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This article presents key findings from a study conducted from 2017 to 2024 to validate the educational and social project “L.I.F.T. – Lernen.Integration.Förderung. Tagesbetreuung” in Dumbrăveni, Transylvania, which was started by Diakonie International in 2016. The study was based on an innovative heuristic called Existential Poverty, which applies key elements of the psychotherapeutic theoretical school of existential analysis and logotherapy to poverty research. Central to this is the interpretation of the structural model of existence with its four basic dimensions and the prerequisites for personal action formulated, which can be deprived for socio-pathological reasons of poverty and social exclusion. On this basis, it is possible both to decipher the poverty-induced living environment of the children who attend the facility and to describe and evaluate the compensatory effects of the services provided by the validated day center.

INTRODUCTION:Poverty traps, locations with multigenerational poverty, result from structural and economic factors that can affect health of residents within these locations. The aim of this study was to define poverty traps within the contiguous United States and their impact on outcomes from liver diseases or cancers.METHODS:A systematic census-tract level analysis was used to spatially define regions that encompassed poverty traps. Clusters of prevalent poverty and mortality from chronic liver diseases or liver cancers were identified. Temporal trends and the relationship between race and ethnicity, type of space and escape from poverty traps on disease mortality within hot spots were determined.RESULTS:The proportion of census tracts enduring multigenerational poverty within counties was strongly associated with mortality from liver disease or cancer. There was a highly significant clustering of persistent poverty and increased mortality. Hot spots of high-mortality areas correlated with factors related to income, ethnicity, and access to health care. Location or noneconomic individual factors such as race and ethnicity were important determinants of disparities within hot spots. Distinct groups of poverty traps were defined. The highly characteristic demographics and disease outcomes within each of these groups underscored the need for location-specific interventions.DISCUSSION:Poverty traps are a major and important spatially determined risk factor for mortality from liver diseases and cancers. Targeted location-specific interventions and economic development aimed at addressing the underlying causes of poverty and enhancing prosperity will be required to reduce mortality from liver diseases within poverty traps.

PurposeThe purpose of this study was to identify the barriers, facilitators, and priority needs related to cancer prevention, control, and research in persistent poverty areas.MethodsWe conducted three focus groups with 17 providers and staff of primary care clinics serving persistent poverty areas throughout the state of Arkansas.ResultsWe identified multiple barriers, facilitators, and priority needs related to cancer prevention and control at primary care clinics serving persistent poverty areas. Barriers included transportation, medical costs, limited providers and service availability, and patient fear/discomfort with cancer topics. Facilitators identified were cancer navigators and community health events/services, and priority needs included patient education, comprehensive workflows, improved communication, and integration of cancer navigators into healthcare teams. Barriers to cancer-related research were lack of provider/staff time, patient uncertainty/skepticism, patient health literacy, and provider skepticism/concerns regarding patient burden. Research facilitators included better informing providers/staff about research studies and leveraging navigators as a bridge between clinic and patients.ConclusionOur results inform opportunities to adapt and implement evidence-based interventions to improve cancer prevention, control, and research in persistent poverty areas. To improve cancer prevention and control, we recommend locally-informed strategies to mitigate patient barriers, improved patient education efforts, standardized patient navigation workflows, improved integration of cancer navigators into care teams, and leveraging community health events. Dedicated staff time for research, coordination of research and clinical activities, and educating providers/staff about research studies could improve cancer-related research activities in persistent poverty areas.

We sought to determine the association of persistent poverty on patient outcomes relative to US News World Report (USNWR) rankings among individuals undergoing common major surgical procedures. Medicare beneficiaries who underwent AAA repair, CABG, colectomy, or lung resection were identified. Multivariable logistic regression was used to evaluate the relationship between care at USNWR hospitals, county-level duration of poverty (never-high poverty (NHP); intermittent high poverty (IHP): persistent-poverty (PP)) and 30-day mortality. Among 916,164 beneficiaries, individuals residing in PP neighborhoods who received surgical care at ranked hospitals had lower risk-adjusted 30-day mortality (5.89% vs 8.89%; p ​< ​0.001). On multivariable analysis, 30-day mortality was lower at ranked hospitals across all poverty categories with greatest decrease among patients from PP regions (NHP: OR-0.91, 95%CI0.87–0.95; IHP: OR-0.78, 95%CI0.69–0.88; PP: OR-0.69, 95%CI0.57–0.83; p ​< ​0.001). Receipt of surgical care at top-ranked hospitals was associated with improvement in postoperative mortality, especially among patients residing in persistent poverty.. •Hospital ranking and social determinants of health (i.e., persistent poverty) may serve as drivers of postoperative outcomes.•Top-ranked hospitals were associated with decreased postoperative mortality and morbidity.•Residence in impoverished regions was associated with worse postoperative mortality and morbidity.

