Social determinants of health, genetic ancestry, and mortality in ECOG-ACRIN E5103.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6527-6527
Author(s):  
Samilia Obeng-Gyasi ◽  
Anne M. O'Neill ◽  
Kathy Miller ◽  
Bryan P. Schneider ◽  
Ann H. Partridge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Genetic Ancestry ◽  
Determinants Of Health ◽  
Neighborhood Socioeconomic Status ◽  
The Relationship ◽  
Overall Mortality

6527 Background: Social determinants of health (SDH) and genetic ancestry have been independently implicated in breast cancer presentation, treatment and mortality. However, little is known about the relationship between SDH and genetic ancestry on clinical trial outcomes. The objective of this study is to assess the association between SDH, genetic ancestry and clinical outcomes in patients enrolled in an adjuvant breast cancer clinical trial. Methods: ECOG-ACRIN (EA) 5103 randomized patients to receive AC + taxane + bevacizumab or placebo. SDH were operationalized as insurance status at trial registration (individual SES) and neighborhood socioeconomic status (nSES). Insurance categories included: (1) Private, 2) Medicare including private/Medicare, military, 3) Medicaid including Medicaid/Medicare, uninsured, 4) self-pay). The nSES index was calculated using zip codes linked to county level data on occupation, income, poverty, wealth, education and crowding. Genome-wide single-nucleotide polymorphism arrays were used to define African ancestry (AA), European ancestry (EA) and other (OA). Multivariable regression and Cox-Proportional Hazard models (odds ratios (OR) and hazard ratios (HR) with corresponding 95% confidence intervals (CI)) were used to assess associations with chemotherapy completion and overall mortality. Estimates were adjusted for the following clinical covariates: age, tumor size, nodal status, hormone receptor status, and primary surgery at randomization. Results: The study cohort included 2453 EA (79.2%), 381 AA (12.2%) and 265 OA (8.6%). Medicaid patients (OR 0.76(0.59-0.99); ref private) and those with AA (OR 0.62(0.49-0.78); ref EA) were less likely to complete chemotherapy. Regarding overall mortality, Medicaid insurance (HR 1.42(1.05-1.92) was associated with a higher mortality than private insurance. Conversely, there was no significant difference in mortality by ancestry (AA HR 1.27 (0.97-1.66); OA HR 0.90 (0.63-1.29): ref EA). Neighborhood socioeconomic status did not appear to be associated with chemotherapy completion or mortality. Conclusions: SDH reflective of individual SES, such as insurance, appear to be stronger drivers of trial completion and mortality compared to nSES among patients enrolled in E5103. Moreover, study results suggest an interplay between ancestry and individual proxies for SDH in trial completion. Nevertheless, the relationship between ancestry and lower rates of chemotherapy completion do not appear to translate into higher mortality rates among patients of AA.

Limitations on Participation and Their Relation to Social Determinants of Health Among Occupational Therapists and Occupational Therapy Students During Coronavirus Lockdown

2021 ◽  
Vol 75 (6) ◽  
Author(s):  
Nuria Menéndez Álvarez ◽  
Emiliano Diez Villoria ◽  
Estíbaliz Jimenez Arberas ◽  
Ana María Castaño Pérez ◽  
Antonio León García Izquierdo
Keyword(s):  
Occupational Therapy ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Occupational Therapists ◽  
Determinants Of Health ◽  
World Health ◽  
International Classification Of Functioning ◽  
Occupational Therapy Students ◽  
The Impact ◽  
The Relationship

