energy price volatility and increase household expenditure burdens. We further find that regions with weak infrastructure, areas prone to natural disasters, and low-income households are particularly vulnerable to these impacts. These findings suggest that climate change may exacerbate social inequality through energy poverty channels.

Assessing socioeconomic disparities and the likelihood of multimodal treatment utilization in patients with pancreatic cancer using SEER Medicare data.

677 Background: Optimal treatment for pancreatic cancer necessitates multimodal therapies combining surgery, chemotherapy, and radiation. Socioeconomic determinants of health may influence access to these treatments, leading to disparities in outcomes. This study examines the association between socioeconomic status (SES) and the likelihood of receiving multimodal treatment among pancreatic cancer patients using SEER Medicare data. Methods: Our study population consists of elderly persons diagnosed with pancreatic cancer from the 2008–2017 SEER-Medicare dataset. A multinomial logistic regression controlling for sociodemographic characteristics, cancer stage, comorbidities, geographic region, and ecological measures of urbanicity and SES was used to assess the likelihood of receiving one of three mutually exclusive treatment categories: no treatment, one modality (surgery, chemotherapy, or radiotherapy), or multiple modalities (different combinations of surgery, chemotherapy, and radiotherapy), with multiple modalities as the reference group. Survival analysis was conducted using Kaplan-Meier curves (KMC) and Cox proportional hazards (CPH) models. Results: Adjusted analyses showed that among stages 0–3 patients, living in areas with a high percentage of individuals without a high school education (non-HS) was associated with increased odds of receiving no treatment (OR = 1.26, p < 0.01) and one modality (OR = 1.20, p < 0.01) versus multiple modalities. Low median household income was linked to higher odds of no treatment (OR = 1.30, p < 0.01) and one modality (OR = 1.16, p < 0.05). This pattern persisted in stage 4 patients, where high non-HS percentage increased odds of no treatment (OR = 1.38, p < 0.01), and low median income was associated with higher odds of no treatment (OR = 1.25, p < 0.05). Non-Hispanic Black patients had higher odds of receiving no treatment in both stages 0–3 (OR = 1.26, p < 0.05) and stage 4 (OR = 1.91, p < 0.01) compared to Non-Hispanic Whites. Being married was associated with reduced odds of receiving no treatment for stages 0–3 (OR = 0.53, p < 0.01) and stage 4 (OR = 0.55, p < 0.01). Lower SES and being Non-Hispanic Black are associated with decreased likelihood of receiving multimodal treatment across all stages. Patients receiving multimodal therapies demonstrated improved survival on our KMC analysis, and CPH models indicated lower mortality for those receiving multiple modalities. Conclusions: Socioeconomic disparities significantly influence multimodal treatment utilization in pancreatic cancer. Lower SES indicators—high non-HS percentages, low median income—and being Non-Hispanic Black are associated with decreased use of multimodal therapies and poorer survival. Addressing these disparities is essential to ensure equitable access to optimal treatments and improve survival rates.

Telemedicine in Coeliac Disease: In-Person Appointments Are Favoured by Patients With a Lower Education Attainment and Lower Household Income.

A gluten-free (GF) diet, the only treatment for people living with coeliac disease (CD), is challenging, and international guidelines highlight the valuable role of healthcare professionals in enabling self-management. The study aimed to explore the acceptability of telephone and online video consultations for adults with CD. A cross-sectional study consisting of an online and paper survey was promoted to adults with CD. Data from 496 adults with CD (87% female, 96% White) are presented, and 44% were adhering to the GF diet. Over half (58%) were very confident in understanding food labels from supermarkets, whereas only 38% were very confident when shopping online. The largest proportion of patients preferred in-person healthcare appointments for CD (44%), with 20% reporting no preference and 21% preferring telephone appointments. Only 15% preferred online video consultations; of these, 97% were confident with online technology. A higher proportion of patients from a lower household income requested 'in-person' appointments compared with those with a higher income (65% vs. 45% (p < 0.01)). Likewise, 58% of patients without a degree qualification requested 'in-person' appointments compared with 45% of degree-educated patients (p = 0.027). We highlight a significant proportion of adults with CD prefer an in-person appointment. The paper survey enabled the views of a broader range of digitally confident patients to contribute to the study. With a global shift towards telemedicine and online resources, access and digital literacy is an important consideration for equitable healthcare to optimize patient self-management of the GF diet.

