Top Quintile Research Articles

INTER-STATE DISPARITIES IN HEALTHCARE COSTS, HEALTH INSURANCE COVERAGE AND FINANCIAL PROTECTION IN INDIA: A COMPARATIVE ANALYSIS OF NATIONAL SAMPLE SURVEYS FOR 1986-87, 1995-96, 2004 AND 2014

By analysing data from the National Sample Survey for four rounds (1986–87, 1995–96, 2004 and 2014) this research focuses on changes in people's health seeking behaviour, the cost of treatment, and principal factors affecting health insurance premium payments by BPL and APL families. With variations between states, it is discovered that over time, less people sought care from public providers and more people preferred private providers. Despite the fact that both men and women are now more likely to seek treatment for their illnesses, a sizeable portion of the population (more in rural than in urban areas), still refuses treatment because they believe their illness is not serious enough to warrant it. Whilst the cost of healthcare has gone up over time, the difference between public and private costs of treatment has shrunk, possibly as a result of the higher recurring cost in public health facilities and imposing of user fees and cutting on the delivery of free medication. Since the middle of the 2000s, public insurance companies have offered low-cost hospitalisation insurance programmes like the Jan Arogya Bima Policy and Rashtriya Swasthya Bima Yojana (RSYB) to help with the healthcare needs of the underprivileged sector of society. According to the insurance premiums, more households that paid premiums in 2004 and 2014 belonged to groups with higher Monthly Per Capita Expenditures (MPCE) and were not economically in the poorest tier. The inter-quintile MPCE differential (between the top and bottom quintile) also reveals significant inter-state disparities in terms of the percentage of households that paid a premium and the percentage of households that had health insurance. The factors that determine whether a family enrols in health insurance imply that increasing enrolment from the poor households got coverage through RSBY. At the national level, BPL/APL households with insurance reported, on average, higher hospitalisation costs than non-insured households, with the difference being significantly higher for urban households. This finding suggests the prevalence of insurance collusion and moral hazard, particularly in the cities from developed states of Punjab, Haryana, Gujarat, and Maharashtra. Further, BPL households, particularly from rural India, have received very little financial relief as a result of the insurance.

Emissions Reductions from Electrifying High-Mileage Vehicles

This paper evaluates a strategy that would target sales of internal combustion vehicles driven at high annual mileage for displacement by electric vehicles at the time of initial sale. Using the 2017 National Household Travel Survey data, we observe that the top 20% of light duty vehicles by kilometers traveled generate 46% of the annual greenhouse gas emissions. Displacing the sale of a combustion engine vehicle in the top mileage quintile with an electric vehicle would reduce annual greenhouse gas emissions and certain criteria pollutants by more than 15 times as much as displacing a vehicle in the bottom mileage quintile.

Polygenic Risk Score, Lifestyles, and Type 2 Diabetes Risk: A Prospective Chinese Cohort Study

The aim of this study was to generate a polygenic risk score (PRS) for type 2 diabetes (T2D) and test whether it could be used in identifying high-risk individuals for lifestyle intervention in a Chinese cohort. We genotyped 80 genetic variants among 5024 participants without non-communicable diseases at baseline in the Wuxi Non-Communicable Diseases cohort (Wuxi NCDs cohort). During the follow-up period of 14 years, 440 cases of T2D were newly diagnosed. Using Cox regression, we found that the PRS of 46 SNPs identified by the East Asians was relevant to the future T2D. Participants with a high PRS (top quintile) had a two-fold higher risk of T2D than the bottom quintile (hazard ratio: 2.06, 95% confidence interval: 1.42–2.97). Lifestyle factors were considered, including cigarette smoking, alcohol consumption, physical exercise, diet, body mass index (BMI), and waist circumference (WC). Among high-PRS individuals, the 10-year incidence of T2D slumped from 6.77% to 3.28% for participants having ideal lifestyles (4–6 healthy lifestyle factors) compared with poor lifestyles (0-2 healthy lifestyle factors). When integrating the high PRS, the 10-year T2D risk of low-clinical-risk individuals exceeded that of high-clinical-risk individuals with a low PRS (3.34% vs. 2.91%). These findings suggest that the PRS of 46 SNPs could be used in identifying high-risk individuals and improve the risk stratification defined by traditional clinical risk factors for T2D. Healthy lifestyles can reduce the risk of a high PRS, which indicates the potential utility in early screening and precise prevention.

