scholarly journals Influence of Social Determinants of Health on Timeliness to Treatment for Metastatic HCC and the Impact of Affordable Care Act

2021 ◽  
Author(s):  
Thejus Jayakrishnan ◽  
Veli Bakalov ◽  
Gene Finley ◽  
Dulabh Monga ◽  
Rodney E Wegner
Keyword(s):  
Hepatocellular Carcinoma ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Affordable Care Act ◽  
Systemic Therapy ◽  
Determinants Of Health ◽  
P Value ◽  
Eligibility Criteria ◽  
Metastatic Hepatocellular Carcinoma ◽  
The Impact

Abstract BackgroundTo achieve progress in cancer treatment, socioeconomic disparities impacting the care need to be recognized and addressed. We hypothesized that social determinants of health may predict a delay in systemic therapy for metastatic hepatocellular carcinoma patients (HCC) and sought to examine the impact of the Affordable Care Act (ACA).MethodsNational Cancer Database (NCDB) was queried for patients with metastatic hepatocellular carcinoma diagnosed from 2004-2015 and considered for first line systemic therapy within 6 months (180 days) of diagnosis. Time to initiation (TTI) was defined as the time in days(d) from diagnosis of cancer to initiation of systemic therapy. Survival was measured in months(m) from the day of diagnosis. Multivariate analyses were performed using 2010 as a cut-off between pre-and post-ACA for analysis.Results630 patients meeting the eligibility criteria. Median TTI in the group was 57d. The only factor associated with delayed TTI (defined as the fourth quartile of TTI) in a multivariate logistic regression was non-Hispanic Black (NHB) race Odds Ratio OR 1.94(95%CI 1.0–3.3), p-value=0.052. The OR showed improvement with implementation of ACA – OR3.6(95%CI 1.4-9.4),p-value 0.008 during pre-ACA vs. 1.3(0.5-3.1),p-value=0.6 post-ACA. There was a non-significant trend towards higher mortality among NHB vs. NHW (HR 1.2, 95% CI 1.0-1.6) and lower mortality for those insured vs. uninsured (HR 0.8, 95% CI 0.5-1.1. ConclusionRace appears to impact timeliness to therapy in metastatic HCC patients and was positively impacted by ACA. Continued research to monitor disparities in care and identify underlying mechanisms to mitigate them are warranted.

scholarly journals 4295 The Impact of Social Determinants of Health on Hepatocellular Carcinoma Outcomes

2020 ◽  
Vol 4 (s1) ◽  
pp. 89-90
Author(s):  
Lauren Devore Nephew ◽  
Susan Rawl ◽  
Archita Desai ◽  
Eric Orman ◽  
Marwan Ghabril ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Hepatocellular Carcinoma ◽  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
T Score ◽  
The Impact

OBJECTIVES/GOALS: Achieving therapy for hepatocellular carcinoma (HCC) involves navigating through a complex cascade of care. Non-HCC cancer mortality has been associated with social determinants of health outside of cancer specific risk. Our objective is to explore the impact of social determinants on HCC outcomes. METHODS/STUDY POPULATION: Patients with HCC were enrolled from 3 hospitals form June, 1 2019 to December 1, 2019. A chart review was done to collect information on liver disease severity and cancer stage. Patients were interviewed to collect information on the following: 1) socioeconomic status (income, education, insurance status, and employment status), 2) literacy (Rapid Estimate of Adult Literacy in Medicine (REALM-R) and Brief Health Literacy Screening Tool (BREIF)), 3) social support (Patent Reported Outcome Measurement Information System (PROMIS) instrumental and information support tool), 4) quality of life (PROMIS global and mental health tool), 5) substance abuse, and 6) linkage to care. RESULTS/ANTICIPATED RESULTS: Data compiled on the social determinants of health revealed (n = 35): 1) 60.0% of patients had incomes below $30,000 per year, 60.0% of patients had not gone past high school for education, and 8.6% had full time employment, 2) the average BREIF score was 10.3 (range 3-15)(4-12 indicate limited literacy). The average REALM-R score was 5.5 (range 0-8) (<6 indicate at risk for poor literacy), 3) patients had strong instrumental (T score 61.4±7.1) and information social support (T score 64.6±4.7) (mean T scores calibrated to a general population mean of 50), 4) patients had poor mental (T score 43.7 ±6.5) and physical quality of life (T score 46.6 ±9.9), 5) 25.7% of patients reported alcohol use in the past 90 days 6) 80.0% of patients reported that their doctor had spoken to them about liver transplantation. DISCUSSION/SIGNIFICANCE OF IMPACT: This patient population was well linked to care with good social support. However their literacy, socioeconomic status, mental and global health was poor and substance use history complex. Continued follow up of this cohort is planned to determine how these factors might impact their ability to navigate through the care cascade as well as survival.

