Unequal Burden Research Articles

Addressing Healthcare Gaps in Sweden during the COVID-19 Outbreak: On Community Outreach and Empowering Ethnic Minority Groups in a Digitalized Context.

Since its early stages, the COVID-19 pandemic has interacted with existing divides by ethnicity and socioeconomic statuses, exacerbating further inequalities in high-income countries. The Swedish public health strategy, built on mutual trust between the government and the society and giving the responsibility to the individual, has been criticized for not applying a dedicated and more diverse strategy for most disadvantaged migrants in dealing with the pandemic. In order to mitigate the unequal burden on the marginalized members of society, increasing efforts have been addressed to digital health technologies. Despite the strong potential of providing collective public health benefits, especially in a highly digitalized context as Sweden, need for a stronger cooperation between the public health authorities and migrant community leaders, representatives of migrant associations, religious leaders and other influencers of disadvantaged groups has emerged. Suggestions are presented on more culturally congruent, patient-centered health care services aimed to empower people to participate in a more effective public health response to the COVID-19 crisis.

Health inequality experienced by the socially disadvantaged populations during the outbreak of COVID-19 in Hong Kong: An interaction with social inequality.

Health inequality creates conditions for the transmission of infectious diseases, and existing health disparities can contribute to unequal burdens of morbidity and mortality. In Hong Kong, low socioeconomic districts were the epicentres of third-wave outbreak of COVID-19 in July and August 2020, suggesting that people from low socioeconomic class are vulnerable groups. Socially disadvantaged people are relatively more vulnerable to the physical, mental, and social impacts of infectious diseases. To achieve more effective infection control, the social determinants of health and existing health inequalities should be identified, and understanding the experiences of socially disadvantaged groups in the COVID-19 outbreak will be beneficial to health authorities in formulating a responsive infection control policy targeting the needs of the socially disadvantaged. This article investigates the experiences of economically disadvantaged groups during the COVID-19 outbreak and examines how they were further disadvantaged in the outbreak by delineating how health inequality intersected with social inequality. In-depth, semistructured interviews were conducted from February to April 2020 with 35 participants from the poverty class in Hong Kong. The high prices of surgical face masks and disinfecting products as well as the economic impacts induced by COVID-19-related social distancing policies imposed severe economic burden on the participants. In addition to economic and housing deprivation, social inequality was closely associated with health inequality, which made the participants more vulnerable to infection. Social inequality is associated with and can worsen health inequality. Here, the participants, who were of low socioeconomic status were more disadvantaged in health and in the attainment of social resources such as employment, education, face masks, disinfection products and right to use public facilities, during the COVID-19 outbreak. All these elements may have interrelated effects and in turn limit accessibility to healthcare and lead to less positive health outcomes and consequently to health inequality.

The Unequal Burden of Self-Reported Musculoskeletal Pains Among South Korean and European Employees Based on Age, Gender, and Employment Status

BackgroundThe objective of this study was to elucidate the relationships musculoskeletal pains with combined vulnerability in terms of age, gender, and employment statusMethodsThe fifth European Working Conditions Survey (EWCS) in 2010 (43,816 participants aged 15 years and over) analyzed for European employees and the third Korean Working Conditions Survey (KWCS) in 2011 (50,032 participants aged 15 years and older) analyzed for Korean employees. In this study, three well known vulnerable factors to musculoskeletal pains (older age, female gender, and precarious employment status) were combined and defined as combined vulnerability. Associations of musculoskeletal pains with combined vulnerability were assessed with prevalence ratios (PRs) and 95% confidence intervals (CIs) estimated by Poisson regression models with robust estimates of variance.ResultsThe prevalences of musculoskeletal pains were lower but the absolute and relative differences between combined vulnerabilities were higher among Korean employees compared with the European employees. Furthermore, the increased risk of having musculoskeletal pains according to combined vulnerability was modestly explained by socioeconomic factors and exposure to ergonomic risk factors, especially in Republic of Korea.ConclusionsThe results of this study showed that the labor market may be more unfavorable for female and elderly workers in Republic of Korea. Any prevention strategies to ward off musculoskeletal pains, therefore, should be found and implemented to mitigate or buffer against the most vulnerable work population, older, female, and precarious employment status, in Republic of Korea.

