Search Results (170)

Background: The US has state variation in edentulism, commonly known as total tooth loss, in older adults. This paper identifies key social determinants of health (SDOH) associated with state differences in older adult edentulism that can be addressed with partnerships between dental providers and policymakers. Methods: Data was collected from three publicly available data sets, including County Health Rankings, provided by the University of Wisconsin Population Health Institute, the U.S. Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS). Results come from multiple regression analysis of panel data for all states and the District of Columbia for even years of 2012–2020. Results: A variety of SDOH, population health behaviors, and demographics are associated with older adult edentulism, with the largest effects for education and smoking. We have other variables of interest, and overall, our model explains over 80 percent of the variation. Conclusion: Policymaking in states should emphasize both education and smoking cessation programs for individuals. Future research may also consider the relationship between state-regulated dental insurance and dental practice location. States may also consider policies to encourage better dental professional training and incentives to address smoking cessation for patients. Full article

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 6% of adults in the United States and contributes to a significant economic burden. Telehealth has emerged as a vital tool in the management of ADHD, offering improved access to care, especially for individuals in underserved communities. Despite its growing role, there remain critical gaps in understanding how social determinants of health (SDOH) are associated with disparities in telehealth utilization for ADHD treatment. Objectives and Methods: This study analyzed data from the National Center for Health Statistics (NCHS) Rapid Surveys System (RSS) Round 2: ADHD (October–November 2023), a nationally fielded survey of U.S. adults. Respondents were classified into three groups: never diagnosed, previously diagnosed, and currently diagnosed with ADHD. The study aimed to (1) compare the distribution of SDOH across ADHD status groups and the general adult population to identify factors associated with ADHD diagnosis; (2) assess the homogeneity of SDOH distributions across ADHD groups; (3) evaluate telehealth utilization among adults currently diagnosed with ADHD; and (4) examine the relationship between SDOH and telehealth use for ADHD treatment. Multivariable logistic regression (MVLR) served as a benchmark model, while machine learning (ML) models—including regularized linear regression, support vector machine (SVM), random forest (RF), LightGBM, multilayer perceptron (MLP), and Few-Shot Learning (FSL)—were trained to identify key predictors. Results: A total of 7009 survey responses were analyzed: 124 had a past diagnosis, 444 were currently diagnosed, and the remainder had never been diagnosed with ADHD, corresponding to a current ADHD prevalence of 6.3%. Adults with current ADHD were more likely to be male, single, younger, white, non-homeowners, and frequent users of online health resources. They also reported lower education, income, and financial security. About 70% used telehealth for counseling and prescriptions; insurance covered telehealth visits for 82.32% of users, yet 38.76% reported no coverage of ADHD-related diagnostic or treatment costs. Nineteen SDOH elements across four domains—demographic, socioeconomic, neighborhood/built environment, and healthcare access—were identified as predictors. ML models outperformed MVLR, with SVM and FSL achieving the highest F1 (both 0.63), and FSL the highest recall (0.69). Age, race, marital status, difficulty paying bills, home ownership, education, and household size were the most consistently important variables. Limitations: This study is limited by a cross-sectional design, reliance on self-reported ADHD diagnoses, and a lack of genetic or family-history measures. Additionally, the omission of complex sampling weights limits the national representativeness of these findings. Finally, the small effective sample size poses risks of model overfitting, and the generalizability of the models could not be externally validated due to the unavailability of comparable independent datasets. Conclusions: Despite widespread internet access, disparities in telehealth use for ADHD persist. Among 19 SDOH predictors, age (aOR = 0.56), difficulty paying medical bills (aOR = 2.52), and race (aOR = 1.37) were significantly associated with telehealth use, and all ML models outperformed the MVLR benchmark, though bootstrap CIs overlapped. Future research should incorporate inclusive data collection and stratified modeling to better represent disadvantaged populations and inform equitable access strategies. Full article

