Worse Health Outcomes Research Articles

RURALITY AND RACE IN WYOMING AND MISSISSIPPI: THE INTERSECTION OF PLACE AND RACE-BASED DISPARITIES

Abstract Across the US, rural populations tend to be “older, poorer, and sicker” than their urban counterparts as they report higher morbidity, mortality, and greater risk of death due to unintentional injuries. In an already disadvantaged population, rural minorities tend to report even worse health outcomes. This study aims to examine the health disparities faced by rural populations by examining county-level 65+ outcomes in the predominately rural states of Wyoming (WY) and Mississippi (MS). Data from the 2023 WY Healthy Aging Data Report (HADR) and MS HADR was utilized to conduct bivariate statistical analyses and mapping to compare rural/frontier, and urban counties in WY and MS. Findings suggest rurality is protective of health in WY, where 21 of 23 counties are classified as rural or frontier, as these counties reported lower morbidity, despite lower access to primary care physicians (PCPs) [Rural: Mean(SD)=46.19(32.67); Urban: M(SD)=245(38.18)] and hospitals [Rural: Mean(SD)=1.1(0.44); Urban: M(SD)=2(1.41)]. Conversely, bivariate analyses found the two frontier counties with a Native American reservation reported the lowest life expectancy [M(SD)=77.7(1.7); WY: M(SD)=80.34(2.26)] and highest homicide rates [M(SD)=4.54(6.42); WY: M(SD)=0.83(2.31)] and COVID-19 mortality [M(SD)=476.64(52.43); WY: M(SD)=356.61(139.24)]. Similarly, predominately Black, rural counties in MS reported worse rates for 26 of 28 indicators of health and lowest access to care [PCPs: M(SD)= 18.52(20.56); Hospitals: M=1.06(0.65)] compared to rural, predominately White counties [PCPs: M(SD)= 23.88(19.92); Hospitals: M(SD)= 1.11(0.64)], and MS state averages [PCPs: M(SD)= 43.54(93.45); Hospitals: M(SD)= 1.23(1.10)]. These findings speak to the unique health disparities rural populations face at the intersection of place and race.

FINANCIAL HARDSHIP IS ASSOCIATED WITH REPEATED STRESSORS AS MEASURED BY STRESSOR DIVERSITY

Abstract Financial hardship supplements traditional measures of socioeconomic status (i.e., education, income) to elucidate how the insufficiency of socioeconomic resources is experienced. Financial hardship may impact health by differentiating exposure to stressors in daily life. This study examined how three domains of financial hardship (i.e., material, behavioral, and psychological) relate to daily stressor concentration (e.g., experiencing many stressors that are all arguments versus fewer stressors spread across arguments, work stress, home overloads). Higher stressor concentration has been associated with poorer health and well-being across adulthood. The present analyses used data from the Midlife in the United States study wave 3 (2016-2020), in which 1,024 participants (ages = 43-90, 57% female) completed 8-day daily diary interviews. Measures of financial hardship include material indicators of poverty, healthcare, and financial aid; psychological perceptions of financial situation; and behaviors including payments, earnings, and spending. Daily stressor concentration was calculated using 1- the Gini diversity index. In a regression model accounting for age, sex, daily stressor exposure, and education, a higher total score of financial hardship was associated with higher stressor concentration (b = 0.07, SE = 0.03, p <.01). This result replicated across material (b = 0.26, SE = 0.09, p <.01) and psychological domains (b = 0.11, SE = 0.04, p <.01) of financial hardship, and the findings were exacerbated with older age (ps <.05). Experiencing repeated stressors in specific domains may be a mechanism by which insufficient economic resources can worsen health outcomes for adults as they age.

Pharmacological treatments for co-occurring PTSD and substance use disorders: A systematic review.