Analysis of the characteristics and illness comprehension bias among Chinese patients with psycho-cardiovascular disease: a multi-centre cross-sectional survey.

Psychological distress, such as depression and anxiety, impacts cardiovascular disease (CVD) prognosis and management. Illness comprehension is essential for effective treatment, but biases can lead to suboptimal outcomes. We explored psycho-cardiovascular disease (PCD) patient characteristics, with a specific focus on comprehension biases and treatment choices from patients' perspectives in China, to improve management strategies. We enrolled 864 PCD patients in Chinese hospitals across 11 provinces. Tools included the seven-item General Anxiety Disorder scale, the nine-item Patient Health Questionnaire, and a self-designed PCD illness comprehensibility survey. We used χ2 test, univariate, and multivariate logistic regression to examine patient characteristics. Of 834 enrolled PCD patients, over 90% experienced mild to moderate anxiety and depression, yet less than 10% received treatment. 52.90% of patients had high illness comprehension. Among the high comprehension group, there were fewer labourers (19.30% vs. 26.40%; P < 0.05), fewer older individuals (39.20% vs. 46.90%; P < 0.05), and those with lower household income (15.60% vs. 30.50%; P < 0.05). A greater proportion of those in the high comprehension group lacked insurance (17.50% vs. 10.00%; P < 0.05), and they were more highly educated (42.90% vs. 32.10% with a college education). Additionally, more patients in the high comprehension group frequently received psychological consultation (24.00% vs. 5.10%; P < 0.05) and therapy (7.70% vs. 2.30%; P < 0.05). These patient groups preferred tertiary hospitals (71.66% vs. 63.33%; P < 0.05) and psycho-cardiovascular clinics (40.14% vs. 25.90%; P < 0.05). In comparison, low comprehension patients prioritised cost (32.65% vs. 46.41%; P < 0.05) and favoured a transition to community hospitals (16.55% vs. 25.38%; P < 0.05). More than 90% of PCD patients in Chinese CVD departments experience mild to moderate anxiety and depression with low treatment rates. Different illness comprehension levels are associated with variations in treatment willingness, considerations, health care preferences, medication choices, and illness knowledge acquisition methods.

Outcomes and treatment patterns for stage I human epidermal growth factor receptor 2-positive breast cancer in the Surveillance, Epidemiology, and End Results database, 2010-2019.

The risk of recurrence in patients with small, lymph node-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancers untreated with adjuvant chemotherapy/HER2-directed therapy is uncertain. To investigate this, the authors conducted a retrospective, population-based study of chemotherapy use and breast cancer-specific survival (BCSS) among patients with stage IA HER2-positive breast cancer. The authors analyzed Surveillance, Epidemiology, and End Results data from patients diagnosed with stage IA HER2-positive breast cancer from 2010 to 2019. They examined the frequency of chemotherapy use by tumor size and hormone receptor (HR) status and applied multivariate logistic regression to assess the factors associated with receipt of chemotherapy. BCSS was evaluated and performed multivariable Cox regression was performed to evaluate the association between chemotherapy receipt and BCSS. Among 12,896 patients, 74.0% had HR-positive/HER2-positive breast cancer, and 26.0% had HR-negative/HER2-positive breast cancer. Adjuvant chemotherapy was received by to 58.9% of patients, with lower utilization for those who were older, Hispanic or Asian/Pacific Islander, separated/divorced/widowed, or had a lower median household income. The median follow-up was 46 months. Among the patients who had pathologic T1 (pT1) microscopic, pT1a, or pT1b tumors, the 5-year BCSS rate was 97.6%-99.6% in those who had no evidence of chemotherapy receipt in the medical record versus 98.4%-100.0% in those who did receive chemotherapy. Among patients who had pT1c tumors and had no evidence of chemotherapy receipt, the 5-year BCSS rate was 92.1% for those with HR-negative/HER2-positive breast cancer and 96.0% for those with HR-positive/HER2-positive breast cancer. Patients who had pT1c tumors and received chemotherapy had a 5-year BCSS rate of 96.7% in those with HR-negative/HER2-positive breast cancer and 98.7% in those with HR-positive/HER2-positive breast cancer. In this large, population-based study of patients with stage IA HER2-positive breast cancer, patients who had tumors ≤1 cm had excellent outcomes with or without chemotherapy. Patients with pT1c tumors had a greater increase in BCSS with the receipt chemotherapy.