Background The coronavirus disease 2019 (COVID-19) pandemic has highlighted the profound impact of diabetes and neighborhood environments on health outcomes. Persistent poverty areas, characterized by long-standing economic deprivation, may contribute to increased risk for severe COVID-19 outcomes, particularly among individuals with poor glycemic control. This study investigated the associations between persistent poverty, longitudinal glycemic control by diabetes status, and adverse COVID-19 outcomes using real world data. Methods We conducted a retrospective analysis using electronic health record (EHR) data from a large Academic health system. The sample included 3,681 adults diagnosed with COVID-19 between March 2020 and January 2021, with available HbA1c and neighborhood level data. Residence in census-tract level persistent poverty areas was categorized as yes vs. no while diabetes status and glycemic control were categorized into five groups based on history of diagnosis and HbA1c measured up to three years prior to infection. Bayesian multivariable logistic regression models assessed independent and multiplicative associations between living in a persistent poverty census tract, glycemic control by diabetes status, and adverse COVID-19 outcomes [e.g. hospitalization, intensive care unit (ICU) admission, and death during hospitalization], controlling for demographics and other social risk factors. Results Among 3,681 patients (mean age 54 years; 60% female; 47% Black), 41.4% were hospitalized, 19.2% were admitted to the ICU, and 6.2% died. Overall, 18.0% resided in persistent poverty areas, 36.2% had diabetes [16.6% undiagnosed diabetes, and 11.1% poorly controlled T2DM]. Residing in persistent poverty areas was associated with an increased risk of hospitalization (OR 1.28, 95% CI: 1.02–1.61), ICU admission (OR 1.40, 95% CI: 1.08–1.80), and mortality (OR 1.50, 95% CI: 1.01–2.22). Patients with undiagnosed diabetes had an increased risk of hospitalization (OR 3.05, 95% CI 2.41–3.86) and mortality (OR 1.96, 95% CI: 1.30–2.97). Conclusion This study highlights that residing in a persistent poverty census tract as well as poor glycemic control independently contribute to COVID-19 outcomes. Ongoing management of glycemic control and early preventive strategies in persistent poverty areas may mitigate adverse outcomes in COVID-19 infection and subsequent sequalae like Long COVID.

Purpose We aimed to (1) determine the extent of coverage of colorectal cancer patients in Arkansas All-Payer Claims Database (APCD), (2) assess coverage difference between persistent poverty and other areas, and (3) identify patient, tumor, and area factors associated with inclusion in APCD. Methods Data were from 2018 to 2020 Arkansas APCD linked with 2019 Arkansas Central Cancer Registry (ACCR). We constructed four cohorts to assess APCD’s coverage of CRC patients: (Cohort 1) ≥ 1 day of medical coverage in APCD in 2019; (Cohort 2) APCD coverage in the diagnosis month; continuous APCD coverage in the 30; Year around diagnosis (six months before to five months after diagnosis month) (Cohort 3); or until death within six months (Cohort 4). We compared proportions in the cohorts by area persistent poverty designation. Logistic regressions identified factors associated with inclusion in APCD cohorts. Patient selection CRC patients diagnosed in 2019 from ACCR, excluding in situ disease. Results Of the 1,510 CRC patients diagnosed in 2019, 83% had ≥ 1 day of medical coverage in 2019 APCD (Cohort1), 81% had coverage in the diagnosis month (Cohort 2), and 63% had continuous coverage in the year around diagnosis (Cohort 3). Additionally, 11% died within six months but had continuous coverage until death (Cohort 4, 74%). No coverage difference was found between persist poverty and other areas. Age and primary payer type at diagnosis were the main predictors of inclusion in APCD. Conclusion Arkansas APCD had high coverage of Arkansas CRC patients. No selection bias by area of persistent poverty designation was present.

PurposePrevious studies have shown that individuals living in areas with persistent poverty (PP) experience worse cancer outcomes compared to those living in areas with transient or no persistent poverty (nPP). The association between PP and melanoma outcomes remains unexplored. We hypothesized that melanoma patients living in PP counties (defined as counties with ≥ 20% of residents living at or below the federal poverty level for the past two decennial censuses) would exhibit higher rates of incidence-based melanoma mortality (IMM).MethodsWe used Texas Cancer Registry data to identify the patients diagnosed with invasive melanoma or melanoma in situ (stages 0 through 4) between 2000 and 2018 (n = 82,458). Each patient’s PP status was determined by their county of residence at the time of diagnosis.ResultsAfter adjusting for demographic variables, logistic regression analyses revealed that melanoma patients in PP counties had statistically significant higher IMM compared to those in nPP counties (17.4% versus 11.3%) with an adjusted odds ratio of 1.35 (95% CI 1.25–1.47).ConclusionThese findings highlight the relationship between persistent poverty and incidence-based melanoma mortality rates, revealing that melanoma patients residing in counties with persistent poverty have higher melanoma-specific mortality compared to those residing in counties with transient or no poverty. This study further emphasizes the importance of considering area-specific socioeconomic characteristics when implementing place-based interventions to facilitate early melanoma diagnosis and improve melanoma treatment outcomes.

