• Title/Summary/Keyword: low income patients

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Impact of socioeconomic status on biologics utilization in rheumatoid arthritis: revealing inequalities and healthcare efficiency

  • Hye Won Kim;Yeon Ju Lee;You-Jung Ha;Eun Bong Lee;Yun Jong Lee;Eun Ha Kang
    • The Korean journal of internal medicine
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    • v.39 no.4
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    • pp.668-679
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    • 2024
  • Background/Aims: This cross-sectional study aimed to investigate biologics treatment disparities in rheumatoid arthritis (RA) patients based on socioeconomic status (SES). Methods: Data from the KOrean Observational Study Network for Arthritis (KORONA) database were analyzed to assess various factors associated with SES, health behaviors, and biologics use. Logistic regression and structured equation modeling (SEM) were utilized for data analysis. Results: Among 5,077 RA patients included, 393 (7.7%) patients were identified as biologics users. Within the entire cohort, 31.8% of the participants were in the low-income and low-education groups, and 39.3% of the participants were in the high-income and high-education groups. Despite the patients with low income or low education experienced higher disease activity at diagnosis, had more comorbidities, exhibited higher medication compliance, underwent more check-ups, and had more hospital admissions than their counterparts, the odds of patients with low-income receiving biologics were 34% lower (adjusted odds ratio = 0.76, 95% confidence interval: 0.60-0.96, p = 0.021) after adjustment for demographics and comorbidities. SEM and pathway analyses confirmed the negative impact of low SES on biologics use. Conclusions: The findings suggest that SES plays a significant role in biologics use among RA patients, indicating potential healthcare inefficiencies for low SES patients. Moreover, adverse healthcare habits negatively affect biologics use in RA patients. The study highlights the importance of considering socioeconomic factors while discussing biologics use and promoting equitable access to biologics for optimal RA management.

The Influence of Health Literacy and Diabetes Knowledge on Diabetes Self-care Activities in Korean Low-income Elders with Diabetes

  • Jeong, Jihye;Park, Namhee;Shin, So Young
    • Research in Community and Public Health Nursing
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    • v.25 no.3
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    • pp.217-224
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    • 2014
  • Purpose: This study aimed to assess the levels of and relationships among health literacy, knowledge about diabetes, and self-care activities in the Korean low-income elderly with diabetes and to identify factors influencing the self-care activities of this vulnerable population. Methods: This study surveyed a total of 151 low-income elderly patients with diabetes registered at 16 Visiting Health Care Services in B City, Korea. Health literacy was measured with the Newest Vital Sign. Diabetes knowledge was measured with the Diabetes Knowledge Test. The Summary of Diabetes Self-care Activities Questionnaire was used to assess diabetes self-care activities. A stepwise multiple regression analysis was conducted to identify significant factors influencing diabetes self-care activities in these patients. Results: In the regression model, diabetes knowledge (${\beta}=.322$, p<.001), exercise (${\beta}=.337$, p<.001), and experiences of diabetes education (${\beta}=.241$, p=.001) were significantly associated with increased diabetes self-care activities in low-income elderly patients with diabetes when gender, education, health literacy, and subjective health state were controlled. Conclusion: To improve diabetes self-care activities in the low-income elderly with diabetes, it is important to develop a customized program considering their knowledge, exercise, and diabetes education experience.

Interaction Effects between Individual Socioeconomic Status and Regional Deprivation on Onset of Diabetes Complication and Diabetes-Related Hospitalization among Type 2 Diabetes Patients: National Health Insurance Cohort Sample Data from 2002 to 2013 (개인의 사회경제적 수준과 지역의 사회경제적 수준의 상호작용이 제2형 당뇨 환자에서 당뇨합병증 발생 및 당뇨와 관련된 입원에 미치는 영향: 2002-2013년 국민건강보험공단 표본 코호트 자료를 활용하여)

  • Jang, Jieun;Ju, Yeong Jun;Lee, Doo Woong;Lee, Sang Ah;Oh, Sarah Soyeon;Choi, Dong-Woo;Lee, Hyeon Ji;Shin, Jaeyong
    • Health Policy and Management
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    • v.31 no.1
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    • pp.114-124
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    • 2021
  • Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

Factors Related to Fundus Examination in Diabetes Mellitus Patients (당뇨병환자 안저검사 수검 요인)

