Geographic concentration of SARS-CoV-2 cases by social determinants of health in metropolitan areas in Canada: a cross-sectional study.

BACKGROUND: Understanding inequalities in SARS-CoV-2 transmission associated with the social determinants of health could help the development of effective mitigation strategies that are responsive to local transmission dynamics. This study aims to quantify social determinants of geographic concentration of SARS-CoV-2 cases across 16 census metropolitan areas (hereafter, cities) in 4 Canadian provinces, British Columbia, Manitoba, Ontario and Quebec. METHODS: We used surveillance data on confirmed SARS-CoV-2 cases and census data for social determinants at the level of the dissemination area (DA). We calculated Gini coefficients to determine the overall geographic heterogeneity of confirmed cases of SARS-CoV-2 in each city, and calculated Gini covariance coefficients to determine each city's heterogeneity by each social determinant (income, education, housing density and proportions of visible minorities, recent immigrants and essential workers). We visualized heterogeneity using Lorenz (concentration) curves. RESULTS: We observed geographic concentration of SARS-CoV-2 cases in cities, as half of the cumulative cases were concentrated in DAs containing 21%-35% of their population, with the greatest geographic heterogeneity in Ontario cities (Gini coefficients 0.32-0.47), followed by British Columbia (0.23-0.36), Manitoba (0.32) and Quebec (0.28-0.37). Cases were disproportionately concentrated in areas with lower income and educational attainment, and in areas with a higher proportion of visible minorities, recent immigrants, high-density housing and essential workers. Although a consistent feature across cities was concentration by the proportion of visible minorities, the magnitude of concentration by social determinant varied across cities. INTERPRETATION: Geographic concentration of SARS-CoV-2 cases was observed in all of the included cities, but the pattern by social determinants varied. Geographically prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to the resurgence of SARS-CoV-2.

Implications of Demographics and Socioeconomic Factors in Breast Cancer Reconstruction.

BACKGROUND: Not all women undergo breast reconstruction despite its vital role in the recovery process. Previous studies have reported that women who are ethnically diverse and of lower socioeconomic status are less likely to undergo breast reconstruction, but the reasons remain unclear. The purpose of this study is to evaluate the demographic characteristics of our patient population and their primary reason for not undergoing breast reconstruction. METHODS: An institutional review board-approved, single-institution study was designed to evaluate all female breast cancer patients of all stages who underwent mastectomy but did not undergo breast reconstruction from 2008 to 2014. Patients were contacted via telephone and asked to participate in a validated, prompted survey. Data regarding their demographic information and primary reason for not undergoing breast reconstruction were collected. RESULTS: Inclusion criteria were met by 181 patients, of which 61% participated in the survey. Overall, the most common reason for not undergoing breast reconstruction (26%) was unwillingness to undergo further procedures. However, the most common reason for patients that identified as Hispanic, Spanish-speaking, high school graduates, or having an annual income less than US $25,000 (P < 0.05) was insufficient information received. CONCLUSIONS: This study demonstrates that ethnicity and socioeconomic factors play a key role in determining why patients forego breast reconstruction. Ethnicity, language, education, income, and employment status are associated with patients not receiving appropriate education regarding their reconstructive options. Breast surgeons with a diverse patient population should ensure that these patients are adequately educated regarding their options, and if perhaps, more of these patients would decide to partake in the reconstruction process.

Integrating micronutrient status assessment into the 2015-2016 Malawi Demographic and Health Survey: A qualitative evaluation.

Demand for national-level micronutrient status data continues to grow, yet little is known about the implementation of different approaches for collecting these data. We conducted an evaluation of the process of linking the 2015-2016 Malawi Demographic and Health Survey (MDHS) and 2015-2016 Malawi Micronutrient Survey (MNS). We conducted 24 in-depth interviews with stakeholders from the Malawi government and international agencies and field staff. Interview questions explored perceptions of what worked and what was challenging during three phases of implementation: preparation; data collection; and data analysis, reporting, and dissemination. Data were analysed using thematic analysis. Results showed that there was strong government interest to integrate the MDHS and MNS. Perceived benefits included potential cost savings and lower respondent burden. However, government and international agency stakeholders did not view the linkage of the surveys to be a fully integrated approach. The lack of full integration produced challenges throughout implementation, such as complex field logistics and duplication in nutrition indicators assessed and reported. Some stakeholders believed integration was not attainable primarily due to timing. The MDHS and MNS were originally designed as stand-alone surveys, and planning for each survey was at an advanced stage once the government sought to integrate the surveys. Additionally, the MNS could not be incorporated as a module within the MDHS given the complexity of the MNS data collection and short timeframe for planning. These findings can inform decisions about implementing the next MNS and may be transferable to other countries that are conducting micronutrient surveys to address data gaps.

