scholarly journals Who Is Not Linking to HIV Care in Tennessee — the Benefits of an Intersectional Approach

2021 ◽  
Author(s):  
Leslie J. Pierce ◽  
Peter Rebeiro ◽  
Meredith Brantley ◽  
Errol L. Fields ◽  
Cathy A. Jenkins ◽  
...  
Keyword(s):  
Black Males ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hiv Care ◽  
Older Individuals ◽  
Hiv Diagnosis ◽  
Race And Gender ◽  
Targeted Interventions ◽  
And Gender ◽  
Linkage To Hiv Care

Abstract Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.

Intersectionality of Race, Ethnicity, Gender, and Age on Criminal Punishment

2016 ◽  
Vol 60 (4) ◽  
pp. 810-833 ◽  
Author(s):  
Darrell Steffensmeier ◽  
Noah Painter-Davis ◽  
Jeffery Ulmer
Keyword(s):  
Black Males ◽  
Behavioral Outcomes ◽  
Hispanic Males ◽  
Race And Gender ◽  
Focal Concerns ◽  
Gender And Age ◽  
Statistical Studies ◽  
Novel Method ◽  
Race Ethnicity ◽  
And Gender

Race, ethnicity, gender, and age are core foci within sociology and law/criminology. Also prominent is how these statuses intersect to affect behavioral outcomes, but statistical studies of intersectionality are rare. In the area of criminal sentencing, an abundance of studies examine main and joint effects of race and gender but few investigate in detail how these effects are conditioned by defendant’s age. Using recent Pennsylvania sentencing data and a novel method for analyzing statistical interactions, we examine the main and combined effects of these statuses on sentencing. We find strong evidence for intersectionality: Harsher sentences concentrate among young black males and Hispanic males of all ages, while the youngest females (regardless of race/ethnicity) and some older defendants receive leniency. The focal concerns model of sentencing that frames our study has strong affinity with intersectionality perspectives and can serve as a template for research examining the ways social statuses shape inequality.

scholarly journals Characteristics and consequences of medical care interruptions in HIV-infected patients in France

2016 ◽  
Vol 144 (11) ◽  
pp. 2363-2370 ◽  
Author(s):  
L. CUZIN ◽  
P. DELLAMONICA ◽  
Y. YAZDANPANAH ◽  
S. BOUCHEZ ◽  
D. REY ◽  
...  
Keyword(s):  
Medical Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time Interval ◽  
Hiv Diagnosis ◽  
Viral Loads ◽  
Treatment Benefits ◽  
Cox Proportional Hazards Models ◽  
Sex With Men

SUMMARYTo describe the consequences of medical care interruptions (MCIs) we selected patients with at least two medical encounters between January 2006 and June 2013 in the Dat'AIDS cohort. Patients with any time interval >15 months between two visits were defined as having a MCI, as opposed to uninterrupted follow-up (UFU). Patients’ characteristics at the time of HIV diagnosis and at the censoring date were compared between groups. Cox proportional hazards models were built to assess the role of interruptions on survival (total and AIDS-free). Of 11 116 patients, 824 had at least one MCI. These patients were younger at the time of HIV diagnosis (30vs. 33 years,P< 0·0001). MCI was less frequent in men having sex with menvs.heterosexual patients [odds ratio (OR) 0·81, 95% confidence interval (CI) 0·69–0·96)], and a centre effect was described. MCI was independently associated with AIDS (OR 2·54, 95% CI 2·10–3·09) and death (OR 2·65, 95% CI 1·94–3·61). At the censoring date, 52·2% of patients with at least one MCI had viral load below detectionvs.85·3% of the UFU group (P< 0·0001). In conclusion, MCIs were associated with patients’ survival and with the proportion of viral loads below detection in our cohort, compromising individual and collective treatment benefits.

scholarly journals Association of β-amyloid level, clinical progression and longitudinal cognitive change in normal older individuals

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011222
Author(s):  
Laura M. van der Kall ◽  
Thanh Truong ◽  
Samantha C Burnham ◽  
Vincent Doré ◽  
Rachel S Mulligan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cognitive Change ◽  
Cox Proportional Hazards ◽  
Imaging Biomarkers ◽  
Older Individuals ◽  
Mixed Effect ◽  
Preclinical Ad ◽  
Risk Of Progression ◽  
Very High

