Rural Groups Research Articles

Evolutionary game analysis of rural public-private partnership older adult care project in the context of population aging in China.

Public-private partnership (PPP) older adult care project is an effective means to solve the dilemma of the aging population in China's rural areas, but there are some problems in the operation process, such as a low participation rate and poor service quality, resulting in the needs of rural older adult groups not being met. To alleviate the pressure of the aging population in rural areas, this study establishes an evolutionary game model for the PPP older adult care project, then defines the interests of local government, the private sector, and rural older adult residents, based on which it discusses the strategic choices of the three parties in the evolutionary process, and finally analyzes the influencing factors of the strategic choices of the game parties through simulation. The results suggest that whether the private sector chooses to actively participate in the project will be influenced by the willingness of local government and rural older adult residents to participate in the project. Local government could play the role of supervisor through reward and punishment mechanisms. Whether older rural residents choose to participate in the project depends on the number of benefits they would receive. Based on these findings, local governments should clarify the responsibilities of relevant stakeholders, adopt a regulatory strategy combining subsidies and penalties, improve the participation efficiency of rural older adult residents, promote the effective operation of PPP older adult care projects, and improve the quality of rural older adult care services in the new era.

A multicenter study of the relationship between the compulsory time spent at home and sexual functioning.

To investigate how sexual life is affected by the increase in the amount of time spent at home due to the restrictions of the coronavirus disease 2019 (COVID-19) pandemic, and the relationships among depression, anxiety, amount of stress, and sexuality. This cross-sectional study was conducted in two cities, Istanbul (metropolitan city) and Rize (city in a rural area). All data were collected face to face in the gynecology outpatient clinics from patients who came in for benign gynecologic reasons or a check-up. The questionnaire comprised a sociodemographic form, the Arizona Sexual Experience Scale (ASEX) Scale, and the Depression Anxiety Stress Scale. A total of 459 participants took part in the study. Around half of the participants were living in an urban area. There was a statistically significant increase in weekly sexual intercourse frequency for both groups. Sexual desire and arousal scores were significantly higher in the rural groups. There was a significant decrease in sexual pleasure within urban groups. Depression, anxiety, and stress scores were significantly higher in urban groups. There was no statistically significant difference in ASEX total scores between groups. This study suggests that even though the rate of COVID-19 and restrictions did not differ between the compared areas, the lockdown may have had a greater effect on the sexual pleasure of women in urban areas.

The socioeconomic status of adult children, intergenerational support, and the well-being of Chinese older adults

The well-being of older adults is significantly influenced by their adult children, especially in countries with less developed welfare systems. We aim to examine the relationship between children’s intergenerational support, children’s socioeconomic status and the well-being of older adults, as well as compare the differences among various elderly groups. The data in our research are from the 2014 China Longitudinal Aging Social Survey. The survey covered 29 provinces, autonomous regions and municipalities in China with 9146 valid samples. We adopted descriptive statistical analysis and structural equation modeling to analyze the data, and the bootstrap method to test the mediating effects. Our results indicate that the children’s education level and intergenerational support do not significantly affect the well-being of all groups of older adults in China. However, the financial conditions of adult children have a significant and direct impact on the well-being of all groups of older adults. From one child to multiple children, the impact of children’s financial condition on the well-being of older adults is 0.360, 0.452, 0.412 in three urban groups and 0.496, 0.468, 0.443 in three rural groups, specifically. The influence of adult children’s financial conditions on the well-being of all groups of older adults in China is significant, surpassing that of children’s education level and intergenerational support. Moreover, the impact of children’s socioeconomic status on the well-being of older adults is primarily through direct effects, with minimal intervention from intergenerational support. For older adults in China, "whether my children are living well" is more important than "what they could give me".

Rural and urban exposures shape early life immune development in South African children with atopic dermatitis and nonallergic children.

