Association between social determinants of health and survival among the US cancer survivors population
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ABSTRACT:
SUBMITTER: Huang H
PROVIDER: S-EPMC11346002 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundWith the increased availability of data, a growing number of studies have been conducted to address the impact of social determinants of health (SDOH) factors on population health outcomes. However, such an impact is either examined at the county level or the state level in the United States. The results of analysis at lower administrative levels would be useful for local policy makers to make informed health policy decisions.ObjectiveThis study aimed to investigate the ecological association between SDOH factors and population health outcomes at the census tract level and the city level. The findings of this study can be applied to support local policy makers in efforts to improve population health, enhance the quality of care, and reduce health inequity.MethodsThis ecological analysis was conducted based on 29,126 census tracts in 499 cities across all 50 states in the United States. These cities were grouped into 5 categories based on their population density and political affiliation. Feature selection was applied to reduce the number of SDOH variables from 148 to 9. A linear mixed-effects model was then applied to account for the fixed effect and random effects of SDOH variables at both the census tract level and the city level.ResultsThe finding reveals that all 9 selected SDOH variables had a statistically significant impact on population health outcomes for ≥2 city groups classified by population density and political affiliation; however, the magnitude of the impact varied among the different groups. The results also show that 4 SDOH risk factors, namely, asthma, kidney disease, smoking, and food stamps, significantly affect population health outcomes in all groups (P<.01 or P<.001). The group differences in health outcomes for the 4 factors were further assessed using a predictive margin analysis.ConclusionsThe analysis reveals that population density and political affiliation are effective delineations for separating how the SDOH affects health outcomes. In addition, different SDOH risk factors have varied effects on health outcomes among different city groups but similar effects within city groups. Our study has 2 policy implications. First, cities in different groups should prioritize different resources for SDOH risk mitigation to maximize health outcomes. Second, cities in the same group can share knowledge and enable more effective SDOH-enabled policy transfers for population health.
| S-EPMC10131773 | biostudies-literature
Project description: Not available
| S-EPMC9918884 | biostudies-literature
Project description:BackgroundSocial determinants of health (SDoH) are environmental conditions that influence health outcomes. As olfactory dysfunction (OD) in older individuals is associated with increased morbidity and mortality, we sought to investigate the impact of specific SDoH on olfactory function.MethodsA cross-sectional analysis of the Health, Aging and Body Composition Study, a US population-based epidemiologic cohort study, was performed. Olfactory function was assessed utilizing both a self-report and a psychophysical olfactory test (CC-SIT test). Multivariable logistic regressions were performed to examine associations between specific SDoH with self-reported anosmia (sOD) and objective anosmia (oOD) as assessed by psychophysical testing. Differences in sensitivity and specificity were evaluated with sample tests for equality of proportions.ResultsOf 2219 participants, 13% had oOD and 18% had objective hyposmia; only 10% had sOD. Individuals identifying as Black race had higher odds of oOD (odds ratio [OR]:1.41, 95% confidence interval [CI]:1.02-1.95), while females and those reporting family incomes ≥$50,000 had lower odds of oOD (OR: 0.46, CI:0.34-0.62; OR:0.52, CI:0.29-0.93), adjusting for covariates. No specific SDoH was significantly associated with sOD. The sensitivity and specificity of sOD for oOD was 23.1% and 92.0%, respectively. sOD had greater sensitivity in females than males (30.8% vs. 18.8%, p = 0.030), while specificity varied significantly depending on family income (range: 90.0%-94.8%, p = 0.033).ConclusionsUtilizing a large population-based study, we find disparities in the prevalence and self-recognition of OD among individuals of different gender, race, and income levels. Further effort is needed to evaluate factors propagating these disparities and to raise awareness of OD across all patient populations.