P-1986. COVID-19 Surveillance in Infants, Minnesota, October 2023–January 2024

Abstract Background The impact of COVID-19 in infants is incompletely understood. We conducted active surveillance, including interviews of parents of infants with COVID-19. Methods We attempted phone interviews of parents of infants aged &amp;lt; 12 months with lab-confirmed COVID-19 reported to the Minnesota Department of Health from 10/1/2023–1/31/2024 using a standardized form. Analyses were performed using SAS 9.4. Results Parents of 1161 (35%) infants were interviewed. There were no differences among those interviewed vs. not by white/non-white, urban/rural residence, or age. Median age was 6 months (IQR 3–8 months), 65% white, non-Hispanic, 53% male, 46% received federal assistance (WIC), and 38% attended childcare. 25% had an ill household member prior to, and 55% after, infant illness. 95% reported symptoms with fever (84%) and coryza (82%) most common. Co-pathogen detections were reported in 16% (68% RSV). 70% reported emergency (ED) or urgent care (UC) visits; 8% were hospitalized. Having a codetection (OR=4.14, p&amp;lt; 0.01) or underlying condition (OR=2.12, p=0.03) was associated with hospitalization. 16% of illnesses were considered severe by parents. Codetections (OR=2.46, p&amp;lt; 0.01), being non-white (OR=2.46, p&amp;lt; 0.01), receiving WIC (OR=1.99, p&amp;lt; 0.01), or having household income &amp;lt; $30,000 (OR=2.28, p&amp;lt; 0.01) were associated with severe illness. 80% of households had ≥ 1 adult vaccinated, but only 29% were vaccinated &amp;lt; 6 months prior to infant infection; 34% of households with other children had ≥ 1 child vaccinated. 10% of cases remained unrecovered at 30 days after positive test. Factors linked to non-recovery included codetections (OR=2.30, p&amp;lt; 0.01), prematurity (OR=2.19, p&amp;lt; 0.01), being non-white (OR=1.62, p=0.02), receiving WIC (OR=1.56, p=0.03), and low household income (OR=2.09, p&amp;lt; 0.01). Conclusion Among MN infants reported with COVID-19 with interview data, most visited ED/UC, and 16% were considered severely ill by parents. We found medical conditions, race, socioeconomic disparities, and codetections associated with severe and/or longer lasting illness. Improved understanding of the role of codetections and other risk factors, and encouraging up to date vaccination in households, may help mitigate the impact of severe COVID-19 in infants. Disclosures All Authors: No reported disclosures

Instructional Strategy for Teaching Children with Autism in the Classroom

This research looks at a number of persons who have communication problems due to various diseases. Children with autism are one of them. Because children with autism have three basic disorders: communication, social interaction, and behavior, their communication and social interaction will undoubtedly differ from those of typical children. This research will look into instructional communication for children with autism in the classroom at Rumah Autis Depok. Rumah Autis is a social institution created to fill the gap between the demand for therapeutic locations and schools for children with autism and special needs who come from low-income households. The ethnography of communication approach was used in this research because ethnography of communication focuses on communication processes that involve language and culture. The findings of this research indicated that the communication utilized by children with autism, particularly instructional communication in the classroom, is quite unique and distinct. Teachers must speak firmly but not loudly or repeatedly. Therefore, the students easily understand. Children with autism are easily distracted, and thus, the teacher does not allow wearing eye-catching clothing and headscarves in class. The research encourages communication ethnographers to reflect on fieldwork issues and gives a framework for doing so, particularly when it comes to teaching children with autism

Self-perceived and measured visual function, the impact of eye-disease, wellbeing, social determinants, and personality traits in Swedish 70-year-olds-results from the Gothenburg H70 Study.

To explore the potential correlation between subjective and measured visual function, as well as to analyse the influence of eye disease, socioeconomic factors and emotional dimensions. Semi-structured interviews, physical examinations and functional tests (n = 1203). Demographics covered sex, marital status, education, household economy, smoking and alcohol. Participants (born in 1944) rated their visual function (n = 533); those misjudging (n = 48) were studied. Group A (n = 18) had low presenting visual acuity (PVA) but reported good vision; Group B (n = 30) had normal PVA but reported low vision. Control group (n = 485) matched subjective and measured visual function. Ophthalmic examination tested visual acuity (VA), visual field and contrast sensitivity (CS). Psychometric tests: NEO-FFI, sense of coherence (SOC) and Montgomery-Åsberg Depression Rating Scale (MADRS). chi-square, t-tests, Mann-Whitney U test and logistic regression. Of the population, 91% made correct assumptions about their vision. The 9% who made incorrect assumptions about their vision ability (combining groups A + B) were more likely to live alone (p = 0.02) and had lower household incomes compared to the control group (p = 0.04). Additionally, the exhibited significantly lower PVA and BCVA, a higher prevalence of visual field defects (p = 0.02) and lower CS, mean 1.63 (p = 0.005). Group A (3.4%) were women (p = 0.002) with the personality of extraversion, mean 40.0 (p = 0.01). Group B (5.6%) had more self-reported eye diseases (p = 0.01), lower CS (p = 0.01), lower educational level (p = 0.03) and border significantly lower SOC (p = 0.06). The perception of visual function is shaped by awareness of an eye disease but is additionally influenced by sex, socioeconomic factors and emotional parameters.

