Socioeconomic Distress Research Articles

Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair.

Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals. We queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40kg/m2, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index. A total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40kg/m2, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42-0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40kg/m2 compared to males (11%) and other races (11-15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001). Nearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair.

Impact of Community Socioeconomic Distress on Survival Following Heart Transplantation.

The aim of this study was to assess the impact of community-level socioeconomic deprivation on survival outcomes following heart transplantation. Despite growing awareness of socioeconomic disparities in the US health care system, significant inequities in outcomes remain. While recent literature has increasingly considered the effects of structural socioeconomic deprivation, the impact of community socioeconomic distress on outcomes following heart transplantation has not yet been elucidated. All adult heart transplant recipients from 2004 to 2022 were ascertained from the Organ Procurement and Transplantation Network. Community socioeconomic distress was assessed using the previously validated Distressed Communities Index, a metric that represents education level, housing vacancies, unemployment, poverty rate, median household income, and business growth by zip code. Communities in the highest quintile were considered the Distressed cohort (others: Non-Distressed ). Outcomes were considered across 2 eras (2004-2018 and 2019-2022) to account for the 2018 UNOS Policy Change. Three- and 5-year patient and graft survival were assessed using Kaplan-Meier and Cox proportional hazards models. Of 36,777 heart transplants, 7450 (20%) were considered distressed . Following adjustment, distressed recipients demonstrated a greater hazard of 5-year mortality from 2004 to 2018 [hazard ratio (HR)=1.10, 95% confidence interval (CI): 1.03-1.18; P =0.005] and 3-year mortality from 2019 to 2022 (HR=1.29, 95% CI: 1.10-1.51; P =0.002), relative to nondistressed . Similarly, the distressed group was associated with increased hazard of graft failure at 5 years from 2004 to 2018 (HR=1.10, 95% CI: 1.03-1.18; P =0.003) and at 3 years from 2019 to 2022 (HR=1.31, 95% CI: 1.11-1.53; P =0.001). Community-level socioeconomic deprivation is linked with inferior patient and graft survival following heart transplantation. Future interventions are needed to address pervasive socioeconomic inequities in transplantation outcomes.

The Lived Experiences of Survivors of Child Marriage: The Case of Epworth, A Harare Municipality in Zimbabwe

Child marriage is socio-economic distress for young women and girls globally, most importantly in developing nations. Child marriage is a violation of human rights as set out in the Universal Declaration of Human Rights (article 16). Even though studies had been conducted on child marriages in Zimbabwe, very little has been done in relation to lived experiences of survivors of child marriages. The study’s aim was to explore the survivors’ experiences of child marriages in Zimbabwe. The study focused on Epworth, a Harare Municipality. It employed a qualitative research approach with thirty-six (36) participants taking part. Data was collected using semi-structured and unstructured interviews. The themes identified were causes of child marriage, challenges faced by child marriage survivors and coping mechanisms used by survivors to survive. The findings revealed that poverty and unemployment were the main causes of child marriage. As a result of these, young girls get married to secure a better life. Depression and humiliation were challenges faced by child marriage survivors. Street vending, attending churches and prayers were coping strategies used by child marriage survivors to survive. The paper concluded that child marriage is a significant socio-economic concern for young girls. It is recommended that income-generating community-based projects such as social support networks should be made available to survivors of child marriage to access basic opportunities. Keywords: Child, Child Marriage, Survivor, Lived Experience, The African Girl Child.

The Distressed Communities Index: A Measure of Community-Level Economic Deprivation and Rate of Firearm Injuries in Maryland.

This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically significant association was found between economic deprivation and ED visits for firearm injuries. Compared to prosperous communities, the odds ratios (ORs) were comfortable (OR = 1.33, 95% CI 1.04-1.71, P = .03), mid-tier (OR = 1.69, 95% CI 1.33-2.15, P < .001), at-risk (OR = 1.53, 95% CI 1.17-1.99, P < .001), and distressed (OR = 2.65, 95% CI 2.11-3.33, P < .001). The study highlights the significant association between community-level economic deprivation, as measured by the Distressed Communities Index, and the incidence of firearm injuries in Maryland. The findings underscore the importance of addressing socioeconomic disparities and implementing targeted interventions to reduce firearm-related injuries in economically distressed communities.