From "It Has Stopped Our Lives" to "Spending More Time Together Has Strengthened Bonds": The Varied Experiences of Australian Families During COVID-19.

The present study uses a qualitative approach to understand the impact of COVID-19 on family life. Australian parents of children aged 0–18 years were recruited via social media between April 8 and April 28, 2020, when Australians were experiencing social distancing/isolation measures for the first time. As part of a larger survey, participants were asked to respond via an open-ended question about how COVID-19 had impacted their family. A total of 2,130 parents were included and represented a diverse range of family backgrounds. Inductive template thematic analysis was used to understand patterns of meaning across the texts. Six themes were derived from the data, including “Boredom, depression and suicide: A spectrum of emotion,” “Families are missing the things that keep them healthy,” “Changing family relationships: The push pull of intimacy,” “The unprecedented demands of parenthood,” “The unequal burden of COVID-19,” and “Holding on to positivity.” Overall, the findings demonstrated a breadth of responses. Messages around loss and challenge were predominant, with many families reporting mental health difficulties and strained family relationships. However, not all families were negatively impacted by the restrictions, with some families reporting positive benefits and meaning, including opportunities for strengthening relationships, finding new hobbies, and developing positive characteristics such as appreciation, gratitude, and tolerance.

Negative Spillovers of New Technologies: The Unequal Burden of Congestion Created by Autonomous Vehicles

Autonomous vehicle (AV) technologies lower the private cost of driving, leading to induced demand for road use at peak times. Because adoption is likely to skew towards higher-income commuters, we show that the congestion externalities exacerbated by adoption are likely to be experienced disproportionately by lower-income drivers. Unless proactive policies like congestion pricing or improved access to public transit or ride-share are simultaneously implemented, autonomous vehicles are likely to make lower-income commuters actively worse off in congested cities where many higher-income commuters currently take public transit.

A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden

As global deaths from COVID-19 continue to rise, the world’s governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society.

Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses

To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes. US counties and zip codes in Illinois and New York City, as of May 5, 2020. Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code-level area-based socioeconomic measures. As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code-level area-based socioeconomic measures were also observed. Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.

The Unequal Burden of Positive Gender Stereotypes on Women's and Men’s Sense of Autonomy

Seven studies (N = 3,536) examine the conditions under which individuals experience expectations about their social category as a threat to their sense of autonomy and the consequences of autonomy threat elicited by such expectations. Across both work contexts and non-work contexts, women experienced expectations associated with their gender category as more threatening to their sense of autonomy compared to men, even when expectations were positively valenced (Studies 1a-2b). This gender difference was explained by gendered expectations playing a more significant role in women’s lived experiences than men’s and by men tending to encounter more agentic (control-affording) gendered expectations than women (Study 1b). Autonomy threat explained, in part, why women experienced more negative emotions in response to, and reported lower motivation to comply with, positive gender stereotypes about their group at work than men did (Studies 2a-b). Consistent with the notion that highly agentic stereotypes provide a buffer against feelings of autonomy threat, Asian Americans responded more negatively to low agency positive stereotypes about their group than high agency positive stereotypes about their group, explained in part by how much autonomy they felt the stereotype provided (Study 3). Communal expectations felt more controlling to women when explicitly gendered (Study 4) and prescriptive rather than descriptive (Study 5). Overall, results show that women and men’s feelings of autonomy are differentially impacted by society’s expectations about the (positive) qualities they possess, contributing to an unequal psychological burden placed on women at work and beyond.

Oral Health Among Older Adults With Complex Needs Living in the Community and in Aged Residential Care Facilities within New Zealand

ObjectivesTo describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables. DesignSecondary analysis of 2 continuously recruited national cohorts. Setting and ParticipantsAdults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent. MethodsAll community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models. ResultsOverall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Māori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts. Conclusions and ImplicationsHeavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.

