scholarly journals Socio-economic determinants of healthcare costs in early life: a register-based study in the Netherlands

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Marije van der Hulst ◽  
Suzanne Polinder ◽  
Rianne Kok ◽  
Peter Prinzie ◽  
Marijke W. de Groot ◽  
...  
Keyword(s):  
Logistic Regression ◽  
The Netherlands ◽  
Household Income ◽  
Early Life ◽  
Healthcare Costs ◽  
Low Ses ◽  
Perinatal Morbidity ◽  
Neighborhood Deprivation ◽  
Monthly Household Income ◽  
Binomial Logistic Regression

Abstract Background Children with low socioeconomic status (SES) have an increased risk of a suboptimal start in life with ensuing higher healthcare costs. This study aims to investigate the effects of individual- (monthly household income) and contextual-level SES (household income and neighborhood deprivation), and perinatal morbidity (preterm birth and small for gestational age ((<10th percentile), SGA)) on healthcare costs in early life (0–3 years of age). Methods Individual-linked data from three national registries (Perinatal Registry Netherlands, Statistics Netherlands, and Healthcare Vektis) were obtained of all children born between 2011 and 2014 (N = 480,471) in the Netherlands. Binomial logistic regression was used to model annual healthcare costs as a function of their household income (per €1000), neighborhood deprivation index (range − 13.26 – 10.70), their perinatal morbidity and demographic characteristics. Annual healthcare cost were dichotomized into low healthcare costs (Q1-Q3 below €1000) and high healthcare costs (Q4 €1000 or higher). Results Children had a median of €295 annual healthcare costs, ranging from €72 to €4299 (5–95%). Binomial logistic regression revealed that for every €1000 decrease in monthly household income, the OR for having high healthcare costs is 0.99 (0.99–0.99). Furthermore, for every one-unit increase in neighborhood deprivation the OR for having high healthcare costs increase 1.02 (1.01–1.02). Finally, the model revealed an OR of 2.55 (2.48–2.61) for preterm born children, and an OR of 1.44 (1.41–1.48) for children SGA, to have high healthcare costs compared to their healthy peers. Conclusion More neighborhood deprivation was directly related to higher healthcare costs in young children. On top of this, lower household income was consistently and independently related to higher healthcare costs. By optimizing conditions for low SES populations, the impact of low SES circumstances on their healthcare costs can be positively influenced. Additionally, policies that influence more timely and appropriate healthcare use in low SES populations can reduce healthcare costs further.

Associations of Quantity Smoked and Socioeconomic Status With Smoke-Free Homes and Cars Among Daily Smokers

2021 ◽  
pp. 109019812110104
Author(s):  
Annie Pelekanakis ◽  
Jennifer L. O’Loughlin ◽  
Katerina Maximova ◽  
Annie Montreuil ◽  
Jodi Kalubi ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Logistic Regression ◽  
Household Income ◽  
Employment Status ◽  
Telephone Survey ◽  
Low Ses ◽  
Annual Household Income ◽  
Cross Sectional ◽  
Shs Exposure ◽  
Independent Association

Introduction An association between socioeconomic status (SES) and smoke-free private spaces among smokers could be due to heavier smoking among low SES smokers. We assessed whether quantity smoked or SES are independently associated with smoke-free homes or cars in daily smokers. Method Data were drawn from a cross-sectional telephone survey (2011–2012) of 750 daily smokers age ≥18 years in Quebec, Canada (45% response). Multivariable logistic regression was used to model the independent association between (a) number of cigarettes smoked per day, and (b) each of educational attainment, annual household income, or active employment status and smoke-free homes or cars. Results Participants were 41.0 years old on average, 57% were female. Median (IQR) number of cigarettes smoked per day was 14 (10, 20). Forty-eight percent of participants reported smoke-free homes; 34% reported smoke-free cars. Quantity smoked was strongly associated with both smoke-free homes and cars. Income and education (but not actively employed) were associated with smoke-free homes. None of the SES indicators were associated with smoke-free cars. Conclusions Interventions targeting smokers to promote smoke-free homes and cars should incorporate components to help smokers reduce quantity smoked or preferably, to quit. Interventions targeting smoke-free homes will also need to address SES inequalities by education and income. Our data suggest that reduction in quantity smoked may help smokers reduce SHS exposure in cars, but that an inequality lens may not be relevant.

