Household Income as a Predictor for Surgical Outcomes and Opioid Use After Spine Surgery in the United States

Study Design Cross-Sectional Study Objectives Socioeconomic status (SES) is a fundamental root of health disparities, however, its effect on surgical outcomes is often difficult to capture in clinical research, especially in spine surgery. Here, we present a large single-center study assessing whether SES is associated with cause-specific surgical outcomes. Methods Patients undergoing spine surgery between 2015 and 2019 were assigned income in accordance with the national distribution and divided into quartiles based on the ZIP code-level median household income. We performed univariate, chi-square, and Analysis of Variance (ANOVA) analysis assessing the independent association of SES, quantified by household income, to operative outcomes, and multiple metrics of opioid consumption. Results 1199 patients were enrolled, and 1138 patients were included in the analysis. Low household income was associated with the greatest rates of 3-month opioid script renewal (OR:1.65, 95% CI:1.14-2.40). In addition, low-income was associated with higher rates of perioperative opioid consumption compared to higher income including increased mean total morphine milligram equivalent (MME) 252.25 (SD 901.32) vs 131.57 (SD 197.46) (P < .046), and inpatient IV patient-controlled analgesia (PCA) MME 121.11 (SD 142.14) vs 87.60 (SD 86.33) (P < .023). In addition, household income was independently associated with length of stay (LOS), and emergency room (ER) revisits with low-income patients demonstrating significantly longer postop LOS and increasing postoperative ER visits. Conclusions Considering the comparable surgical management provided by the single institution, the associated differences in postoperative outcomes as defined by increased morbidities and opioid consumption can potentially be attributed to health disparities caused by SES.

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A cross-sectional study of opioid involvement in non-poisoning suicide – risks and prevention opportunities

10.21203/rs.3.rs-46823/v1 ◽

2020 ◽

Author(s):

Maryann Mason ◽

Suzanne McLone ◽

Tami Bartell ◽

Sarah Welch ◽

Karen Sheehan ◽

...

Keyword(s):

United States ◽

Suicide Prevention ◽

The United States ◽

Cross Sectional Study ◽

Close Monitoring ◽

Opioid Epidemic ◽

Sectional Study ◽

Opioid Use ◽

Chi Square ◽

Cross Sectional

Abstract Background The current opioid epidemic has drawn attention to drug overdose deaths including unintentional and suicide poisoning deaths which peaked in the United States in 2017. Concurrent with the opioid epidemic, the number and rate of suicides in the United States has increased. At the same time, the proportion of suicide deaths across cause of death has shifted and the proportion of suicides by poisoning (including overdose) has decreased. On the face of it, it would appear that the opioid epidemic has not intersected with suicide as signaled by the decline in suicide deaths due to poisoning. However, opioid use and misuse is associated with suicidal ideation and attempts and therefore it is plausible that opioids may play a role in suicide deaths by causes other than poisoning. Objective This study examines opioid involvement (as measured by the presence of opioids but below the lethality threshold) in suicides by causes other than poisoning, Methods A cross-sectional study utilizing Illinois National Violent Death Reporting System data including all suicides toxicology screened for opioids. Chi-square tests were used to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Results Of 1007 non-poisoning suicides screened for opioids, 83.6% (842) were opioid negative and 16.4% (165) were opioid positive. Over half (52.7%) of decedents positive for opioids died by firearm. White race, age 75 and over, and widowed or unknown marital status were associated with opioid positivity. Opioid positivity is linked to testing positive for other substances. One quarter of decedents testing positive for opioids had a history of substance abuse. Twenty eight percent of opioid positive decedents suffered from physical health problems. Conclusion Suicide decedents who are opioid positive and who die from causes other than poisoning have distinct characteristics which suggest an array of suicide prevention efforts – for example -- including information on risk of suicide for opiate users in firearm sales, including suicide prevention counseling in health care settings in which opiates and/or benzodiazepines are therapeutically prescribed, and close monitoring of pain symptoms among patients experiencing chronic pain.

