Socioeconomic Disparities In Health Research Articles

Socioeconomic mental health disparities and income mobility in Australia: A longitudinal factor decomposition analysis

In recent years mental health disparity has been rising in Australia. The contributing factors to this rising disparity are not well understood. We investigated this by measuring and decomposing socioeconomic mental health inequality in Australia using the Household, Income and Labour Dynamics in Australia (HILDA) panel survey datasets between 2009 and 2017 employing the longitudinal factor decomposition method. In this research, we decompose the Income-Related Health Mobility (IRHM) and the Health-Related Income Mobility (HRIM) index. The IRHM index reflects the effect of the relationship between relative health changes at a constant income level, and the HRIM index represents changes in income ranking or income mobility with a fixed health outcome over time. Our findings suggest that poorer individuals cannot procure private health insurance, experience more long-term health conditions and have larger exposure to life shocks than richer individuals. Thus, long-term health conditions, private health insurance coverage, and number of life disruptions are the primary factors that negatively impact the IRHM index, thereby contributing to an increase in socioeconomic inequality in mental health in Australia. Moreover, the HRIM index exhibits a more pronounced adverse impact from labour force status compared to the relatively weaker positive effects observed in the IRHM index, resulting in a net negative effect from labour force status in this period. To address this, Australian governments should focus on implementing cost-effective intervention policies targeting disadvantaged populations to maximise health system resources and minimise mental health disparity by addressing the socioeconomic determinants of mental health.

Stress, Allostatic Load, and Neuroinflammation: Implications for Racial and Socioeconomic Health Disparities in Glaucoma.

Glaucoma is the leading cause of irreversible blindness, and its pathophysiology includes neuroinflammatory changes. The present therapies for glaucoma target pressure-lowering mechanisms with limited success, making neuroinflammation a target for future interventions. This review summarizes the neuroinflammatory pathways seen in glaucoma and their interplay with stress. Glucocorticoids have been shown to activate proinflammatory glial cells, contributing to the neuroinflammation in glaucoma. Glucocorticoids have also been shown to increase the IOP directly. Stress-associated autonomic dysfunction can affect the vascular homeostasis in the retina and create oxidative stress. Diabetes, hyperglycemic-mediated endothelial damage, and vascular inflammation also play important roles in the neuroinflammation in glaucoma and diabetic retinopathy. Psychosocial stress has been implicated in an increased IOP and glaucoma outcomes. People who experience maladaptive chronic stress suffer from a condition known as allostatic load, which describes pathologic neuroendocrine dysregulation. The effects of allostatic load and chronic stress have been studied in patients affected by a lower socioeconomic status (SES) and marginalized racial identities. A lower SES is associated with higher rates of glaucoma and also affects the access to care and screening. Additionally, people of African ancestry are disproportionately affected by glaucoma for reasons that are multifactorial. In conclusion, this review explores neuroinflammation in glaucoma, highlighting opportunities for future investigation.

Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities

Food insecurity and the lack of access to affordable, nutritious food are associated with poor dietary quality and an increased risk of diet-related diseases, including cardiovascular disease, diabetes, and certain types of cancer. Those of lower socioeconomic status and racial and ethnic minority groups experience higher rates of food insecurity, are more likely to live in under-resourced food environments, and continue to bear the greatest burden of diet-related chronic diseases in the United States. Despite the growing body of literature in this area, there are still significant gaps in our understanding of the various pathways that link food insecurity and neighborhood food environments to racial/ethnic and socioeconomic disparities in health and the most effective intervention strategies to address these disparities. To better understand the science in this area, the National Institutes of Health, in collaboration with the Centers for Disease Control (CDC) and Prevention and the United States Department of Agriculture (USDA), convened a virtual 3-d workshop 21–23 September 2021: Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science. The workshop brought together a diverse group of researchers, practitioners, policymakers, and federal partners with expertise in nutrition, the food environment, health and social policy, and behavioral and social sciences. The workshop had the following 3 research objectives: 1) summarize the state of the science and knowledge gaps related to food insecurity, neighborhood food environments, and nutrition health disparities, 2) identify research opportunities and strategies to address research gaps, and 3) examine evidence-based interventions and implementation approaches to address food insecurity and neighborhood food environments to promote health equity. This article summarizes workshop proceedings and describes research gaps and future opportunities that emerged from discussions.

