Air Pollution and Mortality at the Intersection of Race and Social Class.

BACKGROUND: Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 µm [PM2.5]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM2.5 pollution than high-income Americans. Because information is lacking on exposure-response curves for PM2.5 exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM2.5 standards. METHODS: We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM2.5 exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible). RESULTS: Lower PM2.5 exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM2.5 levels decreased. For example, the hazard ratio associated with decreasing PM2.5 from 12 µg per cubic meter to 8 µg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation. CONCLUSIONS: Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM2.5 levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).

A negative covariation between toxoplasmosis and CoVID-19 with alternative interpretations.

Coronaviruses may exert severely negative effects on the mortality and morbidity of birds and mammals including humans and domestic animals. Most recently CoVID-19 has killed about half million people (27th of June, 2020). Susceptibility to this disease appears to differ markedly across different societies but the factors underlying this variability are not known. Given that prevalence of toxoplasmosis in human societies may serve as a proxy for hygiene, and it also exerts both direct and immune-mediated antiviral effects, we hypothesize a negative covariation between toxoplasmosis and measures of the CoVID-19 pandemic across countries. We obtained aged-adjusted toxoplasmosis prevalence of pregnant women from the literature. Since the differences in the CoVID-19 morbidity and mortality may depend on the different timing of the epidemics in each country, we applied the date of first documented CoVID-19 in each country as a proxy of susceptibility, with a statistical control for population size effects. Using these two indices, we show a highly significant negative co-variation between the two pandemics across 86 countries. Then, considering that the wealth of nations often co-varies with the prevalence of diseases, we introduced GDP per capita into our model. The prevalence of toxoplasmosis co-varies negatively, while the date of first CoVID-19 co-varies positively with GDP per capita across countries. Further, to control for the strong spatial autocorrelation among countries, we carried out a Spatial Structure Analyses of the relationships between the date of first CoVID-19, prevalence of toxoplasmosis, and GDP per capita. Results of this analysis did not confirm a direct causal relationship between toxoplasmosis and susceptibility to the CoVID-19 pandemics. As far as an analysis of observational data let us to suggest, it appears that the interaction between CoVID-19 and toxoplasmosis is mediated by GDP per capita and spatial effects. This prompts the question whether the formerly known covariations of CoVID-19 and BCG vaccination or air pollution might have also emerged as spurious indirect effects.

Bibliometric mapping of microbiology research topics (2012-16): a comparison by socioeconomic development and infectious disease vulnerability values.

Amongst health-related scientific disciplines, microbiology appears to play a vital role in creating a sustainable future with respect to health, the environment and a biobased economy. Microbiology research covers a wide range of different disciplines and addresses many important global issues. This study aimed to identify topics being addressed within the last 5 years (2012-16) in the field of microbiology worldwide and to compare them in terms of three different indicators: gross domestic product, Human Development Index and Infectious Disease Vulnerability Index. The dataset of this study comprised 167 874 articles and reviews from 2012 to 2016, which were extracted from the Web of Science Medline. To identify and visualise the topics addressed during the studied period, VOSviewer was used. The construction and visualisation of the term map was done based on 5918 MESH subject headings. The methodology and procedures employed included Kruskal-Wallis test and two-sample proportion test. Overall, our study showed that the field of microbiology has focused on six different topics during 2012-16. The papers written with the collaboration of countries with low socioeconomic status and high vulnerability to infectious diseases mainly addressed topics related to the primary needs of people such as food safety, the prevention and control of infectious diseases, food and energy poverty. In contrast, papers written with the collaboration of countries with high socioeconomic development status and less vulnerability to infectious diseases mainly focused on big data, alternative methods to animal experiments.

Assessing socioeconomic vulnerability to dengue fever in Cali, Colombia: statistical vs expert-based modeling.