Lung transplantation outcomes in patients from socioeconomically distressed communities

Previous studies have demonstrated racial and gender disparities in lung allocation, but contemporary data regarding socioeconomic disparities in post-transplant outcomes are lacking. We evaluated the impact of a composite socioeconomic disadvantage index on post-transplant outcomes. The Scientific Registry of Transplant Recipients identified 27,763 adult patients undergoing isolated primary lung transplantation between 2005 and 2020. Zip code-level socioeconomic distress was characterized using the Distressed Communities Index (DCI: 0-no distress, 100-severe distress) based on education level, poverty, unemployment, housing vacancies, median income, and business growth, and patients were stratified into high (DCI ≥60) or low (DCI <60) distressed groups. Recipients from high-distress communities (n=8006, 28.8%) were younger (59years [interquartile range {IQR} 50-64] vs 61years [IQR 52-66]), less often white (73 vs 85%), less likely to have a college degree (45 vs 59%), and more likely to have public insurance (57 vs 49%, all p<0.001) compared to those from low-distress communities. Additionally, high-distress recipients were more likely to have group A diagnoses (32 vs 27%) and undergo bilateral lung transplants (72.4 vs 69.3%, all p<0.001). Post-transplant survival at 5years was 55.7% (95% confidence interval [CI]: 54.4-56.9) in high-distress recipients and 58.2% (95% CI: 57.4-58.9) in low-distress recipients (p=0.003). After adjustment, high distress level was independently associated with an increased risk of 5-year mortality (hazard ratio:1.09, 95% CI:1.04-1.15). Recipients from distressed communities are at increased mortality risk following lung transplantation. Efforts should be focused on increased resource allocation and further study to better understand factors which may mitigate this disparity.

Impact of neoliberalism on the socioeconomic life and food system of Kondh tribes of Rayagada, Odisha

The paper focuses on how the neoliberal economy is changing the agriculture and traditional food system of the Kondh tribes of Odisha, India. As Kondhs’ culture and the ritual system moves around agriculture, its increasing commercialization has led to changes in the larger socioeconomic structure. The paper discusses the immediate impacts of neoliberalism on the Kondhs’ youths and rising materialism. Widespread cultivation of Bt. Cotton and GM seeds in the region are one of the ways to trace the impact of the neoliberal market system. Most commercial exchanges performed by Kondhs and nontribal middlemen are a site for multiple negotiations and terms for trading, in which Kondhs most loose, both ecologically and economically. The paper uses ethnographic data and experiences to discuss socioeconomic distress among Kondhs, changing from barter to a cash system. It concludes by discussing if local NGOs and food movements can become a solution.

Socioeconomic disparities in midterm outcomes after repair for degenerative mitral regurgitation

ObjectiveThe influence of socioeconomic disparities on survival after mitral repair is poorly defined. We examined the association between socioeconomic disadvantage and midterm outcomes of repair in Medicare beneficiaries with degenerative mitral regurgitation. MethodsUS Centers for Medicare and Medicaid Services data were used to identify 10,322 patients undergoing isolated first-time repair for degenerative mitral regurgitation between 2012 and 2019. Zip code-level socioeconomic disadvantage was dichotomized with the Distressed Communities Index, which incorporates education level, poverty, unemployment, housing security, median income, and business growth; those with Distressed Communities Index score ≥80 were classified as distressed. The primary outcome was survival, censored at 3 years. Secondary outcomes included cumulative incidences of heart failure readmission, mitral reintervention, and stroke. ResultsOf the 10,322 patients undergoing degenerative mitral repair, 9.7% (n = 1003) came from distressed communities. Patients from distressed communities underwent surgery at lower volume centers (11 vs 16 cases/year) and traveled further for surgical care (40 vs 17 miles) (both P values < .001). At 3 years, unadjusted survival (85.4%; 95% CI, 82.9%-87.5% vs 89.7%; 95% CI, 89.0%-90.4%) and cumulative incidence of heart failure readmission (11.5%; 95% CI, 9.6%-13.7% vs 7.4%; 95% CI, 6.9%-8.0%) were worse in patients from distressed communities (all P values < .001), whereas mitral reintervention rates were similar (2.7%; 95% CI, 1.8%-4.0% vs 2.8%; 95% CI, 2.5%-3.2%; P = .75). After adjustment, community distress was independently associated with 3-year mortality (hazard ratio, 1.21; 95% CI, 1.01-1.46) and heart failure readmissions (hazard ratio, 1.28; 95% CI, 1.04-1.58). ConclusionsCommunity-level socioeconomic distress is associated with worse outcomes in degenerative mitral repair among Medicare beneficiaries.