Situational and Demographic Factors in the Sudden Growth of Pall Mall, 2002-2014.

Objective: Pall Mall gained significant brand share in the cigarette market between 2002 and 2013. We sought to determine whether demographic shifts occurred among the participants reporting Pall Mall as their usual brand during this time span. Method: We examined National Survey of Drug Use and Health (NSDUH) data from 2002-2014. Demographic characteristics included age, education, ethnicity, income, and cigarette use (cigarettes per day, daily/non-daily smoking, and nicotine dependence). We also examined RJ Reynolds investor reports and shareholder documents to determine the impact of tobacco marketing on the growth of Pall Mall. Results: Over 2002-2014, Pall Mall has gained among smokers 26 to 34 years of age. More Pall Mall smokers in 2014 report higher incomes (over $75000), and also report lower scores on measures of cigarette dependence, compared to 2002. Pall Mall smokers over time seem to share characteristics of premium cigarette brands smokers. Conclusion: The profile of the typical Pall Mall smoker has changed as the brand has gained market share. An association exists between brand positioning and economic forces, which has contributed to an increase in the market share for Pall Mall. Implications: It is well known that cigarette marketing drives the sale of tobacco products. The growth in the market share of Pall Mall serves as an excellent example to demonstrate how economic uncertainty paired with brand positioning and advertising worked together to serve as a catalyst for the rapid growth observed for this brand. This paper also looked at various demographic changes that occurred among Pall Mall smokers over a 12 year period and compared them to smokers of all other cigarette brands. The results of this analysis demonstrate the importance of monitoring trends over time among cigarette smokers.

Associations between demographic characteristics and physical activity practices in Nevada schools.

Schools are important settings for not only providing and promoting children's physical activity (PA) but also for reducing PA disparities. We investigated associations between school-level demographic characteristics (racial/ethnic and socioeconomic composition, urban-rural status, and student-to-teacher ratio) and 16 PA-promoting practices in 347 Nevada public elementary, middle, and high schools in 2014. We found that low-cost and easy-to-implement practices are most prevalent. There is relative demographic equity in ten of 16 PA practices and significant differences in six PA practices in Nevada schools. Schools with comparatively larger percentages of Black students are the most disadvantaged, as they have the fewest PA-supportive practices in place. Higher percent black was associated with lower odds of providing classroom activity breaks (AOR=0.632, 95% CI=0.453-0.881) and bike racks (AOR=0.60, 95% CI=0.362-0.996), greater odds of withholding recess/PE for disciplinary reasons (AOR=1.377, 95% CI=1.006-1.885), and lower odds of having recess supervisors who are trained to promote PA (AOR=0.583, 95% CI=0.374-0.909). Schools with greater percentages of Hispanic students have lower odds of providing before-school PA programs (AOR=0.867, 95% CI=0.761-0.987), whereas schools with greater percentages of low-SES students have greater odds of providing after-school PA programs (AOR=1.135, 95% CI=1.016-1.268). Higher student-to-teacher ratio was also associated with greater odds of providing after-school PA programs (AOR=1.135, 95% CI=1.016-1.268). Urban-rural status was unrelated to all PA practices.

[Otorhinolaryngology in the field of demography, growing outpatient care and regionalization]. / Die HNO-Heilkunde im Spannungsfeld von Ambulantisierung und Regionalisierung.