Importance: For the first time in recent history, people worldwide have faced severe restrictions in occupations because of the measures adopted by governments to contain the coronavirus disease 2019 (COVID-19) crisis. Objective: To determine the limitations on participation of occupational therapists and occupational therapy students during “lockdown” and their impact on social determinants of health. Design: A cross-sectional, descriptive study conducted via an online survey. Participants: A total of 488 occupational therapists and occupational therapy students in North America, South America, and Europe. Outcomes and Measures: A questionnaire consisting of the World Health Organization Disability Assessment Schedule 2.0 of the International Classification of Functioning, Disability and Health and items developed to assess the impact of lockdown on daily life was emailed to occupational therapy professional associations, organizations, and universities between April and June 2020. It was available in English, Spanish, and Portuguese and met all the parameters listed in the Declaration of Helsinki. Results: The roles and routines of people across the developed world have been affected by lockdown measures. The study shows marked differences between participants in the domains of getting along and life activities, as well as influence on the environment. Moreover, South American participants experienced these difficulties to a greater extent than European participants. Conclusions and Relevance: This study quantifies the limitations in the participation of occupational therapists and occupational therapy students and the relationship of occupation to social determinants of health. What This Article Adds: The results of this research corroborate the relationship between health and occupation and highlight elements, such as the environment and context, that are important in occupational therapy. Therapists’ ability to analyze occupation in relation to contextual and cultural factors will benefit clients.

scholarly journals Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fiona Haigh ◽  
Lynn Kemp ◽  
Patricia Bazeley ◽  
Neil Haigh
Keyword(s):  
Human Rights ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Critical Realism ◽  
Determinants Of Health ◽  
Construction Of Knowledge ◽  
Critical Realist ◽  
Significant Relationships ◽  
The Social ◽  
The Relationship

Abstract Background That there is a relationship between human rights and health is well established and frequently discussed. However, actions intended to take account of the relationship between human rights and social determinants of health have often been limited by lack of clarity and ambiguity concerning how these rights and determinants may interact and affect each other. It is difficult to know what to do when you do not understand how things work. As our own understanding of this consideration is founded on perspectives provided by the critical realist paradigm, we present an account of and commentary on our application of these perspectives in an investigation of this relationship. Findings We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. Those implications include the need to theorise possible entities involved in the relationship together with their distinctive properties and consequential power to affect one another through exercise of their respective mechanisms (ways of working). This theorising work enabled us identify a complex, multi-layered assembly of entities involved in the relationship and some of the array of causal mechanisms that may be in play. These are presented in a summary framework. Conclusion Researchers’ views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. We demonstrate that by attending to these views, which are founded in their paradigm positioning, researchers can make more progress in understanding the relationship between human rights and the social determinants of health, in particular when engaged in theorizing work. The same approaches could be drawn on when other significant relationships in health environments are investigated.

scholarly journals Physician Assessment of Social Determinants of Health: A Necessary Component in Improving Care of Patients

2021 ◽  
Vol 11 (S1) ◽  
Author(s):  
Emaan Chaudry
Keyword(s):  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Social History ◽  
Low Socioeconomic Status ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Sexual History ◽  
History Of ◽  
Asking Questions ◽  
The Government

The importance of building a therapeutic relationship between a physician and a patient is taught early on in a medical student's training, specifically through the practice of obtaining a patient history. This process consists of gathering information in four main categories: the history of the present illness, personal social history, past medical history, and family history. Each piece of information obtained within these categories is vital in ensuring a patient receives appropriate and effective care. Specifically, a social history consists of asking about a patient's relationship status, support system, home environment, interests, exercise, nutritional habits, substance use, and sexual history. To complete a successful and full social history, one should try to address the social determinants of health. As per the Government of Canada’s website, social determinants of health “refer to a specific group of social and economic factors within the broader determinants of health. These relate to an individual’s place in society such as income, education or employment” [1]. Consequently, a critical component of a complete social history interview should be investigating a patients socioeconomic status. Low socioeconomic status (LSES) has been found to play a role in incidence and susceptibility to a variety of health conditions. As such, I believe that screening for and asking questions pertaining to the socioeconomic status of a patient should be considered a vital and essential component of every patient assessment.

scholarly journals Frailty in older adults and their association with social determinants of Health. The SABE Colombia Study