Despite Lyme disease’s (LD) status as the most common vector borne disease in the United States, relatively little attention has been paid to the demographic characteristics of LD patients or health disparities among them. Using administrative claims for Medicare and Medicaid, two large public health insurance programs, we calculate the incidence of LD within strata of a variety of social determinants of health (SDoH) among beneficiaries living in high incidence LD states. Our findings focus principally on two critical causes of disparities, socioeconomic status and racial residential segregation. We find that distinct patterns in LD incidence exist across these strata for both Medicare and Medicaid beneficiaries who had LD between 2016 and 2021. LD rates are highest in areas with low levels of socioeconomic inequality and racial residential segregation. When positioned against other data in the literature, we argue that these findings may reflect access to health care or inadequate recognition of LD symptoms for patients from particular communities. Full article

Financial toxicity is a significant but often overlooked consequence of cancer for adolescents and young adults (AYAs, 15–39 years old), who face limited savings, unstable employment, and insurance gaps that heighten financial stress. As part of a larger initiative to determine whether our cancer center can use an existing social drivers of health (SDOH) screening process to identify patients who may benefit from targeted supportive interventions, we sought to characterize financial strain, toxicity, and SDOH needs in AYAs treated in our cancer center and compare them to both younger and older cancer patients. This is a cross-sectional observational study at Mayo Clinic of patients with an oncology-related department visit between 8 September 2023–4 June 2024 (N = 81,731) who completed routine institutional electronic screenings for financial strain and SDOH. Survey items assessed financial strain, transportation barriers, and food insecurity; institutional billing data captured financial toxicity (unresolved balances, collection referrals, write-offs). AYAs (n = 5655) were more likely than non-AYAs to report medium/high financial strain, have unpaid debt, or have an unresolved balance, referral to a collection agency, or bad debt write-off, with nearly double the odds of medium/high financial strain compared to patients over 40 (OR 2.02, 95% CI 1.84–2.23, p < 0.001). Within AYAs, ages 26–32 bore the greatest burden: 24.2% in the medium/high-risk category, 9.4% with unresolved billing issues or collections, and 11.6% reporting food insecurity. These findings identify AYAs—particularly those 26–32—as a distinct high-risk group for financial toxicity and health-related social needs, underscoring the need for targeted interventions, tailored financial navigation, and policy efforts to reduce economic barriers to care. Future research should evaluate the effectiveness of these interventions in mitigating financial toxicity, addressing health-related social needs, and improving patient outcomes in this population. Full article

Background: Lung cancer remains the leading cause of cancer-related mortality in the United States, characterized by poor overall survival rates (OS), particularly for advanced-stage disease. While smoking is a primary risk factor, other contributors include environmental exposures, genetics, comorbidities, and socioeconomic factors. Methods: We included 232 patients with lung cancer (96% NSCLC). Patients were categorized into DNA damage response (DDR)-mutant (DDR^mt, n = 67, 29%) and DDR-wild-type (DDR^wt, n = 165, 71%) groups. We evaluated the correlations between individual and socioeconomic factors between DDR^mt and DDR^wt lung cancer patients. Results:Nineteen DDR genes were identified, with ARID1A(31.3%), CHEK2 (19.4%), ATM (14.9%), BRCA2 (14.9%), ATRX (11.9%), MUTYH (11.9%), ATR (8.9%), and MSH6 (5.9%) being the most common. The DDR^mt group had a significantly higher median tumor mutational burden (TMB) (12 vs. 9; p = 0.006) and a higher prevalence of adenocarcinoma (85.1% vs. 64.8%, p = 0.003). Logistic regression identified adenocarcinoma histology (OR = 10.03, p = 0.002) and lower area deprivation index (OR = 0.98, p = 0.04) as predictors of DDR mutation status. Having advanced stage at diagnosis was associated with, age (p = 0.03), lack of lung cancer screening (p < 0.001), and adenocarcinoma histology (p < 0.001). While median OS was 61 months for the DDR^mt group vs. 44 months for the DDR^wt group (p = 0.654), patients with ATR mutations had significantly shorter survival (13 vs. 67 months; p = 0.0008). Population-level factors, including food insecurity (HR = 2.33, p = 0.002), lack of insurance (HR = 2.39, p = 0.008), and proximity to potential chemical accidents (HR = 1.73, p = 0.037), were significant predictors of OS. Conclusions: These findings suggest that DDR^mt lung cancers represent a biologically distinct subgroup characterized by higher tumor mutational burden and enrichment for adenocarcinoma histology; however, DDR mutation status alone was not associated with overall survival. Instead, outcomes appeared to vary by individual DDR gene, with ATR alterations identifying a subgroup with particularly poor survival. In parallel, food insecurity, lack of insurance, and proximity to potential environmental hazards were associated with outcomes, highlighting the need to integrate genomic biomarkers with social and environmental determinants of health. These data suggest the need for future prospective studies incorporating treatment-response data, longitudinal social determinants of health (SDOH) assessment, and environmental exposure measures to define how DDR alterations can guide precision oncology strategies while addressing modifiable barriers to equitable cancer care. Full article