BackgroundSocial determinants of health (SDoH) can impact access to healthcare. We sought to assess the association between persistent poverty (PP), race/ethnicity, and opioid access among patients with gastrointestinal cancer near the end-of-life (EOL).MethodsSEER-Medicare patients with gastric, liver, pancreatic, biliary, colon, and rectal cancer were identified between 2008 and 2016 near EOL, defined as 30 days before death or hospice enrolment. Data were linked with county-level poverty from the American Community Survey and the US Department of Agriculture (2000–2015). Counties were categorized as never high-poverty (NHP), intermittent high-poverty (IHP) and persistent poverty (PP). Trends in opioid prescription fills and daily dosages (morphine milligram equivalents per day) were examined.ResultsAmong 48,631 Medicare beneficiaries (liver: n = 6551, 13.5%; pancreas: n = 13,559, 27.9%; gastric: n = 5486, 1.3%; colorectal: n = 23,035, 47.4%), there was a steady decrease in opioid prescriptions near EOL. Black, Asian, Hispanic, and other racial groups had markedly decreased odds of filling an opioid prescription near EOL (Black: OR 0.84, 95% CI 0.79–0.90; Asian: OR 0.86, 95% CI 0.79–0.94; Hispanic: OR 0.90, 95% CI 0.84–0.95; Other: OR 0.83, 95% CI 0.74–0.93; all p < 0.05). Even after filling an opioid prescription, this subset of patients received lower daily doses versus White patients (Black: −16.5 percentage points, 95% CI −21.2 to −11.6; Asian: −11.9 percentage points, 95% CI −18.5 to −4.9; Hispanic: −19.1 percentage points, 95%CI −23.5 to −14.6; all p < 0.05). The disparity in opioid access and average daily doses among was attenuated in IHP/PP areas for Asian, Hispanic, and other racial groups, yet exacerbated among Black patients.ConclusionsRace/ethnicity-based disparities in EOL pain management persist with SDoH-based variations in EOL opioid use. In particular, PP impacted EOL opioid access and utilization.

Cancer mortality rates are substantially higher in persistent poverty US counties compared to non-persistent poverty US counties. This study aimed to assess the prevalence of cancer risk behaviors by persistent poverty. Counties with poverty rates of ≥ 20 % between 1990 and 2017–21 were classified as ‘persistent poverty’ (n = 318), and others were classified as ‘non-persistent poverty’ (n = 2801). Multivariable linear regression models were used to analyze differences in county-level prevalence estimates of five cancer risk behaviors (current smoking, excessive alcohol consumption, obesity, physical inactivity, insufficient and sleep), controlling for demographic and socioeconomic variables. Compared to non-persistent poverty counties, persistent poverty counties had higher prevalence of smoking (24.3 % vs. 18.5 %), obesity (42.5 % vs. 36.8 %), physical inactivity (34.3 % vs. 25.8 %), and insufficient sleep (38.6 % vs. 34.0 %); however, persistent poverty counties had lower prevalence of excessive alcohol consumption (14.3 % vs. 17.2 %). Adjusted analyses confirmed significant differences in all cancer risk behaviors studied except insufficient sleep. Persistent poverty counties exhibit higher prevalence of several cancer risk behaviors, which may contribute to elevated cancer mortality in these regions. Targeted public health interventions are needed to address these disparities. •Persistent poverty counties have had ≥ 20 % poverty for 30 + years.•Compared to others, persistent poverty counties have higher cancer mortality rates.•Smoking, obesity, physical inactivity are higher in persistent poverty counties.•Modifiable behaviors may contribute to cancer disparities by persistent poverty.

We evaluated the relationship between residing in persistent poverty (PP) and low socioeconomic census tracts on all-cause and colorectal cancer (CRC)-specific mortality, providing a current assessment of economic disadvantage and health outcomes. Using Surveillance, Epidemiology, and End Results Program Data (2006–2020), CRC cases were identified using ICD-10 codes and stage I-III were included in the analysis. Overlap propensity score weighting with marginal structural models estimated the risk of all-cause and CRC-specific mortality. Individuals living in PP had higher risk of all-cause mortality at 15-year follow-up, with an adjusted risk difference (ARD) and adjusted risk ratio (aRR) of 7.2 (95% CI 5.9–8.7) and 1.1 (95% CI 1.1–1.1), respectively, with similar results for CRC-specific mortality. Individuals living in low socioeconomic census tracts had higher risk of all-cause (ARD: 5.3, 95% CI 4.0–6.6; aRR: 1.1, 95% CI 1.6–1.1) and CRC-specific mortality (ARD: 2.7, 95% CI 1.7–3.7; aRR: 1.1, 95% CI 1.1–1.1) at 15-year follow-up. Thus, residing in PP or low socioeconomic census tract may impact health outcomes.