Impact of Socioeconomic Status on Return to Work after Acute Ankle Fracture

Category: Ankle; Trauma Introduction/Purpose: Socioeconomic status has been recognized throughout the medical literature, both within orthopedics and beyond, as a factor that influences outcomes after surgery, and can result in substandard care. Within the foot and ankle subspecialty, there is limited data regarding socioeconomic status and post-operative outcomes, with the current literature focusing on outcomes for diabetic feet. However, ankle fractures are among the most common fractures encountered by orthopedic surgeons. While a few studies have explored the impact of ankle fractures on employment and disability status, the effect of socioeconomic status on return to work post operatively has not yet been investigated. The purpose of this study was to determine the impact of low socioeconomic status on return to work. Methods: We retrospectively reviewed 592 medical charts of patients with CPT code 27766, 27792, 27814, 27822, 27823, 27827, 27829, 27826, 27828 from 2015-2018. Included were patients >18 yrs of age who sustained an acute ankle fracture, were employed prior to the injury, and with information on return to work after ankle surgery, zip code, race, ethnicity and insurance status. Excluded were patients who were not employed prior to their injury. Socioeconomic status was either defined by insurance status - Medicaid/Medicare, commercial, or workman’s compensation -, or by assessing socioeconomic status (SES) using medial household per capita income by zip code as generated and reported by the US National Census Bureau’s 2013-2017 American Community Survey 5-Year Estimates. The national dataset was divided into quartiles with the lowest quartile defined as low SES. Patients who had income that fell within this income category were classified as low SES. Results: 174 patients were included with an average follow-up of 10.2months. 22/174 (12.6%) patients didn’t return to work post-operatively. Univariate analysis identified non-sedentary work to decrease the likelihood of return to work (HR:0.637; p=0.03). Patients with a low SES were more prevalent in the no return group compared to the return to work group (86% vs 60%; p=0.028). 95% of patients with low SES were a minority compared to 56% with average/high SES (p<0.005). Patients with low SES had a higher BMI (p=0.026), a longer hospitalization (p=0.04) and more wound complications (p=0.032). Insurance type didn’t affect return to work (p=0.158). Patients with workman’s compensation had a longer follow-up time and a longer time to return to work compared to other insurances (p<0.005 for each comparison). Conclusion: Low socioeconomic status based on income, not insurance type, affected return to work after an ankle fracture ORIF. Patients with workman’s compensation took a longer time to return to work compared to other insurance types. These findings warrants the need to consider socioeconomic status when allocating resources to treat these patients.

Download Full-text

Increased Healthcare Utilization by Patients With Inflammatory Bowel Disease Covered by Medicaid at a Tertiary Care Center

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz060 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1711-1717 ◽

Cited By ~ 2

Author(s):

Jordan E Axelrad ◽

Rajani Sharma ◽

Monika Laszkowska ◽

Christopher Packey ◽

Richard Rosenberg ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Bowel Disease ◽

Insurance Status ◽

Low Socioeconomic ◽

Inpatient Hospitalizations ◽

Inflammatory Bowel ◽

Ed Visits ◽

The Impact

Abstract Background Low socioeconomic status has been linked with numerous poor health outcomes, but data are limited regarding the impact of insurance status on inflammatory bowel disease (IBD) outcomes. We aimed to characterize utilization of healthcare resources by IBD patients based on health insurance status, using Medicaid enrollment as a proxy for low socioeconomic status. Methods We retrospectively identified adult patients with IBD engaged in a colorectal cancer surveillance colonoscopy program from July 2007 to June 2017. Our primary outcomes included emergency department (ED) visits, inpatient hospitalizations, biologic infusions, and steroid exposure, stratified by insurance status. We compared patients who had ever been enrolled in Medicaid with all other patients. Results Of 947 patients with IBD, 221 (23%) had been enrolled in Medicaid. Compared with patients with other insurance types, patients with Medicaid had higher rates of ever being admitted to the hospital (77.6% vs 42.6%, P < 0.0001) or visiting the ED (90.5% vs 38.4%, P < 0.0001). When adjusted for sex, age at first colonoscopy, and ethnicity, patients with Medicaid had a higher rate of inpatient hospitalizations (Rate ratio [RR] 2.95; 95% CI 2.59–3.36) and ED visits (RR 4.24; 95% CI 3.82–4.70) compared to patients with other insurance. Patients with Medicaid had significantly higher prevalence of requiring steroids (62.4% vs 37.7%, P < 0.0001), and after adjusting for the same factors, the odds of requiring steroids in the patients with Medicaid was increased (OR 3.77; 95% CI 2.53–5.62). Conclusions Medicaid insurance was a significant predictor of IBD care and outcomes. Patients with Medicaid may have less engagement in IBD care and seek emergency care more often.