Objective:To determine the effect of Aβ level on progression risk to MCI or dementia and longitudinal cognitive change in cognitively normal (CN) older individuals.Methods:All CN from the Australian Imaging Biomarkers and Lifestyle study (AIBL) with Aβ PET and ≥3 years follow-up were included (n=534; age 72±6 yrs; 27% Aβ positive; follow-up 5.3±1.7 yrs). Aβ level was divided using the standardised 0-100 Centiloid scale: <15 CL negative, 15-25 CL uncertain, 26-50 CL moderate, 51-100 CL high, >100 CL very high, noting >25 CL approximates a positive scan. Cox proportional hazards analysis and linear mixed effect models were used to assess risk of progression and cognitive decline.Results:Aβ levels in 63% were negative, 10% uncertain, 10% moderate, 14% high and 3% very high. Fifty-seven (11%) progressed to MCI or dementia. Compared to negative Aβ, the hazard ratio for progression for moderate Aβ was 3.2 (95% CI 1.3-7.6; p<0.05), for high was 7.0 (95% CI 3.7-13.3; p<0.001) and for very high was 11.4 (95% CI 5.1-25.8; p<0.001). Decline in cognitive composite score was minimal in the moderate group (-0.02 SD/year, p=0.05) while the high and very high declined substantially (high -0.08 SD/year, p<0.001; very high -0.35 SD/year p<0.001).Conclusion:The risk of MCI or dementia over 5 years in older CN is related to Aβ level on PET, 5% if negative vs 25% if positive but ranging from 12% if 26-50 CL to 28% if 51-100 CL and 50% if >100 CL. This information may be useful for dementia risk counselling and aid design of preclinical AD trials.

Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis

Thorax ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 407-412 ◽  
Author(s):  
Deborah Assayag ◽  
Julie Morisset ◽  
Kerri A Johannson ◽  
Athol U Wells ◽  
Simon L F Walsh
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Proportional Hazards ◽  
Usual Interstitial Pneumonia ◽  
Clinical Information ◽  
Cox Proportional Hazards ◽  
Diagnostic Confidence ◽  
Patient Gender ◽  
And Gender ◽  
Gender Influences

BackgroundPatient sex has clinical and prognostic implications in idiopathic pulmonary fibrosis (IPF). It is not known if sex-related and gender-related discrepancies exist when establishing a diagnosis of IPF. The aim was to determine how patient gender influences the diagnosis of IPF and the physician’s diagnostic confidence.MethodsThis study was performed using clinical cases compiled from a single centre, then scored by respiratory physicians for a prior study. Using clinical information, physicians were asked to provide up to five diagnoses, together with their diagnostic confidence. Logistic regression was used to assess the odds of receiving a diagnosis of IPF based on patient gender. Prognostic discrimination between IPF and non-IPF was used to assess diagnostic accuracy with Cox proportional hazards modelling.ResultsSixty cases were scored by 404 physicians. IPF was diagnosed more frequently in men compared with women (37.8% vs 10.6%; p<0.0001), and with greater mean diagnostic confidence (p<0.001). The odds of a male patient receiving an IPF diagnosis was greater than that of female patients, after adjusting for confounders (OR=3.05, 95% CI: 2.81 to 3.31), especially if the scan was not definite for the usual interstitial pneumonia pattern. Mortality was higher in women (HR=2.21, 95% CI: 2.02 to 2.41) than in men with an IPF diagnosis (HR=1.26, 95% CI: 1.20 to 1.33), suggesting that men were more often misclassified as having IPF.ConclusionPatient gender influences diagnosis of IPF: women may be underdiagnosed and men overdiagnosed with IPF.

scholarly journals Improvement of Abandonment of Therapy in Pediatric Patients with Cancer in Guatemala

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 76s-76s ◽  
Author(s):  
Elysia Alvarez ◽  
Midori Seppa ◽  
Kevin Messacar ◽  
John Kurap ◽  
E. Alejandro Sweet-Cordero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychosocial Intervention ◽  
Intervention Program ◽  
Proportional Hazards ◽  
Conflicts Of Interest ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Middle Income ◽  
Targeted Interventions ◽  
Increased Risk

