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2.
Med J Aust ; 216(3): 160, 2022 02 21.
Article in English | MEDLINE | ID: covidwho-2202842
3.
Nat Rev Neurol ; 18(12): 723-734, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2151050

ABSTRACT

Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are the non-medical factors that influence health outcomes. Evidence indicates that health behaviours, comorbidities and disease-modifying therapies all contribute to multiple sclerosis (MS) outcomes; however, our knowledge of the effects of social determinants - that is, the 'risks of risks' - on health has not yet changed our approach to MS. Assessing and addressing social determinants of health could fundamentally improve health and health care in MS; this approach has already been successful in improving outcomes in other chronic diseases. In this narrative Review, we identify and discuss the body of evidence supporting an effect of many social determinants of health, including racial background, employment and social support, on MS outcomes. It must be noted that many of the published studies were subject to bias, and screening tools and/or practical interventions that address these social determinants are, for the most part, lacking. The existing work does not fully explore the potential bidirectional and complex relationships between social determinants of health and MS, and the interpretation of findings is complicated by the interactions and intersections among many of the identified determinants. On the basis of the reviewed literature, we consider that, if effective interventions targeting social determinants of health were available, they could have substantial effects on MS outcomes. Therefore, funding for and focused design of studies to evaluate and address social determinants of health are urgently needed.


Subject(s)
Multiple Sclerosis , Humans , Multiple Sclerosis/epidemiology , Multiple Sclerosis/therapy , Social Determinants of Health , Social Support
4.
JMIR Public Health Surveill ; 7(8): e29205, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-2141332

ABSTRACT

BACKGROUND: Previous studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level. OBJECTIVE: This analysis was carried out at a granular spatial resolution of census tracts to explore the spatial patterns and contextual SDOH associated with COVID-19 incidence from a Hispanic population mostly consisting of a Mexican American population living in Cameron County, Texas on the border of the United States and Mexico. We performed age-stratified analysis to identify different contributing SDOH and quantify their effects by age groups. METHODS: We included all reported COVID-19-positive cases confirmed by reverse transcription-polymerase chain reaction testing between March 18 (first case reported) and December 16, 2020, in Cameron County, Texas. Confirmed COVID-19 cases were aggregated to weekly counts by census tracts. We adopted a Bayesian spatiotemporal negative binomial model to investigate the COVID-19 incidence rate in relation to census tract demographics and SDOH obtained from the American Community Survey. Moreover, we investigated the impact of local mitigation policy on COVID-19 by creating the binary variable "shelter-in-place." The analysis was performed on all COVID-19-confirmed cases and age-stratified subgroups. RESULTS: Our analysis revealed that the relative incidence risk (RR) of COVID-19 was higher among census tracts with a higher percentage of single-parent households (RR=1.016, 95% posterior credible intervals [CIs] 1.005, 1.027) and a higher percentage of the population with limited English proficiency (RR=1.015, 95% CI 1.003, 1.028). Lower RR was associated with lower income (RR=0.972, 95% CI 0.953, 0.993) and the percentage of the population younger than 18 years (RR=0.976, 95% CI 0.959, 0.993). The most significant association was related to the "shelter-in-place" variable, where the incidence risk of COVID-19 was reduced by over 50%, comparing the time periods when the policy was present versus absent (RR=0.506, 95% CI 0.454, 0.563). Moreover, age-stratified analyses identified different significant contributing factors and a varying magnitude of the "shelter-in-place" effect. CONCLUSIONS: In our study, SDOH including social environment and local emergency measures were identified in relation to COVID-19 incidence risk at the census tract level in a highly disadvantaged population with limited health care access and a high prevalence of chronic conditions. Results from our analysis provide key knowledge to design efficient testing strategies and assist local public health departments in COVID-19 control, mitigation, and implementation of vaccine strategies.


Subject(s)
COVID-19/epidemiology , Social Determinants of Health , Adolescent , Adult , Aged , Aged, 80 and over , Censuses , Female , Health Equity , Humans , Incidence , Male , Mexico/ethnology , Middle Aged , Minority Groups , Physical Distancing , SARS-CoV-2 , Socioeconomic Factors , Spatial Analysis , Texas/epidemiology , United States , Vulnerable Populations , Young Adult
5.
West J Emerg Med ; 23(6): 811-816, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2144842