Analysis of Hospital Operating Margins and Provision of Safety Net Services

Safety net hospitals (SNH) provide many community services. The cost of providing these services is unknown. To determine what safety net criteria are associated with differences in hospital operating margin. This cross-sectional study of US acute care hospitals from 2017 to 2019 included eligible hospitals identified from US Centers for Medicare & Medicaid Services Cost Reports. Five domains of SNH: undercompensated care measured using the Disproportionate Share Hospital index, uncompensated care, essential community services, neighborhood disadvantage, and sole community hospital and critical access hospital status. Each was categorized as a quintile or binary response. Covariates included hospital ownership, size, teaching status, census region, urbanicity, and wage index. Operating margin and its association with each safety net criterion was determined using linear regression adjusting for all safety net criteria and covariates. A total of 4219 hospitals were analyzed, of which 3329 hospitals (78.9%) satisfied at least 1 safety net criterion; 23 hospitals (0.5%) met 4 or all 5 criteria. Among safety net criteria, the highest quintile of undercompensated care (-6.2 percentage point difference compared with lowest quintile; 95% CI, -8.2 to -4.2 percentage points), uncompensated care (-3.4 percentage points; 95% CI, -5.1 to -1.6 percentage points), and neighborhood disadvantage (-3.9 percentage points; 95% CI, -5.7 to -2.1 percentage points) were each associated with a lower operating margin. No association with operating margin was found between critical access or sole community hospital status (0.9 percentage points; 95% CI, -0.8 to 2.7 percentage points) or the highest vs lowest quintile of essential services (0.8 percentage points; 95% CI, -1.2 to 2.7 percentage points). Among essential services, burn, inpatient psychiatry, and primary care services were associated with lower operating margin, while others were either not associated or showed positive association. Fall-off in operating margin by level of uncompensated care was most severe in the highest percentiles of uncompensated care, with the most marked declines among those with the lowest operating margin. In this cross-sectional study of SNH, hospitals in the highest quintiles of undercompensated care, uncompensated care, and neighborhood disadvantage were more financially vulnerable than those not in the top quintile, especially when they met numerous of these criteria. Ensuring targeting of financial support to these hospitals could improve their financial stability.

Causal analysis of socioeconomic influence on cost of care: The emergency general surgery model

BackgroundThis study characterizes the relationship between SES and cost of emergency general surgery (EGS). MethodsUtilizing Florida AHCA (2016–2020), patients undergoing the 7 most common EGS were identified. Distressed Community Index (DCI) was linked, which quantifies SES through unemployment, poverty, and other factors. Zipcodes are assigned DCI 0 (no distress) to 100 (severe distress). Linear regression with stepwise elimination was conducted. Top and bottom DCI quintiles were propensity matched for demographics, comorbidities, and procedure. Results144,924 admissions were included. Linear regression eliminated 5 of 28 variables, including DCI. Top cost contributors were discharge-43%; comorbidities-14%; age-9%. Distressed patients received less home health and inpatient rehab. Distressed patients utilized 4-/5-star hospitals less and had higher odds of mortality. ConclusionDischarge, mortality, and hospital characteristics differ significantly between DCI communities. Total cost was similar, and is strongly influenced by discharge status, while DCI had no effect.

COVID-19 Serology Data Provide Guidance for Future Deployments of Convalescent Plasma.

Measurement of antibody content and function after a viral illness is important for diagnosis and selection of the best convalescent plasma (CP) units for passive immunization. Zhang et al. (mBio 14:e03523-22, 2013, https://doi.org/10.1128/mbio.03523-22) analyzed over 19,000 coronavirus disease 2019 (COVID-19) CP (CCP) samples from the early days of the COVID-19 pandemic and reported a moderately strong correlation between antibody amount and neutralizing titer. Strikingly, about one-third of the samples had little or no neutralizing activity. The results provide a detailed glimpse of the humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunologically naive humans and reveal major differences in the quality of CP units collected for passive therapy before antibody screening. Heterogeneity in CCP quality undoubtedly contributed to the variable therapeutic efficacy. Analysis of the COVID-19 serology data suggest that, for the next infectious disease emergency, the best approach after quick establishment of methods for robust antibody-level stratification would be to use CP units in the top quintile of antibody content and neutralizing capacity.

