Socioeconomic Outcomes Research Articles

Trajectories of otitis media and association with health determinants among Indigenous children in Australia: the Longitudinal Study of Indigenous Children

ObjectivesIndigenous children in Australia experience high burden of persistent otitis media (OM) from very early age. The aim was to identify distinct trajectories of OM in children up to age 10–12 years and examine the association with socio-economic determinants. Study designA multistage clustered national panel survey. MethodsThe study analysed the birth cohort of the Longitudinal Study of Indigenous Children from 2008 to 2018, comprising 11 study waves. Group-based trajectory modelling was used to identify different trajectories of OM outcome. Multinomial logistic regression was applied to examine the relationship between trajectories and individual, household and community-level socio-economic determinants. ResultsThis analysis included 894 children with at least three responses on OM over the 11 waves, and the baseline mean age was 15.8 months. Three different trajectories of OM were identified: non-severe OM prone, early/persistent severe OM and late-onset severe OM. Overall, 11.4% of the children had early/persistent severe OM from birth to 7.5 to nine years, while late-onset severe OM consisted of 9.8% of the children who had first OM from age 3.5 to five years. Children in communities with middle and the highest socio-economic outcomes have lower relative risk of early/persistent severe OM (adjusted relative risk ratio = 0.39, 95% confidence interval = 0.22–0.70 and adjusted relative risk ratio = 0.22, 95% confidence interval = 0.09–0.52, respectively) compared to children in communities with lowest socio-economic outcomes. ConclusionEfforts to close the gap in the quality of life of Indigenous children must prioritise strategies that prevent severe ear disease (runny ears and perforation), including improved healthcare access, reduced household crowding, and better education, and more employment opportunities.

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map.

Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

Oil dependency and happiness in net oil-exporting countries: is it a curse or blessing?

ABSTRACT The resource curse hypothesis postulates that countries endowed with and dependent on abundant natural resources tend to underperform in socioeconomic and development outcomes than those with fewer natural resources. Recently, a few studies argued that this curse also manifests in lower life satisfaction or happiness. Focusing on 31 net oil-exporting countries over the 2006–2019 period, we find no evidence that oil rents (and aggregate and disaggregate resource rents) have an adverse effect on happiness or subjective well-being. This contrasts with recent studies using a global sample. We further contribute to this debate by examining the channels of resource curse or blessing along with income, unemployment, inflation, levels of human development, and governance. We show that oil rent enhances the positive marginal effects of income on happiness. We find no evidence of this conditional effect through other channels. Being rich in oil or natural resources is not necessarily a curse on happiness, but, if any, it is a blessing through income-generating well-being.

Secondary data analysis of the distribution and determinants of maternal and child health outcomes across Kenya’s 47 counties

Introduction There are 47 semi-autonomous counties in Kenya that are in-charge of financing and delivery of healthcare. Although reports exist that demonstrate how the counties differ in socioeconomic status, disease burden, and health outcomes, such reports often fail to show where the greatest inequities lie, and what actually drives them. This analysis is meant to guide better targeting of resources to achieve a greater impact on maternal and child health outcomes. Methods Secondary data sources were analyzed to determine the variations in inequities in Kenyan counties. The inequities and their distribution in the 47 counties were assessed using a Lorenz curve and principal component analysis (PCA). A regression analysis evaluated the relationship between key outcomes- maternal mortality, under-five mortality, full immunization coverage (DPT3), the incidence of diarrhea, and under-five stunting, as the dependent variables, and years of education for women 15 – 49 years, county health financing per capita, public insurance coverage, population per facility, public nurses/100000, doctors/100000 people, poverty headcount rate, and gender inequality index (GII), as the independent variables. Findings Vaccine coverage (Gini Index 0.063) is the most equitably distributed outcome in the country, followed by under-five mortality (GI=0.124). Maternal mortality has the highest inequity (GI=0.381), followed by the distribution of public sector nurses (GI=0.317). County government funding of health per capita also shows wide variations between counties (GI= 0.230) suggesting different levels of expenditure and prioritization. Vaccine coverage and U-5 mortality are the most evenly distributed across the counties. The key drivers of maternal mortality are education of women of reproductive age (p= 0.001), gender inequality (p=0.002), and congestion at health facilities (0.001). Conclusion Promising approaches and interventions to reduce inequity do exist, which includes UHC whose focus should be on reducing geographical, economic, sociocultural, and gender barriers to healthcare.