ABSTRACT

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic caused significant disruptions in daily life. Given the role that social determinants of health play in the overall well-being of individuals and populations, we wanted to determine the effects of the COVID-19 pandemic on our patient population in the emergency department (ED). METHODS: We adapted the Centers for Medicare and Medicaid Services social risk assessment to assess changes to participants' social situations throughout the COVID-19 pandemic from January 2020-February 2021. The survey was administered within the ED to individuals selected by a convenience sample of patients who were stable enough to complete the form. RESULTS: We received 200 (66%) responses from the 305 patients approached. Worsened food access was reported by 8.5% (17) of respondents, while 13.6% (27) reported worsened food concern since the onset of the COVID-19 pandemic. The odds of worsened food access were higher among non-Whites (adjusted odds ratio [aOR] 19.17, 95% confidence interval [CI] 3.33-110.53) and females (aOR 9.77, CI 1.51-63.44). Non-Whites had greater odds of worsened food concern (aOR 15.31, CI 3.94-59.54). Worsened financial difficulty was reported by 24% (48) of respondents. The odds of worsened financial difficulty were higher among females (aOR 2.87, 95% CI 1.08-7.65) and non-Whites (aOR 10.53, CI 2.75-40.35). CONCLUSION: The COVID-19 pandemic has worsened many of the social determinants of health found within communities. Moreover, vulnerable communities were found to be disproportionately affected as compared to their counterparts. Understanding the challenges faced by our patient populations can serve as a guide on how to assist them more comprehensively.


Subject(s)
COVID-19 , Pandemics , Aged , United States/epidemiology , Female , Humans , Social Determinants of Health , COVID-19/epidemiology , Medicare , Emergency Service, Hospital
6.
BMC Public Health ; 22(1): 2193, 2022 Nov 28.
Article in English | MEDLINE | ID: covidwho-2139222

ABSTRACT

BACKGROUND: Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS: This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS: The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION: Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.


Subject(s)
COVID-19 , Psychological Distress , Adult , Humans , Ethnicity , COVID-19/epidemiology , Pandemics , Social Determinants of Health , Cross-Sectional Studies
7.
BMC Health Serv Res ; 22(1): 1364, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2115847

ABSTRACT

OBJECTIVE: Primary health care (PHC) is widely perceived to be the backbone of health care systems. Since the outbreak of COVID-19, PHC has not only provided primary medical services, but also served as a grassroots network for public health. Our research explored the accessibility, availability, and affordability of primary health care from a spatial perspective, to understand the social determinants affecting access to it in Hong Kong. METHOD: This constitutes a descriptive study from the perspective of spatial analysis. The nearest neighbor method was used to measure the geographic accessibility of PHC based on the road network. The 2SFCA method was used to measure spatial availability and affordability to primary health care, while the SARAR model, Spatial Error model, and Spatial Lag model were then constructed to explain potential factors influencing accessibility and availability of PHC. RESULTS: In terms of accessibility, 95% of residents in Hong Kong can reach a PHC institution within 15 minutes; in terms of availability, 83% of residents can receive PHC service within a month; while in terms of affordability, only 32% of residents can afford PHC services with the support of medical insurance and medical voucher. In Hong Kong, education status and household income show a significant impact on accessibility and availability of PHC. Regions with higher concentrations of residents with post-secondary education receive more PHC resources, while regions with higher concentrations of high-income households show poorer accessibility and poorer availability to PHC. CONCLUSION: The good accessibility and availability of primary health care reflects that the network layout of existing PHC systems in Hong Kong is reasonable and can meet the needs of most residents. No serious gap between social groups further shows equality in resource allocation of PHC in Hong Kong. However, affordability of PHC is not ideal. Indeed, narrowing the gap between availability and affordability is key to fully utilizing the capacity of the PHC system in Hong Kong. The private sector plays an important role in this, but the low coverage of medical insurance in outpatient services exacerbates the crowding of public PHC and underutilization of private PHC. We suggest diverting patients from public to private institutions through medical insurance, medical vouchers, or other ways, to relieve the pressure on the public health system and make full use of existing primary health care in Hong Kong.


