scholarly journals Examining the association of social risk with heart failure readmission in the Veterans Health Administration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie M. Wray ◽  
Marzieh Vali ◽  
Louise C. Walter ◽  
Lee Christensen ◽  
Wendy Chapman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Support ◽  
Substance Abuse ◽  
Low Income ◽  
Model Performance ◽  
Social Risk ◽  
Veterans Health ◽  
Social Risk Factors ◽  
Increased Risk ◽  
The Impact

Abstract Background Previous research has found that social risk factors are associated with an increased risk of 30-day readmission. We aimed to assess the association of 5 social risk factors (living alone, lack of social support, marginal housing, substance abuse, and low income) with 30-day Heart Failure (HF) hospital readmissions within the Veterans Health Affairs (VA) and the impact of their inclusion on hospital readmission model performance. Methods We performed a retrospective cohort study using chart review and VA and Centers for Medicare and Medicaid Services (CMS) administrative data from a random sample of 1,500 elderly (≥ 65 years) Veterans hospitalized for HF in 2012. Using logistic regression, we examined whether any of the social risk factors were associated with 30-day readmission after adjusting for age alone and clinical variables used by CMS in its 30-day risk stratified readmission model. The impact of these five social risk factors on readmission model performance was assessed by comparing c-statistics, likelihood ratio tests, and the Hosmer-Lemeshow goodness-of-fit statistic. Results The prevalence varied among the 5 risk factors; low income (47 % vs. 47 %), lives alone (18 % vs. 19 %), substance abuse (14 % vs. 16 %), lacks social support (2 % vs. <1 %), and marginal housing (< 1 % vs. 3 %) among readmitted and non-readmitted patients, respectively. Controlling for clinical factors contained in CMS readmission models, a lack of social support was found to be associated with an increased risk of 30-day readmission (OR 4.8, 95 %CI 1.35–17.88), while marginal housing was noted to decrease readmission risk (OR 0.21, 95 %CI 0.03–0.87). Living alone (OR: 0.9, 95 %CI 0.64–1.26), substance abuse (OR 0.91, 95 %CI 0.67–1.22), and having low income (OR 1.01, 95 %CI 0.77–1.31) had no association with HF readmissions. Adding the five social risk factors to a CMS-based model (age and comorbid conditions; c-statistic 0.62) did not improve model performance (c-statistic: 0.62). Conclusions While a lack of social support was associated with 30-day readmission in the VA, its prevalence was low. Moreover, the inclusion of some social risk factors did not improve readmission model performance. In an integrated healthcare system like the VA, social risk factors may have a limited effect on 30-day readmission outcomes.

scholarly journals The phenomenon of social risk families and its dynamics in Lithuania

2018 ◽  
Vol 51 ◽  
pp. 03001
Author(s):  
Vide Gudzinskiene ◽  
Rimvydas Augutavicius
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Physical Environment ◽  
Social Risk ◽  
Public Concern ◽  
Social Risk Factors ◽  
Scientific Problem ◽  
Number Of Children ◽  
Social And Physical Environment ◽  
The Impact

Families at risk are definitely the urgent public concern that requires immediate solutions in Lithuania. It is important to mention that the children growing within the families at risk are in the centre of concern as their social and physical environment is not stimulating enough, leading to a number of different problems the families and children themselves are facing. In general, the number of such children makes about 4 percent of the total number of children in the country and this rate has remained stable for many years. Scientific problem – the problems experienced by children growing within social risk families and the impact of social risk factors on children's socialization and integration. Object – phenomenon of families at risk in Lithuania. Task of the article – to analyze the phenomenon of social risk families and its trends in Lithuania.

scholarly journals Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

2019 ◽  
Vol 6 (1) ◽  
pp. e000468
Author(s):  
Poppy Evenden ◽  
Anita Roche ◽  
Basel Karo ◽  
Sooria Balasegaram ◽  
Charlotte S Anderson
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
P Value ◽  
Social Risk ◽  
Social Risk Factors ◽  
Asian Ethnicity ◽  
The Third ◽  
Female Sex ◽  
The Impact ◽  
Healthcare Visit