BACKGROUND: Otorhinolaryngology (ENT) departments are strongly affected by current changes in the reimbursement schemes for inpatients. The study was designed to investigate these effects on the ENT Department in Rostock and selected comparison clinics, as well as to outline solutions. METHODS: We analyzed diagnosis-related group (DRG) reports of the ENT Clinic at Rostock University Medical Center from 2013 to 2015, according to the size of the outpatient potential. Comparisons were made with other surgical departments such as maxillofacial surgery and ophthalmology in terms of average length of stay and the resulting deductibles. We also compared billing as day surgery and complete outpatient surgery for the main small surgical procedures such as tonsillectomy and septum surgery. Finally, we compared the discounts with 22 ENT departments in other maximum care hospitals. RESULTS: The average case mix index of an ENT department in Germany is 0.75, case load average of 2,500 patients and common length of stay 4.1 days. In a typical academic ENT department as in Rostock, health plans usually discount around 500 T€ (thousand euro), which is considerably higher than comparable departments, e.g., oral and maxillofacial surgery or ophthalmology departments. However, discounts on a DRG for inpatient surgery is still approximately 1,000 € more revenue than surgery in an outpatient setting. The benchmark analysis shows that health plans in rural areas are more likely to accept inpatient surgery with discounts for small procedures than strict billing according to outpatient reimbursement schemes. CONCLUSION: These effects can result in an insufficient cost effectiveness of ENT departments in Germany. As a consequence, substantial restructuring of the in- and outpatient treatment seems necessary, also for academic ENT departments, e.g., in the form of day surgery or ambulatory surgical centers, outpatient clinics with special contracts and specialized inpatient surgery. However, this results in greater demands on the training of young physicians and management of patient flows within the department.

Demographic Risk Factors for Alcohol-Related Aggression In and Around Licensed Venues.

AIMS: Few studies have examined the role of gender and both area-level and individual socio-economic status (SES) as independent predictors of alcohol-related aggression (ARA) in and around licensed venues. METHODS: The aim of the present study was to investigate the relationship between gender, area-level SES and individual SES (operationalised as occupational category) and ARA in and around licensed venues. The sample comprised 697 men and 649 women aged 16-47, who completed a patron intercept survey as part of a larger study assessing trends in harm and stakeholders' views surrounding local community level interventions in dealing with alcohol-related problems in the night-time economy. RESULTS: Binary logistic regression analyses showed that age, gender, occupational category, area-level SES and level of intoxication at time of interview were all significant predictors of involvement in ARA. Being male doubled the odds of involvement in ARA, while age was a protective factor. Blue collar workers had more than double the odds of ARA involvement of professionals, while those living in the most socio-economically disadvantaged areas were over twice as likely to report experiencing ARA compared to those living in the most advantaged areas. However, assessment of the predictive model by gender revealed that effects of age, occupational category and area-level SES were restricted to male participants, with greater intoxication no longer predictive. CONCLUSIONS: ARA among patrons was significantly more likely to occur among men, those in blue collar occupations, and individuals living in low SES areas, suggesting both individual and area-level disadvantage may play a role in ARA.

Geographical Inequalities in Alcohol-Related Mortality Rates in Taiwan due to Socio-Demographic Differences.

AIMS: To assess the relationships between alcohol-related mortality and socio-demography in Taiwan. METHODS: Using 2002-2006 data from the national death-diagnosis registration system, we calculated the alcohol-attributed disease mortality of those aged 15 and older in 348 townships in Taiwan. This study provides spatial clustering of alcohol-attributed disease mortality rates and area socio-demographic conditions across townships, examining the relationship between the two using a spatial autoregressive model. RESULTS: The relative risk of death due to alcohol-attributed diseases was estimated to increase by 2.1 and 0.9% as a result of a 1% increase in the percentage of men and aboriginal residents, respectively. The risk of death was estimated to decrease by 25% for every 1 year increase in education level. Industrialization and labor participation were also found to be predictors of the outcome measure in areas with differing levels of urbanization. CONCLUSIONS: This study provides significant evidence that township-level relationships between alcohol-related mortality and socioeconomic variables exist in Taiwan. Public health policymakers should better prioritize the specific areas in which comprehensive intervention should be undertaken accordingly.

Implementing the Affordable Care Act: state approaches to premium rate reforms in the individual health insurance market.

The Affordable Care Act protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. We identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law's requirements. Most states took the opportunity to customize at least some aspect of their rating standards. Interviews with state regulators reveal that many states pursued implementation strategies intended primarily to minimize market disruption and premium shock and therefore established standards as consistent as possible with existing rules or market practice. Meanwhile, some states used the transition period to strengthen consumer protections, particularly with respect to tobacco rating.

Gainful employment and risk of mortality after spinal cord injury: effects beyond that of demographic, injury and socioeconomic factors.