Post-traumatic stress disorder and substance use disorders commonly co-occur and are associated with worse health outcomes. Currently, only psychosocial therapies are specifically recommended for use in the co-occurring population, but these come with numerous barriers to access and engagement. This study aims to identify potential pharmacological treatments to enhance treatment options and outcomes for this population. This systematic review identified studies on pharmacological treatment of co-occurring PTSD and SUD in humans, using validated outcome measurements, with study design of RCT, observational study, case control study or cohort study. 29 studies were identified for inclusion, looking at a range of 16 pharmacotherapies. A majority concentrated on alcohol use disorders and males, with many focused on the veteran population. This is an area for further research, inclusive of more SUDs, genders and civilians. Future studies utilizing consistent dosing, populations and measurement outcomes will allow for future meta-analysis.

A CROSS-SECTIONAL STUDY TO INVESTIGATE COST-RELATED NON-ADHERENCE AMONG DIABETIC PATIENTS IN TWIN CITIES

Background: Medication nonadherence is a significant global health issue, particularly among diabetic patients, and is associated with worsened health outcomes and increased healthcare costs. In Pakistan, where diabetes prevalence is high, socioeconomic disparities exacerbate adherence challenges. Cost-related barriers, forgetfulness, and complex medication regimens are commonly cited reasons for nonadherence. Understanding the influence of socioeconomic factors such as income, education, and insurance coverage on medication adherence is essential to developing effective strategies for improving diabetes management. Objective: To investigate the correlation between socioeconomic factors (income levels, education, and insurance coverage) and medication adherence among diabetic patients in Rawalpindi and Islamabad. Methods: A cross-sectional study was conducted involving 300 diabetic patients from Rawalpindi and Islamabad. Data were collected using a validated self-administered questionnaire consisting of six sections, including demographics, adherence challenges, and coping strategies. Statistical analysis, including chi-square tests, was performed using SPSS version 23.0 to identify significant associations (p<0.05). Ethical approval was obtained from the university's ethical review board. Results: Among the 300 participants, 45% reported nonadherence to medication regimens, primarily due to financial concerns (37.3%) and forgetfulness (50.3%). The majority (61%) were aged between 30 and 50 years, and 79.3% sought alternative financial support, while 80.3% were aware of community resources. Significant associations were observed between age and key adherence factors, including cost-related challenges (p<0.001). Despite awareness and financial assistance, adherence barriers persisted. Conclusion: This study highlights the critical impact of socioeconomic factors on medication adherence among diabetic patients in Rawalpindi and Islamabad. Addressing nonadherence requires a multifaceted approach, including enhanced financial support, personalized counseling, and innovative interventions such as healthcare reminders, to improve diabetes management outcomes.

Estimating the economic impact of blister-packaging on medication adherence and health care costs for a Medicare Advantage health plan.

Medication nonadherence is a persistent challenge in the United States, leading to increased health care resource utilization (HCRU) and health care costs and worsened health outcomes. Medicare Star Ratings is a program developed by the Centers for Medicare and Medicaid Services (CMS) to evaluate Medicare health plan quality and performance. Three of the Medicare Part D Star Ratings quality measures assess medication adherence, showing the importance CMS places on improving medication adherence in older adults. Although a variety of medication adherence-enhancing interventions are available to help promote adherence among patients, one intervention that has shown success historically is blister-packaging. To model the potential impact of blister-packaging chronic medications on HCRU and health care costs in the Medicare population. An economic model was developed to assess the potential impact of blister-packaging the 3 Medicare Star Ratings adherence measure medication classes: renin-angiotensin system antagonists (RASAs), statins, and noninsulin antidiabetics. The model perspective was that of a hypothetical Medicare Advantage health plan with a plan size of 100,000 members. A 12-month time horizon was used in the model. The dichotomous adherence threshold in the model was set at 80% or greater of the proportion of days covered (PDC). Literature-based references were used to inform both the impact of blister-packaging on the number of patients who become adherent as well as the impact of medication adherence on HCRU and health care costs for each of the medication classes. One-way sensitivity analyses and several scenario analyses were conducted to assess model uncertainty. Owing to increased adherence from the blister-packaging intervention, the hypothetical health plan in the analysis saw 776 additional members adherent to RASAs, 1,651 additional members adherent to statins, and 414 additional members adherent to oral antidiabetics. Although medication expenditure increased for all 3 medication classes (RASAs: $274,963; statins: $730,083; oral antidiabetics: $100,529), medical costs decreased across all classes (RASAs: -$4,098,848; statins: -$5,549,699; oral antidiabetics: -$917,968). Total net health care costs decreased by $3,823,885 for RASAs (-$3.19 per member per month [PMPM]), $4,819,616 for statins (-$4.02 PMPM), and $817,438 for oral antidiabetics (-$0.68 PMPM). The entire Medicare Advantage population scenario analysis saw reductions in total health care costs of $1,081,394,737 for RASAs, $1,362,987,376 for statins, and $231,171,496 for oral antidiabetics. Dispensing chronic medications with blister-packaging for Medicare Advantage health plan patients was modeled to reduce HCRU and health care costs. Future studies are needed to assess whether the impact of blister-packaging medications is tied to reductions in HCRU and health care costs in real-world settings.