scholarly journals High to low, low to high: neighbourhood socioeconomic trajectories and birth outcomes

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Burgos Ochoa ◽  
L C M Bertens ◽  
E A P Steegers ◽  
J V Been
Keyword(s):  
Socioeconomic Status ◽  
Preterm Birth ◽  
The Netherlands ◽  
Health Outcomes ◽  
Birth Outcomes ◽  
Early Life ◽  
Low Ses ◽  
Adverse Birth Outcomes ◽  
The Relationship

Abstract Background A growing body of literature has consistently linked neighbourhood socioeconomic status (SES) with adverse birth outcomes. However, the available evidence is based on cross-sectional indicators of neighbourhood SES, which fail to reflect neighbourhoods' dynamic nature. The objective of this study was to explore the relationship between temporal trajectories of neighbourhood socioeconomic change and adverse birth outcomes. Methods The study population consisted of registered singleton births occurred in the Netherlands 2003-2017 between 24 and 41 weeks of gestation (N = 2,335,449). Based on neighbourhood socioeconomic data from The Netherlands Institute for Social Research, we categorized neighbourhoods into longitudinal SES trajectories (e.g. stable, declining, ascending). Multilevel logistic regression models were used to estimate the relationship between neighbourhood SES trajectories and birth outcomes, i.e., preterm birth and small-for-gestational-age (SGA). Results Living in a Stable Low SES neighbourhood was associated with higher odds of preterm birth (OR[CI]=1.10[1.06; 1.14]), and SGA (OR[CI]=1.15[1.12; 1.18]), compared to living in Stable High SES areas. Also, women living in a Declining (Middle to Low SES) neighbourhood had higher odds for preterm birth (OR = 1.08[1.03; 1.14]) and SGA (OR = 1.10 [1.06; 1.15]), compared to Stable High SES areas. Conclusions Women from neighbourhoods with long-term low or declining SES were more likely to experience adverse birth outcomes. Policies aimed at mitigating the effect of long-term neighbourhood disadvantage or preventing neighbourhoods' decline have potential to benefit early life health outcomes. Key messages Women living in long-term low or declining socioeconomic status neighbourhoods were more likely to experience adverse birth outcomes. Our results can provide guidance to policies aimed at improving early life health outcomes.

scholarly journals COVID-19-Related Changes in Perceived Household Food Waste in the United States: A Cross-Sectional Descriptive Study

2021 ◽  
Vol 18 (3) ◽  
pp. 1104
Author(s):  
Kelly Cosgrove ◽  
Maricarmen Vizcaino ◽  
Christopher Wharton
Keyword(s):  
Logistic Regression ◽  
Food Waste ◽  
The United States ◽  
Food Groups ◽  
Related Factors ◽  
Cross Sectional ◽  
Household Level ◽  
Binomial Logistic Regression ◽  
Household Food ◽  
Fresh Vegetables

Food waste contributes to adverse environmental and economic outcomes, and substantial food waste occurs at the household level in the US. This study explored perceived household food waste changes during the COVID-19 pandemic and related factors. A total of 946 survey responses from primary household food purchasers were analyzed. Demographic, COVID-19-related household change, and household food waste data were collected in October 2020. Wilcoxon signed-rank was used to assess differences in perceived food waste. A hierarchical binomial logistic regression analysis was conducted to examine whether COVID-19-related lifestyle disruptions and food-related behavior changes increased the likelihood of household food waste. A binomial logistic regression was conducted to explore the contribution of different food groups to the likelihood of increased food waste. Perceived food waste, assessed as the estimated percent of food wasted, decreased significantly during the pandemic (z = −7.47, p < 0.001). Food stockpiling was identified as a predictor of increased overall food waste during the pandemic, and wasting fresh vegetables and frozen foods increased the odds of increased food waste. The results indicate the need to provide education and resources related to food stockpiling and the management of specific food groups during periods of disruption to reduce food waste.

