The effect of household wealth on financial debt after cancer diagnosis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18552-e18552
Author(s):  
Syed Hussaini ◽  
Mia Dana ◽  
Lauren Nicholas
Keyword(s):  
Heart Disease ◽  
Cancer Diagnosis ◽  
Chronic Conditions ◽  
Credit Card ◽  
Chronic Condition ◽  
Household Wealth ◽  
Credit Card Debt ◽  
Home Equity ◽  
Diagnosis Of Cancer ◽  
New Diagnosis

e18552 Background: Cancer is the 2nd most common cause of death in the country, eclipsed only by heart disease. Cancer care is increasingly characterized by financial toxicity related to high-cost treatments, though it is unknown whether other chronic conditions impose similar financial harms. Methods: We conducted a retrospective analysis of the Health and Retirement Study participants interviewed between 2012-2018. This is a national, longitudinal survey conducted every two years of adults 50 and older and their spouses. We used fixed effect regression models to compare changes in financial debt among households with new diagnosis of cancer, other major chronic conditions (diabetes, stroke, or heart disease), and no new health diagnosis (or health shock). Since more affluent households may respond to health shocks differently, we estimated separate comparisons for households above versus below median wealth in 2012, prior to new health conditions. We assessed use of any non-housing financial debt, credit card debt, and home equity lines of credit among the subset of homeowning households. Results: In this study of 14,153 households, average age at interview was 62 years, with 43% male, 70% White, 22% Black, 13% Hispanic, and 70% with up to high school education. Of this population, 25% held credit card debt, 70% owned a home, 18% had a home equity line of credit, and 9% used a home equity line of credit. Among households with below median wealth when they entered the study in 2012 ( < $23,000 in $2016), a new cancer diagnosis was associated with a 4.7 percentage point increase in financial debt (12.5% effect size, p < 0.05). Participants diagnosed with a chronic condition (heart condition, stroke or diabetes) were 3.6 percentage points more likely to develop financial debt (9.6%, p < 0.05) compared to households that did not develop a new chronic condition. Such differences were eliminated in participants in a house with above median wealth. There was no difference in credit card debt, availability of home equity line of credit, or use of home equity line of credit for participants with a new diagnosis. Conclusions: New diagnosis of cancer or a chronic condition were associated with increased financial debt for older Americans living in a household that were below median wealth.

scholarly journals Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program

2018 ◽  
Vol 42 (5) ◽  
pp. 542 ◽  
Author(s):  
Sharon Lawn ◽  
Sara Zabeen ◽  
David Smith ◽  
Ellen Wilson ◽  
Cathie Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
Length Of Stay ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Hospital Admissions ◽  
Self Management ◽  
Psychosocial Needs ◽  
Post Discharge ◽  
The Impact

Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

scholarly journals New diagnosis of cancer and the risk of subsequent cerebrovascular events

Neurology ◽  
2018 ◽  
Vol 90 (23) ◽  
pp. e2025-e2033 ◽  
Author(s):  
Babak B. Navi ◽  
George Howard ◽  
Virginia J. Howard ◽  
Hong Zhao ◽  
Suzanne E. Judd ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cancer Diagnosis ◽  
Hazard Ratio ◽  
Cerebrovascular Event ◽  
Study Visit ◽  
Baseline Study ◽  
Cerebrovascular Events ◽  
Diagnosis Of Cancer ◽  
New Diagnosis

ObjectiveWe aimed to evaluate the association between cancer and cerebrovascular disease in a prospective cohort study with adjudicated cerebrovascular diagnoses.MethodsWe analyzed participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were 45 years and older and had Medicare coverage for 365 days before their baseline study visit. Participants with a history of cancer or cerebrovascular events were excluded. The time-dependent exposure was a new diagnosis of malignant cancer identified through Medicare claims algorithms. Participants were prospectively followed from their baseline study visit (2003–2007) through 2014 for the outcome of a neurologist-adjudicated cerebrovascular event defined as a composite of stroke (ischemic or hemorrhagic) or TIA. Cox regression was used to evaluate the association between a new cancer diagnosis and subsequent cerebrovascular events. Follow-up time was modeled in discrete time periods to fulfill the proportional hazard assumption.ResultsAmong 6,602 REGARDS participants who met eligibility criteria, 1,149 were diagnosed with cancer during follow-up. Compared to no cancer, a new cancer diagnosis was associated with subsequent cerebrovascular events in the first 30 days after diagnosis (hazard ratio 6.1, 95% confidence interval 2.7–13.7). This association persisted after adjustment for demographics, region of residence, and vascular risk factors (hazard ratio 6.6, 95% confidence interval 2.7–16.0). There was no association between cancer diagnosis and incident cerebrovascular events beyond 30 days. Cancers considered high risk for venous thromboembolism demonstrated the strongest associations with cerebrovascular event risk.ConclusionA new diagnosis of cancer is associated with a substantially increased short-term risk of cerebrovascular events.

