Wide Disparity Research Articles

Abortion care preferences and trade-offs when traveling out-of-state for facility-based services: findings from a discrete choice experiment

BackgroundPregnant people living in states that banned abortion after the US Supreme Court’s decision overturning Roe v Wade (Dobbs v Jackson Women’s Health Organization -Dobbs decision) may evaluate multiple factors when deciding where to obtain facility-based abortion care in another state. We examine Texans’ stated preferences for out-of-state facility-based abortion care and quantify the trade-offs they would make when choosing between out-of-state facilities following a 2022 abortion ban.MethodsIn August 2022, we surveyed Texans ≥ 16 years old seeking abortion at in-state facilities or who were searching online for information about accessing abortion care. We used a Bayesian discrete choice experiment to analyze 12 choice sets for out-of-state facility-based abortion care and to assess preferences for three care attributes: wait time to appointment, distance to facility, and cost. We estimated conditional, multinomial, and mixed logit models to examine respondents’ attribute preferences and how these differed across subgroups. We used marginal rates of substitution to express Texans’ tradeoffs in terms of willingness to pay and willingness to travel for different attributes.ResultsAmong 136 respondents (1,362 observations), time to next appointment was the most important attribute (β = -0.887, p < 0.001), followed by cost (β = -0.006, p < 0.001) and distance (β = -0.001, p < 0.001). Respondents were willing to pay an additional $248 (95% CI: $220, $278) and travel 917 miles (95% CI: 711, 1123) further to get an appointment one week sooner. The willingness to pay for a one-week reduction in wait time to appointment was higher among respondents who did not report any economic hardships ($313, 95% CI: $255, $371) than among those who had one or more economic hardships ($175, 95% CI: $142, $208).ConclusionThis discrete choice experiment examining Texans’ preferences for out-of-state facility-based abortion care demonstrates that people seeking abortion prioritize wait time to appointment when deciding where to obtain care. Efforts to make timely care a more feasible option for all those seeking abortion care are needed to mitigate the potential widening of disparities in access to care now that more states have banned abortion.

Determinants of potential HIV vaccine uptake among young sexual minoritized men 17-24 years old.

Failures in prior roll-out of HIV prevention efforts have widened disparities in HIV incidence by race/ethnicity among young sexual minoritized men (YSMM). We hypothesized greater perceptions of medical mistrust would be associated with lower willingness to get an HIV vaccine, mediating the relationship between race/ethnicity and willingness to accept a future HIV vaccine. HIV-negative and unknown-status YSMM 17-24 years old (n = 229) recruited via social media and men-for-men networking apps completed online surveys from September 2021 to March 2022. Participants were asked about demographics, medical mistrust (healthcare-related sexual orientation stigma, healthcare-related race stigma, global medical mistrust, and trust in healthcare providers), and willingness to accept a future HIV vaccine. Vaccine willingness was highest among White YSMM (96.0%) and lower among Black (71.0%), Latino (83.6%), and multiracial or another race/ethnicity YSMM (80.0%). Even after accounting for medical mistrust constructs as mediators, compared to White participants, Black participants had lower odds of being willing to accept a future HIV vaccine. Participants with greater trust in healthcare providers had higher odds of willingness to accept a future HIV vaccine. Gaps in willingness to get an HIV vaccine are evident among YSMM by race/ethnicity, indicating potential further widening of disparities in HIV incidence when a vaccine becomes available without intervention.

Centre-periphery circulation patterns in Ghana’s print media landscape: exploring the underlying determinants

After 202 years (1822‒2024) of its inception in the then Gold Coast, now Ghana, and witnessing an unprecedented upsurge in publication since 1992, the circulation of print media appears unevenly distributed between the centre (capital) and the peripheries. Since there are not enough studies that explore the circulation of print media under Ghana’s fourth republic to show its circulation patterns, this article analyses print distribution figures and views sourced from newspaper firms to examine the situation within the participatory communication and the political economy of the media frameworks. It uncovers that a few newspaper firms have regional offices but do not print in those locations. They function only as bulk distribution and administrative centres that gather news to feed their headquarters in the capital. Ghana’s print industry operates a centre-periphery production and distribution framework. Furthermore, the study unveils that four factors contribute to newspaper concentration in urban centres, namely ownership tendencies, revenue motives, skilled labour availability and seat of government, and urban media credibility. Thus, Ghana experiences wide rural‒urban print disparities which retard timely information sourcing, consensus building and participatory development communication. The findings from the study have implications for Africa.

