Effect of Poverty Level on the Relationship Between Hyperlipidemia and Cardiorenal Syndrome

Purpose. Elevated cholesterol is known to be associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) independently. Cardiorenal syndrome (CRS), a recently defined syndrome, is characterized by renal failure that is closely interrelated to cardiac dysfunction. The effect of socioeconomic status on cardiorenal syndrome has not been explored in a multi-ethnic population. In this retrospective secondary analysis, the hypothesis was tested if socioeconomic status modifies the effect of hyperlipidemia on CRS. Methods. The National Health and Nutrition Examination Survey (NHANES) is a cross sectional survey done on the non-institutionalized population of the United States. All patients from the NHANES study, 20 years and older between the years 1999-2010 were included in the analysis. CRS was determined using a standard GFR equation and history of CVD. Analysis was performed using complex samples logistic regression to determine the relationship of hyperlipidemia on CRS. Results. Data on CRS status was available for 24,625 individuals (48.9% males & 51.1% females) and was representative of 173,805,863 individuals. The overall unadjusted odds ratio of CRS for hyperlipidemia to no hyperlipidemia was 3.01 (95% confidence interval [CI], 2.62-3.47, p \u3c 0.001). The adjusted OR was elevated, 2.20 (CI 1.20-4.05, p \u3c 0.01), among individuals living below poverty threshold but close to 1.0 (1.63 CI 1.31-2.03, p \u3c 0.001) among patients above poverty threshold, after the results were controlled for medical risk factors and demographic risk factors. Conclusions. Hyperlipidemia is strongly associated with CRS in a nationally representative multi-ethnic population and must be taken into special consideration when treating underprivileged patients. Longitudinal studies should further examine this association and demonstrate how socioeconomic status plays a role

Disparities in Breast Cancer Stage at Diagnosis: Importance of Race, Poverty, and Age

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis

Housing Search in the Age of Big Data: Smarter Cities or the Same Old Blind Spots?

Housing scholars stress the importance of the information environment in shaping housing search behavior and outcomes. Rental listings have increasingly moved online over the past two decades and, in turn, online platforms like Craigslist are now central to the search process. Do these technology platforms serve as information equalizers or do they reflect traditional information inequalities that correlate with neighborhood sociodemographics? We synthesize and extend analyses of millions of US Craigslist rental listings and find they supply significantly different volumes, quality, and types of information in different communities. Technology platforms have the potential to broaden, diversify, and equalize housing search information, but they rely on landlord behavior and, in turn, likely will not reach this potential without a significant redesign or policy intervention. Smart cities advocates hoping to build better cities through technology must critically interrogate technology platforms and big data for systematic biases

Wellbeing and social determinants of health among Australians during the COVID-19 pandemic: A mixed methods study

Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), or COVID-19, was first identified in China in December 2019. Due to the severity and swiftness of the spread of the outbreak, the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern on 30 January 2020. Subsequent public health mitigation strategies, such as lockdowns, border restrictions and social distancing, were implemented globally to combat the widespread transmission of COVID-19. The flow-on effect of the paused social and economic activity of the nationwide Australian lockdowns caused some population groups to experience unemployment, loss of income, housing instability and food insecurity. However, the impact of the public health mitigation strategies on Australians is dependent on the state of their pre-pandemic social determinants of health. ‘Social determinants of health’ was first coined as a term in the 1970s and refers to the conditions in an individual’s environment wherein they are born, grow, live, learn, work and age. These conditions are shaped by the distribution of power, money and resources, influencing health both directly and indirectly. Furthermore, it has been established that social determinants of health can impinge on an individual’s wellbeing. Wellbeing, as used in this thesis, is a multidimensional paradigm encompassing physical, psychological, financial, spiritual, occupational, social, intellectual and environmental elements that interconnect to facilitate positive wellbeing. With the emergence of a new infectious disease, and with many Australians already experiencing the negative effects of the social determinants of health, this PhD thesis explores the relationship between wellbeing and the social determinants of health among Australian adults during the COVID-19 pandemic. Methods An explanatory sequential mixed methods study design underpinned by the WHO Commission on Social Determinants of Health conceptual framework was used. The study was undertaken in two distinct phases: quantitative and qualitative. Phase 1—quantitative—used an online cross-sectional study design undertaken between August 2020 – October 2020 and recruited a diverse sample of 1,211 participants from across Australia. Data were analysed using descriptive and inferential statistics using Statistical Package for the Social Sciences (SPSS) version 25. All data in phase 1 were analysed prior to conducting phase 2 of the research. Phase 2—qualitative—used a descriptive qualitative study design informed by the results of phase 1. Purposeful sampling was used to identify and recruit participants from the online cross-sectional study (phase 1) who agreed to participate in an interview. Data were collected using semi-structured interviews between March 2021 – August 2021, with the interviews audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis supported by NVivo version 12. Results Fundamental to a mixed methods study design, the results of each of the phases was integrated using a connection model as described by Creswell. Three key findings emerged from this thesis. 1. Food and housing insecurity impact wellbeing: The most significant finding of this thesis is that food and housing insecurity during the COVID-19 pandemic were high among Australians and were associated with diminished wellbeing. Difficulty accessing food was more prevalent among Australians living in lower socioeconomic areas and was amplified by reduced financial capacity and loss of employment as a result of the pandemic. Similarly, housing insecurity was predominantly associated with Australians living in lower socioeconomic areas and almost exclusively among women. Economic vulnerability through loss of employment and income, especially among Australians in a low socioeconomic areas experiencing food- and housing-related stress, influenced their overall wellbeing. 2. Social capital influences the ability to cope during the pandemic: It was determined that those with strong social support had significantly higher wellbeing scores compared to Australians with moderate and poor social support. Additionally, social support was found to be a predictor of wellbeing; those with strong social support had better wellbeing. Australians’ lived experiences of social capital during the pandemic demonstrated that ‘no person is an island’, with most participants voicing concerns regarding a loss of social connection. The results showed that Australians with high social capital prior to the pandemic were able to remain socially connected during the lockdown periods, resulting in a greater capacity to cope mentally during the pandemic. Australians with low social capital and social support during the pandemic resorted to drug and alcohol use as a way to cope with the loneliness and isolation of the lockdowns. 3. Employment and income loss are associated with low socioeconomic status: Economic wellbeing was influenced by employment and income loss among Australians during the pandemic. There was an association between economic wellbeing and Australians who resided in low socioeconomic areas, with those living in low socioeconomic areas having significantly higher odds of experiencing employment loss during the pandemic. Loss of employment and income during the pandemic resulted in housing and food insecurities, as explained by participants in the qualitative study. This was particularly true for female Australians who resided in low socioeconomic areas. Those who experienced employment and income loss felt that their wellbeing substantially worsened as they were not only dealing with the uncertainties of the pandemic but were also trying to cope with challenges such as lack of finances, inability to pay bills and loss of employment. Conclusion This thesis provides new evidence for the relationship between Australians’ wellbeing and social determinants of health during the COVID-19 pandemic. The findings demonstrate that Australians, particularly those residing in low socioeconomic areas, experienced significant food and housing insecurity, had low social capital, and were more likely to have income and employment loss that influenced their overall wellbeing during the COVID-19 pandemic. This thesis shines a light on the social determinants of health and reveals that there are social and health inequalities within Australian society that need addressing. Recommendations for public health in addressing the social determinants of health include lobbying governments to incorporate the social determinants of health in all policies, implementing strategies to address food security, and implementing public health interventions to address low social capital. Policy recommendations involve addressing housing affordability, renewing action on the United Nations Sustainable Development Goals and implementing policies to address employment and income security