Download Full-text

Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study

JMIR Formative Research ◽

10.2196/13854 ◽

2019 ◽

Vol 3 (4) ◽

pp. e13854 ◽

Cited By ~ 3

Author(s):

Mélina Côté ◽

Annie Lapointe ◽

Catherine Laramée ◽

Simone Lemieux ◽

Sophie Desroches ◽

...

Keyword(s):

Socioeconomic Status ◽

Prospective Study ◽

Focus Groups ◽

Low Socioeconomic Status ◽

Quebec City ◽

Low Ses ◽

Community Centers ◽

Web Based ◽

Low Socioeconomic ◽

The Impact

Background NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. Objective This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. Methods A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants’ beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. Results Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. Conclusions These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet.

Download Full-text

Associations of rural residence and low socioeconomic status on the risk of new onset cardiovascular disease (CVD) in cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.90 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 90-90

Author(s):

Atul Batra ◽

Shiying Kong ◽

Rodrigo Rigo ◽

Winson Y. Cheung

Keyword(s):

Socioeconomic Status ◽

Educational Attainment ◽

Cancer Patients ◽

Low Socioeconomic Status ◽

Low Income ◽

Low Ses ◽

Rural Residence ◽

Low Socioeconomic ◽

Low Education

90 Background: Cancer patients are predisposed to CVD due to cancer treatments and shared risk factors (smoking/physical inactivity). We aimed to assess if rural residence and low socioeconomic status (SES) modify the risk of developing CVD. Methods: Patients diagnosed with non-metastatic solid organ cancers without baseline CVD in a large Canadian province from 2004 to 2017 were identified using the population-based registry. Postal codes were linked with Census data to determine rural residence as well as neighborhood-level income and educational attainment. Low income was defined as <46000 CAD/annum; low education was defined as a neighborhood in which <80% attended high school. Myocardial infarction, congestive heart failure, arrythmias and cerebrovascular accident constituted as CVD.We performed logistic regression analyses to examine the associations of rural residence and low SES with the development of CVD, adjusting for measured confounding variables. Results: We identified 81,275 patients diagnosed with cancer without pre-existing CVD. The median age was 62 years and 54.2% were women. The most prevalent cancer types included breast (28.6%), prostate (23.1%), and colorectal (14.9%). At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD was 29 months. Rural patients (32.3 vs 28.4%,P < .001) and those with low income (30.4% vs 25.9%,P < .001) or low educational attainment (30.7% vs 27.6%,P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio[OR], 1.07; 95% confidence interval[CI], 1.04-1.11;P < .001), low income (OR,1.17;95%CI,1.12-1.21;P < .001) and low education (OR,1.08;95%CI,1.04-1.11;P < .001) continued to associate with higher odds of CVD. Further, patients with colorectal cancer were more likely to develop CVD compared with other tumors (OR,1.12;95% CI,1.04-1.16;P = .001). A multivariate Cox regression model showed that patients with low SES were more likely to die, but patients residing rurally were not. Conclusions: Approximately one-third of cancer survivors develop CVD on follow-up. Despite universal healthcare, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs. [Table: see text]

Download Full-text

Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study (Preprint)

10.2196/preprints.13854 ◽

2019 ◽

Author(s):

Mélina Côté ◽

Annie Lapointe ◽

Catherine Laramée ◽

Simone Lemieux ◽

Sophie Desroches ◽

...

Keyword(s):

Socioeconomic Status ◽

Prospective Study ◽

Focus Groups ◽

Low Socioeconomic Status ◽

Quebec City ◽

Low Ses ◽

Community Centers ◽

Web Based ◽

Low Socioeconomic ◽

The Impact

BACKGROUND NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. OBJECTIVE This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. METHODS A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants’ beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. RESULTS Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. CONCLUSIONS These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet.