OBJECTIVE: To evaluate the association of three levels of gainful employment with the risk of mortality after traumatic spinal cord injury (SCI) while controlling for known predictors of mortality status (including education and income). STUDY DESIGN: Prospective cohort study. SETTING: A total of 20 federally funded SCI Model Systems of care in the United States. METHODS: Participants included 7955 adults with traumatic SCI. Preliminary assessments were conducted between 1995 and 2006. Mortality status was determined by the Social Security Death Index (1308 deaths). A two-stage logistic regression model was used to estimate the chance of dying in any given year. Life expectancy was calculated under different economic assumptions. RESULTS: Compared with those who were working 30+ h per week, the odds of mortality was 1.37 for those who worked 1-29 h and 1.67 for those who were unemployed. The addition of gainful employment only modestly reduced the effects of household income and education, both of which remained significant. For instance, the odds of mortality for household income (referent $75 000+) decreased from 1.50 to 1.38 for $25 000-$75 000 and from 2.10 to 1.82 for < $25 000. Life expectancy varied widely depending on socioeconomic characteristics more than doubling under certain assumptions. CONCLUSION: Substantial variation in mortality is attributable to employment, above and beyond the effects of previously established demographic, injury and socioeconomic predictors. Although some excess mortality may be the inevitable consequence of SCI, risk is substantially increased with poor socioeconomic characteristics.

Immigrants' health in Europe: a cross-classified multilevel approach to examine origin country, destination country, and community effects.

In this study, we examined origin, destination, and community effects on first- and second-generation immigrants' health in Europe. We used information from the European Social Surveys (2002­2008) on 19,210 immigrants from 123 countries of origin, living in 31 European countries. Cross-classified multilevel regression analyses reveal that political suppression in the origin country and living in countries with large numbers of immigrant peers have a detrimental influence on immigrants' health. Originating from predominantly Islamic countries and good average health among natives in the destination country appear to be beneficial. Additionally, the results point toward health selection mechanisms into migration.

Firing discrimination: Selective labor market responses of firms during the COVID-19 economic crisis.

The speed of the economic downturn in the wake of the COVID-19 pandemic has been exceptional, causing mass layoffs-in Germany up to 30% of the workforce in some industries. Economic rationale suggests that the decision on which workers are fired should depend on productivity-related individual factors. However, from hiring situations we know that discrimination-i.e., decisions driven by characteristics unrelated to productivity-is widespread in Western labor markets. Drawing on representative survey data on forced layoffs and short-time work collected in Germany between April and December 2020, this study highlights that discrimination against immigrants is also present in firing situations. The analysis shows that employees with a migration background are significantly more likely to lose their job than native workers when otherwise healthy firms are unexpectedly forced to let go of part of their workforce, while firms make more efforts to substitute firing with short-time working schemes for their native workers. Adjusting for detailed job-related characteristics shows that the findings are unlikely to be driven by systematic differences in productivity between migrants and natives. Moreover, using industry-specific variation in the extent of the economic downturn, I demonstrate that layoff probabilities hardly differ across the less affected industries, but that the gap between migrants and natives increases with the magnitude of the shock. In the hardest-hit industries, job loss probability among migrants is three times higher than among natives. This confirms the hypothesis that firing discrimination puts additional pressure on the immigrant workforce in times of crisis.

Defining socially-based spatial boundaries in the region of Peel, Ontario, Canada.

BACKGROUND: The purpose of the project was to delineate a series of contiguous neighbourhood-based "Data Zones" within the Region of Peel (Ontario) for the purpose of health data analysis and dissemination. Zones were to be built on Census Tracts (N = 205) and obey a series of requirements defined by the Region of Peel. This paper explores a method that combines statistical analysis with ground-truthing, consultation, and the use of a decision tree. DATA: Census Tract data for Peel were derived from the 2006 Canadian Census Master file. METHODS: Following correlation analysis to reduce the data set, Principal Component Analysis was applied to the data set to reduce the complexity and derive an index. The Getis-Ord Gi*statistic was then applied to look for statistically significant clusters of like Census Tracts. A detailed decision tree for the amalgamation of remaining zones and ground-truthing with Peel staff verified the resulting zones. RESULTS: A total of 15 Data Zones that are similar with respect to socioeconomic and sociodemographic attributes and that met criteria defined by Peel were derived for the region. CONCLUSION: The approach used in this analysis, which was bolstered by a series of checks and balances throughout the process, gives statistical validity to the defined zones and resulted in a robust series of Data Zones for use by Peel Public Health. We conclude by offering insight into alternative uses of the methodology, and limitations.