Kinetic simulations of nuclear burning plasmas in inertial confinement fusions taking into account the large-angle collisions

Although ignition had been achieved at the National Ignition Facility (NIF), recent observations of the experiments indicate novel physics that beyond theoretical predictions emerge, e.g., the neutron analysis of experiments has revealed deviations from the Maxwellian distributions in ion relative kinetic energies of burning plasmas, with the surprising emergence of supra-thermal deuterium and tritium (DT) ions that fall outside the predictions of macroscopic statistical hydrodynamic models. Via our newly developed hybrid-particle-in-cell code, incorporating the newly-proposed model of large-angle collisions, we infer that this could be attributed to the increased significance of large-angle collisions among DT ions and α-particles in the burning plasma. Extensive and unprecedented kinetic investigations into the implications of large-angle collisions in the burning plasma have yield several key findings, including an ignition moment promotion by ∼10ps, the presence of supra-thermal ions below an energy threshold, and approximately twice the expected deposition of α-particles densities. The rationality of our findings is confirmed through the congruency between the neutron spectral moment analyses conducted by the NIF and our kinetic simulations, both highlighting progressively widening disparities between neutron spectral moment analyses and hydrodynamics predictions, which becomes more pronounced as the yield increases. Our kinetic simulations with large-angle collisions not only provide novel insights for experiment interpretation but also open new research opportunities for the largely unexplored regime of the nuclear burning plasmas, which are distinguished by their exceptionally high energy densities and hold immense potential for illuminating the intricate physics that underpins the evolution of the early universe.

Racial and sociodemographic disparities in the use of targeted therapies in advanced ovarian cancer patients with Medicare

ObjectiveTo describe sociodemographic and racial disparities in receipt of poly ADP-ribose polymerase inhibitors (PARPi) and bevacizumab among insured patients with ovarian cancer.MethodsThis retrospective study used the Surveillance, Epidemiology, and End...

Investigating emergency rescue readiness on Indian national highways: A case study of Jaipur-Jodhpur Highways (India) using a geospatial approach

ABSTRACT Background: Highways represent the most significant capital asset that any country’s public sector holds. A system of national highways with easy access to ambulance and trauma centers is termed emergency rescue ready and helps reduce the mortality due to road accidents. Given the rich impetus for road infrastructure development by the government of India, there is a need to consider emergency rescue readiness on highways. Previous research suggests that on typical Indian highways, an ambulance can reach the accident scene within 30 minutes; the remaining 30 minutes of golden hour is essential for saving the life of the injured by admitting to a healthcare facility with a trauma unit. Objective: To investigate the emergency rescue readiness for a stretch of highway between two cities in India. The main objective is to determine the possibility of transporting the injured due to the accident on the highway to the nearest available trauma center within 30 minutes. Methods: A Geographic Information System (GIS)-based network analysis method has been adopted to find the possibility of transporting the injured anywhere on the circuit of a national highway to the nearest healthcare unit within 30 minutes. Results: A map representing the status of emergency rescue readiness has been presented for the study area. For a circuit of national highway with a length of 805 km, in a stretch of 89.5% (718.5 km), the injured can be transported to the healthcare unit within 30 minutes. In the remaining 10.5% of the highway, the healthcare units are significantly far from the highways and may hamper the post-crash rescue operations. Conclusion: There exists a wide disparity in trauma care delivery in the study area. Currently, the healthcare units established to serve the areas with dense populations also serve as emergency rescues during accidents on the national highways. Using GIS techniques for highway stretches with difficulty reaching the trauma centers, a national-level assessment is highly recommended.