| S-EPMC11647574 | biostudies-literature
Project description:ImportancePrevious studies suggest that race or ethnicity may be associated with risk for developing retinopathy of prematurity (ROP). Little is known about how socioeconomic factors mediate the relationship between race or ethnicity and ROP outcomes.ObjectiveTo evaluate how socioeconomic factors, in the context of race and ethnicity, are associated with ROP outcomes.Design, setting, and participantsThis retrospective cohort study used US Census Bureau income data and electronic medical records from neonatal intensive care units at 4 hospitals, UCLA Mattel Children's Hospital, UCLA Santa Monica Hospital, Cedars-Sinai Medical Center, and Harbor-UCLA Medical Center. Eligible participants included neonates born at a gestational age (GA) of 30 weeks or less, birth weight less than 1500 g, or a GA at birth greater than 30 weeks but with an unstable clinical course. Participants were screened for ROP between January 1, 2010, and December 31, 2020.ExposuresRace and ethnicity data, GA, demographic and clinical information, proxy household income, and health insurance status were collected as risk factors.Main outcomes and measuresDiagnosis and severity of ROP were the main study outcomes. Severity was determined according to a classification system developed by the Early Treatment for Retinopathy of Prematurity Cooperative Group.ResultsIn a crude model, Hispanic neonates were more likely to be diagnosed with ROP (OR, 1.70; 95% CI, 1.20-2.42) and had more severe ROP (OR, 2.24; 95% CI, 1.21-4.15) compared with non-Hispanic White neonates; these associations were no longer found when adjusting for GA and socioeconomic factors (OR, 1.12; 95% CI, 0.68-1.82, and OR, 1.67; 95% CI, 0.80-3.52, for ROP diagnosis and severity, respectively). In a fully adjusted model, lower GA was the primary predictor of ROP incidence (OR, 0.52; 95% CI, 0.48-0.57; P < .001), and higher median household income was associated with higher GA (OR, 0.26; 95% CI, 0.09-0.43; P = .002).Conclusions and relevanceIn this cohort study, GA was the primary driver of disparities in ROP outcomes in a heterogeneous population of neonates in Los Angeles, California. When examined in the context of socioeconomic factors, GA did not differ between racial and ethnic groups. Studies of disparities associated with race and ethnicity should consider these constructs in conjunction with other sociodemographic factors and social determinants of health.
| S-EPMC9011172 | biostudies-literature
Project description:ObjectiveTo compare outcomes after bariatric surgery between Medicaid and non-Medicaid patients and assess whether differences in social determinants of health were associated with postoperative weight loss.BackgroundThe literature remains mixed on weight loss outcomes and healthcare utilization for Medicaid patients after bariatric surgery. It is unclear if social determinants of health geocoded at the neighborhood level are associated with outcomes.MethodsPatients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2008 to 2017 and had ≥1 year of follow-up within a large health system were included. Baseline characteristics, 90-day and 1-year outcomes, and weight loss were compared between Medicaid and non-Medicaid patients. Area deprivation index (ADI), urbanicity, and walkability were analyzed at the neighborhood level. Median regression with percent total body weight (TBW) loss as the outcome was used to assess predictors of weight loss after surgery.ResultsSix hundred forty-seven patients met study criteria (191 Medicaid and 456 non-Medicaid). Medicaid patients had a higher 90-day readmission rate compared to non-Medicaid patients (19.9% vs 12.3%, P < 0.016). Weight loss was similar between Medicaid and non-Medicaid patients (23.1% vs 21.9% TBW loss, respectively; P = 0.266) at a median follow-up of 3.1 years. In adjusted analyses, Medicaid status, ADI, urbanicity, and walkability were not associated with weight loss outcomes.ConclusionsMedicaid status and social determinants of health at the neighborhood level were not associated with weight loss outcomes after bariatric surgery. These findings suggest that if Medicaid patients are appropriately selected for bariatric surgery, they can achieve equivalent outcomes as non-Medicaid patients.