Abstract 16126: Cumulative Impact of Social Determinants of Health Risk Score on Obesity Among Young Adults in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammad Haisum Maqsood ◽  
Javier Valero-Elizondo ◽  
Rahul Singh ◽  
Karan Shah ◽  
Maryam Hyder ◽  
...  
Keyword(s):  
Young Adults ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
The United States ◽  
Determinants Of Health ◽  
P Value ◽  
Cumulative Impact ◽  
Cumulative Score ◽  
Prevalence Of Obesity ◽  
The Impact

Introduction: The growing prevalence of obesity has created a major burden on the health care system. To date, studies examining social determinants of obesity in adults have mostly focused on individual social determinants of health (SDOH) components. In this study, we explore the influence of cumulative SDOH on obesity among young adults (< 45) as compared with middle- aged (45-64) and elderly (≥ 65) populations in the US. Methods: We examined cross-sectional data on 164,696 adult participants from the National Health Interview Survey (2013-17). For each individual, the unfavorable SDOH risk factor was identified from 39 sub-components, stemming from 6 general domains (economic stability, neighborhood and physical environment, community and social context, food, education, and healthcare system access). Risk factors were then aggregated to develop a cumulative score, wherein individuals were divided into quartiles. Obesity was calculated from self-reported height and weight and defined as BMI ≥ 30 kg/m 2 . Adults with a BMI <18.5 kg/m 2 were excluded from the analysis. Results: The age-adjusted prevalence of obesity was 32.5%, which translates to 78 million US adults annually. A linear increase in the prevalence of age-adjusted obesity was noted with increasing unfavorable SDOH prevalence across all age groups. In the overall population, those with the worst (4 th quartile) vs best (1 st quartile) SDOH profile had 1.47 higher odds of being obese in adjusted models. There was evidence, however, of effect modification by age (p-value for interaction < 0.001), with a stronger association of unfavorable SDOH risk with obesity in the young (<45 years) as compared with middle age and elderly (Table). Conclusions: A higher burden of SDOH is more strongly associated with obesity in young adults. Estimating and understanding the impact of SDOH may have practical implications for informing effective interventions to combat early adulthood obesity and its ensuing complications.

Assessing baccalaureate nursing students’ knowledge and attitudes of social determinants of health after a health equity simulation

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Quyen Phan ◽  
Naomi Johnson ◽  
JoAnna Hillman ◽  
Daniel Geller ◽  
Laura P. Kimble ◽  
...  
Keyword(s):  
Nursing Students ◽  
Social Determinants Of Health ◽  
Health Equity ◽  
Social Determinants ◽  
Baccalaureate Nursing ◽  
Baccalaureate Nursing Students ◽  
Determinants Of Health ◽  
Marginalized Populations ◽  
Knowledge And Attitudes ◽  
The Impact

AbstractObjectiveFor nursing students, competency in population health management involves acquiring knowledge and forming attitudes about the impact of the social determinants of health (SDoH) on health equity. The purpose of this pilot study was to assess nursing students’ knowledge and attitudes about the SDoH and health equity following a focused simulation activity.MethodBaccalaureate nursing students (N=182) participated in a ninety-minute health equity simulation and a post-simulation debrief. Forty-four students (23%) completed a 19-item post-simulation survey.ResultsSixty-four percent of participants reported positive attitude change in working with marginalized populations caused by the SDoH, and 89% reported being knowledgeable about the role of the registered nurse in addressing health equity. Seventy-five percent reported enhanced knowledge of the SDoH through the health equity simulation.ConclusionUsing health equity simulation may be effective in enhancing students’ knowledge, as well as their attitudes in caring for the health of marginalized populations by addressing the SDoH.

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.

Sign in / Sign up

Export Citation Format

Share Document