  • Choi, Joo-Hyuck;Na, Baeg-Ju;Chun, Sung-A
    • Health Policy and Management
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    • v.20 no.1
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    • pp.125-136
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    • 2010
  • Objectives: The purpose of this study is to analyze the proportion of fundus examination of DM patients for preventing microvascular complication and to examine the factors related to fundus examination in DM patients. Methods: This study used 2005 Korean national health and nutrition survey data. We selected all 1,129 diabetes mellitus patients from the data. And we choose 8 factors related to diabetes mellitus patients. These are sex, age group, type of residential area(rural or urban), education level, income level, comorbidity with hypertension, current insulin use, and duration of suffering from DM. We have analysed these factors by whether he had been examined fundus or no through Chi-square and logistic regression analysis. Results: Female DM patients have tendency to get more fundus examination than Male DM patients. And Young patients, patients who live in urban area, well educated patients, high income patients, comorbidity with hypertension, patients have got the insulin injection, patients have long duration of suffering from DM are to get more fundus examination. According to multivariate logistic regression analysis, sex and education level, income level, and duration of suffering from DM, comorbidity with hypertension, patients have got the insulin injection are significant factors on fundus examination for prevent microvascular diabetes mellitus complications. Conclusions and Discussion: We have concluded that physicians and policy makers should consider to fundus examination especially of man and DM patients who have more shorter disease period and low educated patients and low incomed patients and patients who have taken insulin therapy.

Risk of Death and Occurrence of Secondary Disease of Cancer and Cardiovascular Disease Patient by Income Level in Korea (암, 심뇌혈관 질환자의 소득수준에 따른 사망 및 이차 질환 발생 위험)

  • Kang, Minjin;Son, Kangju
    • The Journal of the Korea Contents Association
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    • v.18 no.10
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    • pp.145-157
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    • 2018
  • In this study, we analyzed the effect of the income level of cancer, stroke, and myocardial infarction on mortality by using National Health Insurance Service(NHIS) Cohort 2.0 DB. Patients who newly developed the disease in 2007 were observed till 2015. The analysis used the Cox probability proportional risk model and the competing risk model. The income level used information at the time of the onset of the disease in 2007, categorized into low / mid / high. The results showed that there were differences in the risks of death and secondary disease in patients with cancer, stroke, or myocardial infarction according to the income level. In addition to the need for a social safety net to lower the incidence of early deaths in low-income families, it seems necessary to continue to strengthen universal protection for serious diseases similar to the current policy.

Comparison of the Health Behaviors according to Income and Education Level among Cardio-Cerebrovascular Patients; based on KNHANES data of 2010-2011 (심뇌혈관질환자의 소득과 교육수준에 따른 건강행태 비교 - 2010-2011년도 국민건강영양조사 자료를 이용하여 -)

  • Choi, Ji-Yeon;Choi, Seong-Woo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.15 no.10
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    • pp.6223-6233
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    • 2014
  • The aim of this study was to help disease management and prevention by analyzing the effects of income and education levels on the health of cardio-cerebrovascular patients. Using the raw data of 2010-2011 Korea Health & Nutrition Examination Survey, the correlations of health behaviors, general (socio-demographic) characteristics, body measurements, and blood test results of 3,687 cardio-cerebrovascular patients aged 30 or older were analyzed based on their income and education levels. The results suggested that lower income and education levels were correlated with a high prevalence of cardio-cerebrovascular diseases. In addition, the OR values (95% CI) of current smoking were 0.71 (0.52-0.96) for patients with a high-income and 0.41 (0.29-0.58) for those with a high level of education, showing a strong correlation between lower levels of income and education and current smoking, which is related to health deterioration. In terms of one-month drinking and high risk drinking, the OR values (95% CI) of the patients with a high income were 1.55(1.22-1.95) and 1.42(1.11-1.82), respectively. Drinking was more prevalent among high-income patients but had no correlation with the education level. The practice of walking had no significant correlation with both income and education levels. Therefore, it is imperative to emphasize the importance of temperance to high-income patients, and the importance of quitting smoking to low-income patients, as well as to provide institutional support.

African American Race and Low Income Neighborhoods Decrease Cause Specific Survival of Endometrial Cancer: A SEER Analysis

  • Cheung, Min Rex
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.4
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    • pp.2567-2570
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    • 2013
  • Background: This study analyzed Surveillance, Epidemiology and End Results (SEER) data to assess if socio-economic factors (SEFs) impact on endometrial cancer survival. Materials and Methods: Endometrial cancer patients treated from 2004-2007 were included in this study. SEER cause specific survival (CSS) data were used as end points. The areas under the receiver operating characteristic (ROC) curve were computed for predictors. Time to event data were analyzed with Kaplan-Meier method. Univariate and multivariate analyses were used to identify independent risk factors. Results: This study included 64,710 patients. The mean follow up time (S.D.) was 28.2 (20.8) months. SEER staging (ROC area of 0.81) was the best pretreatment predictor of CSS. Histology, grade, race/ethnicity and county level family income were also significant pretreatment predictors. African American race and low income neighborhoods decreased the CSS by 20% and 3% respectively at 5 years. Conclusions: This study has found significant endometrial survival disparities due to SEFs. Future studies should focus on eliminating socio-economic barriers to good outcomes.