Exploring the Interplay Between Climate Change, 24-Hour Movement Behavior, and Health: A Systematic Review.

Given the emergence of climate change and health risks, this review examined potential relationships between varying indicators of climate change, movement behaviors (ie,physical activity [PA], sedentary behavior, and sleep), and health. Seven databases were searched in March 2020, April 2023, and April 2024. To be included, studies must have examined indicators of climate change and at least one of the movement behaviors as either an exposure or a third variable (ie,mediator/moderator), and a measure of health as outcome. Evidence was summarized by the role (mediator/moderator) that either climate change or movement behavior(s) has with health measures. Relationships and directionality of each association, as well as the strength and certainty of evidence were synthesized. A total of 79 studies were eligible, representing 6,671,791 participants and 3137 counties from 25 countries (40% low- and middle-income countries). Of 98 observations from 17 studies that examined PA as a mediator, 34.7% indicated that PA mediated the relationship between climate change and health measure such that indicators of adverse climate change were associated with lower PA, and worse health outcome. Of 274 observations made from 46 studies, 28% showed that PA favorably modified the negative association between climate change and health outcome. Evidence was largely lacking and inconclusive for sedentary behavior and sleep, as well as climate change indicators as an intermediatory variable. PA may mitigate the adverse impact of climate change on health. Further evidence is needed to integrate PA into climate change mitigation, adaptation, and resilience strategies.

Politicians, power, and the people's health: US elections and state health outcomes, 2012-2024.

Our descriptive study examined current associations (2022-2024) between US state-level health outcomes and 4 US state-level political metrics: 2 rarely used in public health research (political ideology of elected representatives based on voting records; trifectas, where 1 party controls the executive and legislative branches) and 2 more commonly used (state policies enacted; voter political lean). The 8 health outcomes spanned the life course: infant mortality, premature mortality (death at age <65), health insurance (adults aged 35-64), vaccination for children and persons aged ≥65 (flu; COVID-19 booster), maternity care deserts, and food insecurity. For the first 3 outcomes, we also examined trends in associations (2012-2024). For all political metrics, higher state-level political conservatism was associated with worse health outcomes, especially for the metrics for political ideology and state trifectas. For example, in 2016, the premature mortality rate in states with Republican vs Democratic trifectas was higher by 55.4 deaths per 100 000 person-years (95% CI: 7.7, 103.1), and the slope of the rate of increase to 2021 was also higher, by 27.0 deaths per 100 000 person-years (95% CI: 24.4, 29.7). These results suggest elections, political ideology, and concentrations of political power matter for population health.