Download Full-text

Intertemporal impulsivity can also arise from persistent failure of long-term plans

Behavioral and Brain Sciences ◽

10.1017/s0140525x17001133 ◽

2017 ◽

Vol 40 ◽

Author(s):

Nisheeth Srivastava ◽

Narayanan Srinivasan

Keyword(s):

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Social Utility ◽

Low Ses ◽

Low Socioeconomic ◽

Planning And Control ◽

Intertemporal Discounting ◽

And Control ◽

Control Failures

AbstractWe suggest that steep intertemporal discounting in individuals of low socioeconomic status (SES) may arise as a rational metacognitive adaptation to experiencing planning and control failures in long-term plans. Low SES individuals' plans fail more frequently because they operate close to budgetary boundaries, in turn because they consistently operate with limited budgets of money, status, trust, or other forms of social utility.

Download Full-text

COVID-19 infections in day care centres in Germany: social and organisational determinants of infections in children and staff in the second and third wave of the pandemic

BMC Public Health ◽

10.1186/s12889-021-12470-5 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Franz Neuberger ◽

Mariana Grgic ◽

Svenja Diefenbacher ◽

Florian Spensberger ◽

Ann-Sophie Lehfeld ◽

...

Keyword(s):

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Online Survey ◽

Random Effect ◽

Low Ses ◽

Third Wave ◽

Low Socioeconomic ◽

Long Run ◽

Hygiene Measures ◽

Education And Care

Abstract Background During the SARS-CoV-2 pandemic, German early childhood education and care (ECEC) centres organised children’s attendance in different ways, they reduced opening hours, provided emergency support for a few children, or closed completely. Further, protection and hygiene measures like fixed children-staff groups, ventilation and surface disinfection were introduced in ECEC centres. To inform or modify public health measures in ECEC, we investigate the occurrence of SARS-CoV-2 infections among children and staff in ECEC centres in light of social determinants (i.e. the socioeconomic status of the children) and recommended structural and hygiene measures. We focus on the question if the relevant factors differ between the 2nd (when no variant of concern (VOC) circulated) and the 3rd wave (when VOC B.1.1.7 (Alpha) predominated). Methods Based on panel data from a weekly online survey of ECEC centre managers (calendar week 36/2020 to 22/2021, ongoing) including approx. 8500 centres, we estimate the number of SARS-CoV-2 infections in children and staff using random-effect-within-between (REWB) panel models for count data in the 2nd and 3rd wave. Results ECEC centres with a high proportion of children with low socioeconomic status (SES) have a higher risk of infections in staff and children. Strict contact restrictions between groups like fixed group assignments for children and fixed staff assignments to groups prevent infections. Both effects tend to be stronger in the 3rd wave. Conclusion ECEC centres with a large proportion of children with a low SES background and lack of using fixed child/staff cohorts experience higher COVID-19 rates. Over the long run, centres should be supported in maintaining recommended measures. Preventive measures such as the vaccination of staff should be prioritised in centres with large proportions of low SES children.

Download Full-text

Early-Life Adversities and Recalcitrant Smoking in Midlife: An Examination of Gender and Life-Course Pathways

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa023 ◽

2020 ◽

Vol 54 (11) ◽

pp. 867-879

Author(s):

Chioun Lee ◽

Lexi Harari ◽

Soojin Park

Keyword(s):

Life Course ◽

Low Socioeconomic Status ◽

Early Life ◽

Financial Strain ◽

Low Ses ◽

Family Instability ◽

Family Problems ◽

Low Socioeconomic ◽

Logistic Regression Models

Abstract Background Little is known about life-course factors that explain why some individuals continue smoking despite having smoking-related diseases. Purpose We examined (a) the extent to which early-life adversities are associated with the risk of recalcitrant smoking, (b) psychosocial factors that mediate the association, and (c) gender differences in the associations. Methods Data were from 4,932 respondents (53% women) who participated in the first and follow-up waves of the Midlife Development in the U.S. National Survey. Early-life adversities include low socioeconomic status (SES), abuse, and family instability. Potential mediators include education, financial strain, purpose in life, mood disorder, family problems/support, and marital status. We used sequential logistic regression models to estimate the effect of early-life adversities on the risk of each of the three stages on the path to recalcitrant smoking (ever-smoking, smoking-related illness, and recalcitrant smoking). Results For women, low SES (odds ratio [OR] = 1.29; 1.06–1.55) and family instability (OR = 1.73; 1.14–2.62) are associated with an elevated risk of recalcitrant smoking. Education significantly reduces the effect of childhood SES, yet the effect of family instability remains significant even after accounting for life-course mediators. For men, the effect of low SES on recalcitrant smoking is robust (OR = 1.48; 1.10–2.00) even after controlling for potential mediators. There are noteworthy life-course factors that independently affect recalcitrant smoking: for both genders, not living with a partner; for women, education; and for men, family problems. Conclusions The findings can help shape intervention programs that address the underlying factors of recalcitrant smoking.

