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"social deprivation"
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Association of mortality and social deprivation index in patients undergoing emergency general surgery: Results from a regional healthcare system
Emergency General Surgery (EGS) has high complication and mortality rates and social factors have been associated with outcomes in national datasets. Social deprivation index (SDI) is a validated geographic area demographic index used to quantify variations in healthcare. We sought to examine the association of SDI with mortality of high-risk EGS procedures at a regional level across a large integrated healthcare system.
This is a retrospective cohort study of adult patients with ICD10 codes for EGS diagnoses who underwent high-risk procedures (small bowel resection, colectomy, gastroduodenal repair or resection, or combined procedures) in a large integrated healthcare system from 2017 to 2021. Our primary exposure was SDI. Primary outcome was inpatient mortality. Secondary outcomes were return to OR (RTOR), venous thromboembolism (VTE), and extended length of stay (≥75th percentile by procedure) (ELOS). Outcomes were analyzed by SDI and adjusted for age, race, Elixhauser Comorbidity Index, insurance, procedure, and initial shock index using multivariable logistic regression. Facilities were also analyzed by the SDI distribution of their EGS population.
A total of 9441 hospital encounters were identified with 2765 high-risk procedure hospital encounters across nine hospitals. Overall inpatient mortality in the study cohort was 8.6 %. EGS patients undergoing high-risk procedures from the most disadvantaged areas had higher mortality rates and were more likely to require RTOR than those from the least disadvantaged areas after adjustment for covariates (OR 2.1, p = 0.01; OR 1.9, p = 0.001).
SDI is associated with higher mortality and RTOR in EGS patients undergoing high-risk procedures. This study highlights the importance of local or regional area descriptions of population deprivation which may lead to geographically targeted interventions and prevention strategies.
•Emergency general surgery patients from disadvantaged areas had higher mortality rates than patients from less disadvantaged areas•Emergency general surgery patients from disadvantaged areas were more likely to require return to the OR than patients from less disadvantage areas•Facilities within a large healthcare system had different proportions of patients from disadvantaged areas•Geographic targeting of interventions to communities at risk may improve surgical outcomes
Journal Article
A Comprehensive Insight into the Economic Profile of People Receiving Metabolic and Bariatric Surgery Use in France
Background
The use of metabolic and bariatric surgery (MBS) is not uniformly distributed within the population, even if it is governed by established guidelines. This disparity seems to be associated, among other factors, with the economic profile of people receiving this surgery.
Objectives
We investigated the disparities in the use of MBS with respect to the socio-economic level in France based on socio-economic status (SES).
Materials and Methods
A descriptive observational study was conducted to compare the population of individuals with obesity who underwent MBS (MBS group) with individuals with obesity with no history of MBS (obese group). Data were extracted from the French National Hospital discharge database (“Programme De Médicalisation des Systèmes d’Information,” PMSI). Socio-economic status (SES) was assessed through the French Deprivation Index (FDep).
Results
The use of MBS was significantly lower in patients having a higher SES compared to those having a lower one. There was no statistically significant difference in the use of MBS between individuals within the 4th and 5th SES quintiles compared to those in the 2nd and 3rd quintiles. No difference was found in the specific MBS procedures used depending on the SES. The obesity level was significantly lower in patients from the 1st and 3rd SES quintiles compared to the patients having a lower SES.
Conclusion
Our study provides valuable insights into the complex interrelationships between the use of MBS, patients’ SES, and obesity levels according to the FDep. These findings underscore the importance of developing targeted interventions to address disparities in the use of bariatric care.
Graphical Abstract
Journal Article
Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis
The incidence of psychotic disorders varies between geographical areas and it has been hypothesized that neighbourhood-level factors may influence this variation. It is also plausible that the duration of untreated psychosis (DUP) is associated with neighbourhood characteristics. The aims of this study were to determine whether the incidence of first-episode psychosis (FEP) and the DUP are associated with the level of social deprivation, fragmentation, social capital and population density.
All individuals with a FEP from a geographical defined catchment area over a 5-year period were included. Age-standardized incidence rates were calculated for each neighbourhood factor.
A total of 292 cases of FEP were included in the study and 45% had a diagnosis of a schizophrenia-spectrum disorder. The age standardized incidence rate of FEP in the most deprived area was 72.4 [95% confidence interval (CI) 26.4-162.7] per 100 000 person-years compared with 21.5 (95% CI 17.6-26.0) per 100 000 person-years in the most affluent areas. This represents a 3.4-fold increase in FEP incidence in the most deprived areas. The incidence of FEP was also increased in neighbourhoods that were more socially fragmented [incidence rate ratio (IRR) = 2.40, 95% CI 1.05-5.51, p = 0.04] and there was a trend for the incidence to be increased in neighbourhoods with lower social capital (IRR = 1.43, 95% CI 0.99-2.06, p = 0.05). The median DUP was 4 months and was higher in more socially fragmented neighbourhoods.
