Lowest Income Quintile Research Articles

Abstract 326: Epidemiology Of Pediatric Out-of-hospital Cardiac Arrest In Ontario, Canada

Introduction: There are no epidemiological studies of Pediatric Out-of-Hospital Cardiac Arrest (POHCA) in Canada for at least 20 years. Understanding who has a POHCA event is key to prevention, education, and management strategies. Methods: In this retrospective cohort study, we used a validated algorithm applied to large hospital administrative databases to describe the epidemiology of pediatric (age 1 day to &lt 18 years) OHCA in Ontario, Canada, from 2004-2020, by pre-existing comorbidities, sociodemographic features, and outcomes. Results: The cohort included 1,839 unique pediatric patients with a POHCA event with a median age of 2 (0-12) years and 721 patients (39.2%) less than 1 year. Males accounted for 61.1% (n=1,123) of the cohort. Incidence was 4.2/100,000 with a gradual increase over the study period. Thirty percent (n=560) of the cohort lived in a neighborhood in the lowest income quintile, while 13.6% (n=251) lived in a neighborhood in the highest income quintile. Seventy five percent (n=1,380) lived in an urban setting. Seventy nine percent (n=1,444) first presented to a non-teaching, non-pediatric hospital following the POHCA event. The majority (n=1,533, 83.4%) of patients did not have significant comorbidities prior to the POHCA. The most common comorbidity was congenital cardiac malformation for 147 (8.0%) of patients. Three hundred and thirty-three (18.1%) survived hospital admission, and 132 (7.2%) survived to hospital discharge. Less than 6 patients had a subsequent POHCA in the year following the index event. Conclusions: This is the largest Canadian POHCA cohort and the first to describe incidence, comorbidities, and sociodemographic characteristics for this population. This is the first study to use a validated algorithm to create a POHCA cohort using large hospital administrative databases. We found a gradual increase in annual incidence over 17 years, POHCA mostly occurred in healthy children, and survival was lower than other reported cohorts. There were more than double the number of children with POHCA events living in the lowest income quintile neighborhoods compared to the highest income quintile neighborhoods. Most children with POHCA presented to non-teaching, non-pediatric hospitals first.

Exploring the dynamic nexus between renewable energy, poverty alleviation, and environmental pollution: fresh evidence from E-9 countries.

The present study aims to scrutinize the long- and short-run relationship along with the direction of causality among environmental pollution (CO2), renewable, non-renewable energy, income disparity, exchange rate, and poverty alleviation in E-9 countries of continent Asia, using a panel dataset from 1990 to 2018. The current study used pooled mean group autoregressive distributed lag (PMG ARDL) and Dumitrescu-Hurlin (D-H) causality test after affirming a stable long-run association among environmental pollution and all the explanatory variables. However, ECM (error correction mechanism) was specified to explore short-run dynamics. The study's outcomes confirmed strong co-integration among environmental pollution (CO2), renewable, non-renewable energy, income disparity, exchange rate, and poverty alleviation. Moreover, uni (bi) directional causality runs from non-renewable energy, exchange rate, and income disparity (poverty alleviation and renewable energy) to environmental pollution (CO2). Results also revealed that poverty alleviation, exchange rate, and renewable energy usage substantially negatively influence environmental pollution (CO2). Contrarily, income disparities and non-renewable energy usage positively influence long- and short-run environmental pollution. Therefore, from the policy perspective, the current study focused on twofold; first, there is a desire to alleviate poverty, the decline in non-renewable energy use and income disparity among upper and lower-income quintiles. Second, boost exchange rate and renewable energy use to control environmental pollution in the described least developed countries (LDCs).