Early detection of lung cancer through programmatic management of pulmonary nodules in the Mississippi Delta.

126 Background: Lung cancer (LC) causes the most cancer deaths in the US, but early detection improves outcomes. Uptake of Low-Dose CT screening (LDCT) has been low, contributing to race-based disparities. Programmatic management of incidentally detected pulmonary nodules (PN) provides a complementary avenue for early detection which could address disparities. In our PN cohort, Detecting Early LC in the Mississippi Delta (DELUGE), we provide broad access to early detection across a region fraught with geographic, socioeconomic, and race-based disparities. However, many detected PN will not result in LC. After successful implementation at the program level, we seek to evaluate individual-level factors important for early-detection. We evaluated how individuals with small PN identified in DELUGE differ between those who were and were not diagnosed with LC. Methods: DELUGE is a prospective cohort study where we systematically manage incidentally detected PN with trained navigators and evidence-based risk stratification. We constructed DELUGE in a community-based healthcare system across the mid-south with some of the highest per-capita LC incidence and mortality rates in the US. We evaluated all PN ≤30mm in DELUGE from 2015-2022. We compared clinical and demographic characteristics between individuals who were or were not diagnosed with LC within 24 months. Primary analysis used logistic regression, reporting odds ratios (OR) with 95% confidence intervals. Results: From 2015-2022, 17,945 individuals with PN ≤30 mm (71% of the total cohort of 25,339) were identified and enrolled in DELUGE. They had median age of 65 years, were 56% female, and 27% Black / 69% White. 853 (4.8%) patients were diagnosed with LC within two years. PN size significantly predicted LC diagnosis. For every 1 mm increase in nodule size the odds of LC increased by 15% (OR: 1.15 [1.14-1.16]); PN in an upper lobe (OR: 2.0 [1.7-2.2]) and those with cavitation also increased the odds of LC (OR: 2.9[1.9-4.2]). Sex, rural/urban residence, and number of PN were not associated with LC. The most predictive individual level characteristics were age, prior cancer history (OR: 1.3 [1.1-1.5], family cancer history (OR: 1.7 [1.5-2.0], COPD (OR: 3.3 [2.9-3.8]), and smoking history (OR: 6.6 [5.3-8.4]). In the multiple variable model, the most significant associations with LC diagnosis included PN size, age, insurance, family cancer history, COPD, and smoking history (all p<0.0001). This model could provide estimated sensitivity 0.81 and specificity 0.81 for predicting LC (AUC= 0.88). Conclusions: Factors measurable at baseline have predictive ability, and predictive modeling may be useful in management of small PN. More focused follow-up could improve programmatic efficiency, targeting the alleviation of geographic, socioeconomic, and race-based health disparities in this high poverty region of the US.

Municipal social expenditures and maternal health disparities: a study of linked birth and hospitalisation records

BackgroundLocal government expenditures provide services and benefits that can affect health but the extent to which they are associated with narrowing or widening of racial/ethnic and socioeconomic disparities in health...

Do disasters exacerbate socioeconomic inequalities in health among older people?

Disasters can exacerbate socioeconomic health disparities because of differential exposure (e.g., socioeconomically disadvantaged groups are more likely to be exposed to disaster-related trauma) and differential vulnerability (disadvantaged groups are more likely to suffer health consequences of exposure to trauma). We sought to test whether health disparities among older adults widened in the area which was directly affected by the 2011 Great East Japan Earthquake & Tsunami compared to areas which largely escaped tsunami damage. We used data from a cohort of community-dwelling older adults who were directly affected by the 2011 disaster (the Iwanuma Study) and municipalities that were not directly affected (the JAGES parent cohort excluding Iwanuma city). The Iwanuma Study gathered pre-disaster information from participants in 2010 (seven months before the disaster) as well as post-disaster information in 2013, 2016 and 2019 (2.5, 5.5 and 8.5 years after the disaster). Our outcomes were depressive symptoms (GDS) and instrumental activities of daily living (IADL). We examined the pre-versus post-disaster trends in socioeconomic health disparities using the slope index and relative index of inequality. We then conducted a difference-in-difference analysis comparing the pre/post disaster change in health disparities in the “exposed” city (Iwanuma) compared to “control” cities. We found clear pre-disaster socioeconomic inequalities in both GDS and IADL in both the exposed and control cities. However, the magnitude of these inequalities did not change after the disaster on either the absolute or relative scales. The 2011 disaster in northeastern Japan did not exacerbate pre-existing patterns of health inequalities in the older population.