Management of Diabetic Mellitus in Low-income Rural Patients (일개 농촌지역 저소득층 당뇨병환자의 관리 상태)

  • Kim, Hye-Yeon;Yun, Woo-Jun;Shin, Min-Ho;Kweon, Sun-Seong;Ahn, Hye-Ran;Choi, Seong-Woo;Lee, Young-Hoon;Cho, Dong-Hyeok;Rhee, Jung-Ae
    • Journal of Preventive Medicine and Public Health
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    • v.42 no.5
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    • pp.315-322
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    • 2009
  • Objectives : Knowledge about the management status of diabetic melitus (DM) is essential to improve diabetic management. Moreover, low income is associated with poor adherence to treatment and increased mortality. This study was performed to evaluate the management status of DM in low-income patients in a rural area. Methods : We enrolled 370 patients with type 2 DM living in Gokseong county, JeollaNamdo. A well-trained examiner measured the height, weight, waist circumference, blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and glycosylated hemoglobin (HbA1c) levels. Carotid ultrasonography was used to measure carotid artery carotid artery intima media thickness (IMT) and plaque. anklebrachial index (ABI) was used to evaluate peripheral artery disease. A fundoscopic examination was performed to evaluate diabetic retinopathy. A history of diabetes complications and health-related questionnaires were also completed. Results : The age of diabetic subjects was 68.7$\pm$8.7 years and the duration of diabetes was 8.9$\pm$8.2 years. Most (63.5%) had hypertension, and 45.7% had triglycerides below 150 mg/dl, 38.1% had low density lipoprotein cholesterol (LDL) cholesterol below 100 mg/dl, 48.7% had urine albumin to creatinine ratio (UACR) below 30 mg/g. Less than half (45.9%) achieved the goal of HbA1c less than 7% suggested by the American Diabetes Association (ADA). 10.6% had peripheral vascular disease, 11.9% had retinopathy, and 60.8% had chronic kidney disease. Conclusions : DM management in low income patients is very poor and requires further work to improve.

Associations between income and survival in cholangiocarcinoma: A comprehensive subtype-based analysis

  • Calvin X. Geng;Anuragh R. Gudur;Jagannath Kadiyala;Daniel S. Strand;Vanessa M. Shami;Andrew Y. Wang;Alexander Podboy;Tri M. Le;Matthew Reilley;Victor Zaydfudim;Ross C. D. Buerlein
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.2
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    • pp.144-154
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    • 2024
  • Backgrounds/Aims: Socioeconomic determinants of health are incompletely characterized in cholangiocarcinoma (CCA). We assessed how socioeconomic status influences initial treatment decisions and survival outcomes in patients with CCA, additionally performing multiple sub-analyses based on anatomic location of the primary tumor. Methods: Observational study using the 2018 submission of the Surveillance, Epidemiology, and End Results (SEER)-18 Database. In total, 5,476 patients from 2004-2015 with a CCA were separated based on median household income (MHI) into low income (< 25th percentile of MHI) and high income (> 25th percentile of MHI) groups. Seventy-three percent of patients had complete follow up data, and were included in survival analyses. Survival and treatment outcomes were calculated using R-studio. Results: When all cases of CCA were included, the high-income group was more likely than the low-income to receive surgery, chemotherapy, and local tumor destruction modalities. Initial treatment modality based on income differed significantly between tumor locations. Patients of lower income had higher overall and cancer-specific mortality at 2 and 5 years. Non-cancer mortality was similar between the groups. Survival differences identified in the overall cohort were maintained in the intrahepatic CCA subgroup. No differences between income groups were noted in cancer-specific or overall mortality for perihilar tumors, with variable differences in the distal cohort. Conclusions: Lower income was associated with higher rates of cancer-specific mortality and lower rates of surgical resection in CCA. There were significant differences in treatment selection and outcomes between intrahepatic, perihilar, and distal tumors. Population-based strategies aimed at identifying possible etiologies for these disparities are paramount to improving patient outcomes.

The Socioeconomic Burden of Cancer in Member Countries of the Association of Southeast Asian Nations (ASEAN) - Stakeholder Meeting Report

  • Jan, Stephen;Kimman, Merel;Kingston, David;Woodward, Mark
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.2
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    • pp.407-409
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    • 2012
  • The ACTION (Asean CosTs In ONcology) Study will be one of the largest observational studies of the burden of cancer ever conducted in Asia. The study will involve 10,000 newly diagnosed patients with cancer and will be carried out across eight low- and middle income countries within the ASEAN region (Indonesia, Thailand, Malaysia, Cambodia, Myanmar, Viet Nam, Laos and the Philippines). Patients will be interviewed three times over 12 months to assess their health, use of health care services, out of pocket costs related to their illness, social and quality of life issues. The project is a collaboration between the George Institute for Global Health, the ASEAN Foundation and Roche. The aim of the study is to assess the health and socioeconomic impact of cancer on patients in ASEAN communities, and the factors that may impact on these outcomes.