Social Determinants Research Articles

From screening to action: Social determinants and early outcomes in pediatric Liver Transplant recipients.

From screening to action: Social determinants and early outcomes in pediatric Liver Transplant recipients.

Link Your Large Health Data Sets to the Area Deprivation Index, the ezADI Way.

Increasing attention has been paid to investigations on how social determinants of health (SDOH; e.g., income, employment, education, housing, etc.) impact health outcomes. However, these variables are often not collected in routine clinical practice. As a consequence, researchers may attempt to link retrospective medical records to those datasets that can provide additional SDOH information, such as the Area Deprivation Index (ADI). However, time-consuming geographic calculations can deter these analyses. To reduce this burden, the ezADI R package performs batched geocoder mapping on inputted addresses, constructs Federal Information Processing Series (FIPS) codes, and then merges these data with ADI scores. The applicability and feasibility of this ezADI tool was tested on a sample of patients with sickle cell disease (SCD). Individuals with SCD are at risk for developing serious comorbidities; disadvantageous SDOH may increase this risk, in turn leading to higher rates of hospital utilization and longer lengths of stay on admission. In this sample of 1,105 individuals with SCD in Tennessee (53.8% female, 97.5% African American), higher ADI scores (i.e., more neighborhood disadvantage) were significantly associated with increased hospital utilization (rho = 0.093, p = 0.002) and longer lengths of stay (rho = 0.069, p = 0.021). These areas could be targeted with neighborhood-level interventions and other resources to improve SDOH. This study provides proof of concept that the ezADI tool simplifies geocoding calculations to allow researchers to link datasets with the ADI and assess associations between SDOH factors and health outcomes.

Outpatient Gout Follow-up After an Emergency Department Visit for Gout Flares.

Gout follow-up after an emergency department (ED) visit for gout flare may improve outcomes, which could be influenced by demographics and social determinants of health. We aimed to determine the factors associated with outpatient gout follow-up within our health care system within 6 months following an ED visit for a gout flare. This historical cohort study was conducted at an academic medical center that includes 3 EDs and 1 urban urgent care. Among patients with a gout flare during their ED visit, we determined the presence/absence of an outpatient visit for gout within 6 months of the ED visit. We reported the proportion of patients who received outpatient gout follow-up. We used multivariable logistic regression to test the association between key covariates and outpatient follow-up for gout. From September 2021 to August 2022, we analyzed 159 patients with gout flare at the ED visit, of whom 56 (35.2%) had an outpatient visit addressing gout within 6 months. Being married (odds ratio [OR], 2.66; confidence interval [CI], 1.25-5.68; p = 0.01), absence of comorbidities (OR, 3.86; CI, 1.01-14.71; p = 0.048), use of colchicine at the ED visit or discharge (OR, 2.67; CI, 1.18-6.02; p = 0.02), and increased age (OR, 1.44; CI, 1.15-1.82; p = 0.002, for each 5-year increase) were associated with increased odds of gout follow-up. Among a cohort of patients seeking urgent/emergent care for gout flare, only one-third followed up for gout in the outpatient setting. Modifiable factors such as colchicine prescription use were associated with gout follow-up, which may represent areas to target in future studies focused on promoting improved outpatient follow-up for gout.

Social Determinants of Health and Parent and Child Physical Activity: A Cross-Sectional and Longitudinal Exploration among Socioeconomically and Racially and Ethnically Diverse Families.

PurposeTo examine the associations between baseline social determinants of health (SDOH) and physical activity (PA) in children and parents cross-sectionally (baseline) and longitudinally (18-months later).DesignCross-sectional and longitudinal.SettingFamily Matters Cohort Study, Minneapolis-St. Paul, Minnesota.SampleParents with children aged 5-9 years (n = 1146).MeasuresParent self-reported (1) 25 SDOH factors mapped across 5 domains and (2) parent and children moderate-to-vigorous intensity physical activity (MVPA).AnalysisAdjusted linear regression models.ResultsEach of the SDOH domains were positively associated with parents and children MVPA levels (all P < 0.05), except Economic Stability (all P > 0.05). Families with high family functioning reported higher MVPA among children, cross-sectionally (β 1.27; 95% CI [0.67, 1.87]) and longitudinally (β 0.87; 95% CI [0.29, 1.46]). Parents exhibited higher levels of MVPA both cross-sectionally (β 0.66; 95% CI [0.11, 1.21]) and longitudinally (β 0.73; 95% CI [0.21, 1.26]) when they had greater social capital. Children also exhibited increased MVPA (β 1.10; 95% CI [0.41, 1.79]) when living in areas with high walkability to recreational places.ConclusionResults indicate that SDOH may shape the PA habits of parents and children in a racially/ethnically diverse population. To advance health equity and support engagement in PA, researchers and clinicians should take into consideration SDOH factors related to a family's educational, social, home, family functioning, and neighborhood environments.