‘A Different Ball Game’: Engaging Men from Rural and Lower Socioeconomic Areas in Behavioural Weight Management Interventions

Men in lower socioeconomic rural areas are at higher risk of ill-health but less likely to participate in preventative health interventions than rural women. This thesis highlights that a greater consideration of socioeconomic factors in weight management interventions for men is required. Then, provides a case example for how a metropolitan program can be adapted with rural stakeholders, and offers insights into how popular local sports can help engage rural men in health interventions

Inequality, Social Networks, and Internet Use: Exploring the Implications of the Social Diversification Hypothesis

The social diversification hypothesis (SDH) suggests that in multicultural societies Internet use can help mitigate structural inequalities in access to social resources. Whereas traditionally disadvantaged groups are predicted to use the Internet to expand and diversify their social networks, advantaged groups use it to maintain existing connections. The present study investigates this central prediction of the SDH by examining the relationship between Internet and social network site (SNS) use and inequalities in network size and diversity based on race, sex, and education among a nationally representative sample of U.S. adults. The results largely contradict the SDH. Internet and SNS use were associated with greater network-based inequalities stemming from education. The relationships between education and indicators of network size and diversity were stronger among Internet users than non-users and stronger among SNS users than Internet-only users. Network inequalities directly related to race, sex, and education were also explored

Inequality Matters

This is one of a series of five papers outlining the particular domains and dimensions of inequality where new research may yield a better understanding of responses to this growing issue.The aim of this paper is to describe, in very broad brushstrokes, the state of academic scholarship regarding social inequality, with an eye toward identifying important gaps. The focus is on four key interacting social domains: 1) socioeconomic (financial and human capital)2) health (including physical and psychological) 3) political (access to power and political representation)4) sociocultural (identity, cultural freedoms, and human rights

Social vs. practical problems in attaining a colonoscopy: Different patient profiles?

Background: Colonoscopy is an effective procedure for identifying precancerous polyps and cancerous lesions, but it is unlike other cancer screening tools in that it requires sedation and thus assistance from at least one other individual. The intent of this paper was to identify logistical problems in completing the colonoscopy and to examine their relationships with sociodemographic characteristics. Methods: All eligible patients (n = 2500) from two academic-affiliated colonoscopy centers (one free standing, one hospital-based) were invited to participate in an onsite, pre-colonoscopy survey; patients agreeing to participate (n = 1841, RR = 73.6%) received a $5.00 gift card. Multiple correspondence analysis (MCA) was used to identify the underlying dimensional structure of the problems. Bivariate statistics were performed to compare demographic variables and health literacy levels among patients reporting problems. Multivariate logistic regression with a backwards conditional solution was used to determine the demographic variables independently associated with problems. Results: Multiple correspondence analyses indicated two dimensions of problems (social and practical). Using logistic regression, social problems (e.g., finding someone to accompany the patient) were associated with not living in the same home as the driver, not working due to disability, and younger age. Practical problems (e.g., making an appointment) were associated with “other” minority race, poorer health, lower health literacy, and younger age. Conclusion: Patients experience different problems completing the colonoscopy based on socio-demographics. Particularly at risk are patients who find it difficult to navigate the system, are of younger age, or who may have smaller social networks