scholarly journals Conflicts with Wolves Can Originate from Their Parent Packs

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1801
Author(s):  
Diederik van Liere ◽  
Nataša Siard ◽  
Pim Martens ◽  
Dušanka Jordan
Keyword(s):  
The Netherlands ◽  
Early Life ◽  
Negative Reinforcement ◽  
Life Experiences ◽  
Farm Animals ◽  
Next Generation ◽  
New Methods ◽  
Google Search

Transmission of experience about prey and habitat supports the survival of next generation of wolves. Thus, the parent pack (PP) can affect whether young migrating wolves (loners) kill farm animals or choose to be in human environments, which generates human–wolf conflicts. Therefore, we researched whether the behavior of loners resembles PP behavior. After being extinct, 22 loners had entered the Netherlands between 2015 and 2019. Among them, 14 could be DNA-identified and linked with their PPs in Germany. Some loners were siblings. We assessed the behavior of each individual and PP through a structured Google search. PP behavior was determined for the loner’s rearing period. Similarity between loner and PP behavior was significant (p = 0.022) and applied to 10 of 14 cases: like their PPs, three loners killed sheep and were near humans, five killed sheep and did not approach humans, while two loners were unproblematic, they did not kill sheep, nor were they near humans. Siblings behaved similarly. Thus, sheep killing and proximity to humans may develop during early-life experiences in the PP. However, by negative reinforcement that can be prevented. New methods are suggested to achieve that. As a result, new generations may not be problematic when leaving PPs.

scholarly journals Evaluating the role for renal biopsy in T1 and T2 renal masses: A single-centre study

2018 ◽  
Vol 12 (5) ◽  
pp. E226-30 ◽  
Author(s):  
Dylan Hoare ◽  
Howard Evans ◽  
Heidi Richards ◽  
Rahim Samji
Keyword(s):  
Logistic Regression ◽  
Adverse Events ◽  
Diagnostic Accuracy ◽  
Renal Biopsy ◽  
Predictive Value ◽  
Lesion Size ◽  
Renal Masses ◽  
Ct Guided ◽  
Binomial Logistic Regression ◽  
T1 And T2

Introduction: Once used primarily in the identification of renal metastasis and lymphomas, various urological bodies are now adopting an expanded role for the renal biopsy. We sought to evaluate the role of the renal biopsy in a Canadian context, focusing on associated adverse events, radiographic burden, and diagnostic accuracy.Methods: This retrospective review incorporated all patients undergoing ultrasound (US)/computed tomography (CT)-guided biopsies for T1 and T2 renal masses. There were no age or lesion size limitations. The primary outcome of interest was the correlation between initial biopsy and final surgical pathology. A binomial logistic regression analysis was conducted to determine any confounding factors. Secondary outcomes included the accuracy of tumour cell typing, grading, the safety profile, and radiographic burden associated with these patients.Results: A total of 148 patients satisfied inclusion criteria for this study. Mean age and lesions size at detection were 60.9 years (±12.4) and 3.6 cm (±2.0), respectively. Most renal masses were identified with US (52.7%) or CT (44.6%). Three patients (2.0%) experienced adverse events of note. Eighty-six patients (58.1%) proceeded to radical/partial nephrectomy. Our biopsies held a diagnostic accuracy of 90.7% (sensitivity 96.2%, specificity 87.5%, positive predictive value 98.7%, negative predictive value 70.0%, kappa 0.752, p<0.0005). Binomial logistic regression revealed that age, lesion size, number of radiographic tests, time to biopsy, and modality of biopsy (US/CT) had no influence on the diagnostic accuracy of biopsies.Conclusions: Renal biopsies are safe, feasible, and diagnostic. Their role should be expanded in the routine evaluation of T1 and T2 renal masses.