The Global Impact of Edentulism: A Systematic Review

Abstract Background The evidence to describe the consequences of edentulism has been limited. This systematic review aimed to identify, appraise and summarise the evidence available to describe the broad health and socio-economic impacts of edentulism experienced by individuals living in low-, middle- and high-income countries. Methods Searches were carried out on five databases: Scopus, Web of Science, CENTRAL, EMBASE and MEDLINE. Grey literature was searched, in addition to professional recommendations and reference cross-checks. The search was completed on 15th June 2022 and updated on 21st March 2023. Searches were restricted to human studies of community dwelling adults aged ≥18 years. No restrictions were placed on publication date, language, gender or country. Data was independently extracted by two researchers and risk of bias assessment was conducted using the QualSyst Tool. The study was registered on PROSPERO (CRD42022320049). Results 402 articles were identified from database searches, reference cross-checks and professional recommendations. Title, abstract and full text screening resulted in 32 articles for narrative review. A diverse range of outcomes were identified, including frailty, nutrition, health behaviours, quality of life, mental health and general health conditions. Due to heterogeneity between studies, Synthesis Without Meta-Analysis (SWiM) Guidelines will be used to synthesis the study results. Results from the synthesis using SWiM Guidelines are pending. Despite the inclusion of broad search terms, no relevant studies to explore the impact of edentulism on socio-economic outcomes such as productivity were identified. Conclusions There was a lack of high quality interventional evidence to support robust conclusions within this review. Further research to understand the impact of edentulism and establish causal relationships is needed to inform future preventative and treatment strategies. Key messages • Global disease burden of edentulism is high. The World Health Organisation (WHO) has estimated that global prevalence of edentulous adults aged ≥60 is 23% (WHO, Oral Health Factsheet, March 2023). • Many of the factors that contribute to edentulism are preventable and distributed inequitably. Understanding the impact of edentulism remains an area of global public health importance.

Does health literacy mediate the relationship between socioeconomic status and health outcomes?

Abstract Background Health literacy (HL) has been hypothesized as one of the mediators in the pathway through which socioeconomic status (SES) affects health outcomes. This study explores whether HL mediates the relation between SES and a selection of health(-related) outcomes. Methods Data from the participants of the Belgian health interview survey 2018 aged 15 years and over were individually linked with data from the Belgian compulsory health insurance (n = 6878). HL was assessed with the HLS-EU-Q6. Mediation analyses were performed using the SES as independent variables, health(-related) outcomes as dependent variables and HL as mediating variable. Results People with low SES were less likely to have preventive dental care (PDC), breast cancer screening (BCS), enough physical activity, good nutritional habits, good self-rated health (SRH). In contrast, they were more likely to use antibiotics and antidepressants. A positive correlation was found between HL and PDC, good nutritional habits, physical activity and SRH, but a negative correlation with use of antidepressants. HL partially mediated the association between SES and PDC, use of antidepressants, nutritional habits, physical activity and SRH. In the relationship between these outcomes and education, the mediation effect of HL accounted significantly for 4.4% to 15.4% of the total effect, while it accounted significantly for 4.2% to 12.0% of the total effect in the relationship with income. There was no significant mediating contribution of HL in the pathway by which SES affects influenza vaccination uptake and BCS. Conclusions Although the influence of HL in the pathway is limited, the findings suggest that strategies for improving various health(-related) outcomes among low SES groups may benefit from attention to HL. The low percentage mediated for the use of antidepressants might suggest a shared decision between physician and patients. Key messages • HL partially mediates the association between SES and PDC, use of antidepressants, nutritional habits, physical activity and SRH. Improving HL might reduce SES disparities in these areas. • No mediating effects for influenza vaccination uptake and BCS, indicating a possible influence of the universal health coverage in place.