Immunological traits and functions have been consistently associated with environmental exposures and are thought to shape allergic disease susceptibility and protection. In particular, specific exposures in early life may have more significant effects on the developing immune system, with potentially long-term impacts. We performed RNA-Seq on peripheral blood mononuclear cells (PBMCs) from 150 children with atopic dermatitis and healthy nonallergic children in rural and urban settings from the same ethnolinguistic AmaXhosa background in South Africa. We measured environmental exposures using questionnaires. A distinct PBMC gene expression pattern was observed in those children with atopic dermatitis (132 differentially expressed genes [DEGs]). However, the predominant influences on the immune cell transcriptome were related to early life exposures including animals, time outdoors, and types of cooking and heating fuels. Sample clustering revealed two rural groups (Rural_1 and Rural_2) that separated from the urban group (3413 and 2647 DEGs, respectively). The most significantly regulated pathways in Rural_1 children were related to innate activation of the immune system (e.g., TLR and cytokine signaling), changes in lymphocyte polarization (e.g., TH17 cells), and immune cell metabolism (i.e., oxidative phosphorylation). The Rural_2 group displayed evidence for ongoing lymphocyte activation (e.g., T cell receptor signaling), with changes in immune cell survival and proliferation (e.g., mTOR signaling, insulin signaling). This study highlights the importance of the exposome on immune development in early life and identifies potentially protective (e.g., animal) exposures and potentially detrimental (e.g., pollutant) exposures that impact key immunological pathways.

Neighborhood Poverty and Distance to Pediatric Hospital Care.

To describe the relationship between neighborhood poverty and geographic access to pediatric inpatient care. This is a retrospective, cross-sectional study using 2017-18 hospital and demographic data, as well as geographic data from the 2010 census. Acute care hospitals in 17 states were included, comprising approximately one-third of the national population. The main outcome was distance to capable pediatric hospital care by neighborhood Area Deprivation Index (ADI), both overall and by urbanicity. Median distance to pediatric hospital care increased linearly with poverty across ADI national deciles (Pearson coefficient of 0.986; P < .001). The most advantaged neighborhoods were a median of 2.5 miles from the nearest pediatric capable hospital (interquartile range [IQR] 1.2-5.6) while those in the most disadvantaged were a median of 13.8 miles away (IQR 3.3-35.9; P < .001). The nearest hospital admitted children in 51.17% (7927) of advantaged neighborhoods (lowest national ADI quintile) and only 26.02% (3729) of disadvantaged neighborhoods (highest national ADI quintile). The association between poverty and median distance to care was observed in rural, suburban, and urban census block groups (P < .001 for all trends). In suburban neighborhoods, children from the most disadvantaged neighborhoods were 3 times as likely as children from the most advantaged neighborhoods to live more than 20 miles from pediatric inpatient care (27.85%, 456,533 of children from bottom quintile neighborhoods vs 9.24%, 259,787 of children from top quintile neighborhoods, P < .001). Distances to capable pediatric hospital care are greater from poor than affluent neighborhoods. This carries potential implications for disparities in pediatric health outcomes.

Designing and Building a Digital Literacy Park for Children in Ndalem Pulosari

Ndalem Pulosari is a subsidized residential area by the government located in RT 02, Pedukuhan Krebet. This residential area is predominantly inhabited by young families with small children and toddlers. The abundance of children in this settlement who are familiar with gadgets poses a problem for parents, as they are still in the process of learning how to care for their children. Therefore, an effort is needed to guide children in using gadgets appropriately according to their age limits. Enriching digital literacy in children is one of the methods that can address this issue. This service project focuses on designing and constructing a park that includes digital literacy enrichment for children, combined with various educational games to reduce children's dependence on gadgets. The applied method in this service project is Direct Action and Together Learning. The direct involvement of the community is crucial in determining the agenda of this service project. Some of the community engagement techniques include Participatory Rural Appraisal and Focus Group Discussion. This service project is in the initial phase of building the digital literacy park, so the outcomes of this project are currently limited to building design and material preparation.

Woody plant functional traits and phylogenetic signals correlate with urbanization in remnant forest patches.