Unveiling social disparities in later life: Income’s Impact on mortality among the elderly in Italy

Abstract Background Income is an important predictor of adult mortality, as a proxy of living conditions, capability and access to health services. Previous studies show that mortality decreases by increasing income. In Italy, studies at a national level are missing. This study aims to investigate inequalities in mortality by income in Italy. Methods The analysis is based on the integration of the National Population Register (comprising the resident population as of Dec 31, 2018, and deaths in 2019) and the Income Statistical Register (representing perceived income during 2018). This integration enabled the availability of information on age, sex, residence, education, income, and vital status at the individual level for 13 million people aged 65 or above. Individuals were categorized according to their individual disposable income quintiles both before and after disability benefits. Inequalities by income are assessed by mortality rate ratios (MRR) estimated using negative binomial regression models controlling for demographic and socioeconomic features. The study is carried out within the Next Gen EU-funded project “Age-It Ageing well in an ageing society” (PE0000015), NRRF, M4.C2, Intervention 1.3. Results Considering income net of disability benefits, lower income levels are associated with higher mortality rates compared to the highest income level, for both sexes. Inequalities are more marked for men. The highest excess was observed for individuals with the lowest income (male MRR=1.65, 95%CI: 1.6-1.71; female MRR=1.43, 95%CI: 1.38-1.48). The excess decreases with increasing income. Conclusions The observed relationships between income and mortality are crucial for targeting policies to reduce health inequalities and promote the well-being of the elderly, the goal of which should be to improve access to social and health care and develop supportive policies for the most disadvantaged people. Further research will be devoted to the use of household income for individuals. Key messages • For the elderly, lower income levels are associated with higher mortality, with wider disparities in men. • The choice of definition of income is essential for an accurate assessment of the association between income and mortality.

Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States

Abstract Objectives The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States. Methods Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients. Results TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better. Conclusions We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.

Addressing disparities in the long-term mortality of non-ST segment myocardial infarction (NSTEMI) patients according to the presence of diabetes mellitus: a nationwide cohort study

Abstract Background Diabetes mellitus (DM) is an important risk factor for non−ST segment elevation myocardial infarction (NSTEMI). How DM is related to management and longer-term clinical outcomes in contemporary NSTEMI cohorts is not well described. Methods and Results We analysed data on 456,376 adults hospitalised with NSTEMI from the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics (ONS) death registry. We compared outcomes and quality of care by DM status. People with DM were older (median age 74 vs. 73 years, p&amp;lt;0.001) and more commonly of Asian ethnicity (13% vs. 4%, p&amp;lt; 0.001). Those with DM underwent invasive coronary angiography (59% vs. 63%, p &amp;lt;0.001) or revascularization (PCI or CABG) (38% vs. 40%, p &amp;lt;0.001) less frequently. Mortality risks for people with DM were significantly higher at 30-days (HR: 1.06, CI; 1.04-1.09, p &amp;lt;0.001), 1-year, (HR: 1.17, CI; 1.15-1.18, p &amp;lt;0.001) and 5-years, (HR: 1.25, CI; 1.24-1.26, p &amp;lt;0.001), when compared to people without DM. In people with DM, higher-quality inpatient care, assessed by opportunity-based quality-indicator score category (OBQI; poor, fair, good or excellent), was associated with lower mortality rates (good: HR 0.70, CI 0.67-0.73, P&amp;lt;0.001; excellent: HR 0.59, CI 0.57- 0.62, P&amp;lt;0.001), when compared to people receiving poor quality care. In people with DM, "excellent-care", compared to those receiving poor quality care, was associated with the lowest mortality in diet-treated or insulin-treated subgroups (diet-treated: HR 0.55, CI 0.50-0.61, P&amp;lt;0.001)(insulin-treated: 0.60 CI 0.56-0.64, P&amp;lt;0.001). Conclusion People with DM experience wide disparities in inpatient care following NSTEMI. They have a higher risk of long-term mortality compared to people without DM, with some evidence that better quality inpatient care is linked to better survival.

Association between Social Demographic Factors and Health Literacy in Jordan

The study highlights that low health literacy is a serious global health threat, causing health problem denial, poor communication with healthcare providers, and widening disparities. It aims to investigate how income, education, and socio-economic status affect health literacy levels. The study conducted an occasional design using quantitative data. This study was conducted using a structured questionnaire to obtain information from 413 randomly selected Ammani residents The questions were designed to assess the impact of health literacy level. The study's quantitative results show that socio-economic factors are the reasons for the health literacy among Amman residents, based on the 413 sample. Although gender only shows little differences, age, income, and education greatly affect health literacy, with those aged 30-60, higher income earners, and people with higher education levels having better understanding. It is necessary to design health literacy interventions for different demographic groups so as to eliminate the disparities and to get the so desired health outcomes. This study assesses the association between social demographic factors and health literacy in Jordan and found the level of literacy affected by social and economic factors, but in varying proportions for each topic with some recommendations.