Understanding Sustenance of Small Farm Holders: A Study of Income Inequality among Farm Households in Indian Punjab

The sustenance of marginal and small farm households is a pertinent question given that their number is on the rise in South-Asia. The study aims to assess their present socio-economic profile and the challenges faced in order to draw a roadmap of development for these underprivileged households. The study pertains to Indian Punjab and data from the Situation Assessment Survey of the 70th Round of NSSO are used. The concepts of economic surplus, occupational diversity, farm productivity and vertical and horizontal inequalities are used to achieve the objectives. This study reveals that marginal farm households faced food insecurity as they failed to meet consumption expenditure from the income earned. In fact, small farm households are left with an annual economic surplus of Rs 8890 per capita only, after meeting consumption needs. Income is unevenly distributed among farm households with a Gini coefficient of 0.48. The majority of the marginal and small farm households fall in lower-income quintiles and are occupationally more diversified than their larger counterparts. Horizontal inequalities are lower between the farm-size categories (0.14) than within farm-size categories (0.27). The Gini coefficient within each farm-size category is the highest among marginal farm households (0.50), followed by small farm households (0.45), highlighting their economic stress and tug-of-war survival. Further, the farm households belonging to socially lower castes falls only in the marginal farm-size category and represent the lowest income. Development must be sustainable and inclusive, hence, policies to develop marginal farmers’ centric farming systems and high value crops such as potato, cotton, sugarcane and oilseeds, providing high yielding livestock breeds, value addition through farmer-producer organizations, non-farm employment through MGNREGA, provision of institutional credit at subsidised rate of interest and quality health and education facilities in the public sector are recommended to uplift the affected households.

Survival After Out-of-Hospital Cardiac Arrest: The Role of Racial Residential Segregation.

Racial and racialized economic residential segregation has been empirically associated with outcomes across multiple health conditions but not yet explored in relation to out-of-hospital cardiac arrest (OHCA). We sought to examine if measures of racial and economic residential segregation are associated with differences in survival to discharge after OHCA for Black and White Medicare beneficiaries. Utilizing age-eligible Medicare fee-for-service claims data from 2013 to 2015, we identified OHCA claims and determined survival to discharge. The primary predictor, residential segregation, was calculated using the index of concentration at the extremes (ICE) for the beneficiary residential ZIP code. Multilevel modified Poisson regression models were used to determine the association of OHCA outcomes and ZIP code level ICE measures. In total, 194,263 OHCA cases were identified among beneficiaries residing in 75% of US ZIP codes. Black beneficiaries exhibited 12.1% survival to discharge, compared with 12.5% of White beneficiaries. In fully adjusted models of the three ICE measures accounting for differences in treating hospital characteristics, there was as high as a 28% (RR 1.28, CI 1.23-1.26) higher relative likelihood of survival to discharge in the most segregated White ZIP codes (Q5) as compared to the most segregated Black ZIP codes (Q1). Racial residential segregation is independently associated with disparities in OHCA outcomes; among Medicare beneficiaries who generated a claim after suffering an OHCA, ICE measures of racial segregation are associated with a lower likelihood of survival to discharge for those living in the most segregated Black and lower income quintiles compared to higher quintiles.

Socioeconomic status and waiting time in the emergency department for patients with chest pain

Abstract Introduction Acute coronary syndrome (ACS) is one of the leading causes of death in the world and timeliness of treatment and diagnosis is of utmost importance to reduce mortality and morbidity. Emergency department (ED) crowding results in longer waiting times and length of stay in the ED and is a globally growing phenomenon with clear negative consequences for patients. Low socioeconomic status (SES) has previously been associated with poor prognosis after ACS, but it remains unclear if treatment and diagnostics in the acute state is a contributing factor. ED length of stay has been linked to crowding and poor patient outcomes whereas mechanisms for generally worse prognosis in low SES remains poorly understood. Purpose To investigate whether SES, measured as disposable income, is associated with ED waiting times among patients with the most common chief complaint in ACS, chest pain. Methods A registry-based cohort study on all 140,388 patients arriving at 14 Swedish emergency departments between 2015 and 2019 with chest pain as their chief complaint registered in the Swedish Emergency Registry (SVAR). Individual-level sociodemographic and clinical data were linked from multiple national registries. The associations between disposable income quintiles and ED length of stay and time to doctor were assessed using multivariable regression models adjusting for age, sex, education, comorbidities (diabetes, hypertension, hyperlipidemia, obesity and cardiovascular disease) and ED-visit characteristics (arrival mode, triage level, arrival time (day, evening or night as well as weekday or weekend) and hospital type). Results Median length of stay was 11 minutes (4.4%) longer among patients in the lowest income quintile, 4:04 [hours:minutes] (95% confidence interval [CI] 4:02–4:05), compared to patients in the highest income quintile (3:53, 95% CI 3:52–3:55). Similarly, time to doctor was 6 min (8.7%) longer among patients in the lowest income quintile (1:15 min, 95% CI 1:14–1:16) than patients in the highest income quintile (1:09, 95% CI 1:08–1:10). The associations were independent of adjustment for studied confounders and mediators. Conclusions Among ED chest pain patients, low income was associated with longer length of stay and time to doctor which may impact negatively on patients with serious cardiovascular diagnosis such as ACS. Longer waiting times may delay diagnosis and timely treatment for the individual patient such as anti-ischemic and antithrombotic therapy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by grants provided by Region Stockholm (ALF-project)