2019 ◽  
pp. 89-101 ◽  
Author(s):  
José M Ocampo Chaparro ◽  
Carlos A Reyes Ortiz ◽  
Ximena Castro Flórez ◽  
Fernando Gómez
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Rural Areas ◽  
Cross Sectional Study ◽  
Determinants Of Health ◽  
Cross Sectional ◽  
Childhood Health ◽  
The Social ◽  
Urban And Rural Areas ◽  
The Relationship

Objective: To estimate the prevalence of frailty and evaluate the relationship with the social determinants of health in elderly residents in urban and rural areas of Colombia. Methods: The SABE (Health, Wellbeing, and Aging) Colombia project is a cross-sectional study, carried out in 2014-2015, involving 24,553 men and women aged 60 years and older who live in the community in Colombia. For this analysis, we used data from 4,474 participants included as a subsample with grip strength measurements. The frailty syndrome was diagnosed according to the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). The independent variables were grouped as (a) biological and genetic flow, (b) lifestyle (adverse conditions in childhood) (c) social networks and community, and (d) socio-economic, cultural and environmental conditions. Multiple logistic and linear regression analyses were used to assess the prognostic value of frailty for the outcomes of interest. Results: The prevalence of frailty was 17.9%. The factors significantly associated with frailty were older age, being women, living in rural areas, having low education, a greater number of medical conditions, insufficient current income, childhood health problems and a poor economic situation in childhood. Conclusions: Our results support the need to include frailty prevention programs, to improve the socioeconomic health conditions of infants to avoid future development of frailty.

scholarly journals Social Determinants of Myocardial Infarction Risk and Survival: A Systematic Review

2020 ◽  
pp. 1-12
Author(s):  
Steven S. Coughlin ◽  
Steven S. Coughlin ◽  
Lufei Young
Keyword(s):  
Myocardial Infarction ◽  
Social Support ◽  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Low Socioeconomic Status ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Access To Health Services ◽  
Immigration Status ◽  
Increased Risk

Social determinants of health that have been examined in relation to myocardial infarction incidence and survival include socioeconomic status (income, education), neighbourhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighbourhood access to health services. Socioeconomic factors influence risk of myocardial infarction. Myocardial infarction incidence rates tend to be inversely associated with socioeconomic status. In addition, studies have shown that low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status, race, education, and census-tract-level poverty. The results of this review indicate that social determinants such as neighbourhood disadvantage, immigration status, lack of social support, and social isolation also play an important role in myocardial infarction risk and survival. To address these social determinants and eliminate disparities, effective interventions are needed that account for the social and environmental contexts in which heart attack patients live and are treated.

scholarly journals Clinical Management for Diabetes Associated with the Concept of Socioeconomic Status (SES)

2021 ◽  
Vol 2 (2) ◽  
pp. 119-121
Author(s):  
Hiroshi Bando
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Socioeconomic Status ◽  
Clinical Practice ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Medical Cost ◽  
Health Condition ◽  
Determinants Of Health ◽  
Capital Social