“Only Time Will Tell”: The Underexplored Impacts of Lead Poisoning and COVID-19 on Pre-Existing ACEs in New York

The peak of the coronavirus-19 (COVID-19) in New York City significantly impacted communities that lived in the New York City Housing Authority (NYCHA). However, these same communities have been historically reported to test positive for lead poisoning due to neglect of proper lead abatement and the removal of lead sources within these buildings. The consequences of these failed actions by NYCHA resulted in multiple generations of lead-poisoned children, which can be argued as a form of mass atrocity and genocide. The long-term neurodevelopmental and socio-economic outcomes of children exposed to lead and COVID-19 remain to be elucidated. This short communication attempts to bring attention to this overlooked matter and draws upon the scarce, but emerging, reports in the literature to start a conversation on the synergistic potential of these looming public health issues. Further, suggestions for providing consistent blood lead screening and COVID-19 testing could serve to clarify whether a “two-hit” hypothesis of a neurotoxicant (lead) and a neuroimmune (COVID-19) virus that produces an Adverse Childhood Experience (ACE-19). More work is needed in this area to (dis)confirm the potential for this “two-hit” hypothesis, and only time will tell.

Clinical and socio-economic characteristics of a cohort of MDR/XDR TB patients in Bucharest, Romania

Abstract Background Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) patients are likely to suffer from TB-related morbidity, social and economic consequences during and beyond anti-TB treatment. The aim of this study is to describe clinical and socio-economic outcomes of TB patients in Bucharest, Romania. Methods We have established a prospective cohort of patients with MDR/XDR TB followed for more than 2 years from TB diagnosis. We have collected TB-related, laboratory and clinical data, including chest X-ray, lung function measured by spirometry, St. George's Respiratory Questionnaire (SGRQ), and socio-economic information. Results From 50 enrolled participants, 31 remained in the study till month 6. 71% were male with mean age 46.7 (SD 15.4). 41.9% had a previous TB infection and median BMI of 20.3 kg/m2. Baseline CXR showed that on average 47.3% of the lung was affected, with 32.7% at month 6. The majority (71%) of participants had lung impairment at baseline, which remained stable till month 6. The total SGRQ score improved between baseline and month 6 (30 vs 22.8), but remained significantly worse compared to healthy individuals. 52% of participants stated that TB affected their social or private life as well as their household financially at treatment start. Conclusions From the start of anti-TB treatment patients are suffering from lung impairment and experiencing socio-economic impact of TB. This cohort demonstrates a slow and slight longitudinal improvement of these outcomes and brings awareness to the need of employing social and rehabilitation programs to target TB impact. Key messages • MDR/XDR TB patients suffer from a significant morbidity and socio-economic burden in Romania. • Targeted measures are needed to address this burden during and after TB treatment.

Free School Meals Extension to all 4-11 year olds in primary education in Wales

Abstract There were 272,339 primary age students in Wales in April 2021, of whom 63,614 (23%) were entitled to free school meals. Free school meals (FSMs) are currently means tested in Wales. Estimates suggest around 40,000 children in primary education may be currently living in poverty but are not eligible for a free school meal .Free school meals have been available to all children in Reception, Year 1 and Year 2 in England since 2014. Wales does not currently have universal provision to children in any school year. However, Welsh Government committed to this for 2023/4. Steered by a Task and Finish Group, a comprehensive mixed-method HIA was conducted over a six month period in 2022-23. A comprehensive database search of peer-reviewed and grey literature published in the ten years to 2021 identified evidence relating to the impacts on health, educational attainment and household socioeconomic outcomes of making school meals free to all primary age children compared with no or means-tested provision. Routine data sources and school census data were analysed to contextualise evidence in relation to Wales. This evidence was supplemented with interviews and data provided by cross sector stakeholders. The HIA identified significant potential impacts across the determinants of health, including impacts across population groups such as children in working families on low incomes, mental well-being and food behaviours. School food policy and provision, length of lunchtimes and implementation were identified as key pathways for health impacts. For example, a strong theme was that current provision is often experienced as stressful, with requirements for rapid turnaround limiting opportunities to socialise and enjoy meals and wider opportunities to play during lunch hours constricted. The report was used to inform the Health and Education ministers who approved the extension and the implementation of the offer. The unique HIA has transferrable learning for others. Key messages • This work has demonstrated the value of evidence based HIA on government policy and has enhanced implementation plans. • Free school meals for children can promote better health and educational and mental wellbeing outcomes.