scholarly journals HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256818
Author(s):  
Lisie Souza Castro ◽  
Grazielli Rocha de Rezende ◽  
Fernanda Rodas Pires Fernandes ◽  
Larissa Melo Bandeira ◽  
Gabriela Alves Cesar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sexual Behaviors ◽  
Household Income ◽  
Hepatitis A ◽  
Hepatitis A Virus ◽  
Transgender Women ◽  
Antibody Testing ◽  
Cross Sectional ◽  
Monthly Household Income ◽  
Sex With Men

Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.

scholarly journals Long-term Effects of Telemonitoring on Healthcare Usage in Patients with Heart Failure or COPD (Preprint)

2018 ◽  
Author(s):  
Jorien Maria Margaretha van der Burg ◽  
Nasir Ahmad Aziz ◽  
Maurits C. Kaptein ◽  
Martine J.M. Breteler ◽  
Joris H. Jansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
The Netherlands ◽  
Healthcare Costs ◽  
Hospital Admissions ◽  
Disease Stage ◽  
Chronic Obstructive ◽  
Home Telemonitoring ◽  
Copd Patients ◽  
Patients With Heart Failure

UNSTRUCTURED Objective The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or chronic obstructive pulmonary disease (COPD). Design The study was a retrospective observational study with a pre-post research design and a follow-up duration of up to 3 years, based on hospital data collected in the period 2012-2016. Setting Data was collected at the Slingeland Hospital in Doetinchem, The Netherlands. Participants In 2012 the Slingeland Hospital in The Netherlands started a telemonitoring program for patients with COPD or heart failure as part of their usual care. Patients were eligible for the telemonitoring program if they were in an advanced disease stage (New York Heart Association (NYHA) functional class 3 or 4; COPD gold stage 3 or 4), received treatment for their condition by a cardiologist or pulmonary specialist at the Slingeland Hospital, were proficient in Dutch and capable of providing informed consent. Exclusion criteria were absence of the cognitive, physical or logistical ability required to fully participate in the program. Hundred seventy-seven patients with heart failure and 83 patients with COPD enrolled the program between 2012 and 2016. Intervention Using a touchscreen, participants with heart failure recorded their weight (daily), blood pressure and heart rate (once a week) through connected instruments, and completed a questionnaire about their symptoms (once a week). Symptoms in patients with COPD were monitored via the Clinical COPD Questionnaire (CCQ), which participants were asked to complete twice per week. All home registrations were sent via a telemonitoring application (cVitals, FocusCura, Driebergen-Rijssenburg) on the iPad to a medical service center were a trained nurse monitored the data and contacted the patient by video chat or a specialised nurse in the hospital in case of abnormal results, such as deviations from a preset threshold or alterations in symptom score. Outcome measures The primary outcome was the number of hospitalisations; the secondary outcomes were total number of hospitalisation days and healthcare costs during the follow-up period. Generalised Estimating Equations were applied to account for repeated measurements, adjusting for sex, age and length of follow-up. Results In heart failure patients (N=177), after initiation of home telemonitoring both the number of hospitalisations and the total number of hospitalisation days significantly decreased (incidence rate ratio of 0.35 (95% CI: 0.26-0.48) and 0.35 (95% CI: 0.24-0.51), respectively), as did the total healthcare costs (exp(B) = 0.11 (95% CI: 0.08-0.17)), all p < 0.001. In COPD patients (N=83) neither the number of hospitalisations nor the number of hospitalisation days changed compared to the pre-intervention period. However, the average healthcare costs were about 54% lower in COPD patients after the start of the home telemonitoring intervention (exp(B) = 0.46, 95% CI 0.25-0.84, p = 0.011). Conclusion Integrated telemonitoring significantly reduced the number of hospital admissions and days spent in hospital in patients with heart failure, but not in patients with COPD. Importantly, in both patients with heart failure and COPD the intervention substantially reduced the total healthcare costs.

scholarly journals Do Socioeconomic Factors Matter in Acreage Owned and Acreage Farmed by Small Livestock Producers in Georgia?