Trends in quality indicators of end-of-life care for women with gynecologic malignancies in Ontario, Canada

ObjectiveA large body of research has validated several quality indicators of end-of-life (EOL) cancer care, but few have examined these in gynecologic cancer at a population-level. We examined patterns of EOL care quality in patients with gynecologic cancers across 13 years in Ontario, Canada. MethodsWe conducted a population-based, retrospective cohort study of gynecologic cancer decedents in Ontario from 2006 to 2018 using linked administrative health care databases. Proportions of quality indices were calculated, including: emergency department (ED) use, hospital or intensive care unit (ICU) admission, chemotherapy ≤14 days of death, cancer-related surgery, tube or intravenous feeds, palliative home visits, and hospital death. We used multivariable logistic regression to examine factors associated with receipt of aggressive and supportive care. ResultsThere were 16,237 included decedents over the study period; hospital death rates decreased from 47% to 37%, supportive care use rose from 65% to 74%, and aggressive care remained stable (16%). Within 30 days of death, 50% were hospitalized, 5% admitted to ICU, and 67% accessed palliative homecare. Within 14 days of death, 31% visited the ED and 4% received chemotherapy. Patients with vulvovaginal cancers received the lowest rates of aggressive and supportive care. Using multivariable analyses, factors associated with increased aggressive EOL care use included younger age, shorter disease duration, lower income quintiles, and rural residence. ConclusionsOver time, less women dying with gynecologic cancers in Ontario experienced death in hospital, and more accessed supportive care. However, the majority were still hospitalized and a significant proportion received aggressive care in the final 30 days of life.

Mirror, mirror on the wall, when are inequalities higher, after all? Analysis of breast and cervical cancer screening in 30 European countries

Screening for breast and cervical cancer is strongly related with a reduction in cancer mortality but previous evidence has found socioeconomic inequalities in screening. Using up-to-date data from the second wave of the European Health Interview Survey (2013–2015), this study aims to analyse income-related inequalities in mammography screening and Pap smear test in 30 European countries. We propose a framework that combines age group and screening interval, identifying situations of due-, under-, and over-screening. Coverage rates, standard and generalised concentration indices are calculated. Overall, pro-rich inequalities in screening persist though there are varied combinations of prevalence of screening attendance and relative inequality across countries. Bulgaria and particularly Romania stand out with low coverage and high inequality. Some Baltic and Mediterranean countries also present less favourable figures on both accounts. In general, there are not marked differences between mammography and Pap smear test, for the recommended situation (‘Due-screening’). ‘Extreme under-screening’ is concentrated among lower income quintiles in basically all countries analysed, for both screenings. These women, who never screened, are at risk of entering the group of ‘Lost opportunity’, once they reach the upper-limit age of the target group. At the same time, there are signals of ‘Over-screening’, within target group, due to screening more frequently than recommended. In several countries, ‘Over-screening’ seems to be concentrated among richer women. This is not only a waste of resources, but it can also cause harms. The inequalities found in ‘Extreme under-screening’ and ‘Over-screening’ raise concerns on whether women are making informed choices.

Potentially non-beneficial interventions in the last 100 days of life of patients with cancer: A population-based retrospective cohort study.