Sociodemographic Influences on Suicide Risk Screening and Management in Hospitalized Youths.

Characterizing the relationship between sociodemographic factors and youth suicide risk is crucial for developing prevention strategies and targeted interventions. We aimed to describe the relationship between hospital-based suicide-risk screening and sociodemographics (race and ethnicity, sex, age, and neighborhood socioeconomic status), discharge disposition, and reuse rates in those with positive screens. This is a retrospective study of patients aged 10 to 17years hospitalized between May 2021 and May 2022 at a freestanding children's hospital in Milwaukee, Wisconsin. Screening rates and results were compared across groups using chi-square tests and logistic regression. Five thousand two hundred sixty-one encounters were included, and 83.2% (4375/5261) received suicide-risk screening. Of those screened, 19.3% (843/4375) had positive suicide-risk results. Screening rates were significantly higher among Black or African American patients (P < .001), girls (P = .01), and those aged 13 to 17years (P < .001). Positive suicide-risk results were most frequent among Hispanic/Latino/Latinx patients (P = .01) and girls (P < .001). Patients aged 10 to 12years were screened less frequently and had fewer positive suicide-risk results (P < .001). There were no differences based on neighborhood socioeconomic status. Black or African American patients were discharged home more often than white patients (P < .001). Patients with positive suicide-risk screens discharged home had a 6.1% emergency department revisit rate within 7days of discharge compared with 2.4% of those transferred to inpatient psychiatry (P = .05). We found differences in screening incidence and result (Black or African American and Latinx, sex, and preteens), discharge disposition (Black or African American), and hospital reuse (discharge home) after a positive suicide-risk screen. Our findings call for increased consideration of social determinants when caring for hospitalized youth.

The Impact of Social Inequities on Presentation of Juvenile-Onset Systemic Lupus Erythematosus at a Large Tertiary Center.

The prevalence of juvenile-onset systemic lupus erythematosus (JSLE) differs by race/ethnicity with environmental, genetic, and social factors implicated in disease severity and outcomes. Yet, the role of social determinants of health (SDoH) in disease presentation is not well understood. We hypothesized that in an urban center with a large, diverse catchment area, SDoH influence the severity of JSLE at diagnosis. We completed an institutional review board-approved medical record review of children newly diagnosed with JSLE between January 1, 2018, and May 31, 2022, at Texas Children's Hospital in Houston, TX. We collected demographic data, clinical severity measures, and SDoH variables such as Area Deprivation Index (ADI), insurance status, pollution burden, and food accessibility. Statistical analysis to compare SDoH with JSLE severity included Kruskal-Wallis test, Fisher exact test, and univariable and multivariable regression. Mean diagnosis age for 136 patients was 13.4 years, with 82.4% female, 52.9% Hispanic, and 25.7% non-Hispanic (NH) Black. One-third of patients did not have a documented primary care provider, and one-third preferred non-English language. We found NH Black patients had worse clinical severity measures, with highest Systemic Lupus Erythematosus Disease Activity Index and more central nervous system involvement and cyclophosphamide therapy. Uninsured and publicly insured patients were more likely to use inpatient resources at diagnosis and live in neighborhoods with higher pollution levels and higher ADI. Hispanic patients reside in communities with higher ADI scores and limited access to supermarkets. In children with JSLE from a large urban catchment area, we observed significant association of nonmodifiable (race/ethnicity) and modifiable (insurance status, access to care, food accessibility) factors on disease severity at presentation.