Social epidemiology of early adolescent nutrition.

This study aimed to investigate associations between sociodemographic factors and dietary intake among a diverse population of early adolescents ages 10-13 years in the United States. We examined data from the Adolescent Brain Cognitive Development (ABCD) Study in Year 2 (2018-2020, ages 10-13 years, N = 10,280). Multivariable linear regression models were conducted to estimate the adjusted associations between sociodemographic factors (age, sex, race and ethnicity, household income, parental education) and dietary intake of various food groups, measured by the Block Kids Food Screener. Older age among early adolescents was associated with slightly less fruit, whole grain, and dairy and more monounsaturated fat consumption. Male sex was associated with a lower intake of fruit, fruit juice, vegetables, whole grains, and fiber and a higher intake of meat/poultry/fish, added sugars, fat, as well as higher glycemic index and glycemic load compared to female sex. Racial and ethnic minority status, lower household income, and lower parental education were generally associated with less fruit and vegetable consumption and more added sugars. These findings can guide public health interventions to reduce diet quality disparities by targeting key populations and addressing differences according to socioeconomic status, sex, and race. Sociodemographic disparities in diet quality have been studied, but none have explored sociodemographic associations with specific food groups and components (e.g., different types of fat) in early adolescence. In this demographically diverse sample of 10-13-year-old early adolescents in the US, we found sociodemographic disparities in dietary intake across various food groups. Most notably, male sex, racial and ethnic minority status, lower household income, and lower parental education were associated with less fruit and vegetable consumption and more added sugars.

Assessing Energy Poverty in the European Union: Indicators, Challenges, and Policy Solutions

Abstract A sharp increase in energy prices since 2021 has had a significant impact on the European Union (EU) energy market turning the energy poverty issue into an important concern. Around 42 million EU citizens or 9.3 % of the total population in the Union faced an inability to adequately heat their homes in 2022. It is a clear call for policymakers to seriously address the energy poverty aspects eliminating the negative socio-economic impact. The research aims to analyse the energy poverty concept, its main indicators and affecting factors, identifying the possible solutions for reducing energy poverty, and paying particular attention to vulnerable users. The qualitative methods were used, i.e., the authors conducted a literature review and scrutinized scientific publications, reports and legal acts. As a result of the research, the authors have characterised the energy poverty situation in different countries, identified the main areas for solving the energy poverty challenge, as well as shared experiences of different countries on the solutions taken. The authors conclude that energy poverty has a particular impact on low-income households, children, disabled people, seniors and single mothers, who may have relatively higher energy consumption and limited resources available. In this regard, countries can benefit from such measures as setting a clear definition of energy poverty and its measurable indicators, identification of supported households, on-the-spot consultations and audits, attracting local governments, and non-governmental organisations, as well as improvement of support instruments of renewable energy sources.

Comparing Financial Outcomes Among Households Headed by Women, Men, or Both Partners: The Gender Pay Gap Prevails

Research shows gender disparities in savings habits and financial literacy. However, recent studies indicate that the higher earner in a household, regardless of gender, typically manages finances more effectively. This study examines if households where women are the primary decision-makers face more financial challenges and if they have less financial resilience, knowledge, and capability due to lower household income. Using data from the Canadian Financial Capability Survey (n= 2,149), we employ regression analysis to analyze differences in financial circumstances among households headed by women, men, and both genders jointly. Our findings show that women-led households have lower incomes, struggle to balance expenses, and are less likely to pay off credit card balances compared with households led by men or those with shared responsibility. Disparities in financial resilience, knowledge, and capability lessen when controlling for household income. Addressing the gender pay gap is crucial for improving financial outcomes for women and their households.