Background: Nursing education has evolved in response to changing social, cultural, political, and healthcare contexts. Although Cultural–Historical Activity Theory (CHAT) has increasingly been applied in medical education research, its application to the historical development of nursing education remains limited. This study examined the historical evolution of Mongolian nursing education through the lens of CHAT to identify patterns of activity system transformation and their implications for contemporary nursing education. Methods: A historical documentary review was conducted using CHAT as the primary analytical framework. Historical evidence was interpreted through Engeström’s activity system model, and transformations across successive historical periods were analyzed by examining changes in the object, mediating tools, institutional rules, community, division of labour, and outcomes of nursing education. Results: The findings demonstrate that the development of Mongolian nursing education was shaped by four complementary analytical dimensions: the Social Determinants of Health (SDOH), Diversity, Equity and Inclusion (DEI), political ideology, and paradigm shifts. These factors collectively influenced the transformation of nursing education activity systems from traditional caregiving practices to a modern, research-oriented, and internationally connected educational system. The analysis further revealed how social reforms, ideological transitions, and educational restructuring generated successive transformations in the organization, objectives, and professional identity of nursing education. Conclusions: This study provides a theoretically grounded historical interpretation of Mongolian nursing education through the lens of CHAT. The findings demonstrate that nursing education evolves through dynamic interactions among social, political, cultural, and educational factors, offering valuable insights for curriculum development, educational reform, and the advancement of nursing education in rapidly changing societies. Full article

Although poverty and tuberculosis are insidiously linked, knowledge of the relationship between social determinants of health (SDoHs) and post-tuberculosis lung disease (PTLD) is limited. This study aimed to analyze the association between physical function, pulmonary function, and SDoHs in individuals with PTLD (iwPTLD), considering the impact of social inequalities on physical performance. This cross-sectional study collected social data from 69 iwPTLDs using a standardized assessment form. The patients underwent pulmonary function testing via spirometry and body plethysmography, as well as respiratory muscle strength and quadriceps muscle strength (QMS) testing. They also completed the six-minute step test (6MST). The median value of steps climbed by participants on the 6MST was 88 (57–117), corresponding to 50.1% (34.9–73.2) of the predicted value. The mean QMS was 28.7 ± 11.9 kgf, with 11 participants (17.4%) showing QMS below the cutoff point. Spirometry revealed normal, obstructive, restrictive, and mixed patterns in 19 (27.5%), 20 (29%), 18 (26.1%), and 12 (17.4%) of the participants, respectively. Performance on the 6MST showed no statistically significant association with SDoHs. QMS showed a statistically significant association with treated sewage (W = 84, p = 0.026). Forced expiratory volume in one second showed significant correlations with education level (ρ = 0.248, p = 0.040), social protection (W = 207, p = 0.050, r = 0.238), and treated water (W = 24.5, p = 0.029, r = 0.264). Maximum inspiratory pressure showed significant correlations with education level (ρ = 0.246, p = 0.042) and treated water (W = 20, p = 0.021, r = 0.280). The regression model for 6MST and QMS performance showed that 12% and 45% of the variability was explained by the studied variables, respectively. In iwPTLD, impairments in physical function and damage to lung function are weakly associated with the deterioration of SDoHs. While this relationship is weak, it should not be ignored because it may operate through indirect pathways. Full article