Immigrant, black and racialized people’s health

Immigrant, black and racialized people’s health Learn about the research of Dr. Bukola Salami, Professor at Cumming School of Medicine, University of Calgary, in this particular focus on Immigrant, Black, and Racialized People’s Health. Immigrants often arrive in Canada in better health than the Canadian-born population due to pre-arrival health screening. This phenomenon is called the healthy immigrant effect. However, the health of immigrants often declines after a period of time in Canada. Several factors contribute to this health decline, including poor socioeconomic outcomes, healthcare access barriers, and discrimination. Professor Salami’s research program focuses on policies and practices shaping migrant and Black people’s health. She has been involved in over 85 funded studies totaling over $230 million. She has led research projects on topics including African immigrant child health, immigrant mental health, access to healthcare for Black women, access to healthcare for immigrant children, Black youth mental health, the health of internally displaced children, the well-being of temporary foreign workers, COVID-19 vaccine hesitancy among Black Canadians, an environmental scan of equity-seeking organizations in Alberta, culturally appropriate practices for research with Black Canadians, international nurse migration, and parenting practices of African immigrants.

Protective factors for psychosocial outcomes following cumulative childhood adversity: systematic review.

The long-term cumulative impact of exposure to childhood adversity is well documented. There is an increasing body of literature examining protective factors following childhood adversity. However, no known reviews have summarised studies examining protective factors for broad psychosocial outcomes following childhood adversity. To summarise the current evidence from longitudinal studies of protective factors for adult psychosocial outcomes following cumulative exposure to childhood adversity. We conducted a formal systematic review of studies that were longitudinal; were published in a peer-reviewed journal; examined social, environmental or psychological factors that were measured following a cumulative measure of childhood adversity; and resulted in more positive adult psychosocial outcomes. A total of 28 studies from 23 cohorts were included. Because of significant heterogeneity and conceptual differences in the final sample of articles, a meta-analysis was not conducted. The narrative review identified that social support is a protective factor specifically for mental health outcomes following childhood adversity. Findings also suggest that aspects of education are protective factors to adult socioeconomic, mental health and social outcomes following childhood adversity. Personality factors were protective for a variety of outcomes, particularly mental health. The personality factors were too various to summarise into meaningful combined effects. Overall GRADE quality assessments were low and very low, although these scores mostly reflect that all observational studies are low quality by default. These findings support strategies that improve connection and access to education following childhood adversity exposure. Further research is needed for the roles of personality and dispositional factors, romantic relationship factors and the combined influences of multiple protective factors.

App-based meditation habits maintain reductions in depression symptoms among autistic adults.

Existing research has identified an increased risk of depression among autistic adults, which can negatively impact their adaptive functioning abilities and socioeconomic outcomes. Mobile app-based meditation is a feasible, accessible, and effective self-care solution for depression among neurotypical adults, but there is limited evidence for the long-term benefits of app-based meditation among autistic adults. Habits are a key behavioral strategy for maintaining behavior change, and anchoring is one effective habit formation intervention that has yet to be tested among autistic adults. This study demonstrates that it is both feasible and effective to integrate the anchoring habit formation strategy into an app-based meditation intervention for establishing meditation habits among autistic adults. In addition, the study shows that app-based meditation habits were successful at maintaining reductions in depressive symptoms over 6 months. These results demonstrate the power of anchoring-based habit formation interventions for establishing healthy habits among autistic adults, which offers a promising behavioral intervention technique for establishing other healthy habits among autistic adults. The study also shows that app-based meditation habits are an effective long-term self-care solution for managing depressive symptoms among autistic adults that should be used by mental health providers and policymakers. Future research should test this combined anchoring and app-based meditation intervention technique among larger samples of autistic adults and over longer durations to better understand the mechanisms underlying the success of this intervention.

The Theory of Uneven and Combined Development and the Sociopolitical Transformations in Syria and Libya

: This article explores the constitutive impact of the ‘international’ on the sociopolitical transformations in Syria and Libya through the lens of the theory of Uneven and Combined Development (UCD). The conventional and numerous critical analyses of Syrian and Libyan sociopolitical change suffer from a Eurocentric and stagist understanding of development. This paper argues that development problems can be better conceptualized with an interactive framework made possible by the UCD theory. In this context, we focus on how the expansion and consolidation of capitalism through the dynamics of UCD have concretely shaped the process of sociopolitical transformation in Syria and Libya to shed light on how the international and the local have articulated to produce the socioeconomic and political outcomes in these two states. We conclude by arguing that the theory of UCD provides an alternative conceptualization in explaining the specific development trajectories in both countries.