Sleep, Poverty, and Biological Stress: Mitigating Sleep Health Disparities in Early Childhood

In the first years of life, poverty increases the risk of sleep problems such as late bedtimes and frequent night awakenings. In turn, children with sleep problems are more likely to go on to have poor physical and mental health outcomes as adults. The development of sleep and biological stress systems is connected, so that sleep problems can lead to abnormal function of the stress hormone cortisol and contribute to enduring socioeconomic health disparities. Sleep also is critical to brain and cognitive development. Sleep practices such as inconsistent bedtime and absence of a bedtime routine are more common in families experiencing poverty and stress. To address early childhood sleep problems, there is an urgent need for policies that help low-income families to access behavioral sleep interventions; provide families with affordable healthcare, housing, and nutrition; and adjust childcare and school practices to support healthy sleep.

“Not a Major or Complicated Task”: Activating Dugnad under COVID-19 and the Imagination of Equality in the Norwegian Welfare State

In Norway, the institution of the welfare state and trust in the government defined the country’s approach to tackling the pandemic. In particular, the government’s strategy to activate the cultural concept of dugnad (voluntary, reciprocal communal work), which relies on an equal standing of all participants, plays into the national imaginary of an egalitarian and just society. However, like in other countries, COVID-19 has put the spotlight on inequalities in access to healthcare, information, adequate housing, and more. Investigating infection measures and their indirect consequences can clarify which values and people are given priority in a crisis and who is seen as belonging to Norwegian society. This article points to the pandemic as a magnifying glass revealing the lack of enough emergency care nurses, physicians, equipment, hospital and psychiatry beds, adequate health literacy efforts and more. Moreover, it magnifies heteronormative and Eurocentric ideas of who makes up a family, compounded by nationalistic notions of who is Norwegian enough to belong. By activating dugnad, politicians transferred their responsibilities as elected leaders to individual citizens, leading to the growth of socioeconomic inequalities and health disparities during the pandemic while also resulting in the poor communication of the long-term and indirect costs of pandemic measures.

"I don't have the energy": Racial stress, young Black motherhood, and Canadian social policies.

Significant socio-economic, health, and mental health disparities due to highly entrenched and systemic anti-Black racism in Canadian institutions, policies, and practices are now well documented in research and policy reports. Yet, few in-depth studies have addressed the mental health impacts of anti-Black racism on Canadian populations. This article is rooted in a community-based, qualitative research project with young first and second-generation Black Caribbean-Canadian mothers and is informed by Black Feminist epistemologies and intersectional theories and methodologies. Our research demonstrates how participants' childhood experiences with xenophobic and racist immigration policies and educational, child welfare, and childcare systems caused their future mental health challenges as young Black mothers, and how these struggles were exacerbated by their encounters with the racist, ageist, xenophobic medical, social, and mental health services they had to access as young mothers. Based on these findings, we recommend enhancements to current social policies to minimize the differential mental health impacts on young Black Canadian mothers.

Repairing the prosthetic science-policy rift: Challenges to improved access to and translation of prosthetic technologies

We outline a brief history of the technology and state of medical care for individuals with limb loss throughout several eras of innovation in the United States. We review current challenges to preventative and post-amputation prosthetic health access, as well as the racial and socioeconomic health disparities among individuals who experience limb loss. We explore scientifically-inspired solutions to bridge the gap between current and emerging advanced technology and health coverage that can expand patient access to prosthetic devices and services.

Policy Brief.

Policy Brief.