Subject(s)
COVID-19 , Primary Health Care , Social Determinants of Health , Humans , Costs and Cost Analysis , COVID-19/epidemiology , Hong Kong/epidemiology , Spatial Analysis , Health Services Accessibility , Healthcare Disparities
9.
Int J Environ Res Public Health ; 19(21)2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2090157

ABSTRACT

Different analyses show that the design of vaccination policies should especially protect the most vulnerable social groups, since the level of acceptance is determined by the population's knowledge, attitude and concerns about the safety and efficacy of vaccines. The objective of this work will be to detect the most socially vulnerable groups with respect to COVID-19 and to analyze the factors that influence predisposition to vaccination. This is a cross-sectional study using data from the Centro de Investigaciones Sociológicas (CIS) on the Effects and Consequences of Coronavirus (Study 3346 of December 2021). Sociodemographic variables (sex, age, employment status, studies and subjective class identification) were extracted, as well as the answers to the questions indicating the attitude towards vaccination, corresponding to questions 7,8,10 and 11 of the study. The most vulnerable group was lower class women (self-perceived), under 45 years of age with lower educational level, unemployed or performing unpaid work in the home. Most of them are not predisposed to vaccinate only because of the obligation to do so, mainly due to lack of belief in the power and efficacy of vaccines, as well as fear of health risks/collateral side effects. The lower vaccine uptake in this vulnerable population group may be due to a lack of awareness and lower trust in the authorities, as well as the benefits of the vaccine, which could be related to a lack of policy targeting the most socially vulnerable populations.


Subject(s)
COVID-19 Vaccines , COVID-19 , Social Determinants of Health , Social Vulnerability , Female , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Cross-Sectional Studies , Spain/epidemiology , Vaccination/methods , Vaccines/adverse effects
10.
Int J Public Health ; 67: 1604628, 2022.
Article in English | MEDLINE | ID: covidwho-2089972

ABSTRACT

Objectives: The aim of this study was to describe and evaluate the sociodemographic profile and assess the levels of anxiety and fear, work engagement, and psychological distress on a sample of migrants living in settlements in the province of Huelva (Spain) during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted on a sample of 623 migrants during the months of April to June 2021, based on the Anxiety and Fear of COVID-19 (AMICO) assessment scale, the 9-item Utrecht Work Engagement Scale to assess work engagement, and the General Health Questionnaire (GHQ-12) to analyse psychological distress. Results: A low level of education, dwelling of less than 3 m2 and the desire to return to the country of origin may be related to the presence of anxiety and fear of COVID-19 and lower levels of work engagement. Conclusion: There is a need to improve the study of the concept of health of the migrant population residing in the settlements of Huelva (Spain) and the assessment of their physical and mental health, in an official way.


Subject(s)
COVID-19 , Pandemics , Social Determinants of Health , Transients and Migrants , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Spain/epidemiology
12.
WMJ ; 121(3): 205-211, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2083759

ABSTRACT

PURPOSE: The impact of the social determinants of health (SDOH) on hospitalized cancer patients and hospital length of stay is unknown. At our institution, a hospital-wide SDOH survey that examined patient-specific barriers to various domains of SDOH and facilitated hospital discharge was integrated into the electronic medical record. This study reports the effect of the SDOH survey on length of stay for oncology patients and the outpatient referrals generated to facilitate the discharge. METHODS: We examined length of stay index data on inpatient oncology patients and 2 comparator services (bone marrow transplant, internal medicine). We evaluated the length of stay using a 2-sample t test, and the rate of referrals per discharge using a 2-sample Poisson test. RESULTS: Compared to the baseline length of stay, after the launch of the SDOH survey, there was a significant (8.9%) decrease in the average length of stay for oncology patients (8.14 to 7.41 days, P = 0.004), the LOS decrease for the bone marrow transplant and subset was a nonsignificant trend only (P > 0.1). Average referrals per discharge increased from baseline 1.063 per discharge to 1.159 after implementation (P = 0.004), and the mean values increased by 9%. CONCLUSIONS: The SDOH survey tool assisted in a timely examination of patient-specific barriers to discharge, leveraged care coordination, and facilitated a safe hospital discharge. Such efforts increase the efficiency of health care service delivery in response to public health threats, such as the COVID-19 pandemic.


Subject(s)
COVID-19 , Neoplasms , Humans , Length of Stay , COVID-19/epidemiology , Social Determinants of Health , Pandemics , Neoplasms/epidemiology , Neoplasms/therapy , Hospitals
14.
Int J Environ Res Public Health ; 19(19)2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2065964