High Polygenic Risk Is Associated with Earlier Initiation and Escalation of Treatment in Early Primary Open-Angle Glaucoma

To assess the association between a glaucoma polygenic risk score (PRS) and treatment outcomes in primary open-angle glaucoma. Prospective, observational cohort study. Participants from the Progression Risk of Glaucoma: Relevant SNPs with Significant Association Study were divided into a cohort with suspect glaucoma who were treatment naive at enrollment and one with early manifest and suspect glaucoma receiving treatment at enrollment. A per-allele weighted glaucoma PRS was calculated for 1107 participants. Multivariable mixed-effects Cox proportional regression analysis assessed the association between PRS and time to commencement of intraocular pressure (IOP)-lowering therapy in 416 patients with suspect glaucoma who were treatment naive at study enrollment. Secondary analysis evaluated the association between PRS and escalation of IOP-lowering therapy among 691 patients with suspect and early manifest glaucoma who were receiving IOP-lowering therapy at enrollment. Commencement or escalation of IOP-lowering therapy. A higher PRS was associated with a greater risk of commencing IOP-lowering therapy within 5 years (hazard ratio [HR], 1.45per 1 standard deviation [/SD]; 95% confidence interval [CI], 1.27-1.62; P < 0.001). Participants in the upper population-based quintile showed a 3.3 times greater risk of commencing therapy by 5 years than those in the lowest quintile (HR, 3.30; 95% CI, 1.63-6,70; P < 0.001) and a 5.4 times greater risk of commencing IOP-lowering therapy by 2 years than the those in the lowest quintile (HR, 5.45; 95% CI, 2.08-14.25; P < 0.001). A higher PRS was associated with a greater risk of treatment escalation among patients receiving treatment at enrollment (HR, 1.19/SD; 95% CI, 1.09-1.31; P < 0.001). In combined analysis of all participants, participants in the top population-based quintile were at 2.3 times greater risk of requiring initiation or escalation of IOP-lowering therapy than those in the lowest quintile (HR, 2.33; 95% CI, 1.75-3.01; P < 0.001). This study demonstrated novel associations between glaucoma polygenic risk and risk of commencement or escalation of IOP-lowering therapy, building on previous work highlighting the potential clinical usefulness of genetic risk stratification in glaucoma. Proprietary or commercial disclosure may be found after the references.

A New Measure of Inequality in Asian Economies

The paper describes a new measure of inequality the Pashum ratio, which was first used in the UNDP Human Development Report for 2020 of Pakistan. The latest estimates of the extent of income inequality are derived from 18 Asian economies using the Gini coefficient and the Pashum ratio respectively. The relative position of nine out of the 18 countries varies in the two measures. Also, the greatest inequality among quintiles is observed in virtually all countries between the top and the second quintile. A number of inequality measures have been developed in the literature. The first and the simplest measure is the quintile dispersion ratio which is the ratio of the share of the top quintile and the bottom quintile. This measure focuses only on the extreme of a distribution.

MP21-13 LOWER SOCIOECONOMIC STATUS IS ASSOCIATED WITH HIGHER URINARY SODIUM: IMPLICATIONS FOR DIETARY STONE GUIDANCE IN UNDERSERVED COMMUNITIES

