Search Results (289)

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Introduction: This study aimed to explore the clinical and psychosocial characteristics associated with functional non-remission in young adults involuntarily hospitalized for a first episode of psychosis (FEP), focusing on the role of duration of untreated psychosis (DUP) and contextual vulnerabilities. Material and method: We conducted a retrospective monocentric study including 123 patients aged 18–30 who were involuntarily admitted between 2013 and 2023 for a first psychotic episode. Sociodemographic, clinical, and care-related data were extracted from medical records. Functional remission was defined as a Global Assessment of Functioning (GAF) score ≥70 at discharge. Univariate and multivariate logistic regressions were used to identify predictors of functional non-remission. Results: Only 48.8% of patients achieved functional remission at discharge. Social isolation, low socioeconomic status, unemployment, lack of structured activities, and a DUP ≥ 4 weeks were significantly associated with functional non-remission. After multivariate logistic regressions, DUP ≥ 4 weeks remained an independent predictor of functional non-remission. Conclusions: Involuntary admission per se was not a direct predictor of poor outcome. Our findings highlight the critical role of prolonged DUP and psychosocial vulnerability in the trajectory of early psychosis. Early detection strategies, psychosocial support integration, and individualized care planning are essential to improve outcomes among young people experiencing FEP under compulsory admission. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Introduction: Gentrification, commonly defined as low-socioeconomic-status (SES) neighborhoods experiencing rapid increases in rental value, can lead to changes in the built and social neighborhood environment. Schools are an important location for pollutant exposure and child opportunities because children spend significant time in school. Given their central role in both environmental and social contexts, we examined the relationship between gentrification, pollutants, and child opportunity near schools in New York City. Methods: School locations (N_total = 1482) were classified into gentrifying (n = 624), non-gentrifying (n = 198), and higher-SES (ineligible for gentrification; n = 660) neighborhoods. Annual average pollutant levels (black carbon (BC), fine particulates (PM_2.5), nitrogen dioxide (NO₂)) were assessed near schools. Child opportunity index (COI 2.0) was used to evaluate overall opportunity and three domains: education; health/environment; social/economic. Results: On average, pollution was highest in gentrifying neighborhoods compared to non-gentrifying (5–8.6% difference) and higher-SES (4.8–14.8% difference) neighborhoods. Average air pollution levels remained consistently higher in gentrifying neighborhoods both before and after gentrification compared to non-gentrifying and higher-SES neighborhoods. Regarding childhood opportunity, education, and social/economic opportunities were better and health/environment opportunities were worse in gentrifying compared to non-gentrifying neighborhoods. Conclusions: Gentrifying neighborhoods are at risk for higher exposure to pollutants and lower health/environment childhood opportunities compared to other neighborhoods. Full article

Background: Women with a lower socioeconomic status (SES) have an increased risk of dying from breast cancer (BC) than those with a higher SES. The association of SES with BC survival may be partially mediated by factors such as Oncotype DX (ODX) testing and stage at diagnosis. This study aims to examine SES disparities in survival among HR+/HER2- BC women and to quantify the mediating effects of the ODX test and stage. Methods: We used data from the Louisiana Tumor Registry to identify women aged 20–90 years diagnosed with stage I–II in 2011–2014 and stage I–III in 2015–2017 HR+/HER2- BC who underwent BC surgery. The follow-up cutoff date was 31 December 2020. Cox proportional hazard regression and generalized mediation analysis were both performed. Results: Of 8931 BC women, 41.4% underwent ODX testing. After adjusting for sociodemographic, tumor characteristic, and treatment variables, low SES women had a higher hazard of overall death (HR = 1.16, 95% CI: 1.02–1.32) and BC-specific death (HR = 1.37; 95% CI: 1.01–1.87) compared to high SES women. The ODX test and stage explained 9.0% and 11.2% SES differences in the hazard of overall death and 4.4% and 13.3% in BC-specific death, respectively. Conclusions: Low SES is associated with higher hazard rates of overall and cause-specific death among women with breast cancer, even after adjustment. Differences in Oncotype DX (ODX) testing and stage at diagnosis explained part of these disparities. Targeted interventions are needed to improve access to genomic testing and early detection to reduce SES-related disparities in breast cancer outcomes. Full article