BACKGROUND: As a result of changes in climatic conditions and greater resistance to insecticides, many regions across the globe, including Colombia, have been facing a resurgence of vector-borne diseases, and dengue fever in particular. Timely information on both (1) the spatial distribution of the disease, and (2) prevailing vulnerabilities of the population are needed to adequately plan targeted preventive intervention. We propose a methodology for the spatial assessment of current socioeconomic vulnerabilities to dengue fever in Cali, a tropical urban environment of Colombia. METHODS: Based on a set of socioeconomic and demographic indicators derived from census data and ancillary geospatial datasets, we develop a spatial approach for both expert-based and purely statistical-based modeling of current vulnerability levels across 340 neighborhoods of the city using a Geographic Information System (GIS). The results of both approaches are comparatively evaluated by means of spatial statistics. A web-based approach is proposed to facilitate the visualization and the dissemination of the output vulnerability index to the community. RESULTS: The statistical and the expert-based modeling approach exhibit a high concordance, globally, and spatially. The expert-based approach indicates a slightly higher vulnerability mean (0.53) and vulnerability median (0.56) across all neighborhoods, compared to the purely statistical approach (mean = 0.48; median = 0.49). Both approaches reveal that high values of vulnerability tend to cluster in the eastern, north-eastern, and western part of the city. These are poor neighborhoods with high percentages of young (i.e., < 15 years) and illiterate residents, as well as a high proportion of individuals being either unemployed or doing housework. CONCLUSIONS: Both modeling approaches reveal similar outputs, indicating that in the absence of local expertise, statistical approaches could be used, with caution. By decomposing identified vulnerability "hotspots" into their underlying factors, our approach provides valuable information on both (1) the location of neighborhoods, and (2) vulnerability factors that should be given priority in the context of targeted intervention strategies. The results support decision makers to allocate resources in a manner that may reduce existing susceptibilities and strengthen resilience, and thus help to reduce the burden of vector-borne diseases.

Evaluating roles of nodes in optimal allocation of vaccines with economic considerations.

Since the allocation of vaccines is often constrained by limited resources, designing an economical vaccination strategy is a fundamental goal of the epidemiological modelling. In this study, with the objective of reducing costs, we determine the optimal allocation of vaccines for a general class of infectious diseases that spread mainly via contact. We use an optimization routine to identify the roles of nodes with distinct degrees as depending on the cost of treatment to that of vaccination (relative cost of treatment). The optimal allocation drives vaccination priority to medium-degree nodes at a low relative cost of treatment or to high-degree nodes at a high relative cost of treatment. According to the presented results, we may adjust the vaccination priority in the face of an endemic situation.

Predictors of warfarin use among Ohio medicaid patients with new-onset nonvalvular atrial fibrillation.

BACKGROUND: Despite demonstrated efficacy in stroke prevention, warfarin is underused in patients with atrial fibrillation (AF). Reasons for warfarin nonuse are unclear. METHODS: We conducted a retrospective cohort analysis using Ohio Medicaid administrative billing data to ascertain determinants of warfarin use for patients with new-onset nonvalvular AF. The database included data from all institutions, providers, and pharmacies providing services to Ohio Medicaid enrollees. Subjects included all 11699 continuously enrolled fee-for-service recipients of Ohio Medicaid with a new diagnosis of nonvalvular AF between January 1, 1998, and December 31, 2000. We determined incipient warfarin use and presence of risk factors for stroke and hemorrhage by searching claims records for corresponding International Classification of Diseases, Ninth Revision, Clinical Modification codes and National Drug Codes. Univariate and multivariable analyses were performed to examine the association of risk factors with warfarin use. RESULTS: Only 9.7% of all patients and 11.9% of those without apparent contraindications filled prescriptions for warfarin from 7 days preceding to 30 days after the development of AF. Hypertension and congestive heart failure independently predicted increased warfarin use. Older age (>or=85 years), younger age (<55 years), prior intracranial hemorrhage, prior gastrointestinal hemorrhage, predisposition to falls, alcohol or other drug abuse, renal impairment, and conditions perceived as barriers to compliance predicted decreased warfarin use. CONCLUSIONS: Few in this cohort of Ohio Medicaid patients with incident AF filled prescriptions for warfarin within 30 days of the diagnosis. Several factors, including alcohol or other drug abuse or dependence, psychiatric disease, homelessness or inadequate housing, and lack of a caregiver, were highly prevalent and seemed to bias against warfarin prescribing.

Rethinking medicine: improving health outcomes with cost-effective psychosocial interventions.

Thoughts, feelings, and moods can have a significant effect on the onset of some diseases, the course of many, and the management of nearly all. Many visits to the doctor are occasioned by psychosocial distress. Even in those patients with organic medical disorders, functional health status is strongly influenced by mood, coping skills, and social support, yet the predominant approach in medicine is to treat people with physical and chemical treatments that neglect the mental, emotional, and behavioral dimensions of illness. This critical mismatch between the psychosocial health needs of people and the usual medical response leads to frustration, ineffectiveness, and wasted health care resources. There is emerging evidence that empowering patients and addressing their psychosocial needs can be health and cost effective. By helping patients manage not just their disease but also common underlying needs for psychosocial support, coping skills, and sense of control, health outcomes can be significantly improved in a cost-effective manner. Rather than targeting specific diseases or behavioral risk factors, these psychosocial interventions may operate by influencing underlying, shared determinants of health such as attitudes, beliefs, and moods that predispose toward health in general. Although the health care system cannot be expected to address all the psychosocial needs of people, clinical interventions can be brought into better alignment with the emerging evidence on shared psychosocial determinants of health by providing services that address psychosocial needs and improve adaptation to illness.