Making the case for lead safe housing: Downstream effects of lead exposure on outcomes for children and youth

Lead based paint is a predominate source of lead exposure in children, which has a documented negative effect on their health and development. Despite public health efforts, the housing stock in disinvested neighborhoods in many cities continues to present significant risk of childhood lead exposure. In this article, we describe how a multi-agency integrated data system was used to document the impact of lead exposure on indicators of child and youth development as recorded in educational and human service systems. By tracking administrative data for two cohorts of Cleveland, Ohio children from birth to early adulthood and using rigorous matching methods to reduce confounders when comparing those with and without elevated blood lead levels, we document negative effects on developmental, behavioral and socio-economic outcomes due to early childhood lead exposure. The magnitude of disparities between individuals who had elevated blood lead levels (≥5 μg/dL) in early childhood, compared to their matched counterparts, is in the ranges of 20–40%. The analysis is framed by clarifying the context, assumptions and limitations associated with the use of administrative data. This type of information has been useful in illuminating the burden of lead exposure for children, families and youth serving agencies and engaging public officials, landlords and residents in initiatives to bring housing up to lead safe standards.

Climate smart agriculture for sustainable productivity and healthy landscapes

In rural areas of developing countries, more than 70% of the population still depends on agriculture. However, economic crises, unscientific land allocation and climate change issues have hindered attempted gains in agricultural productivity and related rural development outcomes. Technology-driven breakthrough has usually pushed agriculture to the brink of another development that can affect not only plant diversity and yield, but also climatological and socio-economic outcomes. The concept of sustainable agriculture has become increasingly popularized as research and farming communities believe that productivity with environmental and social consequences need to be judiciously balanced. Agriculture of developed nations has practically benefitted of this concept worldwide during the 1990 s. In order to be successful worldwide, extensive research must be conducted not only for large-scale farms in developed nations but also for small-scale farms in developing nations. Climate smart agriculture conserves biodiversity by adopting coherent, multifunctional, and multi-cropping approach through design oriented spatial planning and flow among them. Here, a spatiotemporal data driven paradigm for sensing monitoring and directing agricultural ecosystem has been proposed to optimize the use of climate smart circular agricultural system.

Sustainability Assessment of Medicines Reverse Logistics in Brazil: Outcomes from the National and Local Systems

Brazil adopted a national medicines reverse logistic system (MRLS) in 2020 to properly discharge medicines for human use. Parallel to this, there are Brazilian municipal MRLSs that have been working since 2002 that facilitate the appropriate discharge or reuse of medicines. These systems are not linked with each other. This paper evaluates the national and the municipal Brazilian MRLS, and compares them regarding their principles, concepts, procedures, and (socio)economic outcomes using a modified sustainability assessment framework. It was found that shared responsibility is a principle of both MRLSs, but that local systems provide additional community benefits and lead to greater circularity in the use of medicines. Procedural aspects are highly formalized only in the national MRLS. The national MRLS collected and destroyed 52.7 tons of medicines in 2021 but did not disclose the costs. Estimations based on demographic data, information disclosed by one municipality, and secondary data from five other local systems indicate that the six municipalities could return around USD 123 million in 2021 to the benefit of the local population, if they spent USD 12.6 million on correct disposal. Such an estimate, however, is not fully trackable, and it exposes the lack of transparency and data collection at the local level.

Sub-Arctic no more: Short- and long-term global-scale prospects for snow crab (Chionoecetes opilio) under global warming

Snow crab is a sea-ice associated species that supports several economically important fisheries in northern latitudes. During the past decade considerable stock range changes have occurred, characterized by a general shift from sub-Arctic ecosystems into the Arctic. We developed predictive models for short-term biomass trajectories and long-term habitat potential under a changing climate. Sea ice extent and the Arctic Oscillation were important variables in the short-term models. Future sea ice extent was used as an analog for long-term habitat potential and was predicted as a function of projected atmospheric carbon dioxide concentrations and the Arctic Oscillation. Our results show that global scale snow crab habitat and biomass are currently at or near historically measured highs. Similar overall habitat potential to historic and current levels is expected to continue out to 2100 under best case CO2 scenarios but declines below historic levels are projected to begin after about 2050 under worst cast CO2 scenarios. In the short-term, most historical stock ranges are expected to maintain productive fisheries while new habitats open. In the long-term, under all CO2 scenarios, we project a shift in habitats from historic ranges into new frontiers as sea ice recedes. Future population trajectories depend upon the ability of snow crab to track habitat shifts and we discuss possible forthcoming changes in context of potential socioeconomic outcomes.