Objectives: To assess the association between apixaban use and the risk of stroke/systemic embolism (SE) and major bleeding (MB) compared with other anticoagulants (OACs) across demographic and socio-economic subgroups in the treatment of nonvalvular atrial fibrillation (NVAF). Methods: The study included adult NVAF patients initiating OAC treatment between 2013 and 2019 in the Medicare database. Inverse probability treatment weighted Cox proportional hazard models were used to assess stroke/SE and MB outcomes across various subgroups. Results: Overall, the adjusted risks of stroke/SE and MB were lower for apixaban compared with warfarin (stroke/SE: HR, 0.69, [95% confidence interval (CI): 0.65–0.74], MB: 0.59 [95% CI: 0.57–0.60]), rivaroxaban (stroke/SE: 0.88 [95% CI: 0.84–0.92], MB: 0.60 [95% CI: 0.58–0.61]) and dabigatran (stroke/SE: 0.88 [95% CI: 0.80–0.95], MB: 0.76 [95% CI: 0.72–0.80]). Among the low socio-economic status (SES) group, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.73 [95% CI: 0.69–0.77], MB: 0.60 [95% CI: 0.57–0.62]) and rivaroxaban (stroke/SE: 0.88 [95% CI: 0.83–0.94], MB: 0.61 [95% CI: 0.59–0.63]). Among medium SES patients, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.67 [95% CI: 0.63–0.71] MB: 0.60 [95% CI: 0.58–0.63]), rivaroxaban (stroke/SE: 0.85 [95% CI: 0.79–0.91], MB: 0.59 [95% CI: 0.56–0.61]) and dabigatran (stroke/SE: 0.85 [95% CI: 0.73–0.99], MB: 0.77 [95% CI: 0.70–0.84]). Apixaban was also associated with lower risks of stroke/SE and MB compared with other OACs among most other demographic, socio-economic subgroups. Conclusions: Apixaban was associated with lower risk of stroke/SE and MB than warfarin, rivaroxaban, dabigatran across most demographic, socio-economic subgroups. Full article

Background/Objectives: Postpartum depression (PPD) is a prevalent mental health disorder affecting women after childbirth, with significant adverse effects on both maternal and infant outcomes. Early detection and intervention are critical to improving health trajectories. Material and Methods: This narrative review compares the predictive validity of commonly used screening instruments for PPD, including the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and brief tools like PHQ-2 and PHQ-4. It also examines the role of self-esteem, assessed using the Rosenberg Self-Esteem Scale (RSES), and coping mechanisms, evaluated through the COPE Inventory, in moderating PPD risk. Results: Validation studies reveal variability in the performance of screening tools across different populations, emphasizing the need for contextual calibration. Low self-esteem and maladaptive coping strategies are consistently associated with higher PPD risk, with socioeconomic status (SES) further influencing these relationships. Interventions focusing on enhancing self-esteem and promoting adaptive coping, such as cognitive–behavioral therapy and psychoeducation, show promise in reducing PPD incidence. Conclusions: This review highlights gaps in existing research, particularly regarding screening during pregnancy, and calls for integrated predictive models incorporating psychosocial variables. Early, context-sensitive screening approaches are essential for effective PPD prevention and management. Full article

Background: Socioeconomic status (SES) significantly influences outcomes in colorectal cancer (CRC) patients, with those from low-SES backgrounds facing worse prognoses. However, living in an affluent neighborhood may mitigate some of these disparities through environmental advantages. This study investigates whether Medicaid-insured CRC patients, as a proxy for low individual SES, experience better outcomes when residing in high-SES neighborhoods. Methods: Using the National Cancer Database, we examined Medicaid CRC patients, stratifying them by neighborhood SES indicators: median household income and education level. Patients in the highest and lowest quartiles of income and education were compared. Medicaid patients from the highest-SES neighborhoods were compared to the general population. Multivariable regression models analyzed 30- and 90-day postoperative mortality, overall survival (OS), and time from diagnosis to treatment initiation and surgery. Results: CRC patients in high-income neighborhoods began treatment earlier (coefficient −1.847, p = 0.015) and exhibited improved OS (HR 0.810, p < 0.001) compared to those in low-income neighborhoods, irrespective of education level. Similarly, patients in high-education neighborhoods started treatment sooner (coefficient −3.926, p < 0.001) and had better OS (HR 0.897, p < 0.001). No differences were observed in time to surgery or postoperative mortality. Despite these advantages, Medicaid patients in high-income (HR 1.130, p < 0.001) and high-education (HR 1.209, p = 0.002) areas still had worse OS compared to non-Medicaid patients. Conclusions: Higher neighborhood SES is associated with a significant survival benefit for Medicaid CRC patients, but these patients still lag behind their non-Medicaid counterparts. Understanding the mechanisms by which neighborhood SES influences cancer outcomes could inform targeted interventions to close the survival gap. Full article

