Rocky Balboa: The Innocent and the Invincible Hero of Low Income Class

This study is aiming to scrutinize that how American low income class is represented in Rocky Balboa film series in regards of Rocky Balboa character. It will try to understand the mission which is given to Rocky along the film series by examining the concepts such as the values which Rocky represents, class standing, moving up in social ladder, etc. in the scripts of Rocky movies. The life line of Balboa which we have begun to witness while he was living in a poor neighborhood leads us to the different faces of his life along the six films of series: firstly, the world championship that he got by defeating Apollo Creed, then keeping his belt for a long time and defeating Ivan Drago, then losing all his wealth and has to return to the neighborhood where he was living previously and the last fight that he did during his retirement. The hypothesis of the study is that the films of Balboa series are reflecting the life of American low income class ‘realistic’ with Rocky Balboa’s character, and the hypothesis is going to want to verify it along the study.

Abstract 1122‐000143: Vast Global Disparities in Mechanical Thrombectomy Access: A Report from the MT2020+ Regional Committees

Introduction : Mechanical Thrombectomy has been established as a highly cost‐effective therapy for large vessel occlusion stroke (LVOs) since 2015. However, access to MT for eligible MT patients is restricted due to multiple barriers and time constraints. MT 2020+ is a global stroke campaign aimed at accelerating access to mechanical thrombectomy (MT) using public health interventions (PHI) through a regional committees (RCs) network. Methods : MT2020+ conducted an electronic survey in 22 RCs of different income levels in from November 2020‐February 2021 with a questionnaire that included MT eligible patients, centers, operators, procedures and reimbursement. MT access was defined as the proportion of estimated MT eligible patients receiving MT. Linear regression models were used with countries classified by World Bank income classification. Results : For high, upper middle and lower middle income countries, MT access was 15.75 %, 3 % and 0.06 %, MT Centers per million population were 0.95, 0.53 and 0.08 and MT operators per million population were 1.38, 0.81 and 0.10, respectively. On univariate analysis, MT access rate was significantly associated with: income class (p <0.011), reimbursement for MT (p <0.001) and % of GDP spent on healthcare (p = 0.001). On multivariate linear regression models, the factors that independently predict MT access were World Bank income class (p <0.029) and reimbursement (p = 0.002). Top areas where MT2020+ could assist the RCs were identified to be: training MT operators (75 %), approaching healthcare policymakers (50%) and reducing procedural costs (35%). Conclusions : There is a vast disparity in MT access across the globe. Country’s income and reimbursement for MT were independently predictive of MT access for LVOs. These findings help prioritize PHI to accelerate MT access.

The Global Financial Crisis and Healthcare Inequality in Japan

The aim of this study is to clarify whether health-care inequality in Japan widens during a depression, even though Japan has a universal health-care system. To this end, we investigate the time-series fluctuations in health-care expenditure inequalities in Japan for the period 2008–2017, which includes the period during which the global financial crisis affected Japan. We construct an economy-wide inequality index comparing the actual health-care expenditure at various income levels (low, middle and high) against the estimated health-care needs. The findings of the study are as follows. First, the rich (the top 20% income class) spend far more than their estimated needs on health care, whereas the poor (bottom 20%) spend far less. Second, during the global financial crisis, health-care inequality especially among the working generation became greater in Japan, mainly because not only the low-income class but also the middle-income class (the bottom 30–60%) was unable to pay for health care.