ObjectivesThe objective of this study was to describe the receipt of potentially non-beneficial interventions in the last 100 days of life of cancer patients and to examine variations in these interventions according to patient characteristics and cancer site. ApproachWe conducted a population-based retrospective cohort study of all adults age 18+ who died of cancer in Ontario, Canada between January 1, 2013 and December 31, 2017 using linked administrative health data held at ICES. Potentially non-beneficial interventions were captured via hospital discharge records and included chemotherapy, major surgery, intensive care unit admission, cardiopulmonary resuscitation, defibrillation, dialysis, percutaneous coronary intervention, mechanical ventilation, feeding tube placement, blood transfusion and bronchoscopy. We used bivariate analyses and multivariable Poisson regression to examine associations between the receipt of interventions and decedent age, sex, rurality, area-level income, and cancer site. ResultsAmong the 125,755 decedents, the most common intervention was blood transfusion (18.1%) and major surgery (12.8%); 23.8% received no interventions, while 14% of decedents received 3+ interventions. Lower intervention rates were observed in older patients (adjusted rate ratio (RR) 0.46, 95% confidence interval (CI) 0.44-0.49 for age 95+ vs. 19-44), females (RR 0.93, 95% CI 0.92-0.94), and individuals living in higher income areas (RR 0.96, 95% CI 0.95-0.98 for highest vs. lowest income quintile). Higher intervention rates were observed in rural patients (RR 1.13, 95% CI 1.11-1.14). Patients with pancreatic cancer had the highest intervention rate (RR 1.13, 95% CI 1.10-1.16), while breast cancer patients had the lowest intervention rate (RR 0.86, 95% CI 0.84-0.89) compared to colorectal cancer patients. ConclusionPotentially non-beneficial interventions were common in the last 100 days of life of patients with cancer. Variations in interventions across patient demographics and cancer site may reflect differences in healthcare access, end-of-life care preferences, patients’ prognostic awareness, and disease factors.

Prevalence of syphilis coinfection in hepatitis C virus positive prenatal patients from Alberta during a pilot routine screening program.

BACKGROUND: Alberta routinely screens pregnant patients for select communicable diseases. Hepatitis C virus (HCV) was added to the prenatal screening panel as part of a provincial pilot program in February 2020. This retrospective cross-sectional study aimed to characterize the prevalence of syphilis coinfections in prenatal patients infected with HCV following implementation of the pilot program.METHODS: Routine prenatal HCV and syphilis testing data were extracted from the Public Health Laboratory Information System over a 21-month period. HCV positivity was defined as HCV enzyme immunoassay (EIA) reactive with detected HCV ribonucleic acid (RNA) following molecular confirmation, and positive results were examined for syphilis coinfections. All patients reactive on a syphilis EIA and confirmatory Treponema pallidum particle agglutination (TPPA) or follow-up rapid plasma reagin (RPR) test were considered positive for syphilis. Descriptive statistics for coinfected patients were analyzed. RESULTS: Eighty-seven prenatal patients were identified to be positive for HCV. Of those, 19 (21.8%) were reactive on the syphilis EIA and 17 (19.5%) had confirmed infections with the TPPA or RPR tests. For HCV/syphilis coinfected patients, the majority resided in metropolitan regions (64.6%), were from the lowest income quintile neighbourhoods (47.1%) and had previously tested positive for HCV (82.4%) and syphilis (64.6%) at the public health laboratory. CONCLUSIONS: The prevalence of syphilis coinfections in prenatal patients infected with HCV is high in Alberta. HCV/syphilis coinfection prevalence should be further investigated in other jurisdictions and prenatal cohorts to better understand testing and treatment options for prevention of congenital transmission.