The effects of multimodal versus opioid-only analgesia on pain control and opioid exposure for inpatient acute pancreatitis: A retrospective cohort study.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Acute pancreatitis (AP) is a common gastrointestinal condition that carries a significant financial and physical burden for patients due to the painful presentation and frequent need for hospitalization. Treatment varies in the type and route of analgesic used. Unmanaged pain can lead to worsening health outcomes and prolonged admissions. Further research is needed to understand current practices for managing AP. This study was a retrospective, exploratory, single-center cohort study. Patients admitted to an internal medicine unit with AP from September 1, 2020, to December 31, 2021, were included. Our primary outcome was the change in pain scores during the first 24-hours after administration of the first pain-relieving medication. Secondary outcomes included change in pain scores within the first 12-hours, time to oral tolerance, characterization of analgesic orders, comparison of median pain scores by home analgesic usage, and specific inpatient opioid use. One hundred sixty-nine patients were screened, and 94 were included in the study. Forty-four patients were assigned to the multimodal cohort and 50 patients to the opioid-only cohort. Changes in pain scores per unit of time, assessed by a mixed-effects model, within the first 24 hours were -0.080 (SE, 0.018) in the multimodal cohort and -0.090 (SE, 0.014) in the opioid-only cohort (P = 0.780). Morphine milligram equivalents (MME) administered in the multimodal and opioid-only cohorts were 24.50 (interquartile range [IQR], 51.75) and 52.5 (IQR, 68.5) (P = 0.001), respectively. There was no significant difference in the change in pain scores between patients receiving multimodal therapy and those receiving opioids only. Significantly fewer MME were administered in the multimodal group, suggesting that multimodal therapy can be opioid-sparing in AP.

Social Vulnerability is Associated with Worse Urinary Incontinence and Quality of Life in Women

ObjectivesTo investigate whether social vulnerability is associated with the direct and indirect burdens of urinary incontinence. Urinary incontinence affects over half of all adult women living in the United States and can affect quality of life. While individual-level social determinants of health have been associated with urologic disease, the effect of community-level factors is poorly characterized. Community-level social vulnerability as measured using the social vulnerability index from census-level data has been associated with worse health outcomes. MethodsWomen with urinary incontinence were recruited from our urology outpatient clinic and via ResearchMatch to complete questionnaires on urinary incontinence symptoms and incontinence-specific quality of life. Home zip code was merged with census data to determine SVI. Urinary symptom severity and quality of life were compared between those living in low versus high social vulnerability areas, and multivariable logistic regression was performed. ResultsThis sample included 1,004 women. Women with urinary incontinence living areas with the highest social vulnerability had significantly worse urinary incontinence severity and incontinence-specific quality of life, even after adjusting for covariates. ConclusionsIn this cohort, community-level social vulnerability is associated with worse urinary incontinence and worse incontinence-specific quality of life in women, even when controlling for multiple covariates. This suggests that community-level drivers of health play a significant role in urologic outcomes and urinary conditions, and that the social vulnerability index measure may be a useful tool to identify communities who may benefit most from targeted policy intervention efforts.

Is alcohol use disorder associated with higher rates of depression and anxiety among people with new onset type 2 diabetes? A cohort study using linked primary care data in England

IntroductionDepression and alcohol use disorder (AUD) in people living with Type 2 diabetes mellitus (T2DM) are associated with worse health outcomes. AUD is strongly associated with depression and anxiety, but it is not known how these conditions cluster in people with T2DM. We investigated rates of new episodes of depression and anxiety following T2DM diagnosis in people with and without prior AUD among an English primary care population.MethodsThe study population was people diagnosed with T2DM between 2004 and 2019. We used the Clinical Practice Research Datalink (CPRD) Aurum database and linked Hospital Episode Statistics Admitted Patient Care (HES APC) and Office for National Statistics (ONS) mortality data. We examined incidence of new episodes of anxiety or depression in people with T2DM with and without AUD. AUD was defined as any of i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm (physical or mental) using SNOMED-CT or ICD-10 codes. People were excluded if they had codes for depression/anxiety 12 months prior to T2DM diagnosis. Poisson regression models were fitted adjusting sequentially for a) age, gender, calendar time; b) region, Index of Multiple Deprivation, ethnicity, body mass index, smoking status, Charlson co-morbidity index; and c) history of a mental health condition.ResultsOur study population was 479,447 people of whom 10,983 (2.3%) had an AUD code prior to T2DM diagnosis.After adjusting for all measured confounders except history of a mental health condition, IRR for depression was 2.00 (95% CI 1.93, 2.06) for people with AUD compared to without AUD. This reduced to 1.45 (95% CI 1.41, 1.50) after further adjustment for history of a mental health condition.Findings for anxiety were substantially similar to those for depression (adjusted for all measured confounders except history of a mental health condition, IRR 2.08 95% CI 1.99, 2.18 fully adjusted IRR 1.48 95% CI 1.41, 1.55).ConclusionsPeople with AUD have over double the rates of depression and anxiety following T2DM diagnosis than those without AUD. This was only partially explained by pre-existing diagnoses of mental health conditions. A holistic approach incorporating mental health support is needed to improve health outcomes for people with AUD who develop T2DM.Trial registrationNot applicable.