ABSTRACT

BACKGROUND: There is a lack of consensus on the social determinants of Deaths of Despair (DoD), i.e., an increase in mortality attributed to drug overdose, alcohol-related liver disease, and suicide in the United States (USA) during recent years. The objective of this study was to review the scientific literature on DoD with the purpose of identifying relevant social determinants and inequalities related to these mortality trends. METHODS: Scoping review focusing on the period 2015-2022 based on PubMed search. Articles were selected according to the following inclusion criteria: published between 1 January 2000 and 31 October 2021; including empirical data; analyzed DoD including the three causes defined by Case and Deaton; analyzed at least one social determinant; written in English; and studied DoD in the USA context only. Studies were excluded if they only analyzed adolescent populations. We synthesized our findings in a narrative report specifically addressing DoD by economic conditions, occupational hazards, educational level, geographical setting, and race/ethnicity. RESULTS: Seventeen studies were included. Overall, findings identify a progressive increase in deaths attributable to suicide, drug overdose, and alcohol-related liver disease in the USA in the last two decades. The literature concerning DoD and social determinants is relatively scarce and some determinants have been barely studied. However different, however, large inequalities have been identified in the manner in which the causes of death embedded in the concept of DoD affect different subpopulations, particularly African American, and Hispanic populations, but blue collar-whites are also significantly impacted. Low socioeconomic position and education levels and working in jobs with high insecurity, unemployment, and living in rural areas were identified as the most relevant social determinants of DoD. CONCLUSIONS: There is a need for further research on the structural and intermediate social determinants of DoD and social mechanisms. Intersectional and systemic approaches are needed to better understand and tackle DoD and related inequalities.


Subject(s)
Drug Overdose , Liver Diseases , Suicide , Adolescent , Humans , Social Determinants of Health , Unemployment , United States/epidemiology
15.
Vaccine ; 40(47): 6747-6755, 2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2061961

ABSTRACT

BACKGROUND: Although more than half of older adults receive the annual influenza vaccine (flu shot), only about one-third have ever been vaccinated for shingles. With this in mind, our study examines how the associations between sociodemographic characteristics, health behaviors, and vaccine uptake differ between these two viruses. In doing so, it also investigates whether the social predictors of shingles vaccination changed after the rollout of a new vaccine in 2017. METHODS: Data come from the 2017 and 2020 waves of the Behavioral Risk Factor Surveillance System survey, using a subset of older adults aged 60-plus (N = 389,165). We use logistic regression models to test for associations between individual-level characteristics and vaccine uptake. RESULTS: One, when compared to Whites, Black respondents had approximately 30 % lower odds of having received the annual influenza vaccine (Odds Ratios  [OR] = 0.72 [95 % CI 0.66-0.78] in 2017, and 0.66 [0.60-0.72] in 2020). For the shingles vaccine, these racial differences were starker (OR = 0.53 [0.48-0.59] in 2017, and OR = 0.55 [0.49-0.60] in 2020). Two, self-rated health was negatively associated with having received the influenza vaccine, but showed little relationship with shingles vaccination. Three, men were less likely than women to receive both vaccines in 2020 (OR = 0.88 [0.83-0.94] for influenza, and OR = 0.80 [0.75-0.85] for shingles). Four, older adults who abstained from alcohol were, generally, less likely to receive either vaccine, when compared to both moderate and heavy drinkers. Finally, we found that the release of a new shingles vaccine in 2017 (Shingrix) had little effect on vaccination prevalence or its social determinants. CONCLUSION: The importance of social groups, health, and health behaviors on vaccination status may be disease-dependent. This study also provides possible guidance to health care providers and health organizations looking to increase vaccine uptake among older adults, which may have more urgency since the arrival of COVID-19.


Subject(s)
COVID-19 , Herpes Zoster Vaccine , Herpes Zoster , Influenza Vaccines , Influenza, Human , Male , Female , Humans , Aged , Influenza, Human/prevention & control , Social Determinants of Health , Vaccination , Herpes Zoster/prevention & control
16.
Psychoneuroendocrinology ; 140: 105713, 2022 06.
Article in English | MEDLINE | ID: covidwho-2061787
18.
Rev Esp Geriatr Gerontol ; 57(5): 264-268, 2022.
Article in Spanish | MEDLINE | ID: covidwho-2049863

