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"ECONOMIC DISPARITY"
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Good economics for hard times
\"Figuring out how to deal with today's critical economic problems is perhaps the great challenge of our time. Much greater than space travel or perhaps even the next revolutionary medical breakthrough, what is at stake is the whole idea of the good life as we have known it. Immigration and inequality, globalization and technological disruption, slowing growth and accelerating climate change--these are sources of great anxiety across the world ... The resources to address these challenges are there--what we lack are ideas that will help us jump the wall of disagreement and distrust that divides us. If we succeed, history will remember our era with gratitude; if we fail, the potential losses are incalculable. In this ... book, renowned MIT economists Abhijit V. Banerjee and Esther Duflo take on this challenge\"--Publisher's description.
Book
Socioeconomic Disparities in Multiple Myeloma Survival in New South Wales Australia: A Population-Based Cohort Study
IntroductionAustralia has one of the highest incidence rates of multiple myeloma (MM) globally, and this burden is projected to increase significantly in the coming decades. Survival has improved over time, but it is not clear how this differs by socioeconomic group. Here, we used population-based data to evaluate survival differences by socioeconomic group and other prognostic factors of individuals with MM in Australia.MethodsThis retrospective study included individuals diagnosed with primary MM between 2008 and 2019, as recorded in the New South Wales Cancer Registry, with survival follow-up to 2020. The identified individuals with primary MM were classified into 3 socioeconomic groups (low, medium, high) based on their residential location at diagnosis. Competing-risk modelling was used to estimate sub-hazard ratios (SHR) for socioeconomic group adjusting for potential prognostic factors, including age at diagnosis, sex, year of diagnosis, remoteness areas, autologous stem cell transplantation (ASCT) use, and hospital type.ResultsOverall, 6,030 individuals were included in the study. The 5-year cumulative incidence of death due to MM was higher (p<0.0001) in low and medium socioeconomic groups (0.42 and 0.39), compared with the high socioeconomic group (0.34). Individuals in the high socioeconomic group were more likely to receive ASCT and to receive care at public principal referral/private hospitals. Compared to the high socioeconomic group, the excess risk of dying was higher (p<0.0001) in low (SHR=1.27, 95% CI: 1.14-1.42) and medium (SHR=1.20, 95% CI: 1.08-1.33) socioeconomic groups, but not statistically different (p=0.13) when other prognostic factors were considered.ConclusionSurvival disparity by socioeconomic groups among individuals with MM in Australia is largely accounted for by known prognostic factors, especially ASCT receipt and hospital type. Existing disparities suggest that a comprehensive evaluation of access to and availability of MM treatment, including identification of potential barriers to treatment receipt, is urgently needed.
Journal Article
The lies that bind : rethinking identity, creed, country, color, class, culture
\"Who do you think you are? That's a question bound up in another: What do you think you are? Gender. Religion. Race. Nationality. Class. Culture. Such affiliations give contours to our sense of self, and shape our polarized world. Yet the collective identities they spawn are riddled with contradictions, and cratered with falsehoods. Kwame Anthony Appiah's The Lies That Bind is an incandescent exploration of the nature and history of the identities that define us. It challenges our assumptions about how identities work. We all know there are conflicts between identities, but Appiah shows how identities are created by conflict. Religion, he demonstrates, gains power because it isn't primarily about belief. Our everyday notions of race are the detritus of discarded nineteenth-century science. Our cherished concept of the sovereign nation--of self-rule--is incoherent and unstable. Class systems can become entrenched by efforts to reform them. Even the very idea of Western culture is a shimmering mirage. From Anton Wilhelm Amo, the eighteenth-century African child who miraculously became an eminent European philosopher before retiring back to Africa, to Italo Svevo, the literary marvel who changed citizenship without leaving home, to Appiah's own father, Joseph, an anticolonial firebrand who was ready to give his life for a nation that did not yet exist, Appiah interweaves keen-edged argument with vibrant narratives to expose the myths behind our collective identities. These 'mistaken identities,' Appiah explains, can fuel some of our worst atrocities--from chattel slavery to genocide. And yet, he argues that social identities aren't something we can simply do away with. They can usher in moral progress and bring significance to our lives by connecting the small scale of our daily existence with larger movements, causes, and concerns. Elaborating a bold and clarifying new theory of identity, The Lies That Bind is a ringing philosophical statement for the anxious, conflict-ridden twenty-first century. This book will transform the way we think about who--and what--'we' are.\"--Dust jacket.
Book
Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair
BackgroundPreoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals.MethodsWe queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40 kg/m2, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index.ResultsA total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61 years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40 kg/m2, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42–0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40 kg/m2 compared to males (11%) and other races (11–15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001).ConclusionNearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair.