Background: This study explored the observations and experiences of athletic trainers (ATs) regarding food security constraints and drivers among collegiate student-athletes through the framework of the social determinants of health (SDOH). Methods: Seventeen ATs from nine public Mountain West Division I schools participated in one of six 90 min, virtual focus groups conducted in July–December 2023. A phenomenological design and constructivist theoretical framework were employed to analyze transcripts, compile themes, infer food security constraints and drivers, and map them to SDOH domains. Results: Emerging constraints and drivers mapped to seven of the eight SDOH domains (education, employment, health systems and services, housing, income and wealth, physical environment, and social environment); no themes related to the public safety domain. Conclusions: ATs identified a considerable number of food security constraints and drivers; however, based on the findings of other studies, their observations were not comprehensive. Incorporating the findings of those other studies, food security constraints and drivers exist across all eight SDOH domains. Four concepts spanned multiple domains: student-athlete normative expectations, nutrition/food security prioritization, financial disparities, and residing off campus. To ensure food security among collegiate student-athletes, AT perceptions suggest that structural changes facilitating the implementation of necessary food drivers may be warranted. Full article

Escalating healthcare costs and persistent disparities in outcomes have been linked to delayed engagement in preventive care and the ongoing influence of social determinants of health (SDoH). Current care models often assume that individuals can effectively manage their health and seek care at appropriate times, despite evidence that contextual constraints limit this capacity. This perspective proposes that oral health may serve as a practical and scalable entry point for earlier engagement in preventive care. Oral health problems are highly prevalent, behaviorally influenced, clinically observable, and associated with systemic health conditions. We present a six-pillar conceptual framework linking consumer-reported behaviors with clinician-observed oral health status to support risk identification, engagement, and population health strategies. The framework integrates behavioral science, predictive modeling, social risk factors, digital health infrastructure, and policy innovation. We outline a research agenda, identify implementation challenges, and discuss equity considerations. While oral–systemic relationships are well-documented as associations, further prospective and interventional studies are needed to establish causality and population-level impact. Full article

Background. Hispanic populations in the United States experienced disproportionate health and economic impacts during the COVID-19 pandemic. This study assessed relationships between social determinants of health (SDOH) and COVID-19-related health and economic outcomes among Hispanic and non-Hispanic participants in the All of Us Research Program. Methods. Descriptive analyses and logistic regression models explored associations between all variables. Iterative proportional fitting (raking) was used to align survey samples with known population margins. Results. Hispanics reported worse outcomes across all COVID-19-related variables: lower vaccination rates and higher rates of COVID-19 symptoms and experiencing hardships due to COVID-19. Final post-raking models found Hispanics had greater odds of experiencing hardships (OR = 1.81, 95% CI = 1.55, 2.11) especially among those reporting COVID-19 symptoms (OR = 2.45, 95% CI = 1.51, 3.97). The final model identified increased rates of COVID-19 vaccination among Hispanics when controlling for gender, age, and SDOH (OR = 1.22, CI = 1.09, 1.37) than have been reported nationally during the examined time period for Hispanics. Conclusions. Uptake of COVID-19 vaccination and disproportionate negative health, economic, and social impacts of COVID-19 experienced by Hispanic communities were driven by SDOH. Findings underscore the need for targeted efforts to address SDOH to achieve the best health outcomes for all. Full article