1.D. Scientific session: Cross national perspectives: the many faces of health inequities

Abstract Health inequities come in different forms in different countries, often times based on country and population demographics, and exist around the world. Ample evidence has revealed how inequities to accessing and utilizing health services can have detrimental consequences for certain populations and exist across numerous strata including geography, income, race and ethnicity, age, and gender. This workshop identifies different examples of inequities across countries, and their impact on health outcomes and health care use. Health inequities, in whichever form, lead to one common outcome: worse health outcomes and lower life expectancy for those who are marginalized by inequities compared to their counterparts. This session will dive into the research on health inequities by geography (rural versus non rural), income (low/average income versus high income), race/ethnicity, and among people with substance use disorder (SUD) particularly those who use and inject drugs with the goal of 1) exposing the stark disparities in health care among these populations; 2) discussing lessons which can be learned and adapted from other countries; and 3) discussing promising solutions and approaches to restoring justice and access to care for all. The panel will be composed of 1 moderator and up to 5 panelists. Panelists are experts in their fields, established researchers and practitioners, and either employees of the Commonwealth Fund or alumni of the Harkness Fellowship from various high-income countries including Canada, Germany, Norway, the United Kingdom, and the United States. A moderator from the Commonwealth Fund will frame the discussion by introducing a deep dive into affordability barriers utilizing the Commonwealth’s Fund International Health Policy Survey of nine countries. Munira Gunja, senior researcher on the Commonwealth Fund’s International program, will present how a lack of affordability in health care is a growing threat and will likely widen the disparities by income without serious health reforms. Neil MacKinnon, Senior Harkness Fellow from Canada, will continue the discussion focusing on an analysis he and his team at Augusta University completed on disparities in health care by geography in eleven (primarily European) countries. The second panelist, Sidra Khan-Gokkaya, the 2023-2024 Harkness Fellow from Germany, will present on her study of racism in health care in Germany and the U.S. Another of the 2023-2024 Harkness Fellows, Claire Wilson, will present on her research of racial disparities in perinatal mental illness in the U.K. and U.S. Lastly, the fifth panelist, Ane Kristine Finbråten will discuss the unique health needs of those with SUD and the inequities faced by people who use and inject drugs as they navigate health care. Each panelist will speak for roughly 8 minutes, with 20 minutes saved for moderator and audience questions. Key messages • All stakeholders, including patients, public health systems, and health systems benefit when all populations are able to access comprehensive health services. • Health inequities come in many different forms, and to improve health outcomes, we must address them at all levels.

When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease

Abstract Background With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT. Methods A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included. Results 105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity. Conclusions Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view. Key messages • Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity. • The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.

The association between age and functional disability in US adults with lifetime exposure to the criminal legal system, 2015–2019