Exploring the alterations in functional traits of urban remnant vegetation offers a more comprehensive perspective on plant assembly within the context of urbanization. While plant functional traits are influenced by both environmental gradients and the evolutionary history of plant species, the specific mechanisms by which urbanization mediates the combination of functional traits and the evolutionary history of remnant vegetation remain unclear. To examine the relationship between functional traits and phylogenies of remnant vegetation and urbanization, we classified the woody plant species surveyed in 72 sample plots in nine remnant forest patches in Guiyang, China, into four groups (urban, rural, middle and general groups) according to their location under different levels of urbanization and measured nine functional traits of these species. The phylogenetic signals of each functional trait of the four species groups were then quantified based on Blomberg's K. Furthermore, we analysed the correlations between functional traits and species abundance using phylogenetic generalized least squares. The results showed that significant phylogenetic signals were detected in more functional traits of the urban group than other groups. Thirteen and three significant relationships between functional traits and species abundance were detected for tree and shrub species after removing phylogenies. Tall tree species were more abundant in the urban group, while the general group favoured the species with adaptable traits (low height and high leaf area and C/N). Overall, we demonstrate that urbanization drove shifts in plant functional traits in remnant forests after combining the phylogenetic patterns.

Influence of Joint Liability on Enterprise Development of Rural Women in Nyamache Sub-County, Kisii County, Kenya

Group lending has received great attention from economists and policymakers for its successful credit delivery to poor borrowers and its role in alleviating poverty in developing countries. The success of group lending in providing credit to poor borrowers has been attributed to its ability to mitigate the asymmetry of information and enforcement problems in credit markets. The ability of group lending institutions to overcome the asymmetry of information and enforcement problems has been theorised to be the driving force behind their outreach to the poor, their sustainability, and their repayment performance. While there is a host of theoretical models explaining the success of group lending, empirical research has lagged behind. The focus of this study was to explore the determinants of group lending mechanisms on the enterprise development of rural women in the Nyamache sub-county, Kenya. The study targeted the rural women development groups that access loans as a group within Nyamache Sub-County. The total target population comprised 781 members, and by using Krejcie and Morgan’s table of determining sample size, the sample size consisted of 260 respondents. Questionnaires were used. The questionnaires were edited first for accuracy and completeness. The study used frequency distribution and percentages and computer software-Statistical Package for Social Scientists version 22 (SPSS v 22) as a tool for analysing data and establishing relationships between variables. The study established that joint liability, training, group representation and loan size positively and significantly influenced enterprise development

‘A Different Ball Game’: Adaptation of a men’s health program for implementation in rural Australia

BackgroundMen residing in rural areas are less likely to participate in weight management interventions than women, and few men-specific programs target rural areas. Aussie-Fans in Training (Aussie-FIT) is an evidence-based weight management intervention that uses professional Australian Football club affiliations and settings as a ‘hook’ to engage urban-residing men. The aim of this study is to report on how findings from rural stakeholder focus groups were used to inform the adaptation of Aussie-FIT for implementation in rural areas.MethodsSeven focus groups with stakeholders (n = 24) in three rural towns explored existing weight management and physical activity provisions, barriers and facilitators to engaging men, and considerations for adapting Aussie-FIT for implementation in rural contexts. Qualitative data were analysed using the framework approach. Adaptations made to the Aussie-FIT program and strategies to implement the program in rural contexts were reported using a structured framework.ResultsThemes generated from our analysis include limited appealing services for men, Australian Football as a ‘common language’, the influence of the ‘smaller fishpond’(population), considerations for program inclusivity, and the importance of local partner organisations for sustainability. We adapted the recruitment and marketing strategies, delivery settings, football program theme and partnerships for rural implementation. Stakeholders advised that an Australian Football program theme without specific local club affiliations would be important to avoid alienating men with differing club allegiances or non-sporting backgrounds. A multi-component recruitment strategy utilising local trusted sources, and program marketing that aligns with masculine ideals were considered important by stakeholders in small communities where ‘people talk’.ConclusionsRural areas were described as ‘a different ball game’ due to limited local services and resources in comparison to metropolitan areas. Study findings have synergies with previous studies undertaken in rural contexts including in relation to the power of word of mouth, the importance of trust, and local partner organisations. Findings have implications for engaging rural men in health interventions in rural contexts where professional sporting contexts are not available. Assessing the extent to which the adapted Aussie-FIT program can reach and engage men in rural Australia, and exploring the barriers and facilitators to delivering the program in rural contexts is required.