Food manufacturers’ compliance with the FDA's trans fat ban: Evidence from scanner data

AbstractWe use barcode‐level data in the US between 2012 and 2020 to document the evolution of trans fat content in manufactured food products before and after the Food and Drug Administration's (FDA) 2015 determination that trans fats are not safe for human consumption (effectively a “trans fat ban”). First, we document how the number of products containing trans fat has declined over time. Second, using detailed information on household food purchases in retail stores, we quantify the corresponding reduction in total trans fat purchases. We find that although the number of trans fat products on the market has declined over time, products with a positive trans fat content continued to exist beyond the FDA's deadline for trans fat removal. We find a larger presence of trans fat products in small‐scale retailers (Dollar and Convenience stores) than in larger outlets (mass merchandisers and warehouse clubs). Similarly, trans fat products are relatively more prevalent in private label products and in products with a local presence. While trans fat purchases have declined over time, lower income households purchase product baskets with significantly larger amounts of trans fat. The findings can be used to guide more effective and efficient enforcement efforts.

Community-Engaged Approach to Improve Food Access and Consumption of Fruits and Vegetables in a Rural Appalachian Community

Background/Objectives: Community–academic partnerships offer unique opportunities to leverage expertise and resources to modify structural factors that address community priorities. However, few in-depth examples of successful partnerships in rural communities to improve food security are available. This manuscript describes the process of building a partnership to reduce food insecurity in a rural Kentucky community. Methods: The research team worked with Cooperative Extension to form a community advisory board (CAB) representative of diverse sectors of the community who had interest in food security, agriculture, and/or nutrition. The CAB convened regularly, in-person or virtually, to review community assessment information and identify, select, and adapt relevant multi-level interventions. CAB members were invited to complete two surveys and participate in a listening session to provide feedback on working with academic partners. Results: Over the first two years of the project, 17 people served on the CAB. Early in the project, the CAB prioritized interventions for working families, relatives raising children, and lower income households. Some ideas were able to come to fruition (e.g., family cooking social classes, raised garden beds), while others were explored but were unable to gain momentum (e.g., mobile market) due to challenges with feasibility, organizational capacity, and/or interest. CAB members reported high engagement and strong communication between community and academic partners. Conclusions: Full exploration of potential solutions suggested by CABs may build trust between community and academic partners and could provide a strategic selection process for multi-level, evidence-based interventions deemed feasible for addressing complex issues such as food insecurity and nutritional health outcomes.

Zero-Dose Vaccination of Self-Paid Vaccines Among Migrant and Left-Behind Children in China: Evidence from Zhejiang and Henan Provinces

Background/Objectives: As zero-dose vaccination has become a global health concern, understanding the practice of self-paid immunizations in migrant and left-behind children in China is crucial to the prevention and control of infectious diseases. Methods: A cross-sectional study was conducted in 1648 children and their caregivers in urban areas in Zhejiang Province and rural areas in Henan Province. The participants were then classified into four groups: urban local, migrant, non-left-behind, and left-behind. Results: Compared to urban local children, migrant (prevalence ratios: 1.29, 95% confidence intervals: 0.69–2.41), non-left-behind (4.72, 3.02–7.37), and left-behind (4.79, 3.03–7.56) children were more likely to be zero-dose vaccinated. Children aged 1–2 years (odds ratio: 1.60, 95% confidence intervals: 1.14–2.23) and born later (1.55, 1.12–2.14), with caregivers aged &gt;35 years (1.49, 1.03–2.15) and less educated (elementary school or lower: 4.22, 2.39–7.45) were less likely to receive self-paid vaccinations, while caregivers other than parents (0.62, 0.41–0.94) and lower household income (0.67, 0.49–0.90) lowered the likelihood of zero-dose vaccination of self-paid vaccines. For migrant and rural zero-dose children, the majority of caregivers reported they “didn’t know where to get a vaccination”, with responses ranging from 82.3% to 93.8%. Conclusions: Migrant and rural children should be prioritized in the promotion of self-paid immunization in order to accomplish the WHO Immunization Agenda 2030’s goal of “leaving no one behind”.

Disparities in Access and Utilization of Electronic Health Record Patient Portals.