ImportanceAs the global population ages, the proportion of individuals living with functional disability is increasing. Evidence suggests that functional disability is associated with worse health outcomes and is concentrated in populations with high rates of concurrent social risk factors such as criminal legal involvement (CLI), making it an increasingly important issue for advocates of health equity. ObjectiveTo determine whether age is associated with functional disability in a nationally representative sample of United States adults with lifetime exposure to the criminal legal system. DesignCross-sectional survey data from the National Survey of Drug Use and Health, 2015–2019. SettingNationally representative survey data. ParticipantsUS adults who reported lifetime history of arrest (N = 37,279). ExposureRespondents were categorized into age groups: younger adults (age 18–49); middle-aged adults (age 50–64); and older adults (age ≥ 65). Main outcome measureFunctional disability as measure by the World Health Organization Disability Assessment Score 2.0 (WHO-DAS 2.0). A higher score indicates a greater degree of functional disability. ResultsThe sample included 37,279 US adults with lifetime CLI of whom 60.0 % were younger adults, 28.5 % were middle-aged adults, and 11.5 % were older adults. The mean, unadjusted functional disability score for younger adults was 5.0 (95 % CI, 4.9, 5.1); for middle-aged adults it was 4.2 (95 % CI, 4.0, 4.4); and for older adults it was 3.2 (95 % CI, 2.9, 3.5). In models adjusted for sociodemographic and clinical confounders, differences were attenuated but remained statistically significant, indicating increased functional disability in the younger age groups. Conclusion and relevanceOur findings suggest that among adults with CLI, functional disability is distributed by age in a pattern distinct from the general population. A large number of young adults have CLI, and the findings suggest that prevalence of functional disability is exceedingly high in this marginalized group. Future studies should examine if substance use and mental health conditions contribute to these findings, and policy makers should examine if flexible interventions tailored to the needs of those with disability improve reentry outcomes for young adults with CLI.

40 Trust, belonging and understanding - The experiences of families who use languages other than English (LOE) that are hospitalized on general paediatric inpatient units

Abstract Background Despite recognition that social determinants are critical to health outcomes, many groups, including those with lower incomes, racial/ethnic minorities, and other historically marginalized populations, continue to experience significant social and structural barriers to care. There is need for research that incorporates patient and stakeholder engagement in developing, testing, and disseminating interventions to improve outcomes for patient populations that have been marginalized in the health system. Patients who use a language(s) other than English (LOE) for healthcare communication are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in paediatric hospitals. Canadian census data indicates 12.7% of Canadians predominantly speak a language other than French or English. This work aims to generate knowledge to improve health outcomes for children and families who speak LOE. Objectives (1) To understand the lived experience of families who speak LOE around the hospitalization of their child and (2) To understand the perspectives of patients and families who speak LOE on how the healthcare system can improve care during hospitalization. Design/Methods The premise of this study is participatory research. We designed a qualitative study involving children hospitalized in the General Paediatric Inpatient Unit at the Hospital for Sick Children. The study includes family caregivers of children age 0 to 18 years who identify as speaking LOE. Children and families could speak any language that we were able to obtain interpreter support for. We excluded patients that spoke a traditional Indigenous language as we noted this work required a separate study in partnership with the Indigenous community. We conducted semi-structured virtual individual interviews with children and families post-discharge with a medical interpreter. An interview guide was developed and transcripts were analyzed using thematic analysis. We took several steps to ensure an effective study design given our goals of participatory research including ensuring patient and family engagement throughout the design process. Results 19 families participated in the interviews and 16 different languages were represented amongst our participant groups. Our study is unique in especially unique in it's ability to recruit and interview individuals with so many different primary languages. Our study provides rich insight into opportunities within the paediatric inpatient setting for quality improvement to address the health disparities experienced by patients and families who use LOE for healthcare communication. Our analysis of the interviews identify several themes that provide insight into the lived experience of patients and families who use LOE for healthcare communication. 1) Inconsistent interpreter use affects communication “in the moment” and the ability to develop an “overall understanding” of the current clinical situation and broader healthcare context. Our participants note a "snowball effect" when interpreters are not consistently utilized. 2) In addition to language, multiple additional social factors contribute to an increased sense of vulnerability and modulates how families “trust” the healthcare system. 3) Despite families expressing positive experiences, they noted that they did not, nor expect to feel like they “belonged” within the healthcare system. It is critical to recognize the complex interplay between many factors surrounding our participants’ identities. Though they use a LOE for healthcare, the intersectional marginalization they experience was thoroughly represented during our conversations Conclusion Our research aimed to take a participatory approach to consider the lived experience of patients and families who use LOE for healthcare communication. This work builds on the current literature on patient and family centered care, experiences of families who speak LOE and participatory community-based research in the paediatric hospital settings. Our study's findings support the development of a research and intervention agenda in Canada to improve health outcomes for patients and families with LOE.

Assessing Narrative Patterns in Health Access, Outcomes, and Behaviors Across Three Data Sets From England, the United States, and California for Sexual Minority Adults.