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Income-based inequalities in self-reported moderate-to-vigorous physical activity among adolescents in England and the United States: a cross-sectional study

10.1101/2020.05.15.20102673 ◽

2020 ◽

Author(s):

Shaun Scholes ◽

Jennifer S Mindell

Keyword(s):

Physical Activity ◽

Low Income ◽

Vigorous Physical Activity ◽

The United States ◽

Cross Sectional Study ◽

High Income ◽

Sectional Study ◽

Cross Sectional ◽

The Us ◽

Low Income Households

Objective: Quantify inequalities in self-reported moderate-to-vigorous physical activity (MVPA) in England and the United States (US). Design: Population-based cross-sectional study. Participants: 4019 adolescents aged 11-15 years in England (Health Survey for England 2008, 2012, 2015) and 4312 aged 12-17 years in the US (National Health and Nutrition Examination Survey 2007-16). Main outcome measures: Three aspects of MVPA: (1) doing any, (2) average min/day (MVPA: including those who did none), and (3) average min/day conditional on participation (MVPA-active). Using hurdle models, we quantified inequalities (average marginal effects: AMEs) using the absolute difference in marginal means. Results: In England, adolescents in high-income households were more likely than those in low-income households to have done any formal sports/exercise in the last seven days (boys: 11%; 95% CI: 4% to 17%; girls: 13%; 95% CI: 6% to 20%); girls in high-income households did more than their low-income counterparts (MVPA: 6 min/day, 95% CI: 2 to 9). Girls in low-income households spent more time in informal activities than girls in high-income households (MVPA: 21 min/day; 95% CI: 10 to 33), whilst boys in low-income versus high-income households spent longer in active travel (MVPA: 21 min/week; 95% CI: 8 to 34). In the US, in a typical week, recreational activity was greater among high-income versus low-income households (boys: 15 min/day; 95% CI: 6 to 24 min/day; girls: 19 min/day; 95% CI: 12 to 27). In contrast, adolescents in low-income versus high-income households were more likely to travel actively (boys: 11%; 95% CI: 3% to 19%; girls: 10%; 95% CI: 3% to 17%) and do more. Conclusions: Policy actions and interventions are required to increase MVPA across all income groups in England and the US. Differences in formal sports/exercise (England) and recreational (US) activities suggest that additional efforts are required to reduce inequalities.

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Association Between Usage of an App to Redeem Prescribed Food Benefits and Redemption Behaviors Among the Special Supplemental Nutrition Program for Women, Infants, and Children Participants: Cross-Sectional Study (Preprint)

10.2196/preprints.20720 ◽

2020 ◽

Author(s):

Qi Zhang ◽

Junzhou Zhang ◽

Kayoung Park ◽

Chuanyi Tang

Keyword(s):

Infant Formula ◽

Low Income ◽

The United States ◽

Cross Sectional Study ◽

Infants And Children ◽

Supplemental Nutrition ◽

Nutrition Program ◽

Cross Sectional ◽

Supplemental Nutrition Program ◽

The Difference

BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the most important food assistance programs in the United States, serving 6.4 million low-income, eligible women, infants, and children under 5 years of age in 2019. In the program, participants are prescribed a list of food benefits, which can be redeemed in WIC-authorized stores. However, there are multiple behavioral barriers in the program and the stores that prevent participants from redeeming the benefits fully. OBJECTIVE This study aims to examine the relationship between the use of a widely used mobile phone app, WICShopper, and the redemption of the prescribed food packages. METHODS WIC administrative data were obtained from West Virginia for the period January 2019 to January 2020 and included 30,440 WIC households that had received food benefits in that period. The redemption rates of 18 WIC food benefits were compared between app users and nonapp users, that is, those who never used the app in the study period. The use behaviors were defined for the app users, including the number of active use benefit cycles, active benefit cycle rates, number of active use days in the cycle, and proportion rates of daytime use. Panel linear regressions were applied to examine how the redemption rates were related to these behaviors over time. RESULTS App users consistently had higher average redemption rates than nonapp users; the difference ranged from 3.6% (4.8% relative) for infant formula to 14.3% (40.7% relative) for fish. After controlling for sociodemographics, the coefficients of app use were significantly positive for all benefit categories except for WIC-eligible nutritionals. More active cycles and active days in the cycle were significantly related to redemption rates for all categories, except for frozen juice (coefficient=−0.002, <i>P</i>=.09). Daytime app access was positively associated with redemption rates for most food benefits except only a few, such as infant formula (coefficient=−0.03, <i>P</i><.001). CONCLUSIONS Use of the WIC app was significantly related to higher redemption rates across food benefits, although the association varied across benefit categories. More active days were positively related to benefit redemptions across food categories, and the app’s daytime use was positively associated with the redemption of most benefit categories. These findings suggest that the WIC app can be an important tool for the promotion of benefit redemption among WIC participants.