BackgroundA quarter of London’s pulmonary tuberculosis (TB) patients have over 4 months of delay. Late diagnosis increases disease severity and the risk of transmission. We aim to classify delays, identify associated risk factors and assess treatment outcome.MethodsWe conducted a retrospective cohort study using London surveillance data, 2012–2018 on adults aged ≥18 years with pulmonary TB. We defined presentation delay (days from symptom onset to first healthcare visit) and healthcare delay (first healthcare visit to treatment commencement) as dichotomous variables; positive delay being days equal or greater than the third quartile. We applied logistic regression models to identify risk factors associated with delays and treatment outcome at 12 months.ResultsOf 7216 people, 4539 reported presentation and 5193 healthcare delays. The third quartiles for presentation and healthcare delay were 84 and 61 days, respectively. Presentation delay was associated with female sex (adjusted OR (aOR)=1.21; 95% CI 1.04 to 1.39), increasing age (aOR=1.004; 95% CI 1.001 to 1.008), white compared to Asian ethnicity (aOR=1.35; 95% CI 1.12 to 1.62), previous imprisonment (aOR=1.66; 95% CI 1.22 to 2.26) and alcohol misuse (aOR=1.44; 95% CI 1.04 to 1.89). Healthcare delay was associated with female sex (aOR=1.39; 95% CI 1.21 to 1.59), increasing age (aOR=1.014; 95% CI 1.009 to 1.018) and white ethnicity (aOR=1.41; 95% CI 1.19 to 1.68). 16% of 5678 people with known outcome did not complete treatment. Neither delay was associated with non-completion (p value <0.05).ConclusionsFemale, white and older people with TB were more likely to experience both presentation and healthcare delays. Social risk factors were also associated with delay in presentation. Early diagnosis and treatment remain critical to reduce transmission, regardless of whether delay affected completion.

scholarly journals REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S562-S563
Author(s):  
Amit Kumar ◽  
Elham Mahmoudi ◽  
Maricruz Rivera-Hernandez
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Puerto Rico ◽  
Mortality Rates ◽  
Minority Populations ◽  
Social Risk ◽  
Social Risk Factors ◽  
Physician Visits ◽  
The Us ◽  
The Impact

Abstract The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.

scholarly journals Epidemiology of lymphatic filariasis in Nilphamari district, Bangladesh

2016 ◽  
Vol 25 (2) ◽  
pp. 103-111
Author(s):  
Md Khalid Eakbal Anik ◽  
Hamida Khanum ◽  
Iftekhar Ahmed Rizvi ◽  
Shahela Alam ◽  
Hasina Banu
Keyword(s):  
Risk Factors ◽  
Lymphatic Filariasis ◽  
Low Income ◽  
Endemic Area ◽  
Income Group ◽  
Hospitalized Patients ◽  
Current Status ◽  
Social Risk ◽  
Age Group ◽  
Social Risk Factors

The present study was carried out in Filaria Hospital of Nilphamari to find out the current status of lymphatic filariasis (LF) in Nilphamari district: An endemic area for lymphatic filariasis in Bangladesh. The inhabitants of the villages, the outdoor patients and hospitalized patients in Filaria Hospital were selected for the study. The current status and the prevalence of filariasis in Nilphamari district was 4.43%, in Nilphamari Sadar was 3.25% and 4.10% in Sayedpur, 4.82% in Domar, 5.86% in Dimla, 3.85% in Joldhaka and 4.70% in Kishoreganj. It was found that 58.84% filarial patients were male and 41.16% were female; highest prevalence of the disease was observed at the age group of 41 - 60 years. Illiteracy and poverty are the important social risk factors of this disease , about 45% patients were illiterate. Most of the infected patients were very poor and belong to low income group. Only 40.5% patients knew about filariasis. Only 26.1% patients used mosquito curtains. During the study period, it was found that 66.15% of hospitalized filarial patients were male and 33.85% were female, in the Filaria Hospital of Nilphamari. The highest outdoor patients in Nilphamari Hospital were of age group 40 - 59 years and 76.22% patients had hydrocele. Dhaka Univ. J. Biol. Sci. 25(2): 103-111, 2016 (July)

scholarly journals Complex Assessment of Medical and Social Risk Factors and Their Effect on the Health Condition of Children Working at Industrial Waste Landfills

2019 ◽  
Vol 5 (4) ◽  
pp. 137-143
Author(s):  
N. Kudaibergenov
Keyword(s):  
Risk Factors ◽  
Industrial Waste ◽  
Health Condition ◽  
Working Environment ◽  
Control Group ◽  
External Respiration ◽  
Social Risk ◽  
Social Risk Factors ◽  
Statistical Research ◽  
The Impact

The comprehensive assessment of medical and social risk factors and their impact on the health of children working at industrial waste landfills of the Kyrgyz Chemical Metallurgical Plant has presented. Various industrial and environmental factors were covered. To identify signs of environmental pollution by radioactive substances of natural and artificial origin the average values of gamma-radiation power levels have been examined. The hygienic, sociological, medical and statistical research methods are used. During the study, the social-hygienic and living conditions of life and work of children were studied. The selection of respondents conducted by random sampling. The health condition of children living in the region but not working at industrial waste landfills has studied to compare the data of a control group. An assessment of the physical and biological development of children in the experimental and control groups was carried out by measuring somatometric indicators (length and body weight, head circumference), as well as indicators of dynamometry and their external respiration function. The intensive morbidity rates of children have been studied. The article analyzes the impact of medical and social risk factors that adversely affect the health conditions of working children. It describes the various factors of the working environment and the labor process, which form the occupational risk of morbidity. An important part of the study was to assess the situation and identify possible causes that force families to involve children to work at industrial waste landfills.

scholarly journals Social Risk Factors for Medication Nonadherence: Findings from the CARDIA Study