scholarly journals The Relationship between Consumer Credit Card Debt and Immigrants in the UK: A Systematic Review

2020 ◽  
Vol 4 (2) ◽  
pp. 86-114
Author(s):  
Paul Thompson
Keyword(s):  
Consumer Behavior ◽  
Financial Literacy ◽  
Credit Card ◽  
Influential Factors ◽  
Unique Contribution ◽  
Credit Card Debt ◽  
Home Equity ◽  
Screening Process ◽  
The Uk ◽  
The Relationship

Purpose: This paper systematically reviews a reappraisal of the relationship between consumer behavior and credit card debt. Methodology: A thorough search was performed using scholarly databases including EBSCOHost, Google Scholar, Wiley Online Library, JStor, ProQuest, and Taylor & Francis. After a vigorously screening process, a total of 77 articles were accepted with the majority (96%) of articles published after 2012. Several consumer behavior factors were considered such as social factors, psychological factors, impulse buying, compulsive buying, optimism and pessimism, risk-seeking, mental health, age, income, education, immigrants, religion and financial literacy. Findings: Overall, influential factors that contribute to credit debt can be attributed to redlining and predatory lending by financial institutions. Racial inequalities have been shown to play a significant role in credit debt, especially in the UK. Unique contribution to theory, practice and policy: A major knowledge gap concerning immigrants exists and further provide insight on the role played by an individual’s ethnic group in the rate of home equity decline as well as the overall net wealth of a household, ultimately affecting their credit debt. It would be useful for policy-makers to examine the biased placed on credit debt and social-economic backgrounds.

scholarly journals Swāsthya, an integrated chronic condition management programme for families of patients with hypertension and diabetes mellitus: a study protocol for a randomised controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M D Saju ◽  
Bindiya M Varghese ◽  
Lorane Scaria ◽  
Anuja Maria Benny ◽  
Shilpa V Yohannan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Randomised Controlled Trial ◽  
Social Cohesion ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Controlled Trial ◽  
Risk Groups ◽  
Care Model ◽  
Randomised Controlled

Abstract Background Kerala is known as the diabetes mellitus (DM) and hypertension (HTN) capital of the world, thus compelling health professionals to model strategies, addressing their social, behavioural, and cognitive risk factors and eliminating various barriers to management. This paper describes the protocol of our study that aims to examine the effectiveness and sustainability of an integrated care model for the management of chronic conditions and their risk factors through a family-based intervention. The proposed care model targets to modify systems and processes that predispose to chronic conditions by enhancing social cohesion and social networks, preventing lifestyle risks, developing iterative cognitive interventions, and engaging the family into customised treatment adherence strategies navigated by community health social workers (CHSWs). Methods A cluster randomised controlled trial (RCT) in selected participants will be conducted involving additional assessments prior to the baseline assessment. The assessment will identify and categorise patients into four risk groups, namely behavioural, social, cognitive, and multiple, based on dominant risks identified. Eligible participants will be randomly allocated (at a ratio of 1:1) into the intervention or control arm. The intervention arm will receive social, behavioural, and cognitive or multiple interventions corresponding to the identified risk groups, whereas the control arm will receive general intervention. Both the groups will be followed up at 6 months and 12 months post baseline to measure outcomes. The primary outcome will be the control of HTN and DM, and secondary outcomes include decreased depression and anxiety and improved functioning, social cohesion, and social network linkages. The sustainability and scalability of this intervention will be assessed through cost effectiveness, acceptability, and user friendliness of the integrated approach by performing a qualitative evaluation. Discussion This RCT will inform the potential paradigm shift from a medical model of chronic condition management to a multidimensional, multisystem, and multidisciplinary convergence model navigated by CHSWs. Such a model is not currently considered in the management of chronic conditions in Kerala. Trial registration Trial has been prospectively registered on Clinical Trial Registry of India- CTRI/2020/12/029474 on 1st December 2020.

scholarly journals Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chieh-Ying Chou ◽  
Ching-Ju Chiu ◽  
Chia-Ming Chang ◽  
Chih-Hsing Wu ◽  
Feng-Hwa Lu ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Disability ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Disease Diagnosis ◽  
Rate Of Change ◽  
Middle Aged ◽  
Rates Of Change ◽  
Depression Status ◽  
Stage Disease

Abstract Background Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability. Methods This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996–2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling. Results The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9–73.6% and 37.9–100% of the variances in the physical disability intercept and change over time, respectively. Conclusions Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.