ABSTRACT

OBJECTIVE: To assess the association between social determinants of health (SDH) and resilience in older people during the first period of confinement in the COVID-19 pandemic in Chile. MATERIALS AND METHODS: An observational study with a cross-sectional design was conducted using a nationally representative survey data-set. In this survey, using a systematic randomization process, a subsample of people aged ≥60 years from the community were interviewed by telephone during the first wave of the COVID-19 pandemic in Chile. Resilience was assessed using the Brief Resilient Coping Scale (BRCS) and depressive symptoms using the Patient Health Questionnaire (PHQ-9) scale. The SDH considered were: age, sex, educational level, employment status, social isolation, loneliness, discontent with housing and health care needs. RESULTS: A total sample of 582 persons was obtained. The mean age was 71 years (SD: 7.64; 69% women). A significant association was obtained between low resilience and the following conditions: loneliness (OR: 1.776 [95% CI: 1.146-2.751]), high risk of social isolation (OR: 1.667 [95% CI: 1.149-2.419]), and depressive symptoms (OR: 2.602 [95% CI: 1.795-3.774]). Female gender was a protective factor (OR: 0.589 [95% CI: 0.406-0.855]). CONCLUSION: The SDH, such as loneliness and social isolation, are factors associated with low resilience in older people during the COVID-19 pandemic and may be taken into account in planning public health intervention strategies.


Subject(s)
COVID-19 , Female , Humans , Aged , Male , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Social Determinants of Health , Chile/epidemiology
19.
BMC Pregnancy Childbirth ; 22(1): 227, 2022 Mar 19.
Article in English | MEDLINE | ID: covidwho-2038677

ABSTRACT

BACKGROUND: Postpartum depression and maternal-infant attachment scores were examined in uninfected women during the COVID 19 pandemic in Kutahya, a rural province in Turkey's North Aegean region. METHODS: This cohort study was conducted in the Kutahya Health Sciences University Hospital obstetrics unit between April 2021 and August 2021. 178 low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale and Mother-to-Infant Bonding Scale (MIBQ) 6 weeks after birth. The Edinburgh Postpartum Depression Scale was used to determine postpartum depression and the Mother-to-Infant Bonding Scale was used to determine maternal attachment. RESULTS: In this study, the postpartum depression rate was calculated as 17.4%. When depressed and non-depressed patients were compared, education level, maternal age, BMI, MIBQ score, history of previous pregnancies, route of delivery, previous operation history, economic status, employment status and pregnancy follow-up information were found to be similar (p > 0.05). The ratings on the Mother-to-Infant Bonding Scale were found to be similar in depressed and non-depressed patients (p > 0.05). The odds of maternal depression for patients who received guests at home was 3.068 (95%CI [1.149-8.191]) times the odds of patients who did not receive guests at home. CONCLUSIONS: Although a relationship has been found between accepting guests in the postpartum period and postpartum depression, it is necessary to investigate in further studies whether there is a causal relationship.


Subject(s)
COVID-19/psychology , Depression, Postpartum/epidemiology , Mother-Child Relations/psychology , Adult , Cohort Studies , Female , Humans , Infant, Newborn , Object Attachment , Pregnancy , Psychiatric Status Rating Scales , Rural Population , Social Determinants of Health , Turkey/epidemiology
20.
Soc Sci Med ; 306: 115098, 2022 08.
Article in English | MEDLINE | ID: covidwho-2036520

ABSTRACT

Racial/ethnic minorities have experienced higher COVID-19 infection rates than whites, but it is unclear how individual-level housing, occupational, behavioral, and socioeconomic conditions contribute to these disparities in a nationally representative sample. In this study, we assess the extent to which social determinants of health contribute to racial/ethnic differences in COVID-19 infection. Data are from the Understanding America Study's Understanding Coronavirus in America survey (UAS COVID-19 waves 7-29). UAS COVID-19 is one of the only nationally representative longitudinal data sources that collects information on household, work, and social behavioral context during the pandemic. We analyze onset of COVID-19 cases, defined as a positive test or a diagnosis of COVID-19 from a healthcare provider since the previous survey wave, over a year of follow-up (June 2020-July 2021). We consider educational attainment, economic resources, work arrangements, household size, and social distancing as key social factors that may be structured by racism. Cox hazard models indicate that Hispanic people have 48% higher risk of experiencing a COVID-19 infection than whites after adjustment for age, sex, local infection rate, and comorbidities, but we do not observe a higher risk of COVID-19 among Black respondents. Controlling for engagement in any large or small social gathering increases the hazard ratio for Hispanics by 9%, suggesting that had Hispanics had the same social engagement patterns as whites, they may have had even higher risk of COVID-19. Other social determinants-lower educational attainment, working away from home, and number of coresidents-all independently predict higher risk of COVID-19, but do not explain why Hispanic Americans have higher COVID-19 infection risk than whites.


Subject(s)
COVID-19 , Social Determinants of Health , African Americans , COVID-19/epidemiology , Health Status Disparities , Healthcare Disparities , Humans , Social Factors , Socioeconomic Factors , United States/epidemiology
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