Urban-rural differences in hypertension prevalence, blood pressure control, and systolic blood pressure levels.

Higher rates of cardiovascular events have been observed among rural residents compared with urban. Hypertension and lack of blood pressure (BP) control are risk factors for cardiovascular events. We compared the prevalence of hypertension and controlled BP, and the distribution of systolic blood pressure (SBP), by urban-rural residence. Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a prospective cohort of Black and White adults aged ≥45 years, were categorized as either urban, large rural, or small-isolated rural, by using the Rural-Urban Commuting Area (RUCA) categorization B system. Oucomes were hypertension prevalence (BP ≥ 140/90 mmHg or antihypertensive use), BP control (BP < 140/90 among participants on antihypertensive medication), and the distribution of SBP. Counfounders were age, race, sex, antihypertensive medication use, and US Census Bureau division. The analysis included 26,133 participants (80.3% urban, 11.6% large-rural, 8.2% small-isolated rural). The unadjusted prevalence of hypertension was not different between groups. However, after adjustment, the odds of hypertension was higher among participants in the large rural group (odds ratio [OR] 1.17; 95% confidence interval [CI], 1.08-1.27) and small-isolated rural group (OR 1.19; 95% CI, 1.08-1.30), compared with the urban group. There was no evidence of an adjusted difference in BP control for those taking antihypertensive medications. Adjusted differences in SBP were greater for both rural groups, compared with urban, at the higher percentiles of SBP. Rural residence was associated with a higher adjusted odds of hypertension and higher SBP.

Self-organized learning environments (SOLEs) pedagogy as a conduit to learners’ metacognitive skills and conceptual understanding of “S” in STEM: The South African study

The current study examined self-organized learning environments (SOLEs) pedagogy as a conduit to learners’ metacognitive skills and conceptual understanding in physical sciences and science, technology, engineering, and mathematics (STEM) as a whole in Capricorn District of Limpopo Province of South Africa.&lt;b&gt; &lt;/b&gt;The aim was based on ongoing debates related to integrating technology and metacognitive skills in STEM education to improve educational outcomes. Anchored upon the aim and through experimental (one urban and one rural) groups and control (one urban and one rural) groups, the study employed a non-equivalent quasi-experimental (control group) design to glean and analyze data from 155 selected participants through a stratified sampling method. Data were collected using physical sciences pre- and post-tests and metacognition self-assessment scale questionnaire. Data analysis employed descriptive (mean [M], standard deviation, and effect size) and inferential (parametric t-test) analysis. The findings indicate that the mean gain score (M=6.37) of the experimental groups (that were taught through SOLEs pedagogy) was higher than that of their counterparts (M=2.60) in the control groups with a p-value (p=0.037) that is less than 0.005.&lt;br /&gt; Similarly, in terms of conceptual understanding, the findings indicate that the experimental groups improved significantly more than the control groups at a significant p-value of 0.00. Finally, the study concludes that SOLEs pedagogy improves learners’ metacognitive skills that, in turn, enhance conceptual understanding of physical sciences content. Furthermore, the current study recommends further longitudinal studies with larger sample sizes to explore SOLEs pedagogy in STEM.

Favouring Middle-and Upper-Class Students? The Structure and Process of Attending China’s Selective Universities

Research suggests the increasing influence of family socioeconomic status, as measured by parents’ income and occupations, in access to Chinese higher education. Yet, the literature remains inconclusive about the extent to which the social background of rural and urban students is associated with academic and social performance at elite universities. We address this limitation by looking at the academic and social success of representative samples of first- and second-year students enrolled at four Chinese elite universities. Our aim is to understand the characteristics that students from both urban and rural environments bring with them and how those characteristics bear on academic and social performance in university. We found an overrepresentation of students from middle- and upper-class backgrounds in both urban and rural student groups. The fact that the process indicator of cultural capital has a direct association with social success suggests students from urban areas exhibit traits valued in the selective university environment.

