Impact of Social Determinants of Health on Self-Perceived Resilience: An Exploratory Study of Two Cohorts of Adults with Congenital Heart Disease

Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plementary studies:a survey study conducted May 2021–June 2022 and a qualitative study conducted June 2020–August 2021.Resilience was assessed through CD-RISC10 score(range 0–40,higher scores reflect greater self-perceived resilience)and interview responses.Sociodemographic and SDOH(education,employment,living situa-tion,monetary stability,financial dependency,area deprivation index)data were collected by healthcare record review and self-report.We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data.Survey participants(N=127)mean age was 42±14 years;51%were female,87%white.ACHD was moderate(75%)or complex(25%);41%functional class C or D.Resilience(mean 30±7)varied by monetary stability:compared to people with difficulty paying bills,resilience was 15.0 points higher(95%CI:6.9–23.1,p<0.001)for people reporting having enough money and 14.2 points higher(95%CI:5.9–22.4,p=0.001)for those reporting just enough money.Interview participants’(N=25)mean age was 32 years(range 22–44);52%were female,72%white.ACHD was moderate(56%)or complex(44%);76%functional class C or D.Participants discussed factors affecting resilience aligned with each of the major SDOH,prominently,economic stability and healthcare access and quality.Financial stability may be important for supporting self-perceived resi-lience in ACHD.This knowledge can inform the development of resilience interventions for this population.

Social Determinants of Health Behaviors in Primary School Children：A Cross-sectional Study of both Migrant and Resident Children in Beijing,China

Childhood risky behaviors always result in adverse health outcomes. These behaviors are greatly affected by social environment and individual factors. However, few studies explored the social determinants of schoolchildren＇s health behaviors. In this cross-sectional study, the social determinants of health behaviors were examined among both migrant and resident students in Beijing, China. Data of 967 children from six urban and suburban primary schools were analyzed using multiple linear regression analysis. The results showed that less than 60% of children performed some healthy behaviors, although their health knowledge was generally good. Children＇s health behavior scores were greatly determined by school characteristics, health knowledge, demographic characteristics, and family context. Therefore, improving health education and conditions in primary schools is the priority to promote children＇s healthy behaviors, especially for disadvantaged children.

Key Social Determinants to Narrow the Gap between Health-adjusted Life Expectancy and Life Expectancy in Megacities

Objective Improvement in the quality of life is reflected in the narrowing of the gap between healthadjusted life expectancy(HALE)and life expectancy(LE).The effect of megacity expansion on narrowing the gap is rarely reported.This study aimed to disclose this potential relationship.Methods Annual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou,China,from 2010 to 2020.Joinpoint regression was used to evaluate the temporal trend.Generalized principal component analysis and multilevel models were applied to examine the county-level association between the gap and social determinants.Results Although LE and HALE in megacities are increasing steadily,their gap is widening.Socioeconomic and health services are guaranteed to narrow this gap.Increasing personal wealth,a growing number of newborns and healthy immigrants,high urbanization,and healthy aging have helped in narrowing this gap.Conclusion In megacities,parallel LE and HALE growth should be highly considered to narrow their gap.Multiple social determinants need to be integrated as a whole to formulate public health plans.

The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa

Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.

Insights into the Social Determinants of Health in Older Adults

In this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations;however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.

Social Determinants of Health in Understanding the Socio-Economic Impacts of Covid-19 Pandemic in Bangladesh

Social determinants of health are some indicating factors such as income, education, class, gender, and race that influence the socio-economic status of people living in a society. Coronavirus affects the social, economic, and also political sectors of people all over the world. In Bangladesh, during the Covid-19 pandemic, people of all ages and classes have faced social and economic crises based on the social determinants of health. Higher-class families had the facility of advanced medical services rather than the lower and lower-middle classes. This article aims to show the relationship between the social determinants of health and the socio-economic impact of the Covid-19 pandemic in Bangladesh. This paper presents some secondary data to describe the socio-economic impact of Covid-19 and the functions of the social determinants of health in this case.

Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.

“I Felt Defeated. I Felt Helpless”: Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother

Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother’s cancer survivorship in the U.S.-Mexico border region. The participant’s Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant’s baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant’s cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez’s conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.

The Analysis on social determinants of health of the floating population

Health literacy refers to the individual obtaining and understanding and dealing with the basic health information and/or services and the ability of use the information and services to make good health decisions.At present, research works related to health literacy in our country are in the initial stage, the information of floating population health literacy is blank, the Chinese Health Education Center （formerly the Chinese Disease Prevention and Control Center Health Education） Ministry of Social welfare studies undertaken special ＂Chinese public health Literacy survey and evaluation System ＂to develop a suitable evaluation index system of health literacy of the public, used for evaluation of our country＇ s public health literacy level. October to December 2007, the Chinese health education center of this set of evaluation index in Jinan Shandong province examines the health literacy status of floating population, analysis the influence factors of health literacy of the floating population, for the national macroeconomic regulation and control of the floating population, the rational allocation of health resources, determine priority health work, and provide evidence for health related policies and regulations of the floating population.

Influence of Social Determinants in Preference of Public Audience at Music Performances in the Republic of Macedonia

This paper displays the results of a survey of public music performances held during 2010 in Skopje, the capital of the Republic of Macedonia. Study of the audience of public musical events was limited only to the number of visitors. Field research included 653 musical events with a total of 545,340 visitors grouped into eight categories according to the preference by genres of music preference, age, status symbol, origin of the performers, space, and organizers. Our experience in monitoring public musical events through personal presence, the recorded materials, and the continuous monitoring of information from electronic and print media, enabled us to record events and to build some initial comments and assumptions about the structure of the audience and music preference. We have chosen to consider the impact of the sociological determinants on the preference of the audience in the public musical performances through the music genres, the age, the status symbol, the origin of the performers, the area of maintenance, and the organizers of musical events. According to the genre distribution, classical music events prevail, and the greatest numbers of visitors are registered at the pop rock concerts. The structure of the audience according to the age varies depending on the musical genre, so the widest age structure covers the events of pop rock music.

A census tract-level assessment of social