The aim of this study was to assess changes in the accessibility and utilization of electronic health record patient portals in recent years, focusing on whether these changes occurred equitably across different racial, ethnic, and socioeconomic groups. The study utilized nationally representative samples from the 2019 and 2022 Health Information National Trends Surveys. A difference-in-differences design was used to determine if increases in access and utilization occurred equally for all segments of the population. From 2019 to 2022, the proportion of people reporting being offered access to a patient portal by a healthcare provider increased from 72.3 to 83.7% and the proportion who reported using a portal increased from 68.0 to 81.9%. African American or Black respondents had similar increases in access and utilization of portals as non-Hispanic Whites, but disparities remained. Hispanics, who were more likely to utilize patient portals in 2019, saw a smaller increase in utilization than non-Hispanic Whites. Increasing disparities in access and/or utilization of patient portals was observed among people with lower household incomes, people without college degrees, and people over the age of 65. An increased reliance on digital healthcare technologies has increased patient portal accessibility and utilization; however, increases have not been equitable across all demographic groups with many disparities persisting or worsening.

Housing market, social housing, and fertility: evidence from urban China

ABSTRACT This study utilizes panel data from 283 Chinese cities between 2009 and 2017 and employs a fixed-effects model to analyze the effects of commercial housing prices and social housing supply on birth rates, considering the interaction between the housing market and social housing policies. The findings indicate that a 1% increase in housing prices results in a 0.063% decrease in the birth rate, while a 1% increase in social housing supply leads to a 0.075% increase in the birth rate. However, although increasing the supply of social housing can positively influence birth rates, its substitutability with commercial housing may reduce the availability of commercial properties, driving up housing prices and potentially lowering fertility rates. Therefore, an unlimited social housing supply policy may not effectively resolve the issue of low birth rates. To be more inclusive, local governments should adopt a demand-oriented social housing policy that addresses the diverse needs of families, rather than focusing solely on supply-side measures. Highlights Social housing supply in areas with lower housing prices positively affects birth rates. Social housing supply in areas with higher housing prices negatively affects birth rates. Among social housing types, economic and comfortable housing (ECH) has a greater impact on fertility rates than public rental housing (PRH). A demand-driven social housing supply policy is necessary for low-income households.

Outcomes after Heart Transplantation among Non-Native English-Speaking Recipients.

Effective communication and understanding are imperative for heart transplant (HT) recipients who require lifelong adherence to treatment plans and medications. Whether non-native English speaking (NNES) recipients have inferior outcomes compared to native English-speaking recipients (NES) has not been studied post-HT. We reviewed adult HT recipients at Columbia University Irving Medical Center from January 2005 through December 2022 with primary language determined by chart review. Baseline characteristics and patient level zip codes which were used to derive socioeconomic status (SES) index using data from the Agency for Healthcare Research and Quality (AHRQ) were included. Mortality at 1-year and 5-year was compared between NNES and NES. Survival curves were estimated by the Kaplan-Meir method and log-rank testing was used to compare survival between groups. Secondary outcomes including hospitalization, hospitalization for infection, and rejection at 1-year, as well as rejection and CAV at 5-years were analyzed using cumulative incidence functions with Gray's testing to detect outcome differences between groups. Multivariable Cox proportional hazard models were constructed to determine if there was an association between NNES and primary and secondary outcomes. Of 1,066 HT recipients, 103 (10%) were NNES. NNES recipients were more likely to identify as non-White, have Medicaid as the primary payer, and have lower educational attainment. On average, NNES recipients resided in zip codes with higher levels of unemployment, lower educational attainment, and lower household incomes. Overall, NNES had lower median AHRQ SES indices (51 vs 55, p<0.001). After adjustment for clinical factors including socioeconomic status, race/ethnicity, and education level, mortality at 1- and 5-years for NNES and NES recipients were not significantly different although there was a trend towards improved survival in the NNES group (1-year adjusted hazard ratio (HR) 0.24, 95% CI 0.06-1.01, p=0.05; 5-year adjusted HR 0.48, 95% CI 0.22-1.03, p=0.06). Similarly, there were no differences in need for re-hospitalization, infection requiring hospitalization, and rejection at 1 year. There were no significant differences in outcomes at 1 year and 5 years post-HT among NNES and NES. Availability of interpreter services and educational resources in multiple languages are paramount to maintaining effective communication and equitable outcomes. Although the population of individuals living with heart failure in the United States is incredibly diverse, little is known about whether non-Native English speakers (NNES) fare differently after heart transplantation. In this study of over 1000 heart transplant recipients, we found that although NNES patients were more likely to be non-White, had lower education status and had public insurance, outcomes were similar at 1- and 5-years after transplant.