Research on Planning Method of Rural High-Density Building Group Based on Tree Structure Simulation Algorithm

Research on Planning Method of Rural High-Density Building Group Based on Tree Structure Simulation Algorithm

964-P: Real-World Comparison of Rural and Urban Cohorts Using the Bigfoot Unity System for 6 Months

Background: The Bigfoot Unity® System incorporates CGM data, real-time alerts, and clinician-directed dose recommendations. Clinicians use a web portal to view patient data remotely. Our objective was to analyze real world data from rural and urban subgroups. Methods: A 6-month retrospective analysis was done using a prespecified analysis plan for commercial users with ≥50% CGM data at 6 months (N=127, 24 clinics). A baseline A1C was obtained from clinic medical records (N=118). Glycemic and System engagement outcomes for those living in urban (N=102) and rural (N=25) zip codes were compared. Results: Most in urban and rural groups had T2D (82 v 84%); mean age was 65 and 61 years, respectively. Urban users had mean baseline A1C of 8.4±1.6% and 7.5±0.8% mean GMI at 6 months; rural users had baseline A1C of 8.5±1.9% and 6-month GMI of 7.2±0.8%. Subgroup outcomes are shown (Table). Using GMI as an A1C proxy, pairwise comparisons of 6 month GMI to baseline A1C in the overall cohort (N=118) show a 1.1±1.4% improvement (P &amp;lt;0.05). Discussion: Overall, both groups were primarily older adults with T2D using MDI and having suboptimal glycemic control before System use. Given concerns with disparity in diabetes management in rural areas, we evaluated rural and urban users of Bigfoot Unity. The rural cohort was small but data suggests that for both groups, using the System resulted in similar improved and durable glycemic control at 6 months. Disclosure J.Tillman: Employee; Bigfoot Biomedical, Inc. B.P.Olson: Employee; Bigfoot Biomedical, Inc. S.Vaughan: Employee; Bigfoot Biomedical, Inc. F.Sheikh: Employee; Bigfoot Biomedical, Inc. J.K.Malone: Employee; Bigfoot Biomedical, Inc. Funding Bigfoot Biomedical, Inc.

An 8 Week Rural Surgical Clerkship: Does It Help to Produce more Rural Physicians?

Purpose: The purpose of our study was to determine what effect an 8-week rural surgical clerkship rotation during the 3rdyear of medical school has on future practice site location. Methods: We report the subsequent practice site for ninety-five 3rd year medical students who completed an 8-week rural surgical clerkship from 2013-2016 compared to a cohort from the same time who completed this clerkship on the urban campus, matched by year and specialty chosen. Findings: On first analysis, there is a significant correlation (p=.0026) between rural clerkship and subsequent rural practice. With secondary analysis, all but one of the students in the rural clerkship group who chose rural practice were rural track students completing most of both clinical years in the rural setting. Conclusions: As found previously, longer duration rural exposures are associated with more frequent subsequent rural practice, but we found no such association for the 8-week rural surgical clerkship. The previous report of positive attitude changes among urban-based medical students completing this rural clerkship may help them understand rural patients seeking their care in an urban setting, but such attitude changes are not adequate to affect the complex decision of practice choice. Future studies of rural exposures during medical school should focus on intermediate duration exposures as well as different specialty clerkships beyond surgery and seek an association with subsequent practice site location.

Research of Unbalanced Regional Economic Development and Entrepreneurial Happiness based on CFPS Data