Chronic pain among U.S. sexual minority adults who identify as gay, lesbian, bisexual, or "something else".

This study assesses chronic pain prevalence among sexual minority U.S. adults who self-identify as gay/lesbian, bisexual, or "something else," and examines the role of select covariates in the observed patterns. Analyses are based on 2013 to 2018 waves of the National Health Interview Survey, a leading cross-sectional survey representative of the U.S. population. General chronic pain and chronic pain in 3+ sites among adults aged 18 to 64 years (N = 134,266 and 95,675, respectively) are analyzed using robust Poisson regression and nonlinear decomposition; covariates include demographic, socioeconomic, healthcare, and psychological distress measures. We find large disparities for both pain outcomes. Americans who self-identify as bisexual or "something else" have the highest general chronic pain prevalence (23.7% and 27.0%, respectively), compared with 21.7% among gay/lesbian and 17.2% straight adults. For pain in 3+ sites, disparities are even larger: Age-adjusted prevalence is over twice as high among adults who self-identify as bisexual or "something else" and 50% higher among gay/lesbian, compared with straight adults. Psychological distress is the most salient correlate of the disparities, whereas socioeconomic status and healthcare variables explain only a modest proportion. Findings thus indicate that even in an era of meaningful social and political advances, sexual minority American adults have significantly more chronic pain than their straight counterparts. We call for data collection efforts to include information on perceived discrimination, prejudice, and stigma as potential key upstream factors that drive pain disparities among members of these minoritized groups.

Abstract P180: Disparities in Occurrence of Stroke Among Heart Failure Patients- A Case Control Study Evaluating Impact of Community Socioeconomic Distress Index

Introduction: Ischemic stroke is common complication among heart failure patients. Community-level socio-economic distress has been linked to adverse clinical outcomes in prior research. However, few to no studies have examined the relationship between neighborhood level socio-economic distress and stroke within a population of heart failure patients exclusively. Hypothesis: Odds of stroke among patients with heart failure are higher in neighborhoods with increased socio-economic distress, controlling for patient demographic and clinical comorbidities. Methods: Two separate cohorts of heart failure patients were assembled using ICD9/10 codes to identify all patients with a heart failure diagnosis seen at West Virginia University Hospital Systems (WVU Medicine) between 2008 and 2020 and Charleston Area Medical Center (CAMC) between 2017 and 2020. Cases were defined as heart failure patients with a diagnosis of ischemic stroke. Controls were defined as heart failure patients without a diagnosis of stroke and were matched to cases 4:1 on five-year age grouping and sex at birth. Distressed communities index (DCI) was linked to clinical data by patient zip code of residence. Neighborhoods with a DCI above 75 were classified as distressed, while those below were noted as non-distressed. Multivariable conditional logistic regression was used to identify significant associations at the 95% confidence level within each cohort separately. Results: In total there were 26,532 unique heart failure patients in the WVU Medicine cohort and 20,070 in the CAMC cohort. Of these, 10.3% (n=2,741) of the WVU Medicine cohort and 4.5% (n=900) of the CAMC cohort met the case definition of having had a diagnosis of stroke. Among patients in the WVU Medicine cohort with heart failure who experienced a stroke, 47.1% (n=1,291) were male and had an average age of 72.4 (± 12.9). In the CAMC cohort, among heart failure patients who experienced a stroke, 51.1% (n=460) were male and the average age was 70.9 (± 11.8). After controlling for demographics and clinical comorbidities, conditional logistic regression analyses identified a statistically significant association between neighborhood-level socio-economic distress in both the WVU Medicine cohort (OR = 1.31; 95% CI = 1.20 - 1.44) and the CAMC cohort (OR = 1.29; 95% CI = 1.027 - 1.454). Conclusion: Neighborhood-level socio-economic distress was associated with prevalence of stroke among heart failure patients. This is a critical finding for rural states, such as West Virginia, as it has the ability to inform placement of new satellite clinics among large hospital systems, or government funded clinics, such as federally qualified health centers, to address inequities in care for patients living in medically underserved communities.