College enrollment has long been recognized as a critical pathway to better employment prospects and improved economic outcomes. However, the overall enrollment rates have declined in recent years, and students with a lower socioeconomic status (SES) or those from disadvantaged backgrounds remain significantly underrepresented in higher education. To investigate the factors influencing college enrollment among low-SES high school students, this study analyzed data from the High School Longitudinal Study of 2009 (HSLS:09) using five widely used machine learning algorithms. The sample included 5223 ninth-grade students from lower socioeconomic backgrounds (51% female; M_age = 14.59) whose biological parents or stepparents completed a parental questionnaire. The results showed that, among all five classifiers, the random forest algorithm achieved the highest classification accuracy at 67.73%. Additionally, the top three predictors of enrollment in 2-year or 4-year colleges were students’ overall high school GPA, parental educational expectations, and the number of close friends planning to attend a 4-year college. Conversely, the most important predictors of non-enrollment were high school GPA, parental educational expectations, and the number of close friends who had dropped out of high school. These findings advance our understanding of the factors shaping college enrollment for low-SES students and highlight two important factors for intervention: improving students’ academic performance and fostering future-oriented goals among their peers and parents. Full article

Hepatitis E Virus (HEV) has gained public health attention as one of the causative agents of viral hepatitis. Our study aimed to provide data about HEV seropositivity in the Israeli general population, including its seroprevalence geographical distribution, and to identify variables as possible risk factors for HEV exposure. A seroprevalence cross-sectional study was conducted: HEV serological status was determined in 716 blood samples collected from the routine check-up blood samples. Demographic information was available for all samples. The overall prevalence of HEV IgG in an apparently healthy population in the north of Israel was 10.5%, with no evidence of positive HEV IgM. There was a significant association between HEV seropositivity and elderly age and low socioeconomic status (SES). The age-adjusted seroprevalence was significantly lower among Jews compared to Arabs with a rate ratio of 2.02. We identified clusters (hot spots) of HEV infection in three regions under study. Our results confirmed a high prevalence of anti-HEV in the country where clinical hepatitis E is not endemic. For the first time, this study showed that a hot spot analysis was able to provide new knowledge about actual exposure zones. As HEV infection is not a notifiable disease, it is probably underdiagnosed. Thus, better awareness among physicians is warranted. Full article

Type 2 diabetes (T2D) is a rapidly growing global health concern, projected to affect 1.3 billion people by 2050, necessitating a multidisciplinary approach. This review examines the epidemiological disparities in T2D, focusing on modifiable and nonmodifiable risk factors, socioeconomic determinants, and healthcare inequities. While genetic predisposition, age, and ethnicity contribute to T2D risk, socioeconomic status (SES) significantly mediates modifiable factors such as diet, physical activity, and access to healthcare. Lower SES is associated with poorer lifestyle choices, limited access to resources, and increased exposure to risk factors, exacerbating T2D prevalence among vulnerable populations. Geographic variations in T2D prevalence are evident, with racial and ethnic minorities and lower-income individuals being disproportionately affected in regions like the United States and Europe. The economic burden of T2D is substantial, with global healthcare expenditures reaching USD 966 billion in 2021 and projected to rise significantly, albeit with variations across different countries and health systems. Despite advancements in treatment, inequities in healthcare access persist, particularly in low- and middle-income countries, hindering optimal glycemic control and consequently contributing to preventable complications and poor health outcomes. This review highlights the critical need for targeted interventions and policy reforms to address the intersection of demographic, economic, and healthcare-related variables influencing T2D disparities. By bridging gaps in prevention, management, and treatment and accounting for the effect of SES on both modifiable and nonmodifiable risk factors, the global disease burden of T2D could be reduced and health equity could be improved. Full article

Background/Objectives: Adolescence is a crucial developmental stage characterized by significant psychological and emotional changes. Within the school context, academic self-efficacy (ASE) influences students’ emotional well-being, including positive and negative affective states. Research has shown that both ASE and emotional well-being are associated with socioeconomic status (SES) and immigrant background. This study aims to examine whether SES and immigrant background moderate the relationship between ASE and positive/negative affect among adolescents. Methods: Data were collected from a representative sample of 26,564 10th-grade students in Italian schools. ASE, positive and negative affect, SES, and immigrant background were assessed through validated measures. Multigroup structural equation modeling (multigroup SEM) was conducted to test the moderating roles of SES (low, middle, high) and immigrant background (native, first-generation immigrant, second-generation immigrant) on the relationship between ASE and affective states. Results: The results indicated that ASE significantly predicted positive affect (β = 0.34, p < 0.001) and negative affect (β = −0.17, p < 0.001) across all groups. However, results indicated no significant differences in the ASE–emotional affect relationship across SES and immigrant background groups, indicating that neither SES nor immigrant background moderated these associations. Conclusions: The findings suggest that ASE is associated with both positive affect and negative affect in adolescents, irrespective of SES and immigrant background. This highlights the universal importance of fostering ASE in school settings to support emotional well-being across diverse demographic groups. Full article