You have accessJournal of UrologyCME1 Apr 2023MP21-13 LOWER SOCIOECONOMIC STATUS IS ASSOCIATED WITH HIGHER URINARY SODIUM: IMPLICATIONS FOR DIETARY STONE GUIDANCE IN UNDERSERVED COMMUNITIES Wilson Sui, Kevin Chang, Heiko Yang, Kevin Shee, Reuben Sarwal, Rei Unno, Ukrit Rompsaithong, David Bayne, Marshall Stoller, and Tom Chi Wilson SuiWilson Sui More articles by this author , Kevin ChangKevin Chang More articles by this author , Heiko YangHeiko Yang More articles by this author , Kevin SheeKevin Shee More articles by this author , Reuben SarwalReuben Sarwal More articles by this author , Rei UnnoRei Unno More articles by this author , Ukrit RompsaithongUkrit Rompsaithong More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Tom ChiTom Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower socioeconomic status (SES) is associated with higher stone burden at presentation, requiring more frequent and invasive procedures. Unhealthy dietary patterns and impaired access to healthy food in low-income communities are thought to exacerbate this problem. To investigate whether the relationship between SES, diet and stone disease is reflected in 24-hour urine composition, we investigated the associations between 24-hour urine parameters and median income by home zip code in stone patients. METHODS: The Registry for Stones of the Kidney and Ureter was queried for all adult subjects who underwent a 24-hour urine test between 2015 and 2022. A similar number of subjects who were prospectively followed but did not complete 24-hour urine testing were also evaluated. Demographic data including home zip code and clinical characteristics were abstracted for analysis. We then used publicly available zip-code level data from the U.S. Census Bureau to stratify patients into quintiles by median income and 24-hour urine parameters were compared. A multivariable linear regression model was created to identify significant independent predictors among demographic and past medical history characteristics. RESULTS: Of 1,224 subjects who met inclusion criteria, 635 (52%) had undergone 24-hour urine testing. Compared to those in the top quintile, individuals in the bottom quintile of income were younger, more likely to be non-white and had a higher proportion of diabetes (16% vs 9%, p = 0.014), chronic kidney disease (6.2% vs 2.4%, p = 0.038) and chronic obstructive pulmonary disease (5% vs 1.6%, p=0.036). These patients were also less likely to have 24-hour urine testing (42% versus 52%, p=0.004). On comparison of 24-hour urine data, individuals in the bottom quintile of income had higher mean urinary sodium and on multivariable linear regression controlling for demographic and clinical characteristics, lower income remained significantly associated with increased urinary sodium (β = 5.2 ± 2.3, p=0.025). CONCLUSIONS: Lower SES is associated with higher levels of urinary sodium. In addition to reinforcing the need for more epidemiologic investigation and public health intervention, this finding highlights SES as a consideration for tailoring dietary modifications. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e291 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wilson Sui More articles by this author Kevin Chang More articles by this author Heiko Yang More articles by this author Kevin Shee More articles by this author Reuben Sarwal More articles by this author Rei Unno More articles by this author Ukrit Rompsaithong More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Tom Chi More articles by this author Expand All Advertisement PDF downloadLoading ...

Shared Prosperity and the Quintile Income in Sudan: Preliminary Findings

This paper attempted to tackle tow issues: the first issue is the income distribution top income quintiles (including some parcels) with bottom 20% and 40% ones. Secondly whether economic growth alone, could reduce extreme poverty and mitigate income inequality in Sudan? Different prosperity shared indicators applied to data obtained from two Labor Force Migration households’ Surveys collected by Ministry of Manpower for years 1996 and 2011. The findings of this study indicated that the income share of bottom 40% failed to catch up with shares of top 10%.and overall per capita .Accordingly, all the shared prosperity indicators results were associated with idea of polarization in the Sudan society, and more importantly CAGR (as one of indicators) empathized that the bottom 20% income have to grow by more than 60% annually in order to catch up with overall per capita growth during the period of the study. To improve the picture of the income distribution and to reverse the situation of poverty in Sudan, the pattern of economic growth has to be restructured and to be associated with high economic participation. The paper recommended a deliberate government intervention to improve income distribution.

The impact of tropical cyclones on income inequality in the U.S.: An empirical analysis

Despite a growing number of studies on the effects of tropical cyclones on economic growth, not much is known about their effects on income inequality. This paper addresses this question by using a panel data set of U.S. counties affected during the period 2010–2019. It exploits geophysical information to construct the disaster intensity predictor, and shows that storm shocks significantly decrease local income inequality levels in the year that they occur. A close study of the composition effects reveals several interesting patterns. First, the immediate impact is driven by the two lowest quintiles and the top quintile of the income distribution. Second, the beneficial effects on income inequality are stabilised in the short-run and the frequency of events is a crucial parameter to consider as repeatedly exposed counties exhibit larger responses after a cyclone strike than their rarely exposed counterparts. Finally, among others, this study stresses the importance of social safety nets in counteracting tropical cyclones’ adverse income distributional effects.