Community-level socioeconomic distress is associated with nutritional status in adults with sickle cell anemia.

Sickle cell anemia (SCA) negatively impacts the ability to achieve educational and occupational goals increasing vulnerability to socioeconomic challenges. In a cross-sectional analysis of 332 SCA adults, we investigated whether the distressed community index (DCI) was associated with SCA-related complications and nutritional status. More patients with higher DCI had Medicaid insurance. A higher DCI was independently associated with tobacco use and lower body mass index, serum albumin, and vitamin D 25-OH levels after adjusting for insurance status but was not associated with SCA-related complications. Future studies investigating access to healthy foods may help improve health equity in patients with SCA.

How complex is COVID-19: Spatiotemporal variation of chaotic nature of the virus in Indian states.

Like other pandemics, COVID-19 also created a huge socioeconomic imbalance and distress in people. Often, every pandemic is characterized as chaotic and complex. Hence, the nature of the virus spread and deaths should be analyzed to prepare for the next similar pandemic. In this analysis, the popular and well-known time series in chaos theory is implemented, and the results are deduced for the states of India. The phase space reconstruction algorithm is implemented, and false nearest neighbor (FNN) method is applied to determine the dimensionality, and also Lyapunov exponent of the time series is estimated. The chaotic nature of COVID-19 cases showed a less severe and low complexity, with the FNN dimension range of 3-5, whereas the COVID-19 deaths showed moderate complexity with FNN dimensions 2-7. Policymakers should take action on medical availability in rural states and control people's movement in highly populated areas.

Race/ethnicity, sleep duration, and mortality risk in the United States

Current evidence and professional guidance recommend sleeping between 7 and 9 h in a 24-h period for optimal health. The present study examines the association between sleep duration and mortality and assesses whether this association varies by racial/ethnic identity for a large and diverse sample of United States adults. We use data on 274,836 adults, aged 25 and older, from the 2004–2014 waves of the National Health Interview Survey (NHIS) linked to prospective mortality through 2015 (23,382 deaths). Cox proportional hazards models were used in multi-variable regressions to estimate hazard ratios for mortality by sleep duration and racial/ethnic identity, controlling for sociodemographic, socioeconomic, and psychological distress variables. We find elevated risks of mortality from any cause for adults who sleep less than 5 h or more than 9 h in a 24-h period after all adjustments. Further, we find evidence that these elevated risks for mortality are more pronounced for some racial/ethnic groups and less pronounced for others. Improved understanding of differences in sleep duration and sleep health can facilitate more effective and culturally-tailored interventions around sleep health, improving overall well-being and enhancing longevity.

Cardiac Surgery Outcomes During the COVID-19 Pandemic Worsened Across All Socioeconomic Statuses

BackgroundIncreasing socioeconomic distress has been associated with worse cardiac surgery outcomes. The extent to which the pandemic affected cardiac surgical access and outcomes remains unknown. We sought to examine the relationship between the COVID-19 pandemic and outcomes after cardiac surgery by socioeconomic status. MethodsAll patients undergoing a Society of Thoracic Surgeons (STS) index operation in a regional collaborative, the Virginia Cardiac Services Quality Initiative (2011-2022), were analyzed. Patients were stratified by timing of surgery before vs during the COVID-19 pandemic (March 13, 2020). Hierarchic logistic regression assessed the relationship between the pandemic and operative mortality, major morbidity, and cost, adjusting for the Distressed Communities Index (DCI), STS predicted risk of mortality, intraoperative characteristics, and hospital random effect. ResultsA total of 37,769 patients across 17 centers were included. Of these, 7269 patients (19.7%) underwent surgery during the pandemic. On average, patients during the pandemic were less socioeconomically distressed (DCI 37.4 vs DCI 41.9; P < .001) and had a lower STS predicted risk of mortality (2.16% vs 2.53%, P < .001). After risk adjustment, the pandemic was significantly associated with increased mortality (odds ratio 1.398; 95% CI, 1.179-1.657; P < .001), cost (+$4823, P < .001), and STS failure to rescue (odds ratio 1.37; 95% CI, 1.10-1.70; P = .005). The negative impact of the pandemic on mortality and cost was similar regardless of DCI. ConclusionsAcross all socioeconomic statuses, the pandemic is associated with higher cost and greater risk-adjusted mortality, perhaps related to a resource-constrained health care system. More patients during the pandemic were from less distressed communities, raising concern for access to care in distressed communities.