Based on the perspective of happiness economics and using the data of China Family Panel Studies in 2020, this paper empirically analyzes the impact of regional economic development imbalance on entrepreneurial happiness. The results show that regional economic development has a significant negative impact on entrepreneurial happiness on the whole, and it changes with the regional difference and the difference of urban and rural structure. Further research shows that economic development can improve the happiness of urban entrepreneurial groups in economically underdeveloped areas, but it has a significant hindering effect on the happiness of rural entrepreneurial groups in economically developed areas. In addition, this paper studies the mechanism of economic development on entrepreneurial happiness, and finds that each component of entrepreneurial happiness responds differently to economic development. The research results of this paper will provide theoretical basis for the government to formulate more reasonable incentive policies for innovation and entrepreneurship.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Community Health Workers (CHWs) are valuable members within the communities they serve and increase access to health care by garnering the trust of their fellow neighbors, providing services including facilitating access to care, and improving the quality and cultural competence of service delivery. In Southern Haiti, there is a health care provider shortage with one doctor or nurse per 3,000 persons. CHWs are critical to help close the gap of the lack of access to care and facilitate the provision of basic health care. To describe the CHW training initiative at capra-care, a community-based health care provider in rural Haiti, using survey and focus groups results highlighting key findings and implications for the CHW initiative. A mixed-method approach was used to evaluate capracare's CHW Training program. Focus groups were conducted that documented the lived experience of CHWs following the training program; examined barriers and facilitators to translating the training skills to practice in the community. Pretest and post-test data assessed change in knowledge post the Community Health Worker Training (CHWT) program. Findings included 51 (57%) of the graduates. A significant increase was observed in mean test scores from baseline (n = 51; m = 61.48 ± 1.80) to post-test (m = 76.93 ± 1.73; t-7.69; P &lt; 0.001), indicating that the CHW training was successful in increasing participants' knowledge. Themes that emerged from the qualitative analysis were comprehension of skills learned, community benefit, and empowerment. Results from this CHWT program has implications to increase the health care workforce thus facilitating access to care among community residents in under-resourced regions.

Empowering Rural Youth Groups through Islamic Social Enterprise (ISE) in Indonesia

Indonesia has a bonus demography challenge. For this reason, youth development should be prioritized by considering the unproductive migration of rural youth groups. Islamic social enterprise (ISE) offers a strategic approach to empowering the youth. This study investigated youth empowerment through vocational training programs provided by two ISE organizations. This is a descriptive qualitative study. Online interviews were carried out from October 2021 to June 2022 involving eight ISE program participants. The research finding shows that ISE supported intellectual, psychological, spiritual, and social skill development. The results also suggest comprehensive support from the government, private sectors, and local communities to ensure the youth groups can be change agents for their villages.&#x0D; Keywords: change agent, community development, social enterprise, youth empowerment&#x0D; Abstrak&#x0D; Indonesia menghadapi tantangan bonus demografi. Untuk itu, pembangunan untuk kelompok harus diprioritaskan dengan mempertimbangkan adanya masalah migrasi yang tidak produktif oleh kelompok pemuda dari wilayah perdesaan. Kewirausahaan sosial berbasis nilai Islam menawarkan pendekatan strategis untuk memberdayakan kelompok pemuda. Studi ini mendeskripsikan pemberdayaan pemuda melalui program pelatihan vokasi yang dilakukan oleh dua organisasi. Studi ini menggunakan pendekatan kualiatif deskriptif. Wawancara online dilakukan sejak Oktober 2021 hingga Juni 2022 dengan melibatkan delapan peserta program. Hasil penelitian menunjukkan bahwa Kewirausahaan sosial berbasis nilai Islam mendukung perkembangan intelektual, perkembangan psikologis dan spiritual, serta perkembangan keterampilan sosial. Hasil penelitian merekomendasikan dukungan komprehensif dari pemerintah, sektor swasta, dan masyarakat lokal untuk dapat memastikan keberdayaan kelompok pemuda sebagai agen perubahan bagi desa mereka.&#x0D; Kata kunci agen perubah, pengembangan komunitas, kewirausahaan sosial, pemberdayaan pemuda

Analysis of the status of social frailty in Chinese older adults with cardiovascular and cerebrovascular diseases: a national cross-sectional study.