Financial socialization and financial distress: The role of cognitive and noncognitive abilities

AbstractThis study investigated the influence of financial socialization on financial distress and demonstrated the importance of both cognitive and noncognitive ability channels through which this relation operates. Using data from a nationally representative sample of adult US residents, the results showed that adults in the bottom quintile of financial socialization are significantly more likely to experience financial distress than those in the top quintile. We also provide evidence that financial socialization is related to financial distress both directly and indirectly through cognitive ability measures of financial knowledge and financial skills, as well as the noncognitive ability measure of financial self‐control. The findings highlight the importance of financial socialization in familial contexts. Implications for personal finance advocates, financial educators, children and family service providers, and policymakers are discussed.

Challenges of COVID-19 Case Investigation and Contact Tracing in School Settings: An Initial Investigation.

Case investigation and contact tracing (CI/CT) are important public health tools to interrupt COVID-19 transmission. Our study aims to understand how parents and school staff perceive COVID-19 CI/CT. Using a mixed methods approach, we distributed a community survey and conducted 15 focus group discussions (FGDs) in English and Spanish between December 2020 and March 2021 with 20 parents and 22 staff from schools in San Diego County ZIP Codes with COVID-19 rates in the top quintile as of August 2020. One in 4 survey respondents reported that they would be reluctant to participate in CI/CT. FGDs revealed themes of mistrust in government authorities, overburdened institutions, unfamiliarity with CI/CT, and uncertainty about its reliability. School community members emphasized that parents trust schools to be involved in CI/CT efforts, but schools are overwhelmed with this added responsibility. Investing in schools as community hubs is necessary so they can become important partners in prevention and mitigation in public health.

Long-Term Intake of Folate, Vitamin B6, and Vitamin B12 and the Incidence of Parkinson's Disease in a Sample of U.S. Women and Men.

Folate and vitamins B6 and B12 have been proposed as protective against the development of Parkinson's disease (PD). Two prior longitudinal studies were inconclusive. The aim was to examine the association of long-term intake of folate, vitamin B6, and vitamin B12 with the incidence of PD. The study population comprised 80,965 women (Nurses' Health Study, 1984-2016) and 48,837 men (Health Professionals Follow-up Study, 1986-2016) followed prospectively for the development of PD. Intake of B vitamins was measured at baseline and every 4 years thereafter using food frequency questionnaires. We estimated the hazard ratio (HR) and 95% confidence interval (CI) of PD based on quintiles of cumulative average intake adjusting for potential confounders. Secondary analyses considered different lagged exposure periods as well as baseline and recent intakes. In separate analyses of cumulative average intake, total folate, B6, and B12 were not associated with the risk of PD. Results from 8-, 12-, and 16-year lag analyses were consistent with these findings. Results for baseline intake of folate and B6 also pointed toward a null association. In contrast, a lower PD risk was observed among individuals with higher baseline total intake of B12 (pooled HR top vs. bottom quintile: 0.80; 95% CI: 0.67-0.95; P-trend=0.01); results from 20-year lag analyses were consistent with this finding. Our results do not support the hypothesis that a higher intake of folate or vitamin B6 would reduce PD risk in this population. Our results provide moderate support for a possible protective effect of vitamin B12 on the development of PD. © 2023 International Parkinson and Movement Disorder Society.

Multivariate assessment of vaccine equity in Nigeria: A VERSE tool case study using demographic and health survey 2018

Nigeria experiences wide heterogeneity in vaccination rates by vaccine and region. However, inequities in vaccination status extend beyond just geographic covariates. Traditionally, inequity is represented by a single metric pertaining to socioeconomic status. A growing body of literature suggests that this view is limiting, and a multi-factor approach is necessary to comprehensively evaluate relative disadvantage between individuals.The Vaccine Economics Research for Sustainability and Equity (VERSE) tool produces a composite equity metric, which accounts for multiple factors influencing inequity in vaccination coverage. We apply the VERSE tool to Nigeria’s 2018 Demographic and Health Survey (DHS) to cross-sectionally evaluate equity in vaccination status for national immunization program (NIP) vaccines over the following contributing covariates: age of child, sex of child, maternal education level, socioeconomic status, health insurance status, state of residence, and urban or rural designation. We also assess equity for zero-dose, fully immunized for age, and completion of NIP.Results show that socioeconomic status contributes substantially to variation vaccination coverage, but it is not the most substantial factor. For all vaccination statuses, except for NIP completion, maternal education level is the greatest contributor towards a child’s immunization status among model variables. We highlight the outputs for zero-dose, fully immunized at infancy, MCV1 and PENTA1. The percentage point gap in vaccination status between the top and bottom quintiles of disadvantage, as ranked by the composite indicator is 31.1 (29.5–32.7) for zero-dose status, 53.1 (51.3–54.9) for full immunization status, 48.9 (46.9–50.9) for MCV1, and 67.6 (66.0–69.2) for PENTA1. Though concentration indices indicate inequity for all statuses, full immunization coverage is very low at 31.5% suggesting significant gaps in reaching children after initial doses for routine immunizations. Applying the VERSE tool to future Nigeria DHS surveys can allow decisionmakers to track changes in vaccination coverage equity, in a standardized manner, over time.