Impact of health disparities on national breast cancer screening participation rates in South Korea

Socioeconomic barriers to cancer screening exist at a regional level. The deprivation index is used to estimate socioeconomic gradients and health disparities across different geographical regions. We aimed to examine the impact of deprivation on breast cancer screening participation rates among South Korean women. Municipal breast cancer screening participation rates in women were extracted from the National Cancer Screening Information System and linked to the Korean version of the deprivation index constructed by the Korea Institute for Health and Social Affairs. A generalised linear mixed model was employed to investigate the association between the deprivation index and age-standardised breast cancer screening participation rates in 2005, 2012, and 2018. Participation rates increased gradually across all age groups from 2005 to 2018. Participants in their 60 s consistently had one of the highest participation rates (2005: 30.37%, 2012: 61.57%, 2018: 65.88%). In 2005, the most deprived quintile had a higher estimate of breast cancer screening participation than the least deprived quintile (2nd quintile; estimate: 1.044, p = 0.242, 3rd quintile; estimate: 1.153, p = 0.192, 4th quintile; estimate: 3.517, p = 0.001, 5th quintile; estimate: 6.913, p =  < 0.0001). In 2012, the participation rate also increased as the level of deprivation increased. There were no statistically meaningful results in 2018. Regions with high deprivation have a higher participation rate in breast cancer screening. The role of health disparities in determining cancer outcomes among women in Korea requires further examination.

How socioeconomically disadvantaged people access, understand, appraise, and apply health information: A qualitative study exploring health literacy skills.

Health literacy, or a person's competence to access, understand, appraise and apply health information, can be considered a mediating factor between socioeconomic characteristics and health disparities. Socioeconomically disadvantaged people in particular present with less health literacy skills. To develop targeted interventions tailored to their real needs, it is important to understand how they function and what difficulties they encounter when dealing with health information. The purpose of this study was to explore their experiences when accessing, understanding, appraising, and applying health information in their everyday lives. Semi-structured face-to-face interviews were conducted with 12 socioeconomically disadvantaged adults living in the community in Switzerland (age range: 44-60 years old). Thematic analysis of the interviews yielded four themes, describing the health literacy processes of participants, related barriers, and compensatory strategies used: Financial insecurity triggers the need for health information; Pathway 1: Physicians as ideal (but expensive) interlocutors; Pathway 2: The internet as a suboptimal alternative; and Pathway 3: Relatives as a default resource. The progression of socioeconomically disadvantaged people in the health literacy process is like an 'obstacle course', with numerous steps taken backwards before they can develop compensatory strategies to overcome the barriers to obtaining health information. Financial deprivation seems to be the most important factor contributing to health literacy barriers. Appraising health information is the health literacy skill with which socioeconomically disadvantaged people struggle the most. Physician-based, individual skills-based, organizational, and policy-based interventions are needed to help them overcome their health literacy challenges.

Exploring the relationship between multiple dimensions of subjective socioeconomic status and self-reported physical and mental health: the mediating role of affect.

This study aimed to investigate the predictive effects of two types of subjective socioeconomic status on self-reported physical and mental health. Specifically, we examined the MacArthur Scale (MacArthur) which measures perceived socioeconomic rank in the society and a novel scale called ComSim, which assessed how participants compared themselves socioeconomically to others coming from a similar socioeconomic background. We also considered the influence of income, education, and personal relative deprivation (PRD) in these analyses. Additionally, we explored whether these effects were mediated through negative and positive affect. The data were collected through a cross-sectional, two-wave survey of 294 women and 294 men, with a mean age 41.6 years. Participants were recruited via an online platform. The results from multivariate regression models revealed that socioeconomic status measured with both the MacArthur Scale and ComSim significantly predicted both self-reported health measures, whereas income and education did not predict any of these measures in the full multivariate models. PRD only predicted self-reported mental health. Mediation analyses showed that negative and positive affect mediated the relationships between socioeconomic status measured by ComSim and self-reported health measures. These findings are discussed in the context of the similarity hypothesis of social comparison theory. The results underscore the importance of considering multiple dimensions when examining socioeconomic health disparities.

Socioeconomic Status & Health Disparities: Utilizing a Composite Index across Health Datasets

Research indicates that the relationship between socioeconomic status (SES) and health outcomes are robust, though no ‘gold standard’ as to what best captures SES exists. Many studies use individual proxies to control for SES, but there are a number of limitations to doing so. Additionally, little research has been conducted as to how to develop a US-based composite SES index that can be utilized across various datasets. The aim of the study is to generate a weighted SES index, following the National Assessment of Educational Progress (NAEP)’s call for an understanding of SES groupings and the guidance of the Bureau of Justice’s SES index. After generating a composite SES index, we evaluate whether or not each unique index delivers a similar classification of SES across four national datasets and empirically compare the resulting grouping across datasets utilizing multiple regression analyses. Using weighted descriptive statistics and weighted logistic regression analyses, we reveal the key variations in the distribution of determinants of the socioeconomic index. While previous studies conflated race and ethnicity with SES to resulting health indicators, this study captures both, highlighting the importance of each covariate and a composite index. Our findings suggest similar outcomes with regards to the assigned SES classifications (i.e. low, middle, and high SES) across the four national datasets.