Objectives: This study investigated the sequential mediating roles of protein intake and handgrip strength (HGS) in the association between socioeconomic status (SES) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk within the social determinants of health (SDOH) framework. Methods: We conducted a complex survey analysis using data from 6281 adults without baseline ASCVD from the Korea National Health and Nutrition Examination Survey (2016–2018), accounting for stratification, clustering, and weighting. The 10-year ASCVD risk was estimated using the pooled cohort risk equations. SES was classified into three groups based on educational attainment and household income. Relative HGS was calculated as the sum of maximal grip strength in both hands divided by body mass index. Indirect effects were assessed using bootstrap-based confidence intervals (CIs). Results: Compared with the low-SES group, the high-SES group showed a lower 10-year ASCVD risk in both the total effect model (B = −1.630, 95% CI: −2.250 to −1.010) and the direct effect model (B = −1.550, 95% CI: −2.170 to −0.927). The total indirect effect was also significant in both the high-versus-low and middle-versus-low SES comparisons. Protein intake and relative HGS partially mediated the association between SES and 10-year ASCVD risk, and the sequential mediation pathway was also significant. Conclusions: Within the SDOH framework, these findings suggest that nutritional and muscle-strength-related pathways may link socioeconomic disadvantage to ASCVD risk and support integrated interventions targeting nutritional support and muscle-strength improvement for life-course prevention. Full article

Understanding the impact of neighborhood-level factors on stroke prevalence is crucial for addressing existing disparities. However, there is a distinct lack of ecological studies at the census tract level that investigate the social determinants of health (SDOH) influencing stroke prevalence within the U.S. Health and Human Services Region 3 (HHS Region 3: Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia). This study adopted a multivariate modeling approach to investigate the association between the 13 indicators of the Health Opportunity Index (HOI) and stroke prevalence at the census tract level in HHS Region 3 using four HOI indicator profiles and to highlight the specific SDOHs that are most associated with stroke prevalence. The four HOI indicator profiles include: (a) neighborhood and built environment profile, (b) social and community context profile, (c) resource profile, and (d) economic profile. The methodological approach was quantitative, using secondary data. The sample size was 8021 census tracts. The HOI was estimated for each census tract in the study area. Ordinary least squares regression (OLS) analysis and spatial lag model (SLM) were run to examine whether the 13 indicators of the HOI (categorized into four profiles) reliably predict stroke prevalence and to determine the most appropriate model that best identifies the strongest predictors of stroke prevalence. The results show that affordability, education, spatial segregation, and income inequality indicators were the strongest predictors of stroke prevalence in HHS Region 3. This granular research identifies the neighborhood-level SDOH most strongly linked to stroke prevalence, which can be leveraged to guide the development of targeted public health programs, quality improvement initiatives, resource allocation, and policy creation to combat stroke-related morbidity and mortality across census tracts in HHS Region 3. For example, the built environment, encompassing factors like employment access, affordable housing, and walkability, profoundly influences stroke prevalence and provides urban planners with practical insights for developing healthier, more equitable communities, such as creating neighborhood parks to encourage physical activity, a key factor in stroke prevention. This study also provides neighborhood organizations with the evidence needed to pursue grant funding and raise awareness about the socio-structural influences on stroke outcomes in their respective neighborhoods. Lastly, the insights generated from our study can facilitate collaborative decision-making processes with communities in HHS Region 3 regarding the prioritization of neighborhood-level SDOH for targeted public health interventions. This prioritization should focus on addressing predictors of stroke prevalence that are congruent with the community’s established priorities, thereby maximizing cost savings. Full article