Evaluating the interaction effects of housing vulnerability and socioeconomic vulnerability on self-perceptions of psychological resilience in Puerto Rico

In 2017, Hurricanes Irma and Maria caused devastating impacts on Puerto Rico's housing stock, leading to distress among homeowners due to material and social losses. One critical aspect of the recovery effort is their perceived ability to cope. Previous research has identified that socioeconomic and housing vulnerability impact people's distress levels in the aftermath of a disaster. However, this focused on socioeconomic and housing vulnerability on distress with less knowledge of their association with resilience perceptions. Importantly, socioeconomic and housing vulnerability may have a multiplicative effect on self-perceptions of psychological resilience. This research used door-to-door surveys (N = 235) in two of Puerto Rico's municipalities to address this gap. Results based on linear regression showed that the compounding effects of interior damage in housing and education are significantly associated with psychological resilience. The results contribute to the resilience theory, wherein an adversity is mediated by a certain process that contributes to its resilience outcomes. This deviates from conventional studies that consider socioeconomic and housing vulnerabilities as independent contributing factors to psychological resilience. A key point emphasized in this study is that adversity, such as a disaster causing damage to housing, is moderated by a process such as socioeconomic vulnerability, predicting the strength or weakness of psychological resilience. The contrast between self-perceptions of psychological resilience among lower and higher-education individuals provides novel information to stakeholders and implies policy and practice reforms to create resilience.

Association of Community-Level Socioeconomic Distress with Nutritional Status in People with Sickle Cell Anemia

Introduction: Sickle cell anemia (SCA) is characterized by a myriad of acute and chronic complications. These complications negatively impact the ability to achieve educational and occupational goals making this group a particularly vulnerable population to socioeconomic challenges (PMID 30540112). Furthermore, most patients with SCA in the U.S. are Black and are disproportionately affected by socioeconomic inequity due to the historical effects of systemic racism (PMCID: PMC4817358). In the general population, indices of socioeconomic distress are associated with poor nutrition (PMID 25573510). Patients with SCA also experience a high frequency of food insecurity (PMID 34811867). The association of community-level socioeconomic distress with nutritional status in people with SCA is unknown. Methods: We conducted a cross-sectional study to describe the burden of community-level socioeconomic distress and its impact on nutritional status in an SCA cohort (n=332) treated at an urban academic institution. The distressed community index (DCI), a composite of socioeconomic indicators (including no high school diploma, housing vacancy rate, adults not working, poverty rate, median income ratio, and changes in employment and establishments) that estimate the economic well-being of a community, was determined for each individual patient's residential address using 2014-2018 U.S. Census Bureau's American Community Survey and the Business Patterns database. DCI score ranges from 0-100 with a higher score indicating a more distressed community. The association of DCI with measures of nutritional status (serum albumin, body mass index [BMI], vitamin D 25-OH) and hemoglobin concentration were determined using linear regression. The analyses were adjusted for age, sex, and hydroxyurea use. The beta coefficients provided are based on increments of 10 for DCI. Median and interquartile ranges (IQR) are provided. Results: The median age of the cohort was 31 years (IQR, 24-41 years), 55% were female, 53% were on hydroxyurea therapy, and the median BMI was 23 kg/m2 (IQR, 21-26 kg/m2). The median DCI in this cohort was 87 (IQR, 61-96) with 61% of SCA patients living in a distressed tier (DCI≥ 80) and only 5% living in a prosperous tier (DCI< 20). A higher DCI, reflecting an increase in socioeconomic distress, was associated with a trend for a lower odds ratio (OR) of being on hydroxyurea therapy (OR 0.93; 95% CI 0.86-1.0). An increasing DCI was significantly associated with lower serum albumin (β= -0.02; P=0.016), BMI (β= -0.01; P=0.045), and vitamin D 25-OH levels (β= -0.7; P=0.001), adjusting for age, sex, and hydroxyurea use (Figure). Furthermore, SCA patients living in a more distressed community had a trend for lower hemoglobin concentrations (β= -0.05; P=0.077) with similar adjustments. Discussion: In conclusion, we demonstrate that a high proportion of patients with SCA treated at an urban academic institution live in distressed socioeconomic communities. Higher distressed community indices are associated with lower utilization of hydroxyurea and lower measures of nutritional status. Future studies investigating the effects of socioeconomic distress on access to outpatient care and healthy foods may guide public health strategies to improve health disparities in the SCA population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The association between socioeconomic distress communities index and amputation among patients with peripheral artery disease.