The incidence of psychotic disorders is related to neighbourhood factors and it may be useful to consider neighbourhood factors when allocating resources for early intervention services.
Journal Article
The social deprivation index and deep brain stimulation: A cohort study
Deep brain stimulation (DBS) is an important treatment option for patients with movement disorders; however, prior studies have demonstrated inequitable access to this important treatment. We used the Social Deprivation Index (SDI), an index of neighborhood affluence, to examine the distribution of DBS cases and to determine the association between the SDI and outcomes.
This was a retrospective cohort study of all patients who have undergone DBS implantation within the University of Pennsylvania Health System (UPHS) from January 1st, 2013, to April 1st, 2024. SDI values associated with each ZIP code range from zero (no distress/prosperous) to 100 (highest distress) and were dichotomized into low (<50) and high (50−100) categories.
The prevalence of DBS cases performed at UPHS across low SDI ZIP codes was 4.8 per 100,000 (95 % CI (confidence interval) 4.4 – 5.2), compared to 2.4 per 100,000 people (95 % CI 2.1 – 2.7) across high SDI ZIP codes, equivalent to a rate ratio of 2.0 (95 % CI 1.7 – 2.3, p < 0.001). Adjusting for age, sex, insurance type, comorbidities, and indication for DBS, people living in more deprived regions had higher odds of readmission, but this was not statistically significant (OR 2.22, 95 % CI 0.91 – 5.45, p-value 0.08).
In our single-center study, most people who received DBS at our institution resided in more affluent neighborhoods. In the future, the SDI could be used to effectively target outreach efforts to geographic areas with decreased access to DBS.
•The Social Deprivation Index (SDI) is a composite measure of social disadvantage.•The correlation of SDI with DBS access/outcomes has not been examined.•Over three-quarters of DBS patients were residents of more affluent neighborhoods.
Journal Article
Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina
The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions—the social deprivation index (SDI). Data were analyzed using chi-square tests, Student’s t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02–1.10), African American race (OR = 1.35, 95% CI: 1.29–1.41), and being unmarried (OR = 1.17, 95% CI: 1.13–1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.
Journal Article
Neurodevelopmental Effects of Early Deprivation in Postinstitutionalized Children
The neurodevelopmental sequelae of early deprivation were examined by testing (N = 132) 8-and 9-year-old children who had endured prolonged versus brief institutionalized rearing or rearing in the natal family. Behavioral tasks included measures that permit inferences about underlying neural circuitry. Children raised in institutionalized settings showed neuropsychological deficits on tests of visual memory and attention, as well as visually mediated learning and inhibitory control. Yet, these children performed at developmentally appropriate levels on similar tests where auditory processing was also involved and on tests assessing executive processes such as rule acquisition and planning. These findings suggest that specific aspects of brainbehavioral circuitry may be particularly vulnerable to postnatal experience.
Journal Article
Deprivation, ethnicity and the prevalence of intellectual and developmental disabilities
BackgroundSocial gradients and ethnic disparities have been reported in some forms of intellectual and developmental disabilities. However, information on the association between area deprivation, ethnicity and other forms of intellectual and developmental disabilities are inconclusive.AimTo estimate the independent association between household disadvantage, local area deprivation, ethnicity and the identification of intellectual and developmental disability.MethodsCross-sectional survey involving multilevel multivariate analyses of data extracted from educational records on household disadvantage, local area deprivation, ethnicity and identified intellectual and developmental disability in a sample of English children aged 7–15 years (n=5.18 million).ResultsLower household socio-economic position was associated with increased rates of identification of intellectual and developmental disabilities especially less severe forms of intellectual disability. Higher area deprivation was independently associated with increased rates of identification of less severe forms of intellectual disability but decreased rates of identification of profound multiple intellectual disability and autism spectrum disorder. Minority ethnic status was, in general, associated with lower rates of identification of intellectual and developmental disabilities. Exceptions to this general pattern included higher rates of identification of less severe forms of intellectual disability among Gypsy/Romany and Traveller children of Irish heritage, and higher rates of identification of more severe forms of intellectual disability among children of Pakistani and Bangladeshi heritage.ConclusionsChildren whose development is already compromised (and especially children with less severe intellectual disabilities) are at increased risk of exposure to social conditions that are themselves inimical to healthy development.
Journal Article