scholarly journals Does low income effects 5-year mortality of hepatocellular carcinoma patients?

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dong Jun Kim ◽  
Ji Won Yoo ◽  
Jong Wha Chang ◽  
Takashi Yamashita ◽  
Eun-Cheol Park ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Low Income ◽  
Community Level ◽  
Middle Aged ◽  
Risk Of Death ◽  
Female Survival ◽  
The Individual ◽  
The Impact ◽  
Survival Proportion

Abstract Background In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality. Methods The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients. Results From 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients. Conclusion Having a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.

Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Catalina Malinowski ◽  
Xiudong Lei ◽  
Hui Zhao ◽  
Sharon H. Giordano ◽  
Mariana Chavez Mac Gregor
Keyword(s):  
Breast Cancer ◽  
Low Income ◽  
Stage Iv ◽  
Medicaid Expansion ◽  
Risk Of Death ◽  
Stage Iv Breast Cancer ◽  
Increased Risk ◽  
The Impact ◽  
Expansion Period ◽  
White Patients

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.

scholarly journals Pengaruh Faktor Demografi dan Sosial Ekonomi terhadap Status Kesehatan Individu di Indonesia

2021 ◽  
Vol 5 (2) ◽  
pp. 146-157
Author(s):  
Liani Surya Rakasiwi
Keyword(s):  
Socioeconomic Status ◽  
Health Status ◽  
Low Income ◽  
The Other ◽  
Individual Health ◽  
Indonesia Family Life Survey ◽  
Individual Health Status ◽  
The Individual ◽  
Logit Regression Model ◽  
The Impact

This study analyzed the impact of demography and socioeconomic status on individual health status in Indonesia. The data used Indonesia Family Life Survey 5 (IFLS 5). The study use logit regression model for analysis with health status variable as dependent variable. The other variable such as demography and socioeconomic status as independent variables. Socioeconomic status seen from two measures, namely education and income. The result of this study concludes the demography influence significantly on individual health status in Indonesia. Individual who lives in urban area has higher probability of being health by 1,02 percent compared to individual who lives in rural area. The other variable like socioeconomic status also influences significantly on the individual health status in Indonesia. Individual with longer years of education has higher probability of being health by 3,07 percent compared to individual with less years of education. Individual with high income has higher probability of being health compared to individual with low income.

scholarly journals The impact of forms of unemployment on the social conditions in the Palestinian society from the point of view of the Palestinian youth in the current period between 2015 – 2019: تأثير أشكال البطالة على الأوضاع الاجتماعية في المجتمع الفلسطيني من وجهة نظر الشباب الفلسطيني في الفترة الزمنية الحالية ما بين 2015 – 2019م

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Abdelmajid Nayif Alawneh
Keyword(s):  
Low Income ◽  
Point Of View ◽  
Social Conditions ◽  
The Social ◽  
The Family ◽  
Palestinian Society ◽  
Individual Family ◽  
The Future ◽  
The Individual ◽  
The Impact

    The research aims to study the impact of unemployment on the social conditions in the Palestinian society from the point of view of the unemployed youth, especially in the current time period (2019), the researcher used the descriptive analytical method, and the research community consists of young people in the governorate of Ramallah. The researcher used the questionnaire tool, and the data were analyzed by the analysis program (SPSS). It was found that the majority of youth are unemployed, they are middle age, single and large families, urban residents, people with specialties and low income. As for the results of the research, there was an increase in the impact of the forms of unemployment on the social conditions of the individual, family and society and their outlook towards the future, came the highest degree on the social conditions of the individual (6. 90%) and then the social conditions of the family (3. 83%), Followed by the societal conditions to reach the value (78%), came the lowest values ​​for the outlook for the future, which amounted to (67%). Some of the features of the impact of unemployment, including the tension, anxiety and frustration of the young group. As for the nature of the relationship between the variables of the study, there was a statistically significant relationship between the combined unemployment and the low income, between the apparent, persuasive and compulsory unemployment, and the individual, family and societal situations and the outlook for them. At the end of the research a number of recommendations were made, most notably the need to balance the types of education and activate the social and cultural role of the family.  