Short communication: Farm and socioeconomic characteristics of the top 100 dairy farm counties in the United States.

The objectives of this study are to describe dairy farm demographic and socioeconomic conditions in the top 100 counties in the United States for dairy sales in 2007, and to describe the association of dairy farm demographics with socioeconomic conditions. The top 100 counties were responsible for 56% of all US dairy sales in 2007 with a median growth rate of 78% compared with 1997. Counties varied widely for farm demographics with as few as 5 very large dairy farms that averaged $17,924,000 in dairy sales per farm to as many as 1,730 dairy farms with less than $250,000 in dairy sales per farm. Most of the top 100 dairy counties had higher illiteracy rates, a higher proportion of residents without a high school degree, and lower median incomes than state averages, but unemployment rates were similar to the state average. The socioeconomic measures were from public records and not collected specifically for this research. Nevertheless, the top dairy counties in the western states tended to have poorer socioeconomic conditions than the top dairy counties in other regions, and significant associations were observed between dairy farm demographics and socioeconomic conditions. Having many dairy farms was associated more favorably with county socioeconomic conditions than having high dairy sales.

Variations in the gender composition of immigrant populations: how they matter.

This paper estimates and interprets empirical shifts in the gender composition of immigrants to add to scholarship about the gendering of international migrations over time. We map shifts in gender ratios using micro-level data that permit us to create age-standardized estimates among adult foreign born stock living in the United States since 1850 and in 26 other nations worldwide since 1960. We examine regional and national variations in these shifts, and ask whether and how the gendered composition of foreigners from diverse origins in the United States ­ the nation that has received the largest populations of migrants for over a century ­ differs from other nations that receive large numbers of immigrants. We also examine recent variations in gender ratios among immigrants living in six regional destination countries. Results show substantial variation in the gender composition of foreign-born populations, and they offer a starting point for examining causes and consequences in future research.

Human smuggling in Austria: a comparative analysis of data on smuggled migrants from former Yugoslavia and the Russian Federation.

This article provides a summary of the author's research on human smuggling in Austria comparing migrants from Former Yugoslavia and the Russian Federation. The project's primary intent was to collect more detailed information on migrants seeking asylum in Austria and their use of smuggling services to leave their home countries, including detailed information on demographics, force or threat of force by smugglers, routes and methods of transportation, costs of smuggling, payment methods, and deeper perceptual questions regarding the flight. Another central premise of the article discusses how current distinctions between human smuggling and human trafficking are arbitrary in many regards.

Exposure to international migration and its effect on childbearing in Turkey.

International migration alters social norms, family structures, and population development in sending regions. Each of these factors affects fertility, making the impact of international migration on childbearing an increasingly important area of study. In many sending regions, the Demographic and Health Surveys (DHS) provide a promising, but underutilized, source of data for understanding the relationship between international migration and childbearing. Using the household and individual questionnaires in the 2003 Turkish DHS, we develop a multi-layered approach for measuring international migration. We then use these measures to examine differences in childbearing among women in migrant and non-migrant households, assessing the effects of migrant selection and migration-related roles and attitudes on the number of children born. After adjusting for selection characteristics, we find return female migrants and migrant wives are not significantly different from women in non-migrant households; role and attitude differences have only modest impacts on the association between women's exposure to migration and childbearing.

Enduring pictures in our heads: the continuance of authoritarianism and racial stereotyping.

This study highlights the importance of examining the influence of personality measures, specifically authoritarianism, on negative racial stereotyping, even in an era of alleged color blindness. The authors examine the relationship of various demographic variables and authoritarianism with negative racial stereotyping in a sample of White urban respondents. Current literature suggests that age, sex, marital status, religious identification, religious service attendance, education level, income, political affiliation, level of authoritarianism, and the demographic composition in an individual's local population all affect racial stereotyping. The evidence presented, using path analysis, suggests that some demographic characteristics influence the level of negative racial stereotyping. While the effects of most included demographic characteristics were statistically significant, others, which continually resurface in the literature, remained insignificant (such as the demographic composition of the respondent's area). The results of this study challenge the loss of traditional prejudice with color blindness and point to the importance of authoritarianism as a mediating factor in negative racial stereotyping. The authors conclude the greatest indicators of negative racial stereotyping included in this study are authoritarianism, education, and income, while many other demographics - such as marital status, religious identification and attendance, and political affiliation - have indirect influences through authoritarianism.