Factors associated with diet diversity among infants and young children in the Eastern and Southern Africa region.

This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6-23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDDwas defined as consumption ofmore than or equals tofive of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternaland child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6-11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin-A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.

Association between ultra-processed foods and recurrence of depressive symptoms: the Whitehall II cohort study

ABSTRACT Objectives To examine the association between high intakes of ultra-processed foods (UPF) and recurrence of depressive symptoms (DepS) in a Western non-Mediterranean country and its contribution to the overall diet-depression relationship. Methods Analyses were carried out on British participants from the Whitehall II cohort. Present analyses were restricted to white participants N = 4554 (74% men, mean age = 61; SD = 5.9). UPF consumption was estimated from a 127-item food frequency questionnaire using the NOVA classification, and cumulative average of UPF intakes (g/day) over 11 years of exposure (1991/1994–2002/2004) was computed. Recurrent DepS after measurement of UPF was defined as having two or more episodes of DepS (the Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 or antidepressants use) during four phases of follow-up (2002/2004–2015/2016). Results Over the follow-up, 588 (12.9%) cases of recurrent DepS were observed. After adjusting for socio-demographic factors, health behaviours and health status, participants in top quintile of UPF intakes [mean 33% of total daily intakes in grams] had 31% higher odds of recurrent DepS (odds ratio 1.31; 95% CI 1.04–1.64) compared to participants in the four lowest quintiles of UPF [mean 18.1% of total daily intakes in grams]. Additional analyses showed that associations between adherence to several diet quality measures and recurrent DepS were partially attenuated (17–27%) by UPF intakes. Conclusion In this British population, high intakes of ultra-processed foods were associated with increased odds of recurrent depressive symptoms and contributed to the overall diet quality-depressive symptoms association.

The association between the proportion of Brexiters and COVID-19 death rates in England

RationaleA cultural divide may exist between a set of people who accept and a set of people who reject the advice of experts. This cultural divide may have important consequences and policy implications, especially in times of severe crisis. ObjectiveEcological study of whether there exists a significant conditional correlation between two variables that appear unrelated except for attitude towards experts: (1) Proportion of people voting in favour of remaining in the European Union in 2016 and (2) COVID-19 outcomes measured by death rates and vaccination rates. A significant conditional correlation would indicate that polarized beliefs have important consequences across a broad spectrum of societal challenges. MethodsThis study uses simple descriptive statistics and multiple linear regression, considering confounders suggested in the related literature, with data at the District level in England. ResultsDistricts where people voted most heavily in favour of remaining in the EU (top quintile) had nearly half the death rate of districts in the bottom quintile. This relationship was stronger after the first wave, which was a time when protective measures were communicated to the public by experts. A similar relationship was observed with the decision to get vaccinated, and results were strongest for the booster dose, which was the dose that was not mandatory, but highly advised by experts. The Brexit vote is the variable most correlated with COVID-19 outcomes among many variables including common proxies for trust and civic capital or differences in industry composition across Districts. ConclusionsOur results suggest a need for designing incentive schemes that take into consideration different belief systems. Scientific prowess – such as finding effective vaccines – may not be sufficient to solve crises.