Wealth and preferences for redistribution: The effects of financial assets and home equity in 31 countries

2021 ◽  
pp. 002071522098808
Author(s):  
Liza G Steele
Keyword(s):  
Household Wealth ◽  
Welfare States ◽  
Social Effects ◽  
Financial Assets ◽  
Unemployment Benefits ◽  
Home Equity ◽  
Income Equality ◽  
Financial Wealth ◽  
Preferences For Redistribution ◽  
The Social

How does wealth affect preferences for redistribution? In general, social scientists have largely neglected to study the social effects of wealth. This neglect was partially due to a dearth of data on household wealth and social outcomes, and also to greater scholarly interest in how wealth has been accumulated rather than the social effects of wealth. While we would expect household wealth to be an important component of attitudes toward inequality and social welfare policies, research in this area is scarce. In this study, the relationship between wealth and preferences for redistribution is examined in cross-national global and comparative perspective using data on 31 countries from the 2009 wave of the International Social Survey Programme (ISSP), the first wave of that study to include measures of wealth. The findings presented compare the effects of two types of wealth—financial assets and home equity—and demonstrate that there are differences in effects by asset type and by redistributive policy in question. Financial wealth is more closely associated with attitudes about income equality, while home equity is more closely associated with attitudes about unemployment benefits. Moreover, while the upper categories of financial wealth have the largest negative effects on support for income equality, it is the middle categories of home equity that are most strongly associated with opposition to unemployment benefits. Effects also differ by country, but not in patterns that theories of comparative welfare states nor political economy would adequately explain.

Should Physical Activity Intervention Efforts Take a Whole Population, High-Risk, or Middle Road Strategy?

2014 ◽  
Vol 11 (5) ◽  
pp. 966-970 ◽  
Author(s):  
Geeske Peeters ◽  
Richard Hockey ◽  
Wendy Brown
Keyword(s):  
Physical Activity ◽  
Heart Disease ◽  
Longitudinal Study ◽  
High Risk ◽  
Chronic Conditions ◽  
Physical Activity Intervention ◽  
Incidence Rates ◽  
Theoretical Modeling ◽  
Actual Distribution ◽  
Mail Surveys

Purpose:This study was designed to compare theoretical strategies for changing physical activity (PA) in terms of their potential to reduce the incidence of chronic conditions in midage women: (1) whole population: +30 minutes/week in all, (2) high-risk: +60 minutes/week in the lowest 25% of the PA distribution, and (3) middle road: shift all those not meeting guidelines to a level commensurate with meeting guidelines.Methods:10,854 participants (50–55 years in 2001) in the Australian Longitudinal Study of Women’s Health completed mail surveys in 2001, 2004, 2007, and 2010. PA was calculated as MET·minutes/week spent in walking, moderate and vigorous PA in the previous week. Incidence rates per 1000 person-years for diabetes, heart disease, hypertension, cancer, and depression were calculated for the actual distribution and after modeled shifts in PA.Results:The incidence rates were 10.6 for diabetes, 7.0 for heart disease, 30.7 for hypertension, 8.0 for cancer, and 28.4 for depression. Greater reductions in incidence were found for the middle road strategy than for the whole population and high-risk strategies, with reductions ranging from –6.3% for cancer to –12.3% for diabetes.Discussion:This theoretical modeling showed that a middle road strategy to increasing PA was superior to the whole population and high-risk strategies, in terms of reducing incidence rates of chronic conditions in middle-aged women.

scholarly journals Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Maureen Wilson-Genderson ◽  
Allison R Heid ◽  
Rachel Pruchno
Keyword(s):  
Heart Disease ◽  
Depressive Symptoms ◽  
Pulmonary Disease ◽  
Chronic Conditions ◽  
Clinical Care ◽  
Psychological Impact ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
The Subject ◽  
Independent Effects

Abstract Background While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. Methods Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWLSM research panel. Longitudinal multilevel modeling was used to examine the effects that transitioning to having a diagnosis of multiple chronic conditions has on depressive symptoms. Results Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. Conclusions Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis.

scholarly journals Timely cancer diagnosis and management as a chronic condition: opportunities for primary care

2008 ◽  
Vol 189 (2) ◽  
pp. 78-82 ◽  
Author(s):  
Moyez Jiwa ◽  
Christobel M Saunders ◽  
Sandra C Thompson ◽  
Lorna K Rosenwax ◽  
Scott Sargant ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Chronic Condition ◽  
Diagnosis And Management
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