Abstract 59 Background: Abandonment of therapy is a major cause of therapeutic failure in the treatment of childhood cancer in Low and Middle Income Countries (LMIC). This study examines factors associated with increased risk of therapy abandonment in Guatemalan children with cancer and the rates of therapy abandonment before and after implementation of a multidisciplinary psychosocial intervention program. Methods: A retrospective population-based study was performed to identify risk factors for abandonment of therapy in Guatemalan children, ages 0-18, with cancer who were seen at UNOP from 2001-2008. Patient data was collected from the Pediatric Oncology Networked Database (POND4Kids). Abandonment was defined as a lapse of 4 weeks in planned treatment or failure to begin treatment for a potentially curable cancer. Cox proportional hazards analysis identified the effect of age, sex, year of diagnosis, distance travelled to UNOP, ethnicity, and principal diagnosis on abandonment of therapy. Kaplan Meier analysis was used to evaluate survival. Results: A retrospective analysis of 1,789 charts was performed and 367 patients abandoned therapy. The rate of abandonment decreased from 27% in 2001 to 7% in 2008 following a multidisciplinary psychosocial intervention program. Greater distance to UNOP (p = 0.00), younger age (p = 0.02) and earlier year of diagnosis (p = 0.00) were associated with increased risk of abandonment. Abandonment of therapy correlated with decreased survival. The cumulative survival at 8.3 years was 0.57 ± 0.02 (survival±SE) for those who completed therapy vs 0.06 ± 0.02 for those who abandoned and refused therapy (p=0.000) in an abandonment sensitive analysis. Conclusion: This study identified distance, age, and year of diagnosis as risk factors for abandonment of therapy for pediatric cancer in Guatemala. This study highlights risk factors for abandonment of therapy and the role of targeted interventions in altering rates of abandonment that could be replicated in other LMIC countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

scholarly journals Cohort differences in levels and health effects of aging self-perceptions among older Japanese

2021 ◽  
Author(s):  
Takeshi Nakagawa ◽  
Daisuke Ito ◽  
Saori Yasumoto
Keyword(s):  
Health Effects ◽  
Functional Impairment ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Self Perceptions ◽  
Cohort Differences ◽  
Cox Proportional Hazards Models ◽  
Perceptions Of Aging ◽  
Effects Of Aging

This study examined cohort differences in levels and health effects of aging self-perceptions among older individuals. Using longitudinal data collected in Japan during 1987–2006, we compared two cohorts born in the 1920s versus the 1930s. To control for relevant covariates, we identified case-matched controls based on age and gender (age range = 60–65 years; n = 515 per cohort). Self-perceptions of aging were measured at baseline. Health outcome was indexed as functional impairment for 9–10 years. Regression models indicated that the later-born cohort held more positive self-perceptions of aging than the earlier-born cohort. Cox proportional hazards models revealed that the less positive self-perceptions of aging were related to an onset of functional impairment across cohorts. Our findings suggest historical improvements in the levels of aging self-perceptions. Nevertheless, the adverse effects of negative aging self-perceptions on health may not have been mitigated in the past decades.

scholarly journals Impact of Comorbidities On Physical Function And Survival of Middle-Aged As Compared To Older, Individuals With Cancer.

2021 ◽  
Author(s):  
Bogda Koczwara ◽  
Laura Deckx ◽  
Shahid Ullah ◽  
Marjan Van den Akker
Keyword(s):  
Functional Impairment ◽  
Proportional Hazards ◽  
Age Groups ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Middle Aged ◽  
Binary Logit ◽  
Comorbidity Index ◽  
Strength Of Association