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Assessing the Current Market of Sunscreen: A Cross-Sectional Study of Sunscreen Availability in Three Metropolitan Counties in the United States

Journal of Skin Cancer ◽

10.1155/2014/285357 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Kyle T. Amber ◽

Romi Bloom ◽

Patrick Staropoli ◽

Sonam Dhiman ◽

Shasa Hu

Keyword(s):

Low Income ◽

The United States ◽

Cross Sectional Study ◽

Cook County ◽

Dade County ◽

Lower Income ◽

Protection Factor ◽

Cross Sectional ◽

Usage Patterns ◽

Metropolitan Counties

Sunscreen use is recommended for the prevention of sunburn and skin cancer. Little is known regarding sunscreen availability in high versus low income communities. We analyzed sunscreen availability in three large metropolitan counties to determine the relationship between availability and community demographics. We included sun care products in all pharmacies and supermarkets open as of July 2013 in representative high and low income zip codes in Cook County, Illinois, Miami-Dade County, Florida, and San Diego County, California. We recorded the percentage of tanning oil, sunscreens with a sun protection factor (SPF) < 15, SPF > 15, physical sunscreens, spray sunscreens, mean price per ounce (PPO), and mean SPF. Of the total products assessed, 11.0% were tanning oils, with physical sunscreens accounting for only 3.4% of the available sunscreens and 46.2% of sunscreens being spray-on. A comparison between higher and lower income zip codes demonstrated a significantly increased percentage of sunscreens with SPF < 15 in high income zip codes. Lower income zip codes had higher percentages of sunscreens with SPF > 15 and higher PPO, even when taking into account SPF. Further studies of sunscreen usage patterns in different populations must take into account sunscreen availability and price, as these significantly differ based on the community demographic.

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Global, regional, and national consumption of controlled opioids: a cross-sectional study of 214 countries and non-metropolitan territories

British Journal of Pain ◽

10.1177/20494637211013052 ◽

2021 ◽

pp. 204946372110130

Author(s):

Georgia C Richards ◽

Jeffrey K Aronson ◽

Kamal R Mahtani ◽

Carl Heneghan

Keyword(s):

The United States ◽

Cross Sectional Study ◽

Opioid Consumption ◽

Sectional Study ◽

Total Consumption ◽

Cross Sectional ◽

The World ◽

Narcotics Control ◽

Using Data ◽

National Consumption

Introduction: The consumption of opioids has increased globally since the 1990s. Previous studies of global opioid consumption have concentrated on morphine alone or a subset of opioids, with a focus on cancer pain and palliative care. In this study, we have determined the global, regional, and national consumption of all controlled opioids, including anaesthetics, analgesics, antidiarrheals, opioid substitution therapies, and cough suppressants. Methods: We conducted a cross-sectional study using data from the International Narcotics Control Board (INCB). We calculated mean opioid consumption (mg/person) globally, regionally, and nationally for 2015–2017, where consumption refers to the total amount of controlled opioids distributed for medical purposes and excludes recreational use. We ranked countries by total consumption and quantified the types of opioids consumed globally. Results: Between 2015 and 2017, 90% of the world’s population consumed only 11% of controlled opioids. An average of 32 mg/person was consumed annually, but this was not equally distributed across the world. Consumption was the highest in Germany (480 mg/person), followed by Iceland (428 mg/person), the United States (398 mg/person) and Canada (333 mg/person). Oxycodone (35%) was the most heavily consumed controlled opioid globally, followed by morphine (15.9%), methadone (15.8%) and tilidine (14%). Conclusion: Large disparities persist in most of the world in accessing essential opioid medicines. Consumption patterns should continue to be monitored, and collaborative strategies should be developed to promote access and the appropriate prescribing of opioids in all countries and non-metropolitan territories.

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Food Insecurity among Low-Income Food Handlers: A Nationwide Study in Brazilian Community Restaurants

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031160 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1160

Author(s):

Ingrid C. Fideles ◽

Rita de Cassia Coelho de Almeida Akutsu ◽

Rosemary da Rocha Fonseca Barroso ◽

Jamacy Costa-Souza ◽

Renata Puppin Zandonadi ◽

...