Examining the Impact of Individual, Community, and Market Factors on Methamphetamine Use: A Tale of Two Cities

2005 ◽  
Vol 35 (4) ◽  
pp. 665-693 ◽  
Author(s):  
Nancy Rodriguez ◽  
Charles Katz ◽  
Vincent J. Webb ◽  
David R. Schaefer
Keyword(s):  
Drug Market ◽  
Community Level ◽  
Policy Implications ◽  
Individual Level ◽  
Methamphetamine Use ◽  
Level Data ◽  
Two Cities ◽  
Market Factors ◽  
The Individual ◽  
The Impact

Although prior studies have monitored the trends in methamphetamine use and reported its increase over the years, few studies have considered how community-level characteristics affect the use of methamphetamine. In this study, we utilize data from the Arrestee Drug Abuse Monitoring (ADAM) program from two cities to examine how individual-level, community-level, and drug market factors influence methamphetamine use. Results indicate that both individual and community-level data significantly influence methamphetamine use. Also, findings show that predictors of methamphetamine use (at the individual and community-level) differ significantly from marijuana, cocaine, and opiate use. Policy implications regarding law enforcement suppression and the treatment of methamphetamine users are discussed.

Decision Risks and Individual Development Accounts: An Alternative View

2009 ◽  
pp. 142
Author(s):  
Edmund Khashadourian
Keyword(s):  
Low Income ◽  
Individual Development ◽  
Retention Rates ◽  
Alternative View ◽  
Risky Decision ◽  
Attrition Rates ◽  
Current Consumption ◽  
The Individual ◽  
The Impact ◽  
Low Income Households

This article analyzes the impact of risk on decisions made by the poor within the context of the Individual Development Account (IDA) program. IDA is a matched savings program designed to help low-income households invest in appreciating assets. For these households, the risk involved with participation in IDA relates to the sacrifice they make by reducing current consumption - sometimes in a significant way - in order to be able to save. The program does not offer a match on savings per se; rather, it offers the match only when savings are invested in certain assets. Since there is no guarantee that IDA savings will be converted into assets qualified for the IDA match at the time of enrollment, participation in the program is characterized as an inherently risky decision, which is governed by different sets of behavioral factors, including the risk-taking preferences of low-income households. Consideration of risk provides an alternative explanation for issues related to program take-up, inactivity, and attrition rates. It also offers new and simple ideas on how to improve results. In addressing these problems, the article recommends using an IDA model that includes a flexible match component, to insure against the risk of unmatched savings and complement the existing IDA match structure. Simple modifications to current policy will maintain the total cost of IDA match at the existing levels. Introduction of a flexible match may mitigate the risk of decision to participate in IDA for the most vulnerable group of participants. It can also potentially reduce the percentage of inactive accounts while improving the overall retention rates in the program. Moreover, the recommended changes would not alter the nature of the IDA program, as the flexible match would only amount to a fraction of the total asset investment match.

scholarly journals High Rates of Liver Cirrhosis and Hepatocellular Carcinoma in Chronic Hepatitis B Patients with Metabolic and Cardiovascular Comorbidities

2021 ◽  
Vol 9 (5) ◽  
pp. 968
Author(s):  
Jan-Hendrik Bockmann ◽  
Matin Kohsar ◽  
John M. Murray ◽  
Vanessa Hamed ◽  
Maura Dandri ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Disease Surveillance ◽  
Metabolic Diseases ◽  
Cardiovascular Comorbidities ◽  
The Impact

Background: The prevalence of metabolic and cardiovascular diseases is rising worldwide. However, little is known about the impact of such disorders on hepatic disease progression in chronic hepatitis B (CHB) during the era of potent nucleo(s)tide analogues (NAs). Methods: We retrospectively analyzed a single-center cohort of 602 CHB patients, comparing the frequency of liver cirrhosis at baseline and incidences of liver-related events during follow-up (hepatocellular carcinoma, liver transplantation and liver-related death) between CHB patients with a history of diabetes, obesity, hypertension or coronary heart disease (CHD). Results: Rates of cirrhosis at baseline and liver-related events during follow-up (median follow-up time: 2.51 years; NA-treated: 37%) were substantially higher in CHB patients with diabetes (11/23; 3/23), obesity (6/13; 2/13), CHD (7/11; 2/11) or hypertension (15/43; 4/43) compared to CHB patients without the indicated comorbidities (26/509; 6/509). Multivariate analysis identified diabetes as the most significant predictor for cirrhosis (p = 0.0105), while comorbidities did not correlate with liver-related events in pre-existing cirrhosis. Conclusion: The combination of metabolic diseases and CHB is associated with substantially increased rates of liver cirrhosis and secondary liver-related events compared to CHB alone, indicating that hepatitis B patients with metabolic comorbidities warrant particular attention in disease surveillance and evaluation of treatment indication.