Background/Objectives: Prostate biopsy is essential for diagnosing prostate cancer. Social determinants of health (SDOH), including socioeconomic status, race, occupation, education, and environment, affect access, outcomes, and quality of life. Recognizing disparities from technology access to complications is crucial for equitable care. A systematic review examined how SDOH impacts biopsy access, technology, and complications. Methods: A systematic search of PubMed, Web of Science, and Scopus was performed to identify eligible studies published through February 2026. We included studies that evaluated the association between one or more SDOHs and prostate biopsy. Relevant outcomes included biopsy utilization, use of specific biopsy technologies (e.g., magnetic resonance imaging (MRI)-guided, transperineal), and post-procedural complications. Results: Nine observational studies met the inclusion criteria. The findings revealed disparities across three key domains. First, access to advanced biopsy technology was uneven. Four studies showed that Black men were significantly less likely than White men to receive MRI-guided biopsies. Additionally, post-biopsy outcomes showed that Black and Hispanic men faced significantly higher rates of post-biopsy infection and hospitalization compared to White men. Lastly, patients in rural areas, those in public hospitals, and individuals with lower socioeconomic status demonstrated reduced access to modern techniques, including MRI-guided or transperineal biopsy. Conclusions: Social and economic factors influence who receives a prostate biopsy and who has access to advanced technologies. Minority and low-income patients face diagnosis barriers and higher complication rates, highlighting systemic inequities. The healthcare system often rewards access over need, and without bold policy changes, gaps in technology and resources will worsen, moving us further from truly equitable prostate cancer care. Full article

Childhood family support is widely recognized as a protective factor for mental health, yet it remains unclear whether its buffering role is maintained under conditions of cumulative adversity. This study examined whether perceived childhood family support is associated with adult mental health distress and whether this association varies across levels of childhood adversity and victimization. Data were drawn from a convenience sample of 1571 adults in the United States who completed an online survey assessing childhood family support, adult mental health distress (PHQ-4), childhood victimization, non-victimization adversity, family substance use, and childhood social determinants of health (SDoH) hardship. Ordinary least squares regression models with interaction terms were used to test main and moderating effects. Greater perceived family support was associated with lower adult mental health distress (β = −0.23, p < 0.001). Childhood adversity (β = 0.11, p = 0.002) and childhood victimization (β = 0.13, p = 0.001) were independently associated with higher distress. Importantly, both adversity and victimization significantly moderated the association between family support and distress, such that the protective effect of family support weakened at higher levels of cumulative risk. Robustness analyses indicated that these patterns did not differ by family structure. These results suggest that while family support is beneficial, its protective effects are context-dependent and reduced under conditions of elevated risk. Overall, the findings highlight the importance of conceptualizing resilience as a multi-system process and underscore the need for interventions that address both relational and structural sources of adversity. Full article

More than one million adults in Mississippi have hypertension. We examined the association between a summary measure of social determinants of health (SDOH) and health equity (SDOH/HE) and hypertension prevalence among Mississippi adults. Using data from 3867 respondents to the 2023 Mississippi Behavioral Risk Factor Surveillance System SDOH/HE Module, we performed multivariable logistic regression analyses to examine the association between hypertension prevalence and a summary SDOH/HE measure. The SDOH/HE summary measure score was created using responses to 10 questions assessing employment/economic and housing stability, receipt of food assistance, access to quality food and transportation, utilities security, social isolation, social and emotional support, life satisfaction, and mental well-being of the participants. The likelihood of experiencing 0, 1, 2, 3, or 4 or more SDOH/HE risk factors was 38.6, 22.9%, 13.7%, 7.9%, and 16.8%, respectively. Mississippi adults experiencing one (adjusted odds ratio, AOR, 1.47) and four or more (AOR, 2.62) of SDOH/HE risk factors had higher odds of hypertension compared to those experiencing no SDOH/HE risk factors. Associations between presence of two or three SDOH/HE risk factors and hypertension were not significant. Mississippi adults with one and at least four SDOH/HE risk factors had significantly higher odds of hypertension risk than those with no SDOH/HE risk factors. These findings highlight an association between SDOH/HE factors and the burden of hypertension and underscore the need for targeted inventions among Mississippi adults with multiple SDOH/HE risk factors. Full article