Effects of taurocholic acid metabolism by gut bacteria: A controlled feeding trial in adult African American subjects at elevated risk for colorectal cancer

Colorectal cancer (CRC) is the third leading cause of cancer and second leading cause of cancer death in the United States. Recent evidence has linked a high fat and animal protein diet and microbial metabolism of host bile acids as environmental risk factors for CRC development. We hypothesize that the primary bile salt taurocholic acid (TCA) is a key, diet-controlled metabolite whose use by bacteria yields a carcinogen and tumor-promoter, respectively. The work is motivated by our published data indicating hydrogen sulfide (H2S) and secondary bile acid production by colonic bacteria, serve as environmental insults contributing to CRC risk. The central aim of this study is to test whether a diet high in animal protein and saturated fat increases abundance of bacteria that generate H2S and pro-inflammatory secondary bile acids in African Americans (AAs) at high risk for CRC. Our prospective, randomized, crossover feeding trial will examine two microbial mechanisms by which an animal-based diet may support the growth of TCA metabolizing bacteria. Each subject will receive two diets in a crossover design― an animal-based diet, rich in taurine and saturated fat, and a plant-based diet, low in taurine and saturated fat. A mediation model will be used to determine the extent to which diet (independent variable) and mucosal markers of CRC risk and DNA damage (dependent variables) are explained by colonic bacteria and their functions (mediator variables). This research will generate novel information targeted to develop effective dietary interventions that may reduce the unequal CRC burden in AAs.

Getting the measurement right! quantifying time poverty and multitasking from childcare among mothers with children across different age groups in rural north India

ABSTRACT Existing research suggests that women spend a disproportionate amount of time on unpaid housework and childcare compared to men. However, there is a lack of empirical evidence on unequal time burdens due to childcare among women. This study analyses the quantum of time poverty and multitasking behaviours of 3623 rural women with children of varying ages across rural North India. Findings show that mothers with infants spend more time on childcare and less time on self-care and leisure, and employment-related activities as compared to mothers with older children; they also multitask with childcare more than mothers of older children across all their daily activities. Our findings suggest that interventions and policies need to be designed to raise awareness, identify/adopt novel approaches and technologies to reduce work burden of unpaid work on women’s time, provide accessible childcare and encourage a more equitable distribution of household responsibilities.

Abstract B116: Evaluating the ability of clinically approved chemotherapeutics to decrease race-associated breast cancer mortality disparities via targeting the tumor-promoting effect of Crystallin Beta B2

Abstract In the United States, breast cancer (BC) remains the second leading cause of cancer death in women. The unequal burden in the mortality of BC in African American (AA) women compared to Caucasian American (CA) women goes without full explanation. When socioeconomic factors such as education and income are accounted for, this mortality disparity persists. Therefore, to acquire an understanding of how to end BC disparities, it is crucial to examine the underlying cellular and molecular mechanisms driving this disproportionate outcome. Studies on gene expression analyses have identified a particular gene, CRYβB2, with higher expression in AA breast tumors. Expression of CRYβB2 was also found to be increased in studies comparing AA and CA colorectal, renal, glioblastoma, and prostate cancers, and has been linked with decreased survival. Although the precise mechanisms of elevated CRYβB2 expression remain unknown, overexpression is significantly associated with BC tumor promotion. In view of this, we investigated the biological effects of CRYβB2 in basal-like, triple negative breast cancer (TNBC) cell lines. CRYβB2 expression was manipulated via CRIPSR/Cas9-mediated knockout and lentiviral overexpression systems. Our preliminary data show enhanced proliferation and invasion in 3D cultures with cells overexpressing CRYβB2 compared to controls, suggesting two mechanisms by which CRYβB2-overexpression may enhance tumor promotion and promote poor patient outcome. To identify drugs that may specifically target cells overexpressing CRYβB2, we subjected one of our CRYβB2 model systems (SUM159 cells overexpressing CRYβB2, with CRYβB2 knocked out, and the parental SUM159 cells with low CRYβB2 expression) to increasing doses of 125 clinically approved chemotherapeutics. High content live cell imaging was used to evaluate the effects of the drugs by measuring 3D spheroid BC cell growth, and IC50 were generated to determine whether cells with altered CRYβB2 expression were more or less sensitive to particular classes of drugs. Drugs identified with increased cytotoxicity to cells overexpressing CRYβB2 were confirmed using two additional TNBC models with altered CRYβB2 levels. Additional in vitro mechanistic studies evaluating the effect of the drugs on proliferation, cytotoxicity and invasion of CRYβB2-overexpressing were executed in 3D cultures with live cell imaging. Drugs that significantly affect the proliferation or invasion of CRYβB2-overexpressing cells will be evaluated in future studies for efficacy and toxicity in conjunction with other chemotherapeutics via in vivo AA-specific xenografts and PDX models. This information will be used to explore the potential use of these chemotherapeutics for neoadjuvant or adjuvant therapy in BC patients with tumors that overexpress CRYβB2. The identification of clinically approved drugs that inhibit CRYβB2 function may quickly be applied in the clinic to increase survival rates until more effective and less toxic, targeted-therapies are developed. Citation Format: Portia L. Andrews, Denise K. Reaves, Megan E. Martin, Michael Tarpley, Kevin P. Williams, Jodie M. Fleming. Evaluating the ability of clinically approved chemotherapeutics to decrease race-associated breast cancer mortality disparities via targeting the tumor-promoting effect of Crystallin Beta B2 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B116.