Abstract Purpose: To investigate if comorbidity predicts mortality and functional impairment in middle-aged individuals with cancer (50-64 years) as compared to older individuals.Methods: A prospective cohort study. Outcomes were mortality and functional impairment at 5 years follow-up. Comorbidity was assessed using adjusted Charlson comorbidity index and polypharmacy (≥5 drugs) as surrogate for comorbidity. Multivariate Cox-proportional hazards and binary logit models were used to assess the risk of 5-year mortality and functional impairment respectively.Results: We included 477 middle-aged (50-64 years) and 563 older (65+ years) individuals with cancer. The prevalence of comorbidity (at least one disease in addition to cancer) was 29% for middle-aged and 45% for older individuals, with polypharmacy observed in 15% and 31% respectively. Presence of ≥3 comorbidities nearly tripled the mortality risk in middle-aged individuals (HR 2.97, 95% CI: 1.43-6.16). In older individuals the HR was 1.7 (95% CI 1.1-2.8). Polypharmacy also significantly increased the risk for mortality in middle-aged (HR 2.35, 95% CI 1.32- 4.16) but not in older individuals (HR 1.2, 95% CI 0.9-1.8). Polypharmacy quadrupled the risk for functional impairment in middle-aged (OR 4.0, 95% CI 1.59-10.06) and older individuals (OR 4.4, 95% CI 1.6-11.7). Conclusion: Comorbidity and polypharmacy are associated with inferior outcomes in younger and older cancer individuals with the strength of association in younger individuals exceeding that of older individuals. Assessment and management of comorbidity should be a priority for cancer care across all age groups.

scholarly journals Higher risk of dementia in English older individuals who are overweight or obese

2020 ◽  
Vol 49 (4) ◽  
pp. 1353-1365 ◽  
Author(s):  
Yixuan Ma ◽  
Olesya Ajnakina ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Body Weight ◽  
Abdominal Obesity ◽  
Central Obesity ◽  
Proportional Hazards ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Obese Women ◽  
Dementia Incidence

Abstract Background Several risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults. Methods We studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged ≥50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Central obesity was defined as a waist circumference (WC) &gt;88 cm for women and &gt;102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score &gt;3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years. Results From the overall sample, 6.9% (n = 453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence [hazard ratio (HR) = 1.34, 95% confidence interval (CI) 1.07–1.61] independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes (HR = 1.31, 95% CI 1.03–1.59). Women with central obesity had a 39% greater risk of dementia compared with non-central obese women (HR = 1.39, 95% CI 1.12–1.66). When compared with a normal BMI and WC group, the obese and high WC group had 28% (HR = 1.28, 95% CI 1.03–1.53) higher risk of dementia. Conclusions Our results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

scholarly journals Joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals

2020 ◽  
Vol 54 (24) ◽  
pp. 1499-1506
Author(s):  
Ulf Ekelund ◽  
Jakob Tarp ◽  
Morten W Fagerland ◽  
Jostein Steene Johannessen ◽  
Bjørge H Hansen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Proportional Hazards ◽  
Sedentary Time ◽  
Meta Analysis ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Reported Data ◽  
Joint Associations

ObjectivesTo examine the joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality.MethodsWe conducted a harmonised meta-analysis including nine prospective cohort studies from four countries. 44 370 men and women were followed for 4.0 to 14.5 years during which 3451 participants died (7.8% mortality rate). Associations between different combinations of moderate-to-vigorous intensity physical activity (MVPA) and sedentary time were analysed at study level using Cox proportional hazards regression analysis and summarised using random effects meta-analysis.ResultsAcross cohorts, the average time spent sedentary ranged from 8.5 hours/day to 10.5 hours/day and 8 min/day to 35 min/day for MVPA. Compared with the referent group (highest physical activity/lowest sedentary time), the risk of death increased with lower levels of MVPA and greater amounts of sedentary time. Among those in the highest third of MVPA, the risk of death was not statistically different from the referent for those in the middle (16%; 95% CI 0.87% to 1.54%) and highest (40%; 95% CI 0.87% to 2.26%) thirds of sedentary time. Those in the lowest third of MVPA had a greater risk of death in all combinations with sedentary time; 65% (95% CI 1.25% to 2.19%), 65% (95% CI 1.24% to 2.21%) and 263% (95% CI 1.93% to 3.57%), respectively.ConclusionHigher sedentary time is associated with higher mortality in less active individuals when measured by accelerometry. About 30–40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self-reported data.

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