Assessing the financial burden of hemodialysis treatment in Malaysia

Background: Patients with chronic kidney disease (CKD) spend substantial money on hemodialysis (HD) treatment. The growing intersection between socioeconomic status and financial burden represents an emerging challenge to the CKD community. Objective: This study assessed the financial burden of HD treatment on patients at a Malaysian tertiary teaching hospital. Methods: A cross-sectional study was carried out in the HD unit at a Malaysian tertiary teaching hospital from January to February 2021. Patients undergoing HD were purposively selected. A self-administered questionnaire was used to collect data on socio-demographic, finances, the patient's health history, treatment costs, and healthcare utilization. In addition, Pearson Chi-Square tests were used to analyze the data. Results: A total of 100 patients receiving HD treatment were included in the study. The mean age was 62.06 years (SD = 27.50), with 52% reporting moderate financial burdens. The financial burden was associated with employment status, salary, and income class among HD patients (p <0.05). Conclusion: Evidence showed a large proportion of Malaysian patients receiving HD treatment came from the B40 income bracket. The findings indicate that financial burdens can impact HD patients and are related to employment status, salary, and income class. Therefore, the ability to identify HD patients' financial needs is critical in nursing practice.

Prevalence and associated factors of premature discontinuation of antiplatelet therapy after ischemic stroke: a nationwide population-based study

Background We tried to evaluate the prevalence of premature discontinuation of antiplatelets and its affecting factors after ischemic stroke using large-sized representative national claims data. Methods Patients aged 20 years or older with newly confirmed ischemic stroke who started aspirin or clopidogrel for the first time were selected from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of South Korea (n = 4621), a randomly collected sample which accounts for 2.2% (n = 1,017,468) of total population (n = 46,605,433). The prevalence of discontinuation of antiplatelets was measured every 6 months until the 24 months since the first prescription. Then we classified the participants into 2 groups according to the discontinuation status at 12 months and assessed the factors influencing premature discontinuation of antiplatelets within 12 months. Results Among total participants, 35.5% (n = 1640) discontinued antiplatelets within 12 months and 58.5% (n = 2704) discontinued them within 24 months. The remaining 41.5% (n = 1917) continued them for 24 months or more. In the multivariate logistic regression analysis, initiating treatment with aspirin monotherapy [adjusted OR (aOR), 2.66, 95% CI 2.17–3.25] was the most prominent determinant of premature discontinuation within 12 months followed by CCI score ≥ 6 (aOR 1.50, 95% CI 1.31–1.98), and beginning treatment with clopidogrel monotherapy (aOR 1.41, 95% CI 1.15–1.72). Rural residency (aOR 1.36, 95% CI 1.14–1.62), < 4 total prescribed drugs (aOR 1.24, 95% CI 1.05–1.47), lower income (aOR 1.20, 95% CI 1.03–1.40 for middle income class and OR 1.21, 95% CI 1.02–1.45 for low income class), and ages ≥70 years (aOR 1.15, 95% CI 1.00–1.31) were also significantly associated with premature discontinuation of antiplatelets within 12 months. Conclusions The prevalence of premature discontinuation of antiplatelets after ischemic stroke was quite high. Thus, by understanding factors associated with premature discontinuation, a more strategic approach is required for the physicians to improve persistence with antiplatelets.

Diabetes self-care practice and disease knowledge in patients with type 2 diabetes mellitus: A cross-sectional analysis with respect to age, educational attainment, income class and ongoing anti-diabetic treatments