Heterogeneity in disparities by income in cardiovascular risk factors across 209 US metropolitan areas

ObjectiveThe United States has a lower life expectancy and wider income inequality than its similarly developed counterparts, and disparities continue to widen. The objective of our study is to examine the heterogeneity of disparities by income in cardiovascular disease (CVD) risk factors among U.S. metropolitan areas. MethodsData was obtained from the Behavioral Risk Factor Surveillance System for 2012–2019. We used self-reported data for respondent characteristics and for CVD risk factors/prevalence, and on metropolitan-level demographic and socioeconomic characteristics. We computed the relative index of inequality (RII) for each outcome using a multilevel Poisson model, sequentially adjusted for age, sex, and race/ethnicity with a random slope for income. We also included interactions between income and the metropolitan-level variables. ResultsOur sample included 1.4 million participants from 209 metropolitan areas. All CVD risk factors and CVD demonstrated income-related disparities. There were no clear regional patterns for risk factors, though seven of the top 10 large metropolitan areas with the widest disparities in CVD prevalence were in the South. Improved socioeconomic conditions were associated with wider disparities in the five risk factors, and contextual variables explained almost half of the variability in income disparities in smoking, sedentarism, and obesity, even after adjusting for age, sex, and race/ethnicity. ConclusionsThis study found that CVD risk factors and prevalence in U.S. metropolitan areas have heterogeneous income disparities, especially in advantaged metropolitan areas. Further studies with improved data collection may shed more light into potential drivers of income-based disparities in cardiovascular risk.

Rates of fall injuries across three claims databases, 2019

IntroductionIn 2021, among all age groups, falls ranked as the third leading cause of unintentional injury death in the USA. Unlike fatal data, which rely on death certificates as the...

Food choice, embodied knowledge and circumscribed agency: factors influencing adolescent girls' and boys' dietary practices in three states in northern Nigeria.

The objective of this study was to explore adolescent dietary practices, related norms and acceptable communication platforms in northern Nigeria to inform future nutrition project design. This was a qualitative formative research study. We used purposive sampling and conducted thirty focus group discussions with male and female adolescents aged 10-14 and 15-19 years (n 180) and six with adult influencers (n 36). We also administered a 24-h dietary recall with the adolescents using the Diet Quality Questionnaire. The study was conducted in urban and rural areas in three states in northern Nigeria. Adolescents reported consuming six nutritious food groups the previous day on average. However, there was a wide disparity and only half consumed all five recommended food groups. Adolescents' food choices were influenced by perceptions of the functional and physical benefits of nutritious foods and preferences for satisfying foods. Diverse foods were available in the food environment, but affordability constrained access to nutritious foods. Limited access to income and gender norms constrained adolescent agency over food choice. Girls, particularly those who were pregnant, had less agency related to food than boys. Adolescents thought that peers should be reached through group discussions, radio and phones, among other communication platforms. Adolescents consumed relatively diverse diets. Adolescent food choice was influenced by their embodied experience and knowledge related to nutrition and taste, home food environment and circumscribed agency. Opportunities exist to support healthy diets for adolescents by strengthening adolescents' embodied knowledge, food environments and social support.

Patterns and trends in melanoma mortality in Spain (1999-2022).

