A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States

Singh, Sarah; Sridhar, Praveen

doi:10.21037/jtd-21-87

Cited by 10 publications

(3 citation statements)

References 95 publications

(95 reference statements)

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“…Higher levels of education are linked to better health outcomes [ 1 ]. This correlation is observed even in countries with high levels of development, such as the USA and Sweden [ 2 ]. Despite the robust relationship between education and health, the causality of this connection is still under debate [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Educational Status on the Occurrence of Colonic Diverticula: Insights from an Austrian Cohort Study

Völkerer,

Wernly,

Semmler

et al. 2024

Med Princ Pract

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Objective: Education often reflects socioeconomic status. Research indicates that lower socioeconomic status may increase the risk of diverticulosis, and ccording to data from the USA, diverticular disease is a significant and costly health problem. Our study explores the link between educational level and colonic diverticula occurrence. Subject and Methods: We conducted a cohort study on 5,532 asymptomatic Austrian patients who underwent colonoscopy, categorizing them by education level using the updated Generalized International Standard Classification of Education (GISCED). Logistic regression models, adjusting for age, gender, metabolic syndrome, diet, and activity, were used to determine the association between education and diverticulosis. Results: Overall, 39% of the patients had low educational status, while 53% had medium, and 8% had high educational status. Colon diverticula were less frequent in patients with medium (OR 0.73) and high (aOR 0.62) educational status. Medium educational level remained associated with lower rates of diverticulosis after adjustment for age and sex (aOR 0.85) and further metabolic syndrome, dietary habits, and physical activity (aOR 0.84). In higher education status this phenomenon was only seen by trend. Conclusion: Low education correlated with higher colon diverticula risk, while medium education showed lower rates even after adjustments. This trend persisted at higher education levels, highlighting the potential for strategies for cost-reduction tailored to socioeconomic conditions.

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Section: Introductionmentioning

confidence: 99%

The Impact of Educational Status on the Occurrence of Colonic Diverticula: Insights from an Austrian Cohort Study

Völkerer,

Wernly,

Semmler

et al. 2024

Med Princ Pract

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“…[1][2][3] Sociodemographic factors, including lower educaAonal aqainment, lower household income, minority racial and ethnic idenAty, and experiencing food insecurity, have been associated with poor diet quality and higher chronic disease prevalence. [4][5][6][7][8][9][10][11][12] DispariAes due to these risk factors play a role in the inequitable burden of diet-related chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

An evidence-based definition of nutrition security: disparities in sociodemographic characteristics, dietary intake and cardiometabolic risk using the US Healthy Eating Index

Sheinberg,

Schmidt,

Mande

et al. 2024

Preprint

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ImportanceEstablishing a universal metric for nutrition security, defined as, “consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being,” is a national priority. Understanding how the Healthy Eating Index-2020 (HEI-2020) could be used to measure and monitor nutrition security in the population can assist in surveillance and improve the design of nutrition programs and policies.ObjectiveTo examine the utility of the HEI-2020 as an evidence-based measure of nutrition security.DesignThis serial cross-sectional study used data from the 2009-2018 National Health and Nutrition Examination Surveys (NHANES).SettingNationally representative, population-based surveyParticipantsData for N=22,168 US adults (≥20 years) were analyzed.Main outcomeWe derived HEI-2020 scores (0-100), commonly used to capture overall diet quality, from participants’ two 24-hour dietary recalls. Nutrition security categories were established: high nutrition security (>70-100), marginal (>60-70), low (>50-60), and very low (0-50).ResultsOnly 13% of US adults had high nutrition security while nearly two-thirds had low or very low nutrition security. Nutrition security was higher for adults who were older, female, “Other” race or ethnicity, born outside of the US, have higher education attainment, higher income, and food security. Compared to adults with high nutrition security, adults with very low nutrition security had the lowest intakes of unprocessed or minimally processed foods, fruits, vegetables, whole grains, and seafood and the highest intakes of ultra-processed foods, refined grains, and red and processed meats (allP-trends <0.01). Similarly, adults with very low nutrition security were more likely to have elevated adiposity, lower HDL cholesterol, higher triglycerides, higher fasting glucose, and higher hemoglobin A1c (allP-trends ≤0.01).ConclusionsThe HEI is a robust measure of nutrition security that can be directly linked to the construct of nutrition security. Using evidence-based HEI cut-points as nutrition security categories would allow policy makers, public health practitioners and nutrition professionals to set benchmarks and nationwide targets for achieving nutrition security.KEY POINTSQuestionCan the Healthy Eating Index (HEI)-2020 be used as an evidence-based measure of nutrition security?FindingsUsing nationally representative data, we created four categories of nutrition security using HEI-2020 scores: high (≥70), marginal (>60-70, low (>50-60), and very low (≤50). Less than 1 in 6 US adults had high nutrition security. High nutrition security was less prevalent among adults with greater socioeconomic disadvantage. High nutrition security was also associated with more favorable cardiometabolic risk profiles.MeaningThe HEI can be directly linked to categories of nutrition security and used for national program and policy setting.