Keyword(s):

Food Insecurity ◽

Low Income ◽

Household Income ◽

Geographic Location ◽

Cross Sectional Study ◽

Food Handlers ◽

Cross Sectional ◽

High Prevalence ◽

Per Capita ◽

Different Levels

This study aims to evaluate food insecurity (FI) among Brazilian Community restaurant food handlers and its associated factors. This cross-sectional study was performed with a representative sample of 471 food handlers working in community restaurants (CR) from all Brazilian regions. Participants are mostly female (62.2%), ≤40 years old (67.7%), with a partner (52.0%), and with up to eight years of education (54.1%). Predictors of participants’ socioeconomic status and CR geographic location are associated with the household food insecurity categories (p < 0.05). The predictors of socioeconomic conditions are associated with mild and moderate/severe FI category. Workers with less education are twice as likely to belong to the category with the highest FI severity. Lower per capita household income increased the chances of belonging to the mild insecurity category by 86%. It more than doubled the chance to be in the category of moderate/severe insecurity. Predictors of health status, lifestyle, and work are not associated with any multinomial outcome categories. However, working in the South, Southeast, or Midwest regions of Brazilian decreased the chances of belonging to one of the FI categories, with significance only for the mild category. Variables that show an association for this population are per capita household income for the different levels of FI and the CR region for mild FI. A high prevalence of FI in this population points to the need for more studies with low-income workers to prevent FI and its health consequences.

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Sex Differences in the Association between Household Income and Children’s Executive Function

Sexes ◽

10.3390/sexes1010002 ◽

2020 ◽

Vol 1 (1) ◽

pp. 19-31

Author(s):

Shervin Assari ◽

Shanika Boyce ◽

Mohsen Bazargan ◽

Cleopatra Howard Caldwell

Keyword(s):

Sex Differences ◽

Executive Function ◽

Low Income ◽

Household Income ◽

Cross Sectional Study ◽

Stop Signal Task ◽

Cross Sectional ◽

American Children ◽

Using Data ◽

High Household Income

The study aimed to investigate sex differences in the boosting effects of household income on children’s executive function in the US. This is a cross-sectional study using data from Wave 1 of the Adolescent Brain Cognitive Development (ABCD) study. Wave 1 ABCD included 8608 American children between ages 9 and 10 years old. The independent variable was household income. The primary outcome was executive function measured by the stop-signal task. Overall, high household income was associated with higher levels of executive function in the children. Sex showed a statistically significant interaction with household income on children’s executive function, indicating a stronger effect of high household income for female compared to male children. Household income is a more salient determinant of executive function for female compared to male American children. Low-income female children remain at the highest risk regarding poor executive function.

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Sex Differences in the Association of Household Income with Amygdala Volume

Caspian Journal of Neurological Sciences ◽

10.32598/cjns.6.23.2 ◽

2020 ◽

Vol 6 (4) ◽

pp. 233-243

Author(s):

Shervin Assari ◽

Keyword(s):

Sex Differences ◽

Low Income ◽

Household Income ◽

Brain Magnetic Resonance Imaging ◽

Brain Regions ◽

Cross Sectional Study ◽

Study Data ◽

Cross Sectional ◽

Amygdala Volume ◽

American Children

Background: Household income and other socioeconomic position (SEP) indicators are among the most salient social determinants of children’s emotions and behaviors. Some research has shown that income and other SEP indicators may have certain sex-specific effects on the structures and functions of particular brain regions. Objectives: To investigate sex differences in the association of household income with amygdala volumes in US children. Materials & Methods: This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) study. The study data was collected between 2016 and 2018 across 21 sites distributed across US states. Wave 1 ABCD included 10262 American children aged between 9 and 10 years old. The independent variable was household income. The primary outcome was the left amygdala volume, which was measured by T1-weighted structural brain Magnetic Resonance Imaging (MRI). We used a data exploration and analysis portal for our data analysis. Results: Overall, the household income was positively associated with left amygdala size in children. Sex showed a statistically significant interaction with household income on children’s left amygdala volume, net of all confounders, indicating a stronger effect of high household income on male children compared to female children. Conclusion: Household income is a more salient determinant of left amygdala volume for male children compared to female American children. Low-income male children remain at the highest risk of a small amygdala.