To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

8642 Continuous glucose monitor: reclaiming type 2 diabetes self-efficacy and mitigating disparities

Abstract Disclosure: K. Ni: None. C.A. Tampe: None. K. Sol: Employee; Self; Patient accepted job with Dexcom Jan 2024. L. Cervantes: None. R.I. Pereira: None. Context: The increase in continuous glucose monitor (CGM) use has been notable for widening disparities between the least and most socially marginalized. Given access barriers, there is limited CGM patient experience information that is inclusive of those with type 2 diabetes mellitus from socially marginalized backgrounds. Objective: To understand the CGM usage experience across a U.S. Medicaid population with type 2 diabetes at federally qualified health centers (FQHCs). Methods: This qualitative study used semi-structured phone interviews with 28 English or Spanish speaking participants prescribed CGM who were enrolled in a U.S. Medicaid program that subsidized CGM. Audio-recordings of interviews were transcribed and analyzed by inductive thematic analysis. Results: Participants had a median age 56 (interquartile range 48-60) with varying levels of formal schooling (55% with 9 years or less) and were from diverse racial or ethnic backgrounds (57% Hispanic, 18% non-Hispanic Black, 21% non-Hispanic White). Interviews were conducted in English (68%) or Spanish (32%). We identified six major themes: initial expectations and overcoming initiation barriers (subthemes: initial expectations, overcoming initiation barriers), convenience and ease promote daily use (subthemes: benefits over fingersticks), increased knowledge leads to improved self-management (subthemes: increased understanding and knowledge, glucose level self-awareness, motivating healthy behaviors), collaboration with provider and clinical team, improved self-reported outcomes (subthemes: improved glucose and non-glucose targets, positive emotional effect, essential for management), and barriers and burdens are generally tolerated (subthemes: barriers to monitoring, burden of self-monitoring). Conclusions: CGM was experienced as easy to understand and use and viewed as a tool for diabetes self-efficacy. Expanded CGM access for socially marginalized patients with type 2 diabetes can enhance diabetes self-management to help mitigate diabetes outcome disparities. Presentation: 6/2/2024

PDOC-02 SUB-SAHARAN AFRICAN EXPERIENCE OF NEUROSURGICAL-ONCOLOGIC CARE: CHALLENGES AND BARRIERS ENCOUNTERED AT 7 CANCER TREATMENT CENTERS

Abstract BACKGROUND Wide disparities in neurosurgical-oncologic care and treatment outcomes exists globally despite recent improvements in diagnostics and cancer therapy. To better understand the challenges to neurosurgical-oncologic care in low resource settings, we collected data on national neurosurgery capacity and hospital diagnostic and treatment capacity across 7 national referral hospitals in 7 countries Sub-Saharan Africa (SSA). METHODS A 42-item self-administered questionnaire was distributed to partner neurosurgeons at the 7 sites via REDCap in April 2023 to provide country and hospital level capacity data on neurosurgical-oncologic care. RESULTS Neurosurgical and neurosurgical-oncologic care was reported to be available in a limited number of provinces/states/regions in 6 out of the 7 countries. The neurosurgery and pediatric neurosurgery workforce density across the 7 countries ranged between 0.03 – 0.67 per 100,000 and 0 – 0.05 per 100,000 respectively. Three hospitals had no pediatric ICU with the remaining four having between 2-8 bed-capacity pediatric ICU. One hospital did not have both CT and MRI scanner available and relied solely on private diagnostic facilities for neuroimaging. Histopathology services were largely limited to basic hematoxylin and eosin (H&amp;E) and/or advanced histopathology staining. Molecular subtyping was available at only one hospital. None of the 7 hospitals had neurocritical care expertise, neuroradiologist, or neuropathologist. Four hospitals had a pediatric anesthesiologist. Only one hospital had a neuro-oncologist, but none had a pediatric neuro-oncologist. Both adjuvant chemotherapy and radiotherapy was unavailable at 3 hospitals. Rehabilitation was largely limited to basic physical and occupational therapy at all 7 hospitals. Although all 7 countries had a multiple health payer system, the payment structure differed across the 7 hospitals for different neurosurgical-oncologic services with patients making out-of-pocket payments for all services in some cases. Financial constraint was reported as a major barrier to care. CONCLUSION System-level interventions are needed to strengthen neurosurgical-oncologic care capacity in SSA.

Trends and Disparities in Mental Health Use Among Asian American Sub-groups, 2013-2019.

The objective of this study was to characterize and compare national estimates of mental healthcare use among White and Asian American groups to provide an update using post Affordable Care Act data. We analyzed yearly cross-sectional data from the 2013-2019 Medical Expenditure Panel Survey, including White (n=112,590) and Asian American (n=10,210) individuals, and examined rates of mental healthcare use for Asian (overall), Asian Indian, Chinese, Filipino, and Other Asian individuals relative to White individuals. Using multivariable logistic regression models and predictive margin methods, we estimated overall Asian disparities and Asian subgroup disparities compared to White group rates in mental health care (outpatient, specialty, psychotropic medication) among adults with and without elevated risk for mental illness. Regression models were adjusted for variables related to need for treatment, demographic, and socioeconomic status variables. Asian individuals had lower rates of mental healthcare use than White individuals. Unadjusted results and adjusted regression model predictions are consistent in identifying wide disparities in mental health care treatment across risk for mental illness, Asian subgroups, and types of treatment. Asian Americans have significantly lower rates of mental healthcare use than White Americans, even among those with elevated risk for mental illness. There is small variation by Asian subgroups but disparities persist across subgroups and types of treatment. Our results imply interventions are needed to improve linguistically, culturally, and ethnically tailored outreach and engagement in treatment services, as well as examining treatment and its effectiveness for Asian American individuals living with psychological distress.