Residential social vulnerability among healthcare personnel with and without severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in Five US states, May-December 2020.

To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection. Case-control study. This study analyzed data collected in May-December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon. Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed. HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase- polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression. Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37-2.26). These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.

A Systematic Review and Meta-Analysis on Oral Health Disparities Among the Indigenous Paediatric Population.

There is a knowledge gap in the literature regarding oral health disparities (OHD) in minority and indigenous (IG) paediatric cohortsthat needs to be addressed. Disparities in oral health among children are a pressing concern, highlighting inequities in access to dental care and meeting needs. The current systematic review aims to provide a comprehensive synthesis of the prevailing understanding of OHD in the minority and IG strata. A meticulous search strategy was formulated by a team of reviewers to identify pertinent studies fromdatabases of PubMed, MEDLINE, Scopus, Google Scholar and EMBASE. Data extraction and article selection strictly adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle-Ottawa Scale (NOS)was employed to evaluate the methodological quality of the studies included. Review Manager version5.4 was used to synthesise quantitative data. A total of five cross-sectional studies were included in the final analysis. The findings consistently demonstrated the existence of racial and socioeconomic disparities in oral health across varying age groups and geographical locations in the defined population. Significant disparities in oral health outcomes were observed between IG and non-IG populations, with IG and minority groups exhibiting a heightened vulnerability to oral health challenges. Through a meta-analysis of the compiled data, a statistically significant association was established between children (being a member of a minority group) and unmet oral health needs. Socioeconomic status (SES) and maternal education were factors that showed a significant impact on oral health disparity. All studies were graded to be of the low-risk category based on the NOS risk of bias tool. This review successfully identified several influential factors contributing to oral health disparities, such as cultural practices, dietary patterns and access to oral healthcare services. Additionally, discernible differences in oral health status were evident between IG and non-IG children, with IG children enduring a greater burden of oral health difficulties. These findings underscore the imperative for targeted interventions and policy measures aimed at addressing the specific oral health needs of minority and IG paediatric populations, with the overarching goal of mitigating the existing disparities.

A Comparison of Antenatal Depressive Disorders in Urban and Rural Pregnant Women in Nigeria

Background: The prevalence of antenatal depression (AND) is consistently higher in urban areas in developed counties while the reverse is the case in developing counties developing countries. This highlights that socioeconomic gaps and health disparities between different settings could have important implications on perinatal mental health. Nigeria, the most populous nation in Africa, is home to multiple ethnic and cultural groups and about half of the population is rural. But then a majority of Nigerian studies on and were conducted in the urban and semi-urban southern regions. Few, if any, such studies were ever conducted in the urban or rural settings of northern Nigeria. The study aimed to determine and compare the prevalence and factors associated with AND among pregnant women in urban and rural northern Nigeria settings. A descriptive comparative cross-sectional study was conducted among antenatal clinic attendees of an urban and a rural health facility in Kano State, northern Nigeria. Data were collected from pregnant mothers. A socio-demographic and clinical characteristics questionnaire was used to obtain the relevant data. Edinburgh Postnatal Depression Scale (EPDS), Hamilton Depression Rating Scale (HDRS) and the major depression module of the Mini International Neuropsychiatric Interview (MINI-7) were used to screen, rate and diagnose depression among the respondents respectively.&#x0D; Results: The urban pregnant women were older (28.3±5.7 versus 26.0±5.6 years, p=0.001), better educated (12.8±2.8 versus 8.9±4.3 years of schooling, p&lt;0.001), earning higher average monthly income (36.0 USD vs 13.0 USD, p&lt;0.001), in the second trimester of the pregnancy (22% versus 9.7%, p=0.004). While the rural women were more likely to have planned to get pregnant (84.1% versus 69.3%, p=0.003) and used psychoactive substances while pregnant (20.7% versus 8.7%, p=0.003). The prevalence of AND was significantly higher among the rural respondents as compared to the urban respondents (33.1% versus 14.7% p&lt;0.001). Anaemia in pregnancy (AIP), a history of a background medical problem (BMP) was significantly associated with AND in the urban setting (p= 0.032 and p= 0.001 respectively). While in the rural setting, AIP and a history of BMP were significantly associated with AND (p=0.0063 and p=0.008 respectively). Furthermore, among the multigravid urban and rural respondents, previous pregnancy complication was found to be significantly associated with AND (p=0.030). Among the urban women, the predictor for AND was a history of BMP (OR=5.049, 95%CI=1.451-17.570). The significant predictors for AND in the rural setting were AIP (OR=3.337, 95%CI=1.468-7.798) and history of BMP (OR=3.298, 95%CI=1.267-8.885).&#x0D; Conclusion: Rural prevalence of AND was significantly much higher than the urban rate. Certain factors, such as BMP and AIP, were associated with AND in both urban and rural settings.