We examined peer-reviewed publications analyzing data from the English GP Patient Survey (GPPS), U.S. National Health Interview Survey (NHIS), and California Health Interview Survey (CHIS) to explore how the health of sexual minority populations varies across settings and subgroups. We searched for English language articles published 2011-2022, screening abstracts (n = 112), reviewing full text (n = 97), and extracting data (n = 85). We conducted a content analysis to identify patterns across settings for sexual minority people compared with heterosexual counterparts and each other. Across all settings, sexual minority adults had poorer health care access, worse health outcomes and patient experiences, more detrimental health behaviors, and greater health care services utilization (reflecting risk awareness and need). When subgroup data were reported, differences were greater among women, except for HIV and related cancers, which were most prevalent among sexual minority men. Sexual minority people generally reported significantly worse health access, outcomes, and behaviors in all three settings.

Age Discrimination of Senior Citizens in European Countries

This paper addresses perceived age discrimination of older persons in European countries. This disturbing issue has become all the more prominent, having doubled over a relatively short period between 2018 and 2021. Strongly associated with bad health outcomes, low levels of wellbeing, and considerable social tensions, age-related discrimination against senior citizens is a sign of the lack of their social integration. Our study used secondary data analysis based on survey methodology. Statistical analysis was performed on data from the European Social Survey wave 10 (2021) subsample of people aged 65 and above to assess the senior population’s age-based discrimination experiences and its individual and macro-level determinants. The results indicate that in all European countries, low socioeconomic status, older age, and living alone are strongly associated with the experience of age discrimination. Having bad health and being functionally limited in everyday activities results in a state of dependency that is connected to a higher risk of perceived exposure to age discrimination. Smaller populations, such as those in villages, are protective against discrimination at older age. Finally, compared to other welfare regimes, in social democratic welfare states with egalitarian redistribution systems and high levels of social benefits, there is a significantly larger share of old people who reported to have been victims of age discrimination. Our results have implications for policy in the context of ageing societies.

An anatomical analysis of liver volume and quality by ethnicity in a New Zealand population.

Post-hepatectomy liver failure is a major cause of mortality, where future liver remnant (FLR) is the key controllable factor. Recommended minimum FLR is influenced by quality of liver parenchyma. Historical research has often failed to include Māori and Pacific Island (PI) populations despite worse health outcomes. Liver analysis by ethnicity is one such example of this. The aims were to determine digital FLR for various anatomical hepatectomies, investigate any correlations between computed tomography (CT) hepatic textural analysis and body mass index (BMI); and assess the variance of these relationships for different ethnicities. One hundred and fifty-one patients who underwent abdominal CT scans at Burwood Hospital, Christchurch were retrospectively analysed. Māori and PI patients were selectively recruited to represent New Zealand's diversity. Liver volumetry, segmental ratio, and intra-hepatic fat deposits (IHFD) per ethnicity were examined. Median age of the cohort was 66 (19-95) and 75 (50%) were males. 68%, 23% and 9% patients identified as being European, Māori/PI and Asian, respectively. No statistically significant difference in volume or segment/total volume ratio were noted across different ethnicities. Obese patients had higher IHFD compared with overweight and normal BMI groups. When stratified across ethnic groups, higher IHFD were observed in Asian compared with Māori/PI populations, despite lower BMI. No significant variances in liver volumetry were found across different ethnic groups in New Zealand. However association between BMI and IHFD varied across different ethnic cohorts. Consequently, knowledge of liver volumetry is not enough; patient liver quality and ethnicity should considered for hepatic-surgery planning.

A Clinical Decision Support System for Addressing Health-Related Social Needs in Emergency Department: Defining End User Needs and Preferences.