scholarly journals Adaptive Subsets Limit the Anti-Tumoral NK-Cell Activity in Hepatocellular Carcinoma

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1369
Author(s):  
Charlotte Rennert ◽  
Catrin Tauber ◽  
Pia Fehrenbach ◽  
Kathrin Heim ◽  
Dominik Bettinger ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Nk Cells ◽  
Nk Cell ◽  
Cell Activity ◽  
Cell Subset ◽  
Cell Repertoire ◽  
Healthy Donors ◽  
B Virus ◽  
The Impact

Hepatocellular carcinoma (HCC) is a global health burden with increasing incidence, poor prognosis and limited therapeutic options. Natural killer (NK) cells exhibit potent anti-tumoral activity and therefore represent potential targets for immunotherapeutic approaches in HCC treatment. However, the anti-tumoral activity of NK cells in HCC associated with different etiologies, and the impact of the heterogeneous NK cell subset, e.g., adaptive and conventional subsets, are not understood in detail. By comparatively analyzing the NK-cell repertoire in 60 HCC patients, 33 liver cirrhosis patients and 36 healthy donors (HD), we show in this study that the NK-cell repertoire is linked to HCC etiology, with increased frequencies of adaptive NK cells in Hepatitis B virus (HBV)-associated HCC. Adaptive NK cells exhibited limited anti-tumoral activity toward liver cancer cells; however, this was not a result of a specific NK-cell impairment in HCC but rather represented an intrinsic feature, since the characteristics of circulating and intra-tumoral adaptive NK cells were conserved between HD, HCC and liver cirrhosis patients. Hence, the expansion of adaptive NK cells with reduced anti-tumoral activity, detectable in HBV-associated HCC, may have implications for tumor surveillance and therapy.

scholarly journals Evaluating the Impact of Microfinance at the Individual Level in Albania, Particularly in the Region of Vlora and Fier

2018 ◽  
Vol 1 (1) ◽  
pp. p143
Author(s):  
Oltiana Muharremi ◽  
Edlira Luҫi ◽  
Filloreta Madani ◽  
Erald Pelari
Keyword(s):  
Low Income ◽  
Financial Services ◽  
Microfinance Institutions ◽  
Way Of Life ◽  
Individual Level ◽  
Right To Development ◽  
Micro Insurance ◽  
The Individual ◽  
The Impact ◽  
Micro Credit

Microfinance is defined as the provision of financial services such as micro-credit, micro savings, and micro insurance for individuals with low income. Although access to micro credit is seen as a right to have credit, it rather represents a right to development and economic initiatives that could change the borrower’s way of life. The purpose of this article is to examine the impact of microfinance loans in improving the living conditions of borrowers. This study is based on an empirical investigation of 384 structured questionnaires directed at microfinance institutions in the regions of Vlore and Fier, Albania.

scholarly journals Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jessica Y. H. Aw ◽  
Naomi E. Clarke ◽  
James S. McCarthy ◽  
Rebecca J. Traub ◽  
Salvador Amaral ◽  
...  
Keyword(s):  
Low Income ◽  
Large Scale ◽  
Giardia Duodenalis ◽  
Community Level ◽  
Trial Registration ◽  
Low Income Countries ◽  
Secondary Outcome ◽  
Sanitation And Hygiene ◽  
Timor Leste ◽  
The Impact

Abstract Background Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72–1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04–1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02–1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04–1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57–0.88). Conclusions Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000680662. Registered 27 June 2014, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366540.

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