Social class discrimination during adolescence as a mediator of socioeconomic disparities in actigraphy-assessed and self-reported sleep

ObjectiveTo examine social class discrimination as a mediator of socioeconomic disparities in sleep outcomes in an adolescent sample. MethodsSleep was assessed from established actigraphy (efficiency, long wake episodes, duration) and self-report (sleep/wake problems, daytime sleepiness) measures among 272 high school students in the Southeastern region of the United States (35% low income; 59% White, 41% Black, 49% female, Mean age = 17.3, SD = 0.8). Social class discrimination was assessed using a new measure, the Social Class Discrimination Scale (SCDS; 22-items), and an established measure, the Experiences of Discrimination Scale (EODS; 7-items). Socioeconomic disadvantage (SED) was measured as an aggregate of six indicators. ResultsThe SCDS was associated with sleep efficiency, long wake episodes, sleep/wake problems and daytime sleepiness (but not sleep duration), and significantly mediated the socioeconomic gradient in each sleep outcome. Black males experienced higher levels of social class discrimination than Black females, White males, or White females. A race by gender moderation effect was evident for two of the five sleep outcomes (sleep efficiency and long wake episodes) suggesting a stronger association between social class discrimination and sleep problems for Black females than White females but no clear race differences among males. The EODS was not associated with objective sleep outcomes or SED but was associated with self-reported sleep and showed a similar pattern of moderation effects. ConclusionsFindings suggest that social class discrimination may contribute to socioeconomic disparities in sleep problems, with some variability across measures and demographic groups. Results are discussed in light of evolving trends in socioeconomic health disparities.

Relationship Between Sexual Orientation, Gender Identity, and Mental Health and Substance Use Disorder Disparities Among Federally Qualified Health Center Adult Patients: A Cross-Sectional Study

Sexual and gender minorities (SGMs) are at increased risk of adverse physical and mental health outcomes. Federally qualified health centers (FQHCs) provide healthcare to underserved and vulnerable populations to address socioeconomic health disparities. This study aims to explore whether SGM adult patients at a large, multisite FQHC in Connecticut, USA, are more likely than heterosexual, cisgender (cis) patients to have indications or diagnoses of depression, suicidal thoughts, and/or substance use disorders (SUDs) in their medical charts. We used retrospective data from the electronic health records of FQHC patients with a medical visit between April 2016 and June 2019 who had sexual orientation and gender identity documented in their chart. In addition to demographic variables, the extracted data included patients’ most recent Patient Health Questionnaire-9 and diagnostic codes for depression, suicidal thoughts, and SUDs. We conducted hierarchical logistic regressions and generalized linear and latent mixed models to answer our research questions. In comparison to heterosexual and cis patients, SGM patients had significantly higher odds of reporting severe depression, any depression, and/or suicidal thoughts. Compared to heterosexual women, sexual minority women were more likely to have an SUD in their medical chart. Bisexual men had higher odds of cannabis use disorder compared to heterosexual men. Compared to cis women, transgender women had higher odds of alcohol and opioid use disorders and having one or more SUDs. This study provides evidence of mental health and substance use disparities experienced by SGM patients at FQHCs.