A study of socio-economic inequalities in self-reported oral and general health in South-East Norway

This study assesses the association between socioeconomic determinants and self-reported health using data from a regional Norwegian health survey. We included 9,068 participants ≥ 25 years. Survey data were linked to registry data on education and income. Self-reported oral and general health were separately assessed and categorized into ‘good’/‘poor’. Exposures were educational level, personal income, and economic security. Prevalence ratios (PR) were computed to assess the associations between socioeconomic determinants and self-reported health using Poisson regression models. Participants with low education or income had poorer oral and general health than those with more education or higher income. Comparing the highest and lowest education levels, adjusted PRs for poor oral and general health were 1.27 (95%CI, 1.11–1.46) and 1.43 (95%CI, 1.29–1.59), respectively. Correspondingly, PRs for lowest income quintiles compared to highest quintile were 1.34 (95%CI, 1.17–1.55) and 2.10 (95%CI, 1.82–2.43). Low economic security was also significantly associated with poor oral and general health. There were socioeconomic gradients and positive linear trends between levels of education and income in relation to both outcomes (P-linear trends < 0.001). We found statistical evidence of effect modification by gender on the association between education and oral and general health, and by age group between income and oral health.

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea.

This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea. All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient. The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile. The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

Income differences in COVID-19 incidence and severity in Finland among people with foreign and native background: A population-based cohort study of individuals nested within households.

Although intrahousehold transmission is a key source of Coronavirus Disease 2019 (COVID-19) infections, studies to date have not analysed socioeconomic risk factors on the household level or household clustering of severe COVID-19. We quantify household income differences and household clustering of COVID-19 incidence and severity. We used register-based cohort data with individual-level linkage across various administrative registers for the total Finnish population living in working-age private households (N = 4,315,342). Incident COVID-19 cases (N = 38,467) were identified from the National Infectious Diseases Register from 1 July 2020 to 22 February 2021. Severe cases (N = 625) were defined as having at least 3 consecutive days of inpatient care with a COVID-19 diagnosis and identified from the Care Register for Health Care between 1 July 2020 and 31 December 2020. We used 2-level logistic regression with individuals nested within households to estimate COVID-19 incidence and case severity among those infected. Adjusted for age, sex, and regional characteristics, the incidence of COVID-19 was higher (odds ratio [OR] 1.67, 95% CI 1.58 to 1.77, p < 0.001, 28.4% of infections) among individuals in the lowest household income quintile than among those in the highest quintile (18.9%). The difference attenuated (OR 1.23, 1.16 to 1.30, p < 0.001) when controlling for foreign background but not when controlling for other household-level risk factors. In fact, we found a clear income gradient in incidence only among people with foreign background but none among those with native background. The odds of severe illness among those infected were also higher in the lowest income quintile (OR 1.97, 1.52 to 2.56, p < 0.001, 28.0% versus 21.6% in the highest quintile), but this difference was fully attenuated (OR 1.08, 0.77 to 1.52, p = 0.64) when controlling for other individual-level risk factors-comorbidities, occupational status, and foreign background. Both incidence and severity were strongly clustered within households: Around 77% of the variation in incidence and 20% in severity were attributable to differences between households. The main limitation of our study was that the test uptake for COVID-19 may have differed between population subgroups. Low household income appears to be a strong risk factor for both COVID-19 incidence and case severity, but the income differences are largely driven by having foreign background. The strong household clustering of incidence and severity highlights the importance of household context in the prevention and mitigation of COVID-19 outcomes.

Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study.

ObjectivesThis study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups.MethodsWe conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression.ResultsBefore OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7–49.6% for low back pain; 30.5–39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8–98.0% for low back pain; 78.1–90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache).ConclusionsOOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

Socioeconomic inequalities in household resilience capacity in the context of COVID-19 in the fisheries sector in Malawi

ABSTRACT Malawi relies on fish as a source of protein, and the fisheries sector employs many individuals. The COVID-19 shock has affected the fisheries sector. The current study measured household resilience in the fisheries sector. We collected primary data from 405 respondents. We used TANGO International's resilience capacity indices (RCI) and concentration indices (CI) to measure resilience and assess the inequality in the household resilience among fish value chain actors, respectively. Our findings show that the lowest average resilience capacities index (RCI = 31.14; p < 0.001) was among households in the lowest income quintile, and the highest resilience capacities index (RCI = 59.74; p <0.001) among the highest wealth category. Regarding inequality in resilience, an overall positive concentration index (CI = 0.12; p <0.001) was found. This means that wealthier households are likely to be more resilient than less wealthy households. In terms of policy, the government may consider extending the urban COVID-19 cash transfers to poor households in fishing communities.