Diabetes mellitus has become a medical and social problem. For better diabetic management and improvement of the health care system, the concept of social determinants of health (SDOH) and socioeconomic status (SES) would be required. SES includes adequate diabetes care, medical cost, health condition, and regular access to care and cure. World Health Organization (WHO) has continued the prevention and management of diabetes and proposed the Global Diabetes Compact in last 2020 [1]. The purpose of the Compact includes several items, such as i) to leverage present capacities in the healthcare system, ii) to meet people’s needs more holistic way, iii) to promote efforts to prevent diabetes especially the young generation, and others. A successful key would be the combined action among public, private, and philanthropic associations. Diabetes mellitus has been a growing medical and social problem in all countries and districts worldwide [2]. The socio economic gradient for diabetic prevalence is shown in high income countries [3]. Further, this gradient seems to be continued for a long despite the improvement of the health care system in those countries [4,5]. In this paper, we describe the social determinants of health (SDOH) and socioeconomic status (SES), among other axes of symmetry for diabetes. In medical practice and health care, population based and value based care have been emphasized. Then, the concept of social determinants of health (SDOH) has been gradually known for an intervention target for estimating health equity [6]. Recently, some comments for SDOH were proposed from medical associations, such as the Society of General Internal Medicine, the American College of Physicians, and other organizations [7]. Moreover, the action perspectives tend to focus on the determinants for individuals and policy [8,9]. In diabetic practice, some basic matters exist including prevalence, incidence, adequate therapy, and economic problems [10]. ADA presented a comment about socio ecological determinants of diabetes. Successively, ADA had an advanced health improvement project for the diabetes writing committee. It has the goal of clarifying diabetic risk and outcomes, academic literature for SDOH [11]. From previous literature, SDOH covers certain areas as follows [6]: i) social context (social support, relationship, and capital, social relationship), ii) health care (quality, accessibility, affordability), iii) local and physical circumstance (residence condition, building environment), iv) food environment (insecurity for food, accessibility for food) and v) socio economic condition (occupation, education, income). According to academic reports, the health disparities for diabetes have been present in the light of adverse influence [12]. Social and environmental factors have been summarized as SDOH in WHO [13]. Among them, social environments seem to be rather main factors. They include societal and community context [14], social capital, social cohesion, and social elements [15]. Health care has been found as an SDOH in the Healthy People 2020, WHO, County health rankings models, associated with accessible factors. WHO regards the health system as one of the SDOH which can give a message of determinants of several health outcomes [15]. On the other hand, it is socioeconomic status (SES) that may influence all related aspects of diabetic treatment in the clinical practice [16]. Actually, lower SES diabetic cases are likely to have some barriers to adequate diabetes care, including medical cost, unsatisfactory health condition, and regular access to care and cure [17]. SES has revealed the multidimensional construct, associated with the occupational, economic, and educational situation [18]. SES has been related to all factors of SDOH [13]. They include medical care, health care, nutrition, social resources, housing, transportation, and so on. The factors of SES and diabetes were investigated for observational studies [19]. It included 28 investigations including diabetic complications, retinopathy, cardiopathy, and others. In summary, SDOH and SES concerning diabetes were introduced. This information will be hopefully useful for developing a bio psycho social perspective in clinical practice.

scholarly journals A County-Level Examination of the Relationship Between HIV and Social Determinants of Health: 40 States, 2006-2008

2012 ◽  
Vol 6 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Gant Z ◽  
Lomotey M ◽  
Hall H.I ◽  
Hu X ◽  
Guo X ◽  
...  
Keyword(s):  
Income Inequality ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
The United States ◽  
Determinants Of Health ◽  
Physical Factors ◽  
County Level ◽  
Hiv Diagnosis ◽  
Hiv Surveillance ◽  
The Relationship

Background: Social determinants of health (SDH) are the social and physical factors that can influence unhealthy or risky behavior. Social determinants of health can affect the chances of acquiring an infectious disease – such as HIV – through behavioral influences and limited preventative and healthcare access. We analyzed the relationship between social determinants of health and HIV diagnosis rates to better understand the disparity in rates between different populations in the United States. Methods: Using National HIV Surveillance data and American Community Survey data at the county level, we examined the relationships between social determinants of health variables (e.g., proportion of whites, income inequality) and HIV diagnosis rates (averaged for 2006-2008) among adults and adolescents from 40 states with mature name-based HIV surveillance. Results: Analysis of data from 1,560 counties showed a significant, positive correlation between HIV diagnosis rates and income inequality (Pearson correlation coefficient ρ = 0.40) and proportion unmarried – ages >15 (ρ = 0.52). There was a significant, negative correlation between proportion of whites and rates (ρ = -0.67). Correlations were low between racespecific social determinants of health indicators and rates. Conclusions/Implications: Overall, HIV diagnosis rates increased as income inequality and the proportion unmarried increased, and rates decreased as proportion of whites increased. The data reflect the higher HIV prevalence among non-whites. Although statistical correlations were moderate, identifying and understanding these social determinants of health variables can help target prevention efforts to aid in reducing HIV diagnosis rates. Future analyses need to determine whether the higher proportion of singles reflects higher populations of gay and bisexual men.

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