Objective: To evaluate diabetes self-care practice and disease knowledge in type 2 diabetes mellitus (T2D) patients with respect to age, educational attainment, income class and antidiabetic treatments. Methods: A total of 583 patients with T2D (mean (SD) age: 57.3 (9.5) years, 55.9% females) were included in this cross-sectional study. Data on sociodemographic characteristics, diabetes characteristics (duration, current treatment), diabetes self-care practice [forgetting to take anti-diabetic medication, discontinuation of treatment due to side effects, self-monitoring of blood glucose (SMBG), diabetes education and regular exercise] and disease knowledge (definition and target levels of HbA1c, hypoglycemia symptoms and diabetes-related complications) were recorded. Results: Overall, HbA1c levels were >8% in 53.2% of patients, 38.3% of patients reported that they had no diabetes education, while at least twice daily SMBG and regular exercise was reported by 27.4% and 19.7% of patients, respectively. Lack of knowledge on definition and target levels of HbA1c was noted in up to 65.5% of patients, while majority of patients reported that they know hypoglycemia symptoms (89.2%) and diabetes-related complications (86.4%). Illiteracy was associated with higher likelihood of treatment discontinuation (p<0.001) and with lesser likelihood of performing regular exercise (10.3 vs. 32.8%, p<0.001). Older patient age, lower educational attainment and lower income level were associated with lesser likelihood of knowing the definition or target levels of HbA1c (p<0.001 for each) and sexual complications of diabetes (p<0.001, p<0.001 and p=0.028, respectively). Knowing diabetes-related complications were less common in those with lower educational attainment (p<0.001) and lower income level (p=0.010), while insulin-naïve patients were less likely to know hypoglycemia symptoms (p=0.010). Conclusion: In conclusion, our findings revealed poor glycemic control, low level of knowledge on definition and targets of HbA1c and lack of diabetes education with suboptimal adherence to self-care practice in a considerable percentage of patients. Disease knowledge but not SMBG practice significantly differed with respect to patient age, educational attainment, income class and treatment. Our findings seem to indicate lower disease-related insight among older patients and those with lower educational and income levels, emphasizing the potential role of individualized diabetes education interventions tailored to needs of patients to improve disease knowledge and thus the adherence to self-care practice in T2D patients.

P–721 Probability of receiving assisted reproductive technology treatment through out-of-pocket payment and household income: A discrete choice experiment in Japan

Study question What is the probability that patients will receive assisted reproductive technology (ART) treatment based on their out-of-pocket payment and income class? Summary answer Higher-income patients opted for ART even at a higher cost, whereas an out-of-pocket payment was the most influential determinant in all income groups. What is known already Economic disparities affect access to ART treatment in many countries. At the time of this survey, Japan provided partial reimbursement for ART treatment exclusively for those in low- or middle-income classes due to limited governmental budgets. However, the optimal financial support by income class is unknown. Study design, size, duration We conducted a discrete choice experiment (DCE) in Japan in January 2020 including 824 women with fertility problems who were recruited via an online social research panel. Participants/materials, setting, methods Participants included women aged 25–44 years undergoing fertility diagnosis or treatment. They completed a DCE questionnaire including 16 hypothetical scenarios, created by orthogonal design, to measure six relevant ART attributes (pregnancy rate, risk of adverse effects, number of visits to outpatient clinics, consultation hours, kindness of staff, and out-of-pocket expense) and their relation to treatment choice. We used mixed-effect logistic regression models to estimate the probability of receiving ART treatment for each attribute. Main results and the role of chance Of the 1,247 eligible women recruited, 824 completed the survey (66% participation rate). All six attributes significantly influenced treatment preference, with participants valuing out-of-pocket payment the most, followed by pregnancy rates and kindness of staff. The odds ratios of each attribute to receiving ART treatment were 0.58 (95% confidence interval [CI]: 0.57 − 0.59) for out-of-pocket payments per additional 100,000 Japanese yen (JPY; i.e., 800 euros), 1.47 (95% CI: 1.43 − 1.53) for pregnancy rates per additional 5%, and 4.16 (95% CI: 3.73 − 4.64) for kindness of staff, after adjusting for clinical and socioeconomic factors. Significant interactions occurred between high household income (≥8 million JPY) and high out-of-pocket payment (≥500,000 JPY). However, the mean predicted probability of the highest-income patients (i.e., ≥10 million JPY) to receive ART treatment at the average cost without public funding (i.e., 400,000 JPY) was 47% (interquartile range: 18%−76%), whereas that of middle-income patients (i.e., 6–8 million JPY) to receive ART at the average subsidized cost (i.e., 100,000 JPY) was 60% (interquartile range: 33%–88%). Limitations, reasons for caution Other attributes not included in our DCE scenarios might be relevant in real-life settings. Choices made in a DCE would not wholly match the actual treatment choices. Wider implications of the findings: The present DCE suggested that out-of-pocket payment was the primary determinant in patients’ ART decisions. High-income patients were more likely to receive ART treatment even at a high cost, but their ineligibility for government financial support due to their high income might discourage them from receiving treatment. Trial registration number NA