2020 ◽  
Vol 44 (2) ◽  
pp. 232-243 ◽  
Author(s):  
Gabriela R. Oates ◽  
Lucia D. Juarez ◽  
Barbara Hansen ◽  
Catarina I. Kiefe ◽  
James M. Shikany
Keyword(s):  
Risk Factors ◽  
Chronic Stress ◽  
Low Income ◽  
Population Based ◽  
Financial Strain ◽  
Social Risk ◽  
Social Risk Factors ◽  
Medication Nonadherence ◽  
Annual Household Income ◽  
Cross Sectional

Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72–6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.

scholarly journals Social isolation and loneliness as risk factors for hospital admissions for respiratory disease among older adults

Thorax ◽  
2020 ◽  
Vol 75 (7) ◽  
pp. 597-599 ◽  
Author(s):  
Feifei Bu ◽  
Keir Philip ◽  
Daisy Fancourt
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Respiratory Disease ◽  
Hospital Admissions ◽  
Social Contact ◽  
Living Alone ◽  
Social Risk ◽  
Social Risk Factors ◽  
Increased Risk

Rising hospital admissions due to respiratory disease (RD) are a major challenge to hospitals. This study explored modifiable social risk factors among 4478 older adults from the English Longitudinal Study of Ageing. Data were linked with administrative hospital records and mortality registry data (follow-up 9.6 years) and analysed using survival analysis accounting for competing risks. Living alone and social disengagement but not social contact or loneliness were associated with an increased risk of RD admissions, independent of socio-demographic, health and behaviour factors. Providing support for disengaged adults living alone who are at risk of RD admissions should be explored.

scholarly journals Sporadic and recurrent non-suicidal self-injury before age 14 and incident onset of psychiatric disorders by 17 years: prospective cohort study

2018 ◽  
Vol 212 (4) ◽  
pp. 222-226 ◽  
Author(s):  
Paul O. Wilkinson ◽  
Tianyou Qiu ◽  
Sharon Neufeld ◽  
Peter B. Jones ◽  
Ian M. Goodyer
Keyword(s):  
Risk Factors ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Social Risk ◽  
Social Risk Factors ◽  
Vulnerable Group ◽  
Self Injury ◽  
Increased Risk ◽  
History Of ◽  
New Onset

BackgroundNon-suicidal self-injury (NSSI) is highly prevalent in adolescents and may be a behavioural marker for emergent mental illnesses.AimsTo determine whether sporadic or recurrent NSSI up to the age of 14 years predicted increased risk of new onset of psychiatric disorder in the subsequent 3 years, independent of psychiatric symptoms and social risk factors.MethodIn total, 945 individuals aged 14 years with no past/present history of mental illness completed a clinical interview and completed a questionnaire about NSSI at the ages of 14 and 17 years.ResultsRecurrent NSSI at baseline predicted total disorders, depression and eating disorders. Sporadic baseline NSSI predicted new onset of anxiety disorders only.ConclusionsNSSI (especially recurrent NSSI) in the early-adolescent years is a behavioural marker of newly emerging mental illnesses. Professionals should treat both recurrent and sporadic NSSI as important risk factors, and prevention strategies could be targeted at this vulnerable group.Declaration of interestNone.

scholarly journals Social Inequities in the Impact of COVID-19 Lockdown Measures on the Mental Health of a Large Sample of the Colombian Population (PSY-COVID Study)

2021 ◽  
Vol 10 (22) ◽  
pp. 5297
Author(s):  
Juan P. Sanabria-Mazo ◽  
Bernardo Useche-Aldana ◽  
Pedro P. Ochoa ◽  
Diego F. Rojas-Gualdrón ◽  
Corel Mateo-Canedo ◽  
...  
Keyword(s):  
Mental Health ◽  
General Population ◽  
Social Determinants ◽  
Low Income ◽  
Online Survey ◽  
Social Risk ◽  
Social Risk Factors ◽  
Cross Sectional ◽  
Large Sample ◽  
The Impact

The identification of general population groups particularly vulnerable to the impact of COVID-19 lockdown measures on mental health and the development of healthcare policies are priority challenges in the current and future pandemics. This study aimed to identify the personal and social determinants of the impact of COVID-19 lockdown measures on mental health in a large sample of the Colombian population. In this cross-sectional study, an anonymous online survey was answered by 18,061 participants from the general population residing in Colombia during the first wave of the COVID-19 outbreak (from 20 May to 20 June 2020). The risk of depression, anxiety, and somatization disorders were measured using the Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and Somatic Symptom Questionnaire (SSQ-5), respectively. Overall, 35% of participants showed risk of depression, 29% of anxiety, and 31% of somatization. According to the analysis of social determinants of health, the most affected groups were people with low incomes, students, and young adults (18–29 years). Specifically, low-income young females were the most at-risk population group. These findings show how the lockdown measures affected the general population’s mental health in Colombia and highlight some social risk factors in health.

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