Census block based loglinear regression analysis of health and social determinants of maternal mortality in Indonesia 2010–2021

Despite many health program efforts, the maternal mortality in Indonesia has slowly declined and remains high. A comprehensive understanding of social determinants of maternal mortality is needed to guide improved strategies to accelerate reductions in maternal mortality. This study aimed to assess the health-program and social factors that determine maternal mortality in Indonesia through census block-based log-linear regression analysis of recent large surveys. The following data sets were used: (1) the Indonesia Intercensal Population Survey 2015 merged to the Village Potential Census, 2014; and (2) the Indonesia Population Census 2020-Long Form (conducted in 2022) merged to the Village Potential Census, 2021. Both surveys used the same multistage sampling procedure to select 40,728 and 268,223 census blocks. In each selected census block, a “take all take some” procedure was used to randomly select 16 households. Maternal mortality, its health-program, and social factors were measured at the census block level. Since many census blocks had zero maternal death, a log-linear regression, modelled as Ln Y’i = α + βiXi, was employed. Ln Y’i is the natural log transform of maternal mortality ratio; Xi are the factors investigated; βi is the regression coefficient of Xi on Ln Y’i. βi measures the extent influence of Xi on Yi. On the study results, the maternal mortality has declined but remains high, and geographic and socioeconomic disparities in maternal mortality have reduced, although they are still striking. There are many factors that have influenced the risk of maternal mortality. Proximity to hospital reduced the risk of maternal mortality. The primary health care system is not yet optimal for reducing the risk of maternal death. Traditional birth attendants hinder the referral for maternal complications. Lack of household transportation increases the risk of maternal mortality. The use of contraception to reduce high-risk births also reduces the risk of maternal mortality. Poverty and low maternal education independently increase the risk of maternal death. Households that are too large; have one or more disabled member; and have experienced child loss are at high risk of maternal mortality. Lack of village electrification and a polluted environment independently increase the risk of maternal mortality. The study results imply the need for multiple strategic interventions to accelerate the reduction of maternal mortality. Optimizing the coverage of quality referral hospitals, particularly in the eastern region, is required. There is a need to facilitate easy transportation from households to the nearest functional EmMONC. There is a need to strengthen the primary health care system to early detect, stabilize, and facilitate timely, safe, and effective referral of cases of maternal complications. Social health insurance should not only cover the cost of health care but also improve the quality of healthcare services. The role of traditional birth attendants should be shifted away from delivery care to improve maternal and neonatal health care. Family planning programs should focus on preventing high-risk births. Women’s education needs to be improved. Electrification of all villages and control of environmental pollution to reduce maternal deaths.

“I felt my rights were violated”: Challenges with the discontinuation of provider-dependent contraceptive methods in Eastern Uganda

BackgroundThe right to autonomy in family planning is a cornerstone of reproductive health. Yet, many women face challenges when seeking to discontinue provider-dependent contraceptive methods, such as implants and intrauterine devices (IUDs). This study explored the experiences of women in Eastern Uganda regarding the discontinuation of implants/IUDs.MethodsUsing a qualitative descriptive design, we conducted 15 in-depth interviews with women and six key informant interviews with healthcare providers. The study obtained ethical clearance and used a thematic analysis.ResultsTwo themes were identified: (1) reasons for refusal and (2) women’s reactions to refusal to discontinue IUDs/implants. Women were denied to discontinue IUDs/implants because the due date had not been reached, insertion cards were missing, and there were healthcare constraints, especially inadequate equipment. Early removal or discontinuation before the due date was considered as a waste of resources, unjustifiable, and it was seen to increase risk of pregnancy among young girls. Healthcare workers preferred to first counsel for side effects instead of heeding women's requests to discontinue IUDs/implants. Women often felt betrayed and powerless when they were denied to discontinue using IUDs/implants. They felt that their reproductive rights were undermined which fostered mistrust towards future use of provider-dependent contraceptives. Women reported physical, social, and mental health struggles including strained marital relationships following denial to discontinue IUDs/implants. Most of the women incurred costs in discontinuing the use of IUDs/implants in private facilities.ConclusionThe findings underscore the need to uphold women’s autonomy by improving access to removal services, and addressing systemic and provider-level barriers to discontinuation of IUDs/implants. Insertion cards should not be a mandatory requirement during discontinuation of contraceptives, while enhancing record-keeping systems can address the need for insertion cards. Respecting women’s rights to discontinue contraceptives is essential for ensuring voluntary and sustained family planning use.

