International Journal of Environmental Research and Public Health

Research

15 pages, 340 KiB

Open AccessArticle

Differences in Outpatient Health Care Utilization 12 Months after COVID-19 Infection by Race/Ethnicity and Community Social Vulnerability

by Sarah E. Roth, Diana J. Govier, Katherine Marsi and Hannah Cohen-Cline

Int. J. Environ. Res. Public Health 2022, 19(6), 3481; https://doi.org/10.3390/ijerph19063481 - 15 Mar 2022

Cited by 11 | Viewed by 2764

Abstract

Ensuring access to high-quality outpatient care is an important strategy to improve COVID-19 outcomes, reduce social inequities, and prevent potentially expensive complications of disease. This study assesses the equity of health care response to COVID-19 by examining outpatient care utilization by factors at [...] Read more.

Ensuring access to high-quality outpatient care is an important strategy to improve COVID-19 outcomes, reduce social inequities, and prevent potentially expensive complications of disease. This study assesses the equity of health care response to COVID-19 by examining outpatient care utilization by factors at the individual and community levels in the 12 months prior to and following COVID-19 diagnosis. Employing a retrospective, observational cohort design, we analyzed electronic health record data from a sample of 11,326 adults diagnosed with COVID-19 between March and July 2020. We used two-part models to estimate changes in use of primary and specialty care by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our findings showed that while overall probability and counts of primary and specialty care visits increased following a positive COVID-19 diagnosis, disparities in care utilization by race/ethnicity and living in a socially vulnerable community persisted in the year that followed. These findings reiterate the need for strategic approaches to improve access to and utilization of care among those diagnosed with COVID-19, especially for individuals who are traditionally undeserved by the health system. Our findings also highlight the importance of systematic approaches for addressing social inequity in health care. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

13 pages, 342 KiB

Open AccessArticle

High Fear of Discriminatory Violence among Racial, Gender, and Sexual Minority College Students and Its Association with Anxiety and Depression

by Erin Grinshteyn, Reid Whaley and Marie-Claude Couture

Int. J. Environ. Res. Public Health 2022, 19(4), 2117; https://doi.org/10.3390/ijerph19042117 - 14 Feb 2022

Cited by 9 | Viewed by 2995

Abstract

Minority students experience more discrimination on college campuses, yet little is known about fear of discrimination. This paper (a) establishes a new measure, fear of discriminatory violence, (b) assesses sociodemographic correlates of fear of discriminatory violence, and (c) estimates the effect of fear [...] Read more.

Minority students experience more discrimination on college campuses, yet little is known about fear of discrimination. This paper (a) establishes a new measure, fear of discriminatory violence, (b) assesses sociodemographic correlates of fear of discriminatory violence, and (c) estimates the effect of fear of discriminatory violence on anxiety and depression. A cross-sectional study using online surveys was undertaken among college students. A zero-inflated negative binomial model estimated the association between sociodemographics and fear of discriminatory violence. Multiple logistic regression models estimated the association between fear of discriminatory violence and anxiety/depression. Fear of discriminatory violence was higher among Black (ME: 11.9, p < 0.0001), Hispanic (ME: 5.9, p < 0.0001), Middle Eastern (ME: 5.4, p = 0.03), Asian (ME: 4.9, p < 0.0001), and multiracial (ME: 2.9, p < 0.0001) students compared with White students; transgender/gender non-conforming (ME: 7.2, p = 0.01) and female (ME: 3.4, p < 0.0001) students compared with male students; and gay (ME: 10.7, p < 0.0001), lesbian (ME: 9.0, p = 0.01), and bisexual students (ME: 3.4, p = 0.001) as well as those with a sexual orientation not included (ME: 5.5, p = 0.001), compared with heterosexual students. Increasing fear of discriminatory violence was associated with increased odds of anxiety (AOR: 1.04; 95% CI: 1.02, 1.06) and depression (AOR: 1.03; 95% CI: 1.02, 1.05). This understudied public health issue should be addressed to prevent fear of discriminatory violence and the resulting mental health consequences among college populations. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

10 pages, 358 KiB

Open AccessArticle

How Did the COVID-19 Pandemic Affect Migrant Populations in Lisbon, Portugal? A Study on Perceived Effects on Health and Economic Condition

by Ana Gama, João Victor Rocha, Maria J. Marques, Sofia Azeredo-Lopes, Ana Rita Pedro and Sónia Dias

Int. J. Environ. Res. Public Health 2022, 19(3), 1786; https://doi.org/10.3390/ijerph19031786 - 4 Feb 2022

Cited by 15 | Viewed by 2318

Abstract

Increasing evidence on the effects of the COVID-19 pandemic suggests that its social and health impacts are being disproportionately shouldered by socioeconomically disadvantaged populations, including migrants. Knowledge of how these populations are experiencing the COVID-19 crisis is scarce. We examined the effects of [...] Read more.