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“…These disparities can partly be attributed to differences in access to care, systems of care, patient-level factors such as comorbidity burden, and social determinants of health. 1 People with suboptimal access to healthcare receive less preventive care, have less effective management of chronic diseases, less screening for early detection of malignancies, later presentations with a cancer diagnosis, and delays in cancer treatment initiation. However, disparities in cancer care are multifactorial and deep-rooted.…”

Section: Introductionmentioning

confidence: 99%

Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer

Cooper,

Chao,

Mukherjee

et al. 2023

Cancer Control

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Purpose The purpose of this study was to assess the association of comorbidity burden with overall survival, accounting for racial/ethnic and socioeconomic differences in patients with cancer. Methods In this retrospective cohort study, patients newly diagnosed with cancer between 2010 and 2018 were identified from a large health plan in southern California. Cancer registry data were linked with electronic health records (EHR). Comorbidity burden was defined by the Elixhauser comorbidity index (ECI). Patients were followed through December 2019 to assess all-cause mortality. Association of comorbidity burden with all-cause mortality was evaluated using Cox proportional hazards model. Crude and adjusted hazard ratio (HR, 95%CI) were determined. Results Of 153,270 patients included in the analysis, 29% died during the ensuing 10-year follow-up. Nearly 49% were patients of color, and 32% had an ECI > 4. After adjusting for age, sex, race/ethnicity, cancer stage, smoking status, insurance payor, medical center, year of cancer diagnosis, and cancer treatments, we observed a trend demonstrating higher mortality risk by decreasing socioeconomic status (SES) (P-trend<.05). Compared to patients in the highest SES quintile, patients in the lowest, second lowest, middle, and second highest quintiles had 25%, 21%, 18%, and 11% higher risk of mortality, respectively [(HR, 95%CI): 1.25 (1.21-1.29), 1.21 (1.18-1.25), 1.18 (1.15-1.22), and 1.11 (1.07-1.14), respectively]. When we additionally adjusted for ECI, the adjusted HRs for SES were slightly attenuated; however, the trend persisted. Patients with higher comorbidity burden had higher mortality risk compared to patients with ECI score = 0 in the adjusted model [(HR, 95%CI): 1.22 (1.17-1.28), 1.48 (1.42-1.55), 1.80 (1.72-1.89), 2.24 (2.14-2.34), and 3.39 (3.25-3.53) for ECI = 1, 2, 3, 4, and >5, respectively]. Conclusions Comorbidity burden affects overall survival in cancer patients irrespective of racial/ethnic and SES differences. Reducing comorbidity burden can reduce some, but not all, of the mortality risk associated with lower SES.

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A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States

Cited by 10 publications

References 95 publications

The Impact of Educational Status on the Occurrence of Colonic Diverticula: Insights from an Austrian Cohort Study

The Impact of Educational Status on the Occurrence of Colonic Diverticula: Insights from an Austrian Cohort Study

An evidence-based definition of nutrition security: disparities in sociodemographic characteristics, dietary intake and cardiometabolic risk using the US Healthy Eating Index

Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer

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