Does Part-Time Mothering Help Get a Job? The Role of Shared Custody in Women’s Employment

Though child shared physical custody arrangements after divorce are much more frequent and parents who use it more diverse in many European countries, little is known about their economic consequences for parents. By relaxing family time constraints, does shared custody help divorced mothers return to or stay on work more easily? Since lone mothers are one of the least-employed groups, and they face high unemployment rates, the type of child custody arrangement adopted after divorce is of particular interest for their employability. This article analyses to what extent the type of child custody arrangement affects mothers’ labour market patterns after divorce.Using a large sample of divorcees from an exhaustive French administrative income tax database, and taking advantage of the huge territorial discrepancies observed in the proportion of shared custody, we correct for the possible endogeneity of shared custody. Results show that not repartnered mothers with shared custody arrangements are 24 percentage points more likely to work one year after divorce compared to those having sole custody, while no significant effect is found for repartnered mothers. Among lone mothers, we also highlight huge heterogeneous effects: larger positive effects are observed for previously inactive women, for those belonging to the lowest income quintiles before divorce, for those with a young child, and for those who have three or more children. Thus, shared physical custody arrangements may reduce work–family conflict by diminishing childcare expenses and enlarge the possibilities to find a suitable job because of more relaxed time constraints for lone mothers.

Income and outcomes of patients with incident atrial fibrillation

BackgroundSocioeconomic disparities can be associated with adverse outcomes in patients with cardiovascular diseases. The impact of personal income on the outcomes of patients with atrial fibrillation (AF) is unclear.MethodsNationwide observational...

Factors Associated with Adolescent and Young Adult Males with Cancer Attending Fertility Consultation: A Population-Based Cohort Study in Ontario, Canada.

Purpose: Cancer and its treatment can impair fertility in men. It is recommended that they be referred for fertility consultation before the start of treatment. This study examined factors associated with men attending a fertility consultation within 30 days of diagnosis. Methods: Males 15 to 39 years of age, diagnosed with cancer in Ontario, Canada, between 2006 and 2019, were identified from the Ontario Cancer Registry. Linked administrative data were used to obtain other clinical and sociodemographic variables. The main outcome was a fertility consultation within 30 days of diagnosis, defined using Ontario Health Insurance Plan billing codes (606 or 628). A backward selection multivariate logistic regression was performed. Results: Of 13,720 cases identified, 8.5% attended a fertility consultation within 30 days of diagnosis. A more recent year of diagnosis (odds ratio [OR] = 5.5; 95% confidence interval [CI] 4.6-6.6), living in an urban area (OR = 1.3; 95% CI 1.0-1.8), receiving radiation therapy (OR = 1.4; 95% CI 1.2-1.6), chemotherapy (OR = 1.9; 95% CI 1.6-2.2), and reproductive organ-related cancer surgery (OR = 1.5; 95% CI 1.2-1.7) were associated with a greater likelihood of attending a consultation. Older age (OR = 0.2; 95% CI 0.1-0.2), living in a northern region (OR = 0.3; 95% CI 0.2-0.5), having a cancer with low (OR = 0.3; 95% CI 0.2-0.4) or moderate risk to fertility (OR = 0.6; 95% CI 0.5-0.7), and residing in a neighborhood with lower income (OR = 0.4; 95% CI 0.3-0.5) or residential instability quintile (OR = 0.8; 95% CI 0.6-1.0) were associated with being less likely to attend a consultation. Conclusion: Although rates of fertility consultation have increased over time, these remain low in various clinical and demographic groups. Funding for fertility preservation appears to have had an important impact on fertility consultation in young men with cancer.