Health-related social needs (HRSNs) are the unmet social and economic needs (e.g., housing instability) that affect individuals' health and well-being. HRSNs are associated with more emergency department (ED) visits, longer stays, and worse health outcomes. More than a third of ED patients have at least one HRSN, yet patients are rarely screened for HRSNs in the ED. A clinical decision support (CDS) system with predictive modeling offers a promising approach to identifying patients systematically and efficiently with HRSNs in the ED. This study aimed to identify ED clinician and staff preferences for designing and implementing an HRSN-related CDS system. A multistep, user-centered design study involving qualitative semistructured interviews, observations of ED workflows, and a multidisciplinary design workshop. We conducted 16 semistructured interviews with ED clinicians and staff. Following the interviews, three research team members observed ED workflows, focusing on patient entry and clinician and staff usage of the electronic health record (EHR) system. Finally, we conducted a 3-hour multidisciplinary design workshop. An HRSN-related CDS system should be visually appealing, color-coordinated, and easily accessible in the EHR. An HRSN-related CDS system should target a select group of ED patients (to be discharged from the ED) and highlight a select set of critical HRSN issues early in the workflow to adjust clinical care adequately. An HRSN-related CDS system should provide a list of actions and the ability to notify the clinical team if the patient's HRSNs were addressed. The user-centered design identified a set of specific preferences for an HRSN-related CDS system to be implemented in the ED. Future work will focus on implementing and refining the CDS system and assessing the rates of changes in clinical care (e.g., rates of referrals) to address patient HRSNs in the ED.

Projected impact of climate change on human health in low- and middle-income countries: a systematic review

Low- and middle-income countries (LMICs) contribute relatively little to global carbon emissions but are recognised to be among the most vulnerable parts of the world to health-related consequences of climate...

Characterizing health-related social needs and their association with medication adherence in a diverse cohort of patients with breast cancer.

139 Background: Food insecurity, housing instability, and transportation challenges are modifiable health-related social needs (HRSN) that have been associated with worse health outcomes in patients with cancer. Nonadherence to medications is also associated with decreased survival and other poor outcomes. Less is known about the association between HRSN and medication adherence in this patient population. Methods: We implemented screening for HRSN among breast oncology patients at our urban academic medical center, primarily through the electronic patient portal. Patients were offered an 8-item HRSN survey with questions covering food insecurity, housing, transportation needs, and emergency department visits. Any level of food hardship, housing instability, or transportation challenges reported during the study period (11/2/22-4/20/24) constituted a positive screen for that HRSN. We also screened patients for nonadherence to medications (any medication) using the 3-item DOSE-Nonadherence questionnaire. Pearson's Chi-squared tests and univariate logistic regressions were used to compare differences between subsets. Results: During the 18-month study period, 2945 patients completed at least 1 item on the HRSN questionnaire, of which 765 (26.0%) screened positive for at least 1 HRSN. Among patients who responded to each HRSN domain, 555/2820 (19.7%) screened positive for food insecurity, 374/2650 (14.1%) for housing instability, and 255/2656 (9.6%) for transportation needs. Food-insecure patients also reported more housing (43.1% v 5.6%, p&lt;0.001) and transportation needs (27.7% v 4.0%, p&lt;0.001) compared to food-secure patients. When comparing the cohort of patients who screened positive for at least 1 HRSN vs those who screened negative, there was a higher proportion of Hispanics (55.3% vs 25.1%, p&lt;0.001), non-Hispanic Blacks (15.3% v 10.0%, p&lt;0.001), and Spanish speakers (41.2% v 17.2%, p&lt;0.001). Patients with any HRSN were more likely to self-report medication nonadherence compared to those with a negative HRSN screen (44.2% v 35.3%, OR 1.45, 95% CI 1.18-1.79). When looking at each individual HRSN domain, food-insecure patients were more likely to self-report medication nonadherence than food-secure patients (45.9% v 35.9%, OR 1.51, CI 1.19-1.92); this was also true for patients with housing instability (45.7% v 36.4%, OR 1.47, CI 1.12-1.92) and transportation needs (49.1% v 36.5%, OR 1.68, CI 1.23-2.31). Conclusions: More than a quarter of breast cancer patients self-reported at least 1 HRSN, with food insecurity being most frequently reported. Patients with at least 1 HRSN had 45% increased odds of medication nonadherence. Further research is warranted to understand the financial, social, psychological, and healthcare-related factors that may underlie this association, and to design interventions targeting at-risk cancer populations.