ОСОБЛИВОСТІ ЦІННІСНО-СМИСЛОВОЇ СФЕРИ ВІЙСЬКОВОСЛУЖБОВЦІВ З РІЗНИМ ДОСВІДОМ УЧАСТІ В БОЙОВИХ ДІЯХ

У статті обґрунтовується актуальність і доцільність дослідження ціннісно-смислової сфери військовослужбовців. Метою дослідження є вивчення впливу досвіду участі військовослужбовців у бойових діях на їх ціннісно-смислову сферу. Аналізуються основні підходи до проблеми ціннісно-смислової сфери особистості у сучасній психології, зокрема, її зміни внаслідок виконання професійних обов’язків у галузі військової діяльності. Її специфіка пов’язана з небезпекою та прийняттям ризикових рішень, що зумовлює переосмислення життєвих цінностей. Тому було сформульовано припущення про деструктивний вплив досвіду участі в бойових діях на ціннісно-смислову сферу військовослужбовців. Подано результати емпіричного дослідження смисложиттєвих орієнтацій військовослужбовців (базового компонента ціннісно-смислової сфери); здійснено порівняльний аналіз їх показників у респондентів із різним досвідом перебування в зоні Операції об’єднаних сил (ООС). Встановлено, що середні показники та відсоткове зіставлення рівнів значущості смисложиттєвих орієнтацій військовослужбовців експериментальної (учасники бойових дій у зоні ООС) і контрольної (не перебували в зоні ООС) груп не мають статистично значущих відмінностей, проте мають деяку специфіку. Проаналізовано, що серед учасників бойових дій, на противагу тим, хто не має такого досвіду, достовірно більша кількість людей є задоволеними власним життям і здатні контролювати його залежно від певних обставин. Виявлено негативний вплив хронологічного (онтогенетичного) віку досліджуваних, які мають досвід перебування в ООС, на якість і показники їх смисложиттєвих орієнтацій. Ціннісні орієнтації учасників бойових дій загалом є більш диференційованими за їх значущістю й осмисленістю, порівняно з військовослужбовцями, які не перебували в зоні проведення ООС. Достовірно більша кількість респондентів із бойовим досвідом, порівняно з тими, хто його не має, виявляє полярність в осмисленні життєвих цінностей: дуже глибоко осмислює смисложиттєві орієнтації чи втрачає у них сенс.

Public Policy Trends: Unequal Burden: Learning from Canada's Responses to the Influenza Pandemic of 1918-20

Public Policy Trends: Unequal Burden: Learning from Canada's Responses to the Influenza Pandemic of 1918-20

Public Policy Trends: Unequal Burden: Learning from Canada's Responses to the Influenza Pandemic of 1918-20

Public Policy Trends: Unequal Burden: Learning from Canada's Responses to the Influenza Pandemic of 1918-20

Unequal social vulnerability to Hurricane Sandy flood exposure.