Socioeconomic disparities in use of rhythm control therapies in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

In patients with atrial fibrillation (AF), socioeconomic disparities have been reported in the use of oral anticoagulant therapy and outcomes, but whether income also affects the utilization of antiarrhythmic therapies (AATs) for rhythm control is unknown. We assessed the hypothesis that AF patients with higher income are more likely to receive AATs. The nationwide retrospective registry based FinACAF cohort study covers all patients with AF from all levels of care in Finland. Patients were divided in AF diagnosis year and age-group specific income quintiles according to their highest annual income during 2004-2018. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. We identified 188175 patients (mean age 72.6±13.0years; 49.6% female) with incident AF during 2010-2018. Patients in higher income quintiles had consistently higher use of all AAT modalities. When compared to patients in the lowest income quintile, the adjusted incidence rate ratios (95% CI) in the highest quintile were 1.53 (1.48-1.59) for any AAT, 1.71 (1.61-1.81) for AADs, 1.43 (1.37-1.49) for cardioversion, and 2.00 (1.76-2.27) for catheter ablation. No temporal change during study period was observed in the magnitude of income disparities in AAT use, except for a decrease in income-related differences in the use of AADs. Profound income-related disparities exist in AAT use among patients with AF in Finland, especially in the use catheter ablation.

Comparing the Effects of Class Origins versus Race in the Intergenerational Transmission of Poverty

Building upon prior research on intergenerational income mobility, we assess class effects versus racial effects on the probability of becoming a poor adult, broken down by gender. We define the class effect (for each race-and-gender group) as the difference between the probability that a person who was born into the lowest income quintile becomes poor and the probability that a person who was born into the highest income quintile becomes poor. For each minority-by-gender group, using Whites as the baseline, the racial effect is defined as the average racial differential in the probability of becoming a poor adult, irrespective of class origins. The results indicate that, for all minority-by-gender groups, the class effect is larger than the racial effect. Our findings underscore the continuing significance of the comparatively large effects of class origins, which have not been adequately acknowledged in recent research.

Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade

ObjectifDéterminer les facteurs de prédiction d'une absence de dépistage de la rétinopathie diabétique (RD) au sein d'une population de patients diabétiques dans un pays industrialisé. NatureÉtude populationnelle transversale, répétée et rétrospective. ParticipantsTous les patients présentant un diabète (de type 1 et de type 2) âgés de ≥ 20 ans et figurant dans le système de soins de santé universel de l'Ontario ont été recensés pendant 2 périodes (2011–2013 et 2017–2019). MéthodesLe test de Mantel–Haenszel a servi à calculer la comparaison du risque relatif (RR) dans les sous-catégories stratifiées en fonction des 2 périodes transversales. RésultatsAu total, 1 145 645 sujets diabétiques ont été recensés pendant la période 2011–2013 et 1 346 578, pendant la période 2017–2019. La proportion de patients qui n'ont subi aucun dépistage de la RD a diminué très légèrement pour passer de 35 % (n = 405 967) en 2011–2013 à 34 % (n = 455 027) en 2017–2019 de l'ensemble des sujets diabétiques (RR = 0,967; intervalle de confiance [IC] à 95 %: 0,964–0,9693; p < 0,0001). Les jeunes adultes (20–39 ans) constituaient la plus grande proportion de patients qui n'ont bénéficié d'aucun dépistage (62 % et 58 % en 2011–2013 et en 2017–2019, respectivement). Qui plus est, les sujets qui appartenaient à un quintile de revenus plus faibles (RR = 1,039; IC à 95% : 1,036–1,044; p < 0,0001), qui étaient des immigrants récents (RR = 1,286; IC à 95 % : 1,280–1,293; p < 0,0001), qui vivaient en milieu urbain (RR = 1,149; IC à 95 % : 1,145–1,154; p < 0,0001), qui avaient des antécédents de troubles de la santé mentale (RR = 1,117; IC à 95 % : 1,112–1,122; p < 0,0001) ou qui n'avaient pas accès à un médecin de soins primaires (RR = 1,656; IC à 95 % : 1,644–1,668; p < 0,0001) couraient un risque plus élevé d’échapper au dépistage. ConclusionsSelon notre étude populationnelle qui s'est étalée sur une décennie, 33 % des patients diabétiques ne font l'objet d'aucun dépistage de la RD. Les principaux facteurs de prédiction d'une absence de dépistage sont le jeune âge, le revenu faible, l'immigration, la résidence dans une grande ville, les troubles de la santé mentale et l'absence d'accès à un médecin de soins primaires.