Equally poorer: inequality and the Greek debt crisis

AbstractIn this paper, we discuss the evolution of inequality in Greece from 2004 to 2021 in light of the Greek debt crisis that led to a sharp drop in gross domestic product per capita between 2008 and 2013. While aggregate measures of income inequality, such as the Gini coefficient, suggest a marginal improvement, domestic perceptions of social fairness remain bleak. To delve deeper into this paradox, we explore additional aggregate and distributional aspects of Greece's social landscape during this period. Our analysis reveals several contributing factors: a compression of earnings, benefits and pensions; a sharp increase in social exclusion; and high inequality in access to basic public services and housing. These factors go beyond what headline inequality indices indicate, illustrating how the sovereign debt crisis and subsequent austerity measures have affected individuals differently based on their socio‐economic background, while also reducing overall welfare across the Greek population. Moreover, chronic institutional inefficiencies and widening disparities in access to services and housing significantly influence perceptions of inequality and contribute negatively to the country's social cohesion.

Spanish implantable cardioverter-defibrillator registry. 20th official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2023)

IntroductionThis article presents data on implantable cardioverter-defibrillator implants in Spain in 2023. MethodsThe registry is based on information provided by centers following device implantation, which is submitted to the Heart Rhythm Association of the Spanish Society of Cardiology via the national online registry platform (Cardiodispositivos). Additional information sources include: a) data transfer from the manufacturing and marketing industry; and b) local databases sent from the implanting centers. Population data from the National Institute of Statistics for the first quarter of 2024 was used to calculate implant rates. ResultsIn 2023, 180 hospitals participated in the registry. Data were reported for 8219 units, compared with 8523 reported by Eucomed (European Confederation of Medical Suppliers Associations). The total implant rate was 172 implants per million inhabitants (177 according to Eucomed), representing an increase compared with previous years. However, differences among autonomous communities persisted, and Spain continues to have the lowest implant rate among the European countries participating in Eucomed. ConclusionsThe data from the 2023 registry reflects 96.4% of the implants performed in Spain. Despite the improvement observed in the implantation rate, Spain's position in Europe remains unchanged, with wide disparities among autonomous communities.

Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID-19 pandemic.

The COVID-19 pandemic prompted a surge in telehealth utilization. However, language barriers have emerged as a potential obstacle to effective telemedicine engagement, impacting millions of limited English proficient (LEP) individuals. Understanding the role of language spoken in telehealth outcomes is critical, particularly in cancer care, in which consistent follow-up and communication are vital. The primary objective was to assess the impact of telehealth utilization and primary language spoken on clinical outcomes in cancer patients. This study utilized a retrospective cohort design, encompassing cancer patients seen at the Chao Family Comprehensive Cancer Center between March 1, 2020, and December 31, 2022. The study incorporated both in-person and telehealth visits, examining the association between encounter type and clinical outcomes. The study included 7890 patients with more than one outpatient visit during the study period. There was decreased telehealth utilization in non-English speaking cancer patients throughout the pandemic. Increased telehealth utilization was associated with higher rates of admission, irrespective of cancer type. Additionally, telehealth visits were associated with longer duration of subsequent admissions compared to in-person visits. Spanish-speaking patients utilizing telehealth had higher rates of re-admission compared to English speakers utilizing telehealth. Patients who died had higher rates of telehealth utilization compared to patients who survived. This study demonstrates that primary language spoken is associated with differences in telehealth utilization and associated outcomes in cancer patients. These differences suggest that the interplay of telehealth and language could contribute to widening of disparities in clinical outcomes in these populations. The study underscores the need to optimize telehealth usage and minimize its limitations to enhance the quality of cancer care in a telehealth-driven era.