Disparities exist in post-disaster flooding exposure and vulnerable populations bear a disproportionate impact of this exposure. We describe the unequal burden of flooding in a cohort of New York residents following Hurricane Sandy and assess whether the likelihood of flooding was distributed equally according to socioeconomic demographics, and whether this likelihood differed when analyzing self-reported or FEMA flood exposure measures. Residents of New York City and Long Island completed a self-administered survey 1.5–4.0 years after the storm. Multivariable logistic regressions were performed to determine the relationship between sociodemographic characteristics and flood exposure. Participants (n=1231) residing in areas of the lowest two quartiles of median household income experienced flooding the most often (FEMA/self-reported: < $40,298: 65.3%/42.0%, $40,298 - $67,188: 43.3%/32.1%) and these areas contained the highest proportions of non-white participants (< $40,298: 39.1%, $40,298 - $67,188: 36.6%) and those with < high school education (< $40,298: 35.5%, $40,298 - $67,188: 33.6%). Both self-report (p < 0.05) and FEMA (p < 0.05) flood measures indicated that older participants were more likely to live in a household exposed to flooding, while those living in higher income areas had decreased likelihood of flooding (p < 0.0001). Socioeconomic and age disparities were present in exposure to flooding during Hurricane Sandy. Future disaster preparedness responses must understand flooding from an environmental justice perspective to create effective strategies that minimize disproportionate exposure and its adverse outcomes.

Race, death of a child, and mortality risk among aging parents in the United States.

The death of a child is a stressful and traumatic life event that has been linked to increased mortality risk among parents. Tragically, black parents are significantly more likely than white parents to lose a child in the United States; however, prior research has not addressed this racial disadvantage in relation to parents' mortality risk. In this study, we focus on the racial context of the United States to suggest that black parents already face higher mortality rates compared to white parents, and the unequal burden of child death adds to their mortality risk. Using discrete-time event history models, we consider whether the death of a child by midlife is associated with increased mortality risk for black parents and for white parents in mid- to later-life using longitudinal data from the Health and Retirement Study (HRS; 1996-2016). Descriptive results show that by midlife, black parents, especially black mothers, experience substantially higher child mortality compared with white parents. At the same time, we find that losing a child prior to midlife is associated with heightened mortality risk for aging black mothers and white mothers. Controlling for educational attainment explains the association between child death and parental mortality risk among white mothers, whereas heightened biopsychosocial and behavioral risk factors explain the association for black mothers. Overall, the death of a child is associated with increased mortality risk for black mothers and for white mothers, but the processes linking child death to parental mortality seem to differ for black and white parents. These findings have implications for policies and interventions that address increased mortality risk for parents following the death of a child.

Race and ethnicity on MS presentation and disease course

Multiple sclerosis (MS) has a strong racial and ethnic component and disproportionately affects whites of European background. Recent incidence reports suggest an increasing rate of MS among African Americans compared with whites. Despite this recent increase in MS in African Americans, Hispanics and Asians are significantly less likely to develop MS than whites of European ancestry. MS-specific mortality trends demonstrate distinctive disparities by race/ethnicity and age, suggesting that there is an unequal burden of disease. Inequalities in health along with differences in clinical characteristics that may be genetic, environmental, and social in origin may be contributing to disease variability and be suggestive of endophenotypes. The overarching goal of this review was to summarize the current understanding on the variability of disease that we observe in selected racial and ethnic populations: Hispanics and African Americans. Future challenges will be to unravel the genetic, environmental, and social determinants of the observed racial/ethnic disparities.

Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India

Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India

Optimal Federal Redistribution During Uncoordinated Response to a Pandemic

Optimal policy during an epidemic calls for depressed economic activity to slow down the outbreak. Sometimes, these decisions are left to local authorities (e.g. states). This creates an externality, as the outbreak doesn't respect states' boundaries. A strategic Pigouvian subsidy that rewards states which depress their economies more than the average corrects that externality by creating a race-to-the-bottom type of response. In equilibrium nobody receives a subsidy, but the allocation is efficient. If local authorities are concerned about unequal burden of the lockdown costs but cannot easily issue new debt to finance transfer payments, then lockdowns will be insufficient in some areas and excessive in others. When that's the case, federal stimulus checks can flatten the infection curve.