| S-EPMC8059876 | biostudies-literature
Project description:Social epigenomics is an emerging field in which social scientist collaborate with computational biologists, especially epigeneticists, to address the underlying pathway for biological embedding of life experiences. This social epigenomics study included long-term childhood cancer survivors enrolled in the St. Jude Lifetime Cohort. DNA methylation (DNAm) data were generated using the Illumina EPIC BeadChip, and three social determinants of health (SDOH) factors were assessed: self-reported educational attainment, personal income, and an area deprivation index based on census track data. An epigenome-wide association study (EWAS) was performed to evaluate the relation between DNAm at each 5'-cytosine-phosphate-guanine-3' (CpG) site and each SDOH factor based on multivariable linear regression models stratified by ancestry (European ancestry, n = 1,618; African ancestry, n = 258). EWAS among survivors of European ancestry identified 130 epigenome-wide significant SDOH-CpG associations (P < 9 × 10-8), 25 of which were validated in survivors of African ancestry (P < 0.05). Thirteen CpGs were associated with all three SDOH factors and resided at pleiotropic loci in cigarette smoking-related genes (e.g., CLDND1 and CPOX). After accounting for smoking and body mass index, these associations remained significant with attenuated effect sizes. Seven of 13 CpGs were associated with gene expression level based on 57 subsamples with blood RNA sequencing data available. In conclusion, DNAm signatures, many resembling the effect of tobacco use, were associated with SDOH factors among survivors of childhood cancer, thereby suggesting that biologically distal SDOH factors influence health behaviours or related factors, the epigenome, and subsequently survivors' health.
| S-EPMC9586655 | biostudies-literature
Project description:PurposeHealth-related quality of life (HRQoL) is a critical aspect of cancer survivorship, influenced by various social determinants of health (SDoH) such as economic stability, education access, and healthcare coverage. Understanding the impact of these determinants is essential for developing interventions that improve the well-being of cancer survivors.MethodsCross-sectional analyses were conducted using data from 20,534 adults with cancer, including 15,754 from the All of Us (AOU) Research Program (2015-2024) and 4,780 from the National Health and Nutrition Examination Survey (NHANES) (2001-2018). HRQoL outcomes were assessed across multiple dimensions: physical health, mental health, emotional well-being, social support, functional ability, and physical activity.ResultsHigher economic stability, education access, and healthcare coverage were significantly associated with better HRQoL outcomes in both cohorts. In the AOU cohort, those with higher family income were more likely to report very good (OR: 20.24; CI: 12.86-31.87) or excellent (OR: 33.06; CI: 20.01-54.64) quality of life. Similar trends were observed for physical and mental health. The NHANES cohort showed consistent findings. Participants with no negative SDoH factors were significantly more likely to report excellent outcomes across all HRQoL dimensions.Conclusions and implications for cancer survivorsThese findings highlight the significant impact of SDoH on cancer survivors' HRQoL and support the need for targeted interventions and policies to mitigate the adverse effects of negative SDoH factors. Addressing economic, educational, and healthcare disparities is crucial for improving the long-term health and quality of life of cancer survivors.
| S-EPMC11398579 | biostudies-literature
Project description:AimsExisting evidence shows that people who report Adverse Childhood Experiences (ACEs) are more likely to exhibit health-risk behaviors. However, limited research on this topic pertains to oncology population. We aim to address this knowledge gap by estimating the prevalence of ACEs and investigating their association with self-reported health-risk behaviors among adult cancer survivors living in the U.S.MethodsWe conducted a secondary analysis using cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System ACE module. We included 4,126 adults, aged ≥18 years, with a history of cancer. The outcome variable was self-reported health-risk behaviors, which included cigarette smoking, e-cigarette use, and binge alcohol drinking. Self-reported ACEs history was the primary independent variable, comprised of 11 questions regarding child abuse and dysfunctional households. We conducted descriptive statistics and multivariable logistic regression to describe the relationship between the ACE history and health-risk behaviors.ResultsOverall, 84.2% of cancer survivors self-reported as White, 58.4% were women, and 76.6% were aged 65+ years. Nearly two-thirds of the sample (63.2%) self-reported at least one ACE (prior to age 18) and 21.7% engaged in ≥1 health-risk-behaviors, such as cigarette smoking, binge alcohol drinking, or e-cigarette use. Experiencing ≥3 ACEs was associated with 145% increased odds of reporting at least one health-risk behavior (OR = 2.45, 95% CI [1.78-3.38]) when compared to those without a history of ACEs. Besides, survivors who were younger, divorced, less educated, and had low income had higher odds of reporting at least one health-risk behavior.ConclusionsOverall, a history of ACEs is associated with health-risk behaviors. These all can negatively impact cancer survivors' overall well-being. Early screening for ACE during oncologic visits can be a protective measure for preventing health-risk behaviors among cancer survivors.