Download Full-text

Less human, more to blame: Animalizing poor people increases blame and decreases support for wealth redistribution

Group Processes & Intergroup Relations ◽

10.1177/1368430219841135 ◽

2019 ◽

Vol 23 (4) ◽

pp. 546-559 ◽

Cited By ~ 2

Author(s):

Mario Sainz ◽

Rocío Martínez ◽

Robbie M. Sutton ◽

Rosa Rodríguez-Bailón ◽

Miguel Moya

Keyword(s):

Socioeconomic Status ◽

Human Nature ◽

Low Socioeconomic Status ◽

Poor People ◽

Low Ses ◽

Negative Attitudes ◽

Low Socioeconomic ◽

Mediation Analyses ◽

Wealth Redistribution ◽

Human Uniqueness

Increasing economic inequality adversely affects groups with low socioeconomic status (low-SES). However, many people are opposed to wealth redistribution policies. In this context, we examined whether dehumanization of low-SES groups has a role in this opposition. In the first study ( N = 303), opposition to wealth redistribution was related to denying human uniqueness (e.g., intelligence and rationality) and having negative attitudes toward low-SES groups, more than denying human nature (e.g., emotionality and capacity to suffer) to low-SES groups. Mediation analyses indicated that this effect occurred via blaming low-SES groups for their plight, after controlling for participants’ SES and negative attitudes towards low-SES groups. In the second study ( N = 220), manipulating the human uniqueness of a fictitious low-SES group affected support for wealth redistribution measures through blame. These results indicate that animalizing low-SES groups reduces support for wealth redistribution via blaming low-SES groups for their situation.

Download Full-text

An Insight Into the Involvement of Mothers of Low Socioeconomic Status in Scottish Primary School Health Education Activities

Health Education & Behavior ◽

10.1177/1090198119871329 ◽

2019 ◽

Vol 47 (1) ◽

pp. 111-122

Author(s):

Samantha Donnelly ◽

Duncan S. Buchan ◽

Ann-Marie Gibson ◽

Gillian Mclellan ◽

Rosie Arthur

Keyword(s):

Socioeconomic Status ◽

Low Socioeconomic Status ◽

School Health ◽

Family Care ◽

Well Being ◽

Low Ses ◽

Low Socioeconomic ◽

School Based ◽

School Health Education ◽

Parent Component

School-based health activities that involve parents are more likely to be effective for child health and well-being than activities without a parent component. However, such school-based interventions tend to recruit the most motivated parents, and limited evidence exists surrounding the involvement of hard-to-reach parents with low socioeconomic status (SES). Mothers remain responsible for the majority of family care; therefore, this study investigated mothers with low SES to establish the reasons and barriers to their involvement in school-based health activities and to propose strategies to increase their involvement in those activities. Interviews were conducted with mothers with low SES, who were typically not involved in school-based health activities ( n = 16). An inductive–deductive approach to hierarchical analysis revealed that there are several barriers resulting in mothers being less involved, particularly due to issues surrounding the schools’ Parent Councils and the exclusivity of school-based events. Efforts made by the school to promote health activities and involve parents in such activities were revealed, alongside recommendations to improve on these practices. The findings offer multiple ways in which future school-based health interventions can recruit and involve mothers with low SES.

Download Full-text

Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India

Clinical Medicine Insights Cardiology ◽

10.1177/1179546820918897 ◽

2020 ◽

Vol 14 ◽

pp. 117954682091889 ◽

Cited By ~ 1

Author(s):

Navdeep Singh Sidhu ◽

Sunil Kumar Kondethimmannahally Rangaiah ◽

Dwarikaprasad Ramesh ◽

Kumaraswamy Veerappa ◽

Cholenahally Nanjappa Manjunath

Keyword(s):

Socioeconomic Status ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Low Socioeconomic Status ◽

Management Strategies ◽

Low Ses ◽

Hospital Outcomes ◽

Low Socioeconomic ◽

Coronary Syndrome ◽

St Elevation

Background: Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India. Objectives: This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population. Methods: We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied. Results: Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%). Conclusions: With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.

Download Full-text