SAT111 Temporal Trends In Patients Hospitalized With Diabetic Ketoacidosis And Associated Outcomes: Insights From The National Inpatient Sample

Abstract Disclosure: M. Chaudhary: None. J. Jung: None. A. Farooq: None. J. Heersink: None. Background: Patients hospitalized with Diabetic Ketoacidosis (DKA) exhibit increased risk for mortality and morbidity. Previous work has illustrated concerns for DKA incidence increasing further highlighting the burden it may present to the US healthcare system. We aim to demonstrate the current baseline characteristics in hospitalized DKA patients and to identify and stratify risk factors that lend to deleterious patient outcomes. Methods: Patient data was collected for years 2011-2018 from the National Inpatient Sample (NIS) using International Classification of Disease-Revision Codes (ICD-9 and 10). We selected patients hospitalized with a principal diagnosis of DKA with ICD Coding. Multivariate logistic regression was used to determine adjusted odds ratios (AOR). Mann-Whitney U testing was utilized to calculate mean differences in age, length of stay (LOS), and total hospital charges. Additionally temporal trends were tabulated with linear regression models to determine any significant changes over time in select risk factors and outcomes. Results: A total of 313,608 patients were included in our data analysis. Self-pay patients had a 28.3% (CI 1.020-1.613, P<0.05) increase in mortality rate compared to Medicare payers. Asians had 60.5% (CI 1.039-2.479, P<0.05) increased risk of mortality compared to Caucasians. Increased mortality rates were seen in patients with following comorbid conditions: ESRD (149%) (CI 1.986-3.140, P<0.05), Obesity (70.5%) (CI 1.425-2.040, P<0.05)and CAD (25%) (CI 1.057-1.478, P<0.05). Females with DKA had a decreased risk of mortality by 21%(Cl 0.697-0.894, P<0.05). Patients in the highest quartile median zip code income had a decreased mortality risk of 18.7% compared to patients in the 1st quartile (add the P value). There was a 25.6% (CI 1.069-1.505, P<0.05) decreased mortality rate in hospitals with large bed size and a 30.8% decreased mortality rate in urban located teaching hospitals (CI 1.062-1.612, P<0.05). We observed decreases in LOS and over time P<0.05 and increase in Hospital Charges over time P<0.05. Conclusion: We observed correlation between socio-economic and demographic factors and mortality outcomes in patients hospitalized with DKA. Based on our analysis, we found patients with ESRD, Obesity, and CAD to exhibit the highest mortality risk. Decreased LOS over time may exhibit incremental improvements in quality of care of patients hospitalized with DKA and would beget further analysis in comparison with available longitudinal studies with more granular data. Increased total charges may represent an increasing patient complexity and this warrants further investigation. Further research in community-based hospital settings is needed and it is important to note that targeted prevention measures, such as diabetes education, may help prevent life-threatening diabetic complications such as DKA from arising. Presentation: Saturday, June 17, 2023

Unpacking the interconnectedness between macro economic policies and socioeconomic outcomes: A case of monetary policies and wealth inequality in the ASEAN region

This study aims to link the interconnectedness between the dynamic of macroeconomic policies and the distribution of wealth in the Association of Southeast Asian Nations (ASEAN) context through the lens of monetary policy. Time series and panel data from the World Inequality Database (WID) for six ASEAN countries from 2000 to 2021 and the panel vector autoregression (PVAR) were used to analyze the dynamic interactions between monetary policy and wealth inequality. The results suggest that lowering the policy interest rate, increasing inflation, and economic growth lead to a significant increase in wealth inequality in the short run. The impulse response function of the top 1% and top 10% wealthiest are more noticeable than those of the middle 40% and the bottom 50%. Additionally, the study highlights an interesting temporal dynamic, suggesting that the effects of monetary policy don't manifest instantaneously. Instead, these effects evolve gradually. This time lag indicates the complexity of how monetary interventions interact with economic factors and underscores the importance of patience and careful observation when assessing the outcomes of such policy decisions. The study's implications emphasize the importance for policymakers to consider the distributional effects of monetary policy in the long run policy objective.

Swedish multimodal cohort of patients with anxiety or depression treated with internet-delivered psychotherapy (MULTI-PSYCH)

PurposeDepression and anxiety afflict millions worldwide causing considerable disability. MULTI-PSYCH is a longitudinal cohort of genotyped and phenotyped individuals with depression or anxiety disorders who have undergone highly structured internet-based...