2020 ◽  
Vol 12 (8) ◽  
pp. 42
Author(s):  
David Nii O. Tackie ◽  
Jannette R. Bartlett ◽  
Akua Adu-Gyamfi ◽  
Nicole I. Nunoo ◽  
Bridget J. Perry
Keyword(s):  
Logistic Regression ◽  
Socioeconomic Factors ◽  
Household Income ◽  
Ordinal Logistic Regression ◽  
Farm Size ◽  
Regression Analyses ◽  
Livestock Farming ◽  
Ordinal Logistic Regression Analysis ◽  
Small Livestock ◽  
Small Producers

Although socioeconomic factors may influence acreage owned and acreage farmed by small producers, limited studies have been conducted on this topic in the Southeastern U.S., such as in Georgia. Therefore, the study ascertained the effect of socioeconomic factors on acreage owned and acreage farmed by small livestock producers in Georgia. The data were obtained from a sample of producers, and assessed by using descriptive statistics and ordinal logistic regression analysis. The findings revealed that a majority had farming experience and livestock farming experience of 30 years or less, respectively, 82 and 77%. Corresponding proportions for 20 years or less were 74 and 71%. Additionally, a little less than half (48%) owned over 60 acres of land, and a majority (55%) farmed over 60 acres. The ordinal logistic regression analyses revealed that, of the socioeconomic factors, farming status, education, and household income had statistically significant effects on acreage owned and acreage farmed. The findings suggest that socioeconomic factors matter in farm size in the study area, and they should be taken into consideration when designing programs for small producers.

A National Cancer Database (NCDB) analysis of the impact of nonmetastatic colon cancer sidedness on survival.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 139-139
Author(s):  
Deven Patel ◽  
Timothy DiPeri ◽  
Brian Cox ◽  
Andrew Eugene Hendifar ◽  
Arsen Osipov ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Logistic Regression ◽  
Adjuvant Chemotherapy ◽  
Large Population ◽  
Stage I ◽  
Prognostic Impact ◽  
Metastatic Colon Cancer ◽  
Prognostic Features ◽  
Binomial Logistic Regression ◽  
The Impact

139 Background: Differences in embryological origin and tumor biology distinguish right-sided colon cancer (RCC) from left-sided colon cancer (LCC). Previous studies characterizing the prognostic impact of colon cancer laterality on clinical outcomes in non-metastatic colon cancer have been conflicting, thus closer examination is needed. Methods: Using the NCDB, patients with stage I-III colon cancer between 2004-2014 were stratified according to tumor location; RCC vs. LCC. Patient (pt) and tumor characteristics were compared in univariate analysis, survival (OS) was estimated by Kaplan-Meier (KM) curves and Cox proportional hazards modeling. Binomial logistic regression analysis was utilized to identify variables associated with colon cancer laterality. Results: Of the 342,735 pts who met inclusion criteria, 210,343 (61.4%) were diagnosed with RCC, and 132,392 (38.6%) with LCC. Pts with RCC were older (mean 71.6 vs. 66.4 years, p< 0.001) and predominantly female (65% vs. 35%, p< 0.001) compared to those with LCC. A trend towards poorer OS was seen in pts with RCC (mean 91.0 mos [95% CI: 90.2-91.8]) compared to LCC (112.2 mos [95% CI: 110.9-113.6]) in unadjusted analysis. On Cox multivariable adjusted analyses there was a significant but minimal impact on OS and laterality (hazard ratio or HR [LCC as ref] 0.978, 95% CI 0.967-0.989 p< 0.0001). Multiple unadjusted KM survival analyses showed RCC with T4 disease, high-grade, LVI/PNI, positive margins, N0-N2 disease, tumor deposits, and receipt of adjuvant chemotherapy had poorer OS than those features in LCC (all p < 0.0001). Binomial logistic regression showed RCCs were significantly more likely to be higher grade (odds ratio or OR 2.024) and MSI-H (OR 2.010) with trends (nonsignificant) towards more likely having N1-2 positive disease, LVI, less receipt of adjuvant chemotherapy, and fewer tumor deposits. Conclusions: The impact of sidedness on prognosis in stage I-III colon cancer is complex. In this large, population-based study, RCC tends to be associated with more adverse prognostic features than LCC. More investigation into the biologic differences between RCC and LCC is warranted and how they impact phenotype and survival.

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