A218 ASSOCIATIONS BETWEEN ADHERENCE TO LITERATURE-DERIVED DIETARY INDICES AND PRE-DISEASE BIOMARKERS: IMPLICATIONS FOR CROHN’S DISEASE PREVENTION

Abstract Background The incidence of Crohn’s disease (CD) is increasing globally, indicating a significant environmental influence such as diet. A plethora of dietary adherence (DA) patterns exist in the literature: the Mediterranean Diet (MD), Empirical Dietary Inflammatory Pattern (EDIP), Specific Carbohydrate Diet (SCD), and low Fermentable Oligosaccharide, Disaccharide, Monosaccharide, or Polyol diet (FODMAP) are all potential candidates to maintain a reduced level of inflammation, improving gastrointestinal function. Contrary, the Westernized diet (WD) is generally reported as a diet promoting inflammation in humans. Purpose To determine if DA to literature-derived dietary indices in a cohort of first-degree relatives (FDRs) of CD patients can modulate pre-disease biomarkers. Method We used food frequency questionnaire (FFQ) data from 2,696 healthy FDR subjects of the Crohn’s Colitis Canada- Genes, Environment, Microbial (CCC-GEM) project. We rederived each of the following scores using our FFQ data, utilizing originally described methods for the MD, EDIP, SCD, low FODMAP, and WD to obtain DA. Each diet was correlated pairwise via Kendall’s Tau. We fit multivariable regression models to identify the association of DA (top quintile vs remaining) and: i) intestinal permeability using urinary fractional excretion of lactulose to mannitol ratio (LMR), LMR≥0.03 defined abnormal; ii) subclinical inflammation using fecal calprotectin (FCP) measured with BÜHLMANN fCAL® ELISA, FCP≥250µg/g defined inflammation; and iii) fecal microbiome richness and composition using 16S rRNA sequencing. Two-sided p&amp;lt;0.05 for primary and q&amp;lt;0.05 for secondary analysis defined significance. Result(s) There were positive correlations between the MD, SCD, and low FODMAP, these diets negatively correlated with the WD. The EDIP negatively correlated with the SCD and low FODMAP, did not correlate with the MD, and positively correlated with the WD. No diet was associated with abnormal LMR or FCP. Only the SCD was associated with increased microbial richness (q=0.03). All diets were associated with microbial genera: the MD (n=18 taxa, (2.0-7&amp;lt;q-values&amp;lt; 0.04), EDIP (n=9, [2.8-4-0.05]), SCD (n=13, [3.7-11-0.05]), low FODMAP (n=14, [1.3-7-0.05]), and WD (n=1, [0.03]). Conclusion(s) This study shows that literature-derived dietary indices correlate generally with each other, yet none were not associated with abnormal LMR or FCP. However, we found that diet can impact microbiome richness and composition. Thus, it is tempting to speculate that diet is a possible intervention capable of maintain microbiome homeostasis to reduce future risk of CD. Submitted on behalf of the CCC-GEM consortium. Funding Crohn’s and Colitis Canada Genetics Environment Microbial (CCC-GEM) III The Leona M. and Harry B. Helmsley Charitable Trust Kenneth Croitoru is the recipient of the Canada Research Chair in Inflammatory Bowel Disease Disclosure of Interest None Declared

Differences in all-cause mortality risk associated with animal and plant dietary protein sources consumption

The relationship between protein intake and mortality is still controversial. We prospectively examined the associations of dietary protein sources with all-cause mortality risk in the Isfahan cohort study (ICS). A total of 5431 participants, aged ≥ 35 years, were enrolled in the ICS, in 2001 and followed through 2013. The frequency of protein intakes from different sources was estimated through a validated food frequency questionnaire at baseline. Any new case of death was recorded over the follow-up duration. Hazard ratio (HR)s and 95% confidence interval (CI)s were estimated through Cox proportional hazards regression models. During a median follow-up of 11.3 years, 483 deaths were documented. Higher intakes of plant proteins (HR = 0.64, 95% CI 0.46, 0.91) and animal proteins (HR = 1.52, 95% CI 1.13, 2.05) were associated with a decreased and increased risk of mortality, respectively. Additional adjustment for some mediators did not considerably affect the associations for animal protein (HR = 1.55, 95% CI 1.15, 2.09), whereas led to a tendency towards lower risk for plant protein in the top quintile compared with the bottom one (HR = 0.67, 95% CI 0.48, 0.95; P trend = 0.06). Among specific major sources, higher intakes of nuts and fish were associated with a 27% (95% CI 0.58, 0.93) and 21% (95% CI 0.62, 1.01) lower risk of mortality, respectively. The inverse association between plant protein and mortality risk might be mediated by some metabolic disorders. However, our results suggest an independent positive association for animal protein and all-cause mortality.