Social frailty is one type of frailty. Physical frailty with cardiovascular and cerebrovascular diseases (CCVD) have been studied a lot, but less research on social frailty. To study the prevalence, related risk factors and regional differences of social frailty with CCVD in Chinese older adults. SSAPUR was a national cross-sectional survey. Participants aged 60 years or older were recruited in August 2015. Demographic data and information regarding family, health and medical conditions, living environment conditions, social participation, spiritual and cultural life, and health condition were obtained. Social frailty was assessed in five areas (HALFE Social Frailty Index) including inability to help others, limited social participation, loneliness, financial difficulty, and living alone. The prevalence of CCVD with social frailty, related risk factors and regional differences in CCVD with social frailty were studied. A total of 222,179 participants were enrolled. 28.4% of them had CCVD history. The prevalence of social frailty in the CCVD group was 16.03%. In CCVD participants, compared with the group without social frailty, there were significant differences in gender, age, urban-rural distribution, ethnicity, marital status, and education levels in the social frailty group. Significant differences were also found in physical exercise participation, health status, cataract, hypertension, diabetes mellitus, hospitalization within 1 year, self-assessed health status, crutch or wheelchair usage, urinary and fecal incontinence, need for care from others, fall history, housing satisfaction, and self-assessed happiness in the social frailty group. Women with CCVD had a higher prevalence of social frailty than men. By age in CCVD with social frailty, the highest prevalence was found in participants 75-79 years old. The prevalence of CCVD was significant difference between social frailty in urban and rural group. The prevalence of social frailty with CCVD was significantly different in different regions. The highest prevalence was 20.4% in southwest area, and the lowest prevalence was 12.5% in northeast with area. The prevalence of social frailty among the CCVD older adults is high. Factors such as gender, age, region, urban-rural residence, and the state of the disease may be associated with social frailty.

(205) Erectile Dysfunction is an Independent Risk Factor for Major Adverse Cardiovascular Events

Abstract Introduction Erectile dysfunction (ED) and cardiovascular disease share similar risk profiles which include: aging, hypertension, diabetes, smoking, obesity, and dyslipidemia. Previous literature has suggested ED as a potential harbinger of future cardiovascular disease. Objective As such, we sought to investigate the association between ED and major adverse cardiovascular events (MACE) using a large population based database. As a secondary objective, we sought to investigate the relationship of place of residence (rural or urban) in regards to the incidence of MACE. Methods A propensity-weighted, retrospective cohort study was conducted by accessing provincial health administrative databases. Eligibility criteria included men 18 years and older, with no prior ED or MACE, who had at least 1 year of provincial health coverage from their index date between June 1st 1996 to March 31st 2018. ED was defined as having at least two ED prescriptions filled within one year (including oral, intraurethral, and/or injection therapies). MACE was defined as myocardial infarction, coronary revascularization procedures, ischemic stroke, or hospitalizations for heart failure. We then classified study groups into ED Urban, ED Rural, No ED Urban and No ED Rural. Multiple logistic regression model that included age categories, socioeconomic status, index year, diabetes, hypertension, dyslipidemia and renal disease was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. A cox proportional hazard model was used to examine our primary outcome of time to a MACE. Results The median time to a MACE was 2721, 2620, 2520, and 2438 days in the ED Urban (N=32,138), ED Rural (N=17,821), No ED Rural (N=145,209) and No ED Urban (N=233,073) study groups, respectfully. The ED Rural, ED Urban and No ED Rural study groups had a 54% (Hazard Ratio [HR] 1.54, 95% CI [1.45 – 1.63]), 26% (HR 1.26, 95% CI[1.20 – 1.32]) and 14% (HR 1.14, 95% CI[1.11 – 1.18]) higher risk of a MACE event as compared to the No ED Urban group, in weighted analyses, respectfully. Among individuals with ED, men from a rural setting had a 22% (HR 1.22, 95% CI[1.14 – 1.32]) higher risk of a MACE event, as compared from an urban setting. Conclusions Our study demonstrates that men diagnosed with ED had a higher risk of MACE as compared to controls. ED is demonstrated to be an independent risk factor for MACE when controlling for comorbidities. In addition, men residing in rural communities had a higher risk of MACE as compared to other urban counterparts. It is imperative for health care professionals who manage patients with ED to discuss the risk of future cardiovascular disease and identify comorbid conditions to mitigate risk. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.