Predicting Risk of Malignant CNS Tumors From Medical History Events.

Malignant brain and other central nervous system tumors (MBT) are the second leading cause of cancer death among males aged 39 years and younger, and the leading cause of cancer death among males and females younger than 20. There are few widely accepted predictors and a lack of United States Preventive Services Taskforce recommendations for MBT. This study examined how medical history could be used to assess the risk of MBT. Using over 400,000 patients' medical histories, including nearly 1,800 with MBT, Logistic Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to predict MBT. More than 25,000 diagnoses were grouped into 16 body systems, plus pairwise and triple combinations, as well as indicators for missing values. Data were split into 80/20 training and validation sets with fit and accuracy assessed using McFadden's R2 and the area under the receiver operating characteristic curve (AUC). Diagnoses of the endocrine, nervous, and lymphatic systems consistently showed greater than three times more association with MBT. The best performing model at an AUC of 0.83 consisted of 14 body system diagnosis groups and pairwise interactions among groups, in addition to demographic, social determinant of health, death, and six missing diagnosis grouping indicators. This study demonstrated how large data models can predict MBT in patients using EHR data. With the lack of preventive screening guidelines and known risk factors associated with MBT, predictive models provide a universal, non-invasive, and inexpensive method of identifying at-risk patients.

Social determinants of health and type 2 diabetes in Asia.

Type 2 diabetes mellitus (T2DM) is a major global public health challenge driven by a complex interplay of genetic, environmental, and social factors. This review highlights the effects of social determinants of health (SDOH) on T2DM in Asia, where rapid urbanization, worsening air pollution, and distinct socioeconomic structures uniquely influence disease outcomes. Key SDOH domains, socioeconomic status (education, income, and occupation), physical environment, food environment, healthcare access, and social context, were analyzed for their associations with T2DM prevalence, progression, and management. Among these, environmental and lifestyle shifts have emerged as particularly influential factors in Asia. Air pollution, particularly fine particulate matter, has been increasingly linked to insulin resistance and diabetes risk in Asian populations. Additionally, rapid urbanization and changing food environments contribute to rising T2DM incidence through shifts in lifestyle and dietary patterns. Across the diverse healthcare systems of Asian countries, primary care remains a universally critical component in addressing T2DM issues. Additionally, social capital and cohesion serve as protective factors, whereas social isolation heightens vulnerabilities. These insights underscore the importance of addressing SDOH in public health strategies to combat T2DM in Asia. Future research should prioritize longitudinal studies and culturally tailored interventions to reduce the region's diabetes burden.

Community health in Victoria: a history of challenges, adaptations and potential.

Background The Whitlam Labor government established the Community Health Program (CHP) in Australia in 1973 to improve access to health and related welfare services nationally. States reacted differently to the program. Designated Australian Government funding for the program ended in 1981. In spite of fluctuating state government support and changing legislative frameworks over time, Victoria is the only state that continues to operate a generic community health centre (CHC) program reflecting the original CHP. Methods Data were collected from policy documents and archival material, as well as interviews with 29 key stake holders from Victoria. Transcripts from the interviews were reviewed by the interviewees and permission given to include identifiable quotes. The research is part of a larger Australian Research Council project looking at the history of community health in Australia. Results In Victoria the CHP broke new ground in several respects including creating a public primary health care (PHC) sector, promoting equitable access to PHC, introducing salaried GPs, creating multidisciplinary PHC teams, valuing community involvement (in planning, accountability, health promotion) and taking action on the social determinants of health. Key stakeholders described the challenges that the sector has faced in the decades from 1973 to the current day. The basis for the sector's survival ultimately rests with how it was initially established and the cultural environment in which it developed and continues to operate. In addition to the (albeit irregular) geographically wide distribution of CHCs, their high level of public recognition and sense of community ownership were seen as critical factors that aided their survival and worked against their closure or absorption into hospital networks. Conclusions Based on a synthesis of our findings and personal experiences, we propose five new directions for policy, management and practice that could support this model to have a greater contribution to the health system in Australia.

Integrating Social Determinants of Health and Established Risk Factors to Predict Cardiovascular Disease Risk Among Healthy Older Adults.