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Association Between Usage of an App to Redeem Prescribed Food Benefits and Redemption Behaviors Among the Special Supplemental Nutrition Program for Women, Infants, and Children Participants: Cross-Sectional Study

JMIR mhealth and uhealth ◽

10.2196/20720 ◽

2020 ◽

Vol 8 (10) ◽

pp. e20720 ◽

Cited By ~ 1

Author(s):

Qi Zhang ◽

Junzhou Zhang ◽

Kayoung Park ◽

Chuanyi Tang

Keyword(s):

Infant Formula ◽

Low Income ◽

The United States ◽

Cross Sectional Study ◽

Infants And Children ◽

Supplemental Nutrition ◽

Nutrition Program ◽

Cross Sectional ◽

Supplemental Nutrition Program ◽

The Difference

Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the most important food assistance programs in the United States, serving 6.4 million low-income, eligible women, infants, and children under 5 years of age in 2019. In the program, participants are prescribed a list of food benefits, which can be redeemed in WIC-authorized stores. However, there are multiple behavioral barriers in the program and the stores that prevent participants from redeeming the benefits fully. Objective This study aims to examine the relationship between the use of a widely used mobile phone app, WICShopper, and the redemption of the prescribed food packages. Methods WIC administrative data were obtained from West Virginia for the period January 2019 to January 2020 and included 30,440 WIC households that had received food benefits in that period. The redemption rates of 18 WIC food benefits were compared between app users and nonapp users, that is, those who never used the app in the study period. The use behaviors were defined for the app users, including the number of active use benefit cycles, active benefit cycle rates, number of active use days in the cycle, and proportion rates of daytime use. Panel linear regressions were applied to examine how the redemption rates were related to these behaviors over time. Results App users consistently had higher average redemption rates than nonapp users; the difference ranged from 3.6% (4.8% relative) for infant formula to 14.3% (40.7% relative) for fish. After controlling for sociodemographics, the coefficients of app use were significantly positive for all benefit categories except for WIC-eligible nutritionals. More active cycles and active days in the cycle were significantly related to redemption rates for all categories, except for frozen juice (coefficient=−0.002, P=.09). Daytime app access was positively associated with redemption rates for most food benefits except only a few, such as infant formula (coefficient=−0.03, P<.001). Conclusions Use of the WIC app was significantly related to higher redemption rates across food benefits, although the association varied across benefit categories. More active days were positively related to benefit redemptions across food categories, and the app’s daytime use was positively associated with the redemption of most benefit categories. These findings suggest that the WIC app can be an important tool for the promotion of benefit redemption among WIC participants.

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Addressing Opioid-Related Chemical Coping in Long-Term Opioid Therapy for Chronic Noncancer Pain: A Multicenter, Observational, Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm7100354 ◽

2018 ◽

Vol 7 (10) ◽

pp. 354 ◽

Cited By ~ 7

Author(s):

Anyela Castañeda ◽

Chang-Soon Lee ◽

Yong-Chul Kim ◽

Dasom Lee ◽

Jee Moon

Keyword(s):

United States ◽

The United States ◽

Opioid Therapy ◽

Cross Sectional Study ◽

Opioid Consumption ◽

Sectional Study ◽

Cross Sectional ◽

Chronic Noncancer Pain ◽

Noncancer Pain

Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, observational, cross-sectional study to address OrCC in long-term opioid therapy (LtOT) for CNCP in South Korea. The objectives were to determine the frequency and predictors of OrCC. We included 258 patients. Among them, fifty-five (21%) patients showed OrCC. The sample had high pain catastrophizing (≥30 points; 66%), moderate-severe insomnia (≥15 points; 63%), low resilience (68 points), and high suicidal ideation (67%). OrCC patients had greater pain interference (85.18% vs. 58.28%, p = 0.017) and lower satisfaction with the LtOT (56.4% vs. 78.3%, p = 0.002). In multivariable analysis, alcohol abuse (OR = 6.84, p = 0.001), prescription drugs abuse (OR = 19.32, p = 0.016), functional pain (OR = 12.96, p < 0.001), head and neck pain (OR = 2.48, p = 0.039), MEDD (morphine equivalent daily dose) ≥ 200 mg/day (OR = 3.48, p = 0.006), and ongoing litigation (OR = 2.33, p = 0.047) were significant predictors of OrCC. In conclusion, the break-out of OrCC in CNCP in South Korea was comparable to those in countries with high opioid consumption, such as the United States, regardless of the country’s opioid consumption rate.

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