Socioeconomic factors have been shown to be associated with amputation in peripheral artery disease (PAD); however, analyses have normally focused on insurance status, race, or median income. We sought to determine whether community-level socioeconomic distress was associated with major amputation and if that association differed by race. Community-level socioeconomic distress was measured using the distressed communities index (DCI). The DCI is a zip code level compositive socioeconomic score (0-100) that accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies. A distressed community was defined as a zip code with DCI of 40 or greater. We calculated one-year risk of major amputation by DCI score for individuals with peripheral artery disease in South Carolina, 2012-2017. Treating death as competing event, we reported Fine and Gray subdistribution hazards ratios (sdHR), adjusted for patient demographic and clinical comorbidities associated with amputation. Further analyses were completed to identify potential differences in outcomes within strata of race and DCI. Among 82,848 individuals with peripheral artery disease, the one-year incidence of amputation was 3.5% (95% CI: 3.3%, 3.6%) and was significantly greater in distressed communities than non-distressed communities (3.9%; 95% CI: 3.8%, 4.1% vs. 2.4%; 95% CI: 2.2%, 2.6%). After controlling for death and adjusting for covariates, we found an increased hazard of amputation among individuals in a distressed community (sdHR: 1.25; 95% CI: 1.14, 1.37), which persisted across racial strata. However, regardless of DCI score, Black individuals had the highest incidence of amputation. Socioeconomic status is independently predictive of limb amputation after controlling for demographic characteristics and clinical comorbidities. Race continues to be an important risk factor, with Black individuals having higher incidence of amputation, even in non-distressed communities, than White individuals had in distressed communities.

Impact of COVID social distancing measures on eating and exercise behaviors among a sample of Hispanic parents of young children in the United States.

In the United States, healthy behaviors, such as eating fruits/vegetables and exercise, are well below recommended levels, particularly for Hispanics. The COVID pandemic may have exacerbated existing health behavior disparities. The current study examines the impact of COVID social distancing measures on Hispanic parents' eating and exercise behaviors, and how the impact may differ by socioeconomic status (SES) and distress levels. This cross-sectional logistic regression study utilized data from a sample of Hispanic parents in Texas (n = 237). COVID-related questions were collected in Summer 2020. Dependent variables included self-reported changes in exercise and eating behaviors due to the pandemic (i.e. got better or got worse). Primary independent variables included family-SES, neighborhood-SES, and distress due to COVID. More than half (60%) of parents reported that their eating and exercise behaviors worsened. Results showed a significant relationship between distress due to COVID and both dependent variables; changes in eating (OR = 1.38, 95% CI [1.20, 1.58]) and changes in exercise (OR = 1.28, 95% CI [1.11, 1.48]). There were no observed differences by SES. Results suggest distress due to COVID was associated with worsening of eating and exercise behaviors, regardless of SES. The direction of the relationship between distress and healthy eating and exercise behaviors requires further attention.

System Failure: The Geographic Distribution of Sepsis-Associated Death in the USA and Factors Contributing to the Mortality Burden of Black Communities.