Background: Lower socioeconomic status (SES) has been associated with increased mortality from coronary heart disease. This excess risk, relative to affluent patients, may be due to a combination of more adverse cardiovascular-risk factors, inequalities in access to cardiac investigations, longer waiting times for cardiac revascularisation and lower use of secondary prevention drugs. We sought to investigate whether socio-economic status influenced long-term all-cause mortality after PCI in a large metropolitan city (London), which serves a population of 11 million people with a mixed social background over a 10-year period. Methods: We conducted an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry. This data set is collected prospectively and includes all patients treated between January 2005 and December 2015. The database includes PCI performed for stable angina and ACS (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina). Patient socio-economic status was defined by the English Index of Multiple Deprivation (IMD) score, according to residential postcode. Patients were analysed by quintile of IMD score (Q1, least deprived; Q5, most deprived). Median follow-up was 3.7 (IQR: 2.0–5.1) years and the primary outcome was all-cause mortality. Results: The mean age of the patients was 64.3 ± 12.1 years and 25.2% were female. A total of 22.4% of patients were diabetic and 27.3% had a history of previous myocardial infarction. The rates of long-term all-cause mortality increased progressively across quintiles of IMD score, with patients in Q5 showing significantly higher long-term mortality rates compared with patients in Q1 (p = 0.0044). This persisted following the inclusion of a propensity score in the proportional hazard model as a covariate (HR for Q5 compared to Q1: 1.15 [95% CI: 1.10–1.42]). Conclusions: This study has demonstrated that low SES is an independent predictor of adverse clinical outcomes following PCI in the large, diverse metropolitan city of London. There clearly are inequalities in cardio-vascular risk factors, time to access to medical treatment/PCI, access to complex imaging and devices during PCI, access to secondary prevention after PCI, and even race differences. Hence, attention to reducing the burden of cardiovascular risk factors and improving primary prevention, particularly in patients with lower SES, is required. Full article

Background/Objectives: Financial stress among university students has been widely documented, impacting academic performance, mental health, and overall well-being. This scoping review explores and synthesizes the existing evidence on the extent and impact of financial challenges experienced by university students in Australia and New Zealand and examines approaches implemented by universities in these countries to address these challenges. Methods: The Arksey and O’Malley framework was utilized for comprehensiveness, structure, and reproducibility. Four scientific databases (Scopus, ProQuest, Web of Science, and Informit) were searched until 30 June 2024, and 3542 articles were identified. Following extensive screening, 19 studies were included. The studies were summarized using a narrative synthesis approach. Results: This review suggests that financial stress continues to be experienced by Australian/New Zealand university students. Some studies indicate that over half (8–68%) of students face significant financial issues and 96% of students report high emotional stress. Some groups are more vulnerable than others. Notably, students from low socio-economic status (SES) backgrounds and international students have increased vulnerability due to factors such as inadequate financial support and limited access to job opportunities and support services. Support services available for students included emergency grants, food pantries (including international students), and community gardens but with limited impact in addressing underlying financial hardships. Conclusion: This review highlights the persistent financial challenges faced by vulnerable university students in Australia and New Zealand. It calls for comprehensive strategies to enhance support services and address structural issues in government and institutional policies. Addressing these needs will enable improved student academic success and mental and physical well-being in these vulnerable groups. Full article

Aggressive behaviour encompasses a spectrum of emotional responses, ranging from mild irritation to intense anger and fury. The goals of the present research were to develop a reduced and adapted version of the Buss–Perry Aggression Questionnaire (VRA-AQ) for Portuguese college students, to explore its relationship with negative life events as well as to ascertain the importance of self-regulation and resilience in preventing aggressive behaviour among young people from higher education, and to explore the differences between genders, academic year, and socioeconomic status to examine the risk factors of aggressive behaviour. The validation of the reduced and adapted Portuguese version of the VRA-AQ was carried out on a Portuguese university sample (N = 2991). There were three main focuses of data analysis: descriptive statistics, correlations, and factor analyses. Differences between genders and academic year were found in men, and undergraduate students displayed higher averages of physical aggression, negative life events, and the impact of these events, while women and post-graduate students exhibited higher averages of self-regulation and resilience. Regarding SES, youth from low to medium-low socioeconomic backgrounds demonstrated higher averages in overall aggression, physical aggression, anger, hostility, negative life events, and the impact of these life events. Conversely, those from higher socioeconomic backgrounds displayed higher averages in resilience. Therefore, it is essential to prevent aggressive behaviour in students, and several strategies can be implemented based on the findings, namely, gender-specific interventions; academic year targeted support; socioeconomic support programmes; promotion of positive coping mechanisms; creating supportive environments; and education on conflict resolution. Full article