Increasing evidence on the effects of the COVID-19 pandemic suggests that its social and health impacts are being disproportionately shouldered by socioeconomically disadvantaged populations, including migrants. Knowledge of how these populations are experiencing the COVID-19 crisis is scarce. We examined the effects of the pandemic on the perceived individual financial situation and health condition of migrants in Lisbon, Portugal, and described the most affected subgroups. A cross-sectional survey was conducted with a diverse community-based sample of 1126 migrants. A worsening of their financial situation since the pandemic was reported by 55.6% of the participants and a worsening of their health condition by 19.9%. A worsened financial situation was most often reported by those ≥45 years old and with a lower income (<EUR 650). Likewise, a worsened health condition was most often reported by older and lower-income migrants, as well as by women and those with a lower level of education. Migration-related factors such as length of stay and migration status were not associated with worsened health conditions. Socioeconomic characteristics appear to be more important when assessing differences in perceived effects of the pandemic among migrants. The social impact of the pandemic both exacerbates economic and gender inequalities and may lead to worse health conditions within the population in the medium and long terms. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

21 pages, 1822 KiB

Open AccessArticle

The Unequal Effect of the COVID-19 Pandemic on the Labour Market and Income Inequality in China: A Multisectoral CGE Model Analysis Coupled with a Micro-Simulation Approach

by Qi Zhang, Xinxin Zhang, Qi Cui, Weining Cao, Ling He, Yexin Zhou, Xiaofan Li and Yunpeng Fan

Int. J. Environ. Res. Public Health 2022, 19(3), 1320; https://doi.org/10.3390/ijerph19031320 - 25 Jan 2022

Cited by 16 | Viewed by 4427

Abstract

The COVID-19 pandemic had an unequal impact on the employment and earnings of different labourers, consequently affecting households’ per capita income and income inequality. Combining a multisector computable general equilibrium model of China with a micro-simulation approach, this study aims to analyse the [...] Read more.

The COVID-19 pandemic had an unequal impact on the employment and earnings of different labourers, consequently affecting households’ per capita income and income inequality. Combining a multisector computable general equilibrium model of China with a micro-simulation approach, this study aims to analyse the unequal effect of the COVID-19 pandemic on China’s labour market and income inequality. The results confirm the unequal impact of the pandemic on the employment and earnings of different labourer types. Labourers who are female, live in urban areas, and have relatively low education levels would suffer greater losses in employment and earnings. The pandemic would reduce household per capita income by 8.75% for rural residents and 6.13% for urban residents. While the pandemic would have a larger negative impact on the employment and earnings of urban labourers, it would have a greater negative impact on the household per capita income of rural residents. Moreover, the per capita income of low-income households is more vulnerable to the pandemic, and the number of residents living below the poverty line would increase significantly. Thus, the pandemic would aggravate income inequality in China and threaten the livelihoods of poor families. This study could inform researchers exploring the distributional effect of the COVID-19 pandemic in developing countries. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

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13 pages, 757 KiB

Open AccessArticle

Race, Adolescent Socioeconomic Status, and Lifetime Non-Medical Use of Prescription Painkillers: Evidence from the National Longitudinal Study of Adolescent to Adult Health

by Amy Ehntholt, Roman Pabayo, Lisa Berkman and Ichiro Kawachi

Int. J. Environ. Res. Public Health 2021, 18(23), 12289; https://doi.org/10.3390/ijerph182312289 - 23 Nov 2021

Cited by 3 | Viewed by 2613

Abstract

The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. [...] Read more.

The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

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13 pages, 664 KiB

Open AccessArticle

Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health?

by Rachelle Meisters, Polina Putrik, Daan Westra, Hans Bosma, Dirk Ruwaard and Maria Jansen

Int. J. Environ. Res. Public Health 2021, 18(19), 10177; https://doi.org/10.3390/ijerph181910177 - 28 Sep 2021

Cited by 9 | Viewed by 3069

Abstract

Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this [...] Read more.

Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this study was to explore the contribution of loneliness to socio-economic health inequalities. These contributions were studied in a Dutch national sample (n = 445,748 adults (≥19 y.o.)) in Poisson and logistic regression models, controlling for age, gender, marital status, migration background, BMI, alcohol consumption, smoking, and physical activity. Loneliness explained 21% of socioeconomic health inequalities between the lowest and highest socio-economic groups in self-reported chronic disease prevalence, 27% in poorer self-rated health, and 51% in psychological distress. Subgroup analyses revealed that for young adults, loneliness had a larger contribution to socioeconomic gaps in self-rated health (37%) than in 80+-year-olds (16%). Our findings suggest that loneliness may be a social determinant of health, contributing to the socioeconomic health gap independently of well-documented factors such as lifestyles and demographics, in particular for young adults. Public health policies targeting socioeconomic health inequalities could benefit from integrating loneliness into their policies, especially for young adults. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

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13 pages, 344 KiB

Open AccessArticle

Neighborhood Income Inequality and Alcohol Use among Adolescents in Boston, Massachusetts

by Roman Pabayo, Daniel M. Cook, Gregory Farmer and Beth E. Molnar

Int. J. Environ. Res. Public Health 2021, 18(16), 8484; https://doi.org/10.3390/ijerph18168484 - 11 Aug 2021

Cited by 4 | Viewed by 2247

Abstract

Objectives: Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area units, such as neighborhoods. We investigated whether neighborhood income inequality is associated with alcohol [...] Read more.

Objectives: Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area units, such as neighborhoods. We investigated whether neighborhood income inequality is associated with alcohol consumption among adolescents. Methods: We analyzed cross-sectional data from a sample of 1878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. Multilevel logistic regression modeling was used to determine the role of neighborhood income inequality and the odds for alcohol consumption and to determine if social cohesion and depressive symptoms were mediators. Results: In comparison to the first tertile of income inequality, or the most equal neighborhood, adolescent participants living in the second tertile (AOR = 1.20, 95% CI: 0.89, 1.61) and third tertile (AOR = 1.44, 95% CI: 1.06, 1.96) were more likely to have consumed alcohol in the last 30 days. Social cohesion and depressive symptoms were not observed to mediate this relationship. Conclusions: Findings indicate that the distribution of incomes within urban areas may be related to alcohol consumption among adolescents. To prevent alcohol consumption, public health practitioners should prioritize prevention efforts for adolescents living in neighborhoods with large gaps between rich and poor. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

12 pages, 1272 KiB

Open AccessArticle

Gender Differences in Prevalence and Risk Factors for Hypertension among Adult Populations: A Cross-Sectional Study in Indonesia

by Selly Ruth Defianna, Ailiana Santosa, Ari Probandari and Fatwa Sari Tetra Dewi

Int. J. Environ. Res. Public Health 2021, 18(12), 6259; https://doi.org/10.3390/ijerph18126259 - 9 Jun 2021

Cited by 14 | Viewed by 5122

Abstract

Although hypertension is among the main public health concerns in Indonesia, due to the scarcity of data, few studies have investigated the factors associated with hypertension in men and women. This study aimed to examine the prevalence of and factors associated with hypertension [...] Read more.

Although hypertension is among the main public health concerns in Indonesia, due to the scarcity of data, few studies have investigated the factors associated with hypertension in men and women. This study aimed to examine the prevalence of and factors associated with hypertension among adult men and women in Indonesia. The 2018 Survey of the Sleman Health Demographic and Surveillance System was utilized, consisting of 4328 individuals aged 18+ years. Multivariable logistic regression analysis was performed to determine the sociodemographic and health behavior factors of hypertension. Overall, the prevalence of hypertension was 40% (42% in men and 38% in women). Age, abdominal obesity and chronic non-communicable diseases were the common predictors of hypertension in men and women (p < 0.05). The odds ratio of hypertension among men with low education was lower than among those with high education (OR = 0.52, 95% CI: 0.29–0.94). For women, being in the poorest socioeconomic condition increased the risk of hypertension by 1.67 times compared to the richest (95% CI: 1.21–2.32). Gender differences in the prevalence of and factors associated with hypertension were observed among adult populations in Sleman District, Yogyakarta, Indonesia. Therefore, a gender-based approach in the health prevention strategy to control hypertension for men and women is needed. Full article

(This article belongs to the Special Issue Social Inequality and Health: Determinants, Mechanisms, and Consequences)

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