Recent evidence underscores the significant impact of social determinants of health (SDoH) on cardiovascular disease (CVD). However, available CVD risk assessment tools often neglect SDoH. This study aimed to integrate SDoH with traditional risk factors to predict CVD risk. The data was sourced from the ASPirin in Reducing Events in the Elderly (ASPREE) longitudinal study, and its sub-study, the ASPREE Longitudinal Study of Older Persons (ALSOP). The study included 12,896 people (5884 men and 7012 women) aged 70 or older who were initially free of CVD, dementia, and independence-limiting physical disability. The participants were followed for a median of eight years. CVD risk was predicted using state-of-the-art machine learning (ML) and deep learning (DL) models: Random Survival Forest (RSF), Deepsurv, and Neural Multi-Task Logistic Regression (NMTLR), incorporating both SDoH and traditional CVD risk factors as candidate predictors. The permutation-based feature importance method was further utilized to assess the predictive potential of the candidate predictors. Among men, the RSF model achieved relatively good performance (C-index = 0.732, integrated brier score (IBS) = 0.071, 5-year and 10-year AUC = 0.657 and 0.676 respectively). For women, DeepSurv was the best-performing model (C-index = 0.670, IBS = 0.042, 5-year and 10-year AUC = 0.676 and 0.677 respectively). Regarding the contribution of the candidate predictors, for men, age, urine albumin-to-creatinine ratio, and smoking, along with SDoH variables, were identified as the most significant predictors of CVD. For women, SDoH variables, such as social network, living arrangement, and education, predicted CVD risk better than the traditional risk factors, with age being the exception. SDoH can improve the accuracy of CVD risk prediction and emerge among the main predictors for CVD. The influence of SDoH was greater for women than for men, reflecting gender-specific impacts of SDoH.

Organizational Characteristics Associated with Addressing Community Social Determinants of Health in U.S. Hospitals: A National Perspective

Organizational Characteristics Associated with Addressing Community Social Determinants of Health in U.S. Hospitals: A National Perspective

Social determinants and mental health resilience after the pandemic: A biosocial perspective

Social determinants and mental health resilience after the pandemic: A biosocial perspective

Cross-cultural dynamics: Social media and health information seeking behaviour among young adults in Cameroon

Cross-cultural dynamics: Social media and health information seeking behaviour among young adults in Cameroon

Integrating social determinants of health into cardiovascular disease management and outcomes.

Integrating social determinants of health into cardiovascular disease management and outcomes.

Social Determinants of Health and No-Show Clinic Appointments in Children with 22q11.2-Related Disorders.

ObjectiveChildren with 22q11.2 deletion syndrome (22q11.2DS) present with complex medical challenges and often are followed by multiple specialists. Healthcare for these patients may be influenced by demographic and socioeconomic factors. This study's aim is to identify factors correlated with no-show clinic visits for these children.DesignRetrospective cohort studySettingTertiary care hospitalParticipantsPediatric patients with a diagnosis of 22q11.2DS. Patients without appointment attendance or socioeconomic data were excluded.InterventionsNoneMain Outcomes and MeasuresTo identify potential healthcare disparities, the patient's home address was cross-referenced with the GeoMarker database to define socioeconomic variables. We analyzed the rate of no-show clinic appointments to identify associations with socioeconomic, racial, or ethnic factors.ResultsOf the 198 patients with 22q11.2DS were included in this study. These patients were scheduled for 2049 visits with the 22q11.2 multidisciplinary clinic (22qMDC) and 8708 additional clinic visits within the institution. The median 22qMDC no-show rate was 0% [interquartile range-IQR: 0, 9.78] and 4.35% [IQR: 0, 15.00] for other clinic appointments. Socioeconomic factors associated with clinic no-show included Hispanic or Latino ethnicity, lower median household income, lower fraction of population with high school diploma, higher fraction of population below the poverty line, and higher fraction of population that required assisted income.ConclusionsThese findings highlight potential influences of socioeconomic factors on no-show clinic appointments in children with 22q11.2DS. These factors can be used to develop targeted interventions aimed at improving clinic attendance and ultimately elevating patient outcomes.

Exploring profiles of fathers integrating food and physical activity parenting practices

Abstract Objective: This study aims to identify fathers’ profiles integrating food parenting practices (FPP) and physical activity parenting practices (PAPP). Design: We analyzed cross-sectional data. The fathers completed the reduced FPP and PAPP item banks and sociodemographic and family dynamics (co-parenting and household responsibility) questionnaires. We identified fathers’ profiles via latent profile analysis. We explored the influence of social determinants, child characteristics, and family dynamics on fathers’ profiles using multinomial logistic regression. Setting: Online survey in the US. Participants: Fathers of 5-11-year-old children. Results: We analyzed data from 606 fathers (age=38±8.0; Hispanic=37.5%). Most fathers self-identified as White (57.9%) or Black (17.7%); overweight (41.1%) or obese (34.8%); attended college (70%); earned &gt;$47,000 (62.7%); worked 40 hrs/week (63.4%); and were biological fathers (90.1%). Most children (boys=55.5%) were 5-8 years old (65.2%). We identified five fathers’ profiles combining FPP and PAPP: 1) Engaged Supporter Father (n=94 [15.5%]); 2) Leveled Father (n=160 [26.4%]); 3) Autonomy-Focused Father (n=117 [19.3%]); 4) Uninvolved Father (n=113 [18.6%]); 5) Control-Focused Father (n=122 [20.1%]). We observed significant associations with race, ethnicity, child characteristics, co-parenting, and household responsibility, but not with education level, annual income, or employment status. We observed significant pairwise differences between profiles in co-parenting and household responsibility, with the Engaged Supporter Father presenting higher scores in both measures. Conclusions: Understanding how fathers’ FPP and PAPP interact can enhance assessments for a comprehensive understanding of fathers’ influences on children’s health. Recognizing the characteristics and differences among fathers’ profiles may enable tailored interventions, potentially improving children’s health trajectories.

Social Determinants of Health Associated with Metabolic Dysfunction-Associated Steatotic Liver Disease Prevalence and Severity: A Systematic Review and Meta-analysis.

Social determinants of health (SDOH) impact disease risk and severity leading to health disparities. SDOH impacting metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence and severity are poorly characterized and results are conflicting. The aim of this systematic review and meta-analysis was to assess the impact of individual SDOH factors on MASLD burden for adults in the United States (US). We searched MEDLINE, Embase and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies from January 2010- May 2024 were included. Quantitative studies of adults in the US that evaluated SDOH beyond race/ethnicity were included. Outcomes included prevalence of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), MASH-associated advanced fibrosis or cirrhosis and clinical outcomes. We identified 18 studies comprising of 547,634 total subjects from 11 unique cohorts. Nine studies evaluated MASLD prevalence, three MASH prevalence, six MASH-associated advanced fibrosis/cirrhosis prevalence, and nine clinical outcomes. High diet quality was the most consistent SDOH factor associated with both MASLD and MASH-associated advanced fibrosis/cirrhosis prevalence (summarized OR of 0.76 p <0.01, and 0.74 p <0.01, respectively). Lower income was most consistently associated with risk of clinical outcomes (significant in 3/9 studies). Diet quality was the most consistent SDOH associated with disease prevalence and severity in MASLD, with other SDOH showing inconsistent associations. Prospective assessments using consensus, validated tools to assess the impact of specific SDOH on MASLD burden in heterogenous patient populations are needed to inform public health interventions.

Changes in disease burden and epidemiological transitions

The epidemiological transition has been characterized by demographic, societal and health changes in societies. Presuming that acute diseases, mostly of communicable etiology, are more important in terms of early-life mortality, whereas chronic diseases are responsible for a greater burden of disease throughout the life course, we attempt to develop an index to measure the stage of the epidemiological transition. Using Global Burden of Diseases, Risk Factors and Injuries (GBD) data available at https://vizhub.healthdata.org/gbd-compare/ on 04/04/2024 to calculate the Epidemiologic Transition Estimate (ETE) index as a ratio of YLD/YLL for the time period of 1990–2019. The values of the index ranged from 0.131 to 1.067 and 0.180 to 2.108 for males and females, respectively, across the 195 included countries. The transition process seems to be faster to females compared to males. The index shows consistently increasing values for five SDI-based country groups, with clear differences among the groups. Although more research and validation studies are needed despite all the uncertainties, the index seems to be robust to assess the progress in epidemiological transition. These findings can help to predict future social care and health system needs to address causes leading to YLD or YLL.