Sepsis is deadly and costly to health care systems, but these costs are disproportionately born by Black patients. Little empirical work has established the geographic patterning of sepsis or its area-level correlates. This study illustrates the geography of sepsis-associated death and racial composition of US counties with area socioeconomic indicators, health care access, and population health. Cartographic and spatially explicit analyses utilize mortality data from the National Cancer Institute and county data from the American Community Survey, Area Health Resource File, and County Health Rankings. Death rates are highest in the South, Southeast, and Appalachia. Counties disproportionately populated by Black people have higher death rates and associated risk indicators including poor air quality and vaccination coverage, socioeconomic distress, and impaired access to high-quality health care. Spatial Durbin error models suggest that conditions in nearby counties may also influence death rates within focal counties. Racial disparities in sepsis-associated death can be narrowed with improved health care equity—including immunization coverage—and by reducing socioeconomic distress in Black communities. Policy options for achieving these ends are discussed.

Readmission and Resource Utilization in Patients From Socioeconomically Distressed Communities Following Lumbar Fusion.

Retrospective cohort study. To determine whether: (1) patients from communities of socioeconomic distress have higher readmission rates or postoperative healthcare resource utilization and (2) there are differences in patient-reported outcome measures (PROMs) based on socioeconomic distress. Socioeconomic disparities affect health outcomes, but little evidence exists demonstrating the impact of socioeconomic distress on postoperative resource utilization or PROMs. A retrospective review was performed on patients who underwent lumbar fusion at a single tertiary academic center from January 1, 2011 to June 30, 2021. Patients were classified according to the distressed communities index. Hospital readmission, postoperative prescriptions, patient telephone calls, follow-up office visits, and PROMs were recorded. Multivariate analysis with logistic, negative binomial regression or Poisson regression were used to investigate the effects of distressed communities index on postoperative resource utilization. Alpha was set at P <0.05. A total of 4472 patients were included for analysis. Readmission risk was higher in distressed communities (odds ratio, 1.75; 95% confidence interval, 1.06-2.87; P =0.028). Patients from distressed communities (odds ratio, 3.94; 95% confidence interval, 1.60-9.72; P =0.003) were also more likely to be readmitted for medical, but not surgical causes ( P =0.514), and distressed patients had worse preoperative (visual analog-scale Back, P <0.001) and postoperative (Oswestry disability index, P =0.048; visual analog-scale Leg, P =0.013) PROMs, while maintaining similar magnitudes of clinical improvement. Patients from distressed communities were more likely to be discharged to a nursing facility and inpatient rehabilitation unit (25.5%, P =0.032). The race was not independently associated with readmissions ( P =0.228). Socioeconomic distress is associated with increased postoperative health resource utilization. Patients from distressed communities have worse preoperative PROMs, but the overall magnitude of improvement is similar across all classes. Level IV.

Wound Healing and Antioxidant Properties of 80% Methanol Leaf Extract of Verbascum sinaiticum (Scrophulariaceae): An Ethiopian Medicinal Plant.

Wounds account for severe morbidity, socioeconomic distress, and mortality around the globe. For several years, various herbal products are used to expedite and augment the innate wound healing process. In Ethiopian folkloric medicine, Verbascum sinaiticum L. (V. sinaiticum) is commonly applied as a wound-healing agent. The present study investigated the potential wound healing and antioxidant properties of hydroalcoholic leaf extract of V. sinaiticum. The 80% methanol extract, formulated as 5% (w/w) and 10% (w/w) ointments, was evaluated in excision and incision wound models using nitrofurazone and simple ointment as positive and negative controls, respectively. Parameters such as wound contraction, period of epithelialization, and tensile strength were determined. Moreover, its in vitro antioxidant property was evaluated using a DPPH assay. In the excision model, both doses (5% and 10% w/w) of the extract showed a significant (p < 0.001) wound healing efficacy compared to the negative control as evidenced by enhanced wound contraction rate and shorter epithelialization time records. In the incision model, the lower dose (5% w/w) ointment formulation of the extract exhibited the maximum increment in tensile strength (85.6%) that was significant (p < 0.001) compared to negative and untreated controls. Animals treated with 5% w/w ointment, furthermore, showed a significantly (p < 0.05) higher percentage of tensile strength than nitrofurazone treated ones. Moreover, the hydroalcoholic extract of the plant showed a noticeable free radical scavenging property. The result of the present study upholds the folkloric use of V. sinaiticum in the treatment of wounds.