Journal Article
The forgotten : how the people of one Pennsylvania county elected Donald Trump and changed America
\"The people of Luzerne County, Pennsylvania, voted Democratic for decades, until Donald Trump flipped it in 2016. What happened? In [this book], Ben Bradlee Jr. reports on how voters in Luzerne County, a pivotal county in a crucial swing state, came to feel like strangers in their own land--marginalized by flat or falling wages, rapid demographic change, and a liberal culture that mocked their faith and patriotism. Fundamentally rural and struggling with limited opportunity, Luzerne County can be seen as a microcosm of the nation. In The Forgotten, Trump voters speak for themselves, explaining how they felt others were 'cutting in line' and that the federal government was taking too much money from the employed and giving it to the idle. The loss of breadwinner status, and more importantly, the loss of dignity, primed them for a candidate like Donald Trump. The political facts of a divided America are stark, but the stories of the men, women and families in The Forgotten offer a kaleidoscopic and fascinating portrait of the complex on-the-ground political reality of America today.\"--Dust jacket.
Book
Eliminating Medication Copayments Reduces Disparities In Cardiovascular Care
Substantial racial and ethnic disparities in cardiovascular care persist in the United States. For example, African Americans and Hispanics with cardiovascular disease are 10-40 percent less likely than whites to receive secondary prevention therapies, such as aspirin and beta-blockers. Lowering copayments for these therapies improves outcomes among all patients who have had a myocardial infarction, but the impact of lower copayments on health disparities is unknown. Using self-reported race and ethnicity for participants in the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial, we found that rates of medication adherence were significantly lower and rates of adverse clinical outcomes were significantly higher for nonwhite patients than for white patients. Providing full drug coverage increased medication adherence in both groups. Among nonwhite patients, it also reduced the rates of major vascular events or revascularization by 35 percent and reduced total health care spending by 70 percent. Providing full coverage had no effect on clinical outcomes and costs for white patients. We conclude that lowering copayments for medications after myocardial infarctions may reduce racial and ethnic disparities for cardiovascular disease. [PUBLICATION ABSTRACT]
Journal Article
High-risers : Cabrini-Green and the fate of American public housing
Braids personal narratives, city politics, and national history to tell the timely and epic story of Chicago's Cabrini-Green, America's most iconic public housing project. Built in the 1940s atop an infamous Italian slum, Cabrini-Green grew to twenty-three towers and a population of 20,000--all of it packed onto just seventy acres a few blocks from Chicago's ritzy Gold Coast. Cabrini-Green became synonymous with crime, squalor, and the failure of government. For the many who lived there, it was also a much-needed resource--it was home. By 2011, every high-rise had been razed, the island of black poverty engulfed by the white affluence around it, the families dispersed. In this novelistic and eye-opening narrative, Ben Austen tells the story of America's public housing experiment and the changing fortunes of American cities. It is an account told movingly through the lives of residents who struggled to make a home for their families as powerful forces converged to accelerate the housing complex's demise. Beautifully written, rich in detail, and full of moving portraits, High-Risers is a sweeping exploration of race, class, popular culture, and politics in modern America that brilliantly considers what went wrong in our nation's effort to provide affordable housing to the poor--and what we can learn from those mistakes.
Book
Socio-Economic Inequalities and Heart Failure Morbidity and Mortality: A Systematic Review and Data Synthesis
Abstract
Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.
Journal Article
Childhood sports club experiences mitigate the association between childhood socioeconomic disadvantage and functional disability in older Japanese men
This study examined whether childhood sports club experiences mitigate the association between childhood socioeconomic disadvantage and later life functional disability among older adults using a population-based study in Japan in a moderation analysis (
n
= 16,095, average age = 73 years). Functional disability was assessed using a 13-item measure of higher-level functional ability; scores below the 10th percentile indicated functional disability. Childhood socioeconomic status (SES) at age 15 years was assessed according to time-appropriate standards. Childhood sports club experiences were assessed according to the extent of club/group sports experience during different age periods. For both sexes, lower childhood SES was associated with higher functional disability risk, and longer cumulative childhood sports club experience was associated with lower risk. Childhood sports club experiences modified the association between childhood SES and functional disability in men. Among men with low childhood SES, those with two or more periods of childhood sports club experience had substantially lower functional disability risk than those with no experience (adjusted odds ratio = 0.32, 95% confidence interval: 0.21–0.50). In women, childhood sports club experience did not modify the association with functional disability, but it modified the association with impaired intellectual activity, a subscale of higher-level functional ability.
Journal Article
Uneven Development
In Uneven Development, a classic in its field, Neil Smith offers the first full theory of uneven geographical development, entwining theories of space and nature with a critique of capitalist development. Featuring pathbreaking analyses of the production of nature and the politics of scale, Smith's work anticipated many of the uneven contours that now mark neoliberal globalization. This third edition features an afterword updating the analysis for the present day.
eBook