| S-EPMC10956880 | biostudies-literature
Project description:ImportancePresenting with complicated appendicitis, which is associated with higher rates of complications and readmissions compared with simple appendicitis, may indicate delayed access to care. Although both patient-level and neighborhood-level social determinants of health are associated with access to care, little is known about the association between neighborhood factors and access to acute pediatric surgical care.ObjectiveTo examine the association between neighborhood factors and the odds of presenting with complicated appendicitis and unplanned postdischarge health care use.Design, setting, and participantsA retrospective cohort study of patients aged 18 years or younger diagnosed with appendicitis was conducted. Discharge data from October 1, 2015, to September 30, 2018, were obtained from the Pediatric Health Information System Database and linked to the Child Opportunity Index (COI) 2.0 Database. Data analysis was conducted from January 1 through July 1, 2021.ExposuresThe COI, a composite score of zip code neighborhood opportunity level information, divided into quintiles ranging from very low to very high opportunity.Main outcomes and measuresBased on COI level, the main outcome was the odds of presenting with complicated appendicitis, which was defined using the Agency for Healthcare Research and Quality-specified International Statistical Classification of Diseases, 10th Edition, Clinical Modification codes. The secondary outcome was the odds of unplanned postdischarge health care use (emergency department visits and/or readmissions) for patients with simple and with complicated appendicitis.ResultsA total of 67 489 patients (mean [SD] age, 10.5 [3.9] years) had appendicitis, with 31 223 cases (46.3%) being complicated. A total of 1699 patients (2.5%) were Asian, 24 234 (35.9%) were Hispanic, 4447 (6.6%) were non-Hispanic Black, and 29 234 (43.3%) were non-Hispanic White; 40 549 patients (60.1%) were male; and 32 343 (47.9%) were publicly insured. Patients living in very low-COI neighborhoods had 28% higher odds of presenting with complicated appendicitis (odds ratio, 1.28; 95% CI, 1.20-1.35) compared with those in very high-COI neighborhoods. There was no significant association between COI level and unplanned postdischarge health care use (very high COI, 20.8%; very low COI, 19.1%).Conclusions and relevanceIn this cohort study, children from lower-COI neighborhoods had increased odds of presenting with complicated appendicitis compared with those from higher-COI neighborhoods, even after controlling for patient-level social determinants of health factors. These findings may inform policies and programs that seek to improve access to pediatric surgical care.
| S-EPMC8851303 | biostudies-literature
Project description:BackgroundPeople in racial and ethnic minority groups have been shown to be at increased risk for a variety of diseases, including COVID-19. However, the role that social needs play in this increased risk has not yet been quantified. Investigating these roles can elicit a greater understanding of how social needs influence the manner in which this disease is contracted and spread.MethodsA retrospective analysis was conducted of 1,969 Lynn Community Health Center patients. Patients that visited the center between February 1st and July 1st, 2020, tested for COVID-19, and screened for social determinants of health (SDOH) risk factors. Demographics were compared between COVID-19 positive and negative patients. Confounding by age on the association between ethnicity and COVID-19 status was evaluated. A stratified analysis was performed to evaluate the effect modification of SDOH on the relationship between race, ethnicity, and COVID-19 status.ResultsHispanic patients had 2.93 times the odds of a positive COVID-19 test compared to non-Hispanics (95% CI: 2.37 - 3.64, p<0.0001). With at least one SDOH risk factor, Hispanics had 4.71 times the odds of a positive COVID-19 test relative to non-Hispanics (95% CI: 3.10 - 7.14). With no SDOH risk factors, Hispanics had 2.45 times the odds of a positive COVID-19 test relative to non-Hispanics (95% CI: 1.91 - 3.16). No significant associations were found for race.ConclusionEthnicity had a significant impact on COVID-19 status in our population, where the effect of ethnicity on COVID-19 status was amplified for those with SDOH risk factors.
| S-EPMC8699061 | biostudies-literature