Socioeconomic Differences and Lung Cancer Survival—Systematic Review and Meta-Analysis

Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival.Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures.Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis.Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation

Air pollution and airway resistance at age 8 years - the PIAMA birth cohort study.

Air pollution has been found to adversely affect children's lung function. Forced expiratory volume in 1 s and forced vital capacity from spirometry have been studied most frequently, but measurements of airway resistance may provide additional information. We assessed associations of long-term air pollution exposure with airway resistance

Long COVID is associated with severe cognitive slowing: a multicentre cross-sectional study

Background COVID-19 survivors may experience a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing. Methods To examine cognitive slowing, patients with PCC completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). All patients with PCC completed the study between May 18, 2021 and July 4, 2023 in Jena University Hospital, Jena, Germany and Long COVID clinic, Oxford, UK. Findings We identified pronounced cognitive slowing in patients with PCC, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC's response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention. Interpretation Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in patients with PCC. Funding Wellcome Trust (206330/Z/17/Z), NIHR Oxford Health Biomedical Research Centre, the Thüringer Aufbaubank (2021 FGI 0060), German Forschungsgemeinschaft (DFG, FI 1424/2-1) and the Horizon 2020 Framework Programme of the European Union (ITN SmartAge, H2020-MSCA-ITN-2019-859890)

Fermi Large Area Telescope Constraints on the Gamma-ray Opacity of the Universe

The Extragalactic Background Light (EBL) includes photons with wavelengths from ultraviolet to infrared, which are effective at attenuating gamma rays with energy above ~10 GeV during propagation from sources at cosmological distances. This results in a redshift- and energy-dependent attenuation of the gamma-ray flux of extragalactic sources such as blazars and Gamma-Ray Bursts (GRBs). The Large Area Telescope onboard Fermi detects a sample of gamma-ray blazars with redshift up to z~3, and GRBs with redshift up to z~4.3. Using photons above 10 GeV collected by Fermi over more than one year of observations for these sources, we investigate the effect of gamma-ray flux attenuation by the EBL. We place upper limits on the gamma-ray opacity of the Universe at various energies and redshifts, and compare this with predictions from well-known EBL models. We find that an EBL intensity in the optical-ultraviolet wavelengths as great as predicted by the "baseline" model of Stecker et al. (2006) can be ruled out with high confidence.Comment: 42 pages, 12 figures, accepted version (24 Aug.2010) for publication in ApJ; Contact authors: A. Bouvier, A. Chen, S. Raino, S. Razzaque, A. Reimer, L.C. Reye

All-sky Medium Energy Gamma-ray Observatory: Exploring the Extreme Multimessenger Universe

The All-sky Medium Energy Gamma-ray Observatory (AMEGO) is a probe class mission concept that will provide essential contributions to multimessenger astrophysics in the late 2020s and beyond. AMEGO combines high sensitivity in the 200 keV to 10 GeV energy range with a wide field of view, good spectral resolution, and polarization sensitivity. Therefore, AMEGO is key in the study of multimessenger astrophysical objects that have unique signatures in the gamma-ray regime, such as neutron star mergers, supernovae, and flaring active galactic nuclei. The order-of-magnitude improvement compared to previous MeV missions also enables discoveries of a wide range of phenomena whose energy output peaks in the relatively unexplored medium-energy gamma-ray band

Regional variations in cancer outcome in Germany – assessing the impact of socioeconomic deprivation and cancer care

Area-based socioeconomic inequalities in cancer survival have been reported in several countries and for several cancer sites showing that cancer patients living in affluent regions have better survival than those living in deprived regions. It has been shown that deprivation-associated survival disparities might be more apparent when using smaller area-level deprivation measures. Possible reasons for these survival disparities could originate in differences in clinical prognostic factors or cancer care. The aims of this dissertation were to first give a comprehensive summary of the current literature on socioeconomic differences in lung cancer survival and then mainly to investigate deprivation-associated differences in cancer survival in Germany and if these differences depend on patient characteristics, clinical prognostic factors or cancer care. Furthermore, a comparison of survival disparities was made between individual and area-based education by using data for patients with colorectal cancer from the Finnish Cancer Registry. First, a systematic review and meta-analysis was conducted including studies reporting a measure of lung cancer survival in relation to education, income, occupation, or composite measures on individual or area-based level. In total, 23 studies measured the socioeconomic status on individual level and 71 on area-based level. The meta-analyses revealed a poorer prognosis for lung cancer patients with low individual income. Group comparisons of area-based studies indicated a poorer prognosis for lower socioeconomic groups. A consistent relationship between level of aggregation and effect size could not be confirmed due to heterogeneous reporting of measurements. To investigate the association between municipality-level socioeconomic deprivation and cancer survival in Germany, data for the 25 most common cancer sites from seven population-based cancer registries (covering 32 million inhabitants) were used. Patients were diagnosed in 1998-2014 and socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation on municipality level. Relative survival was estimated using the period approach for 2012-2014 and model-based period analysis to calculate relative excess risk adjusted for age and stage. In total, 2,333,547 cases were included. For most cancer sites, the most deprived quintile had lower 5-year relative survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, relative excess risk 1.16, 95 % confidence interval 1.14-1.19). To further investigate the underlying reasons for deprivation-associated survival disparities in Germany, data from three clinical cancer registries (Regensburg, Dresden, and Erfurt, covering 4 million inhabitants) were used. Patients diagnosed with lung cancer in 2000-2015 and female patients diagnosed with breast cancer in 2006-2016 were included. For lung cancer, the association of deprivation with overall survival was investigated using Cox regression models. For breast cancer, 5-year relative survival using the period approach for 2011-2016 and model-based period analysis to calculate relative excess risk was used. Both models were adjusted for age, stage, and grading, the breast cancer models additionally for estrogen receptor status. Region-specific analyses and subgroup analyses for patients receiving specific types of treatment were conducted. Overall, 22,905 lung cancer and 31,357 breast cancer cases were included. For lung cancer, the most deprived group had a lower overall survival compared to the least deprived group in the fully adjusted model. Patients diagnosed with stage I-III showed a lower survival in the most deprived quintile which persisted when further restricting to surgery but was attenuated for chemo- or radiotherapy subgroups. For breast cancer, the fully adjusted model showed no association between deprivation and 5-year relative survival. By contrast, there was an association between region and breast cancer survival, even after adjustment for socioeconomic deprivation. Regarding the comparison of cancer survival disparities between individual and municipality-level education, data of colorectal cancer patients diagnosed in 2007-2016 in Finland were used. Relative survival and relative excess risk were estimated by sex using period approach adjusted for age, stage at diagnosis, cancer site, urbanity, hospital district and municipality. In total, 24,462 cases were included. Area-based education revealed smaller effect estimates than individual education in colorectal cancer survival. Associations for individual education persisted even after adjustment for municipality-level education. The results of this dissertation show that a further approach for Germany should be to include individual socioeconomic status as well as area-based indices in analyses of cancer survival disparities. These future studies should include region, prognostic factors, complete data on cancer treatment but also other possibly relevant factors such as comorbidities. Furthermore, these analyses should be conducted stratified by cancer site as the present analyses showed different patterns for different cancer types

The evolution of health literacy assessment tools: a systematic review

Background: Health literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument. Methods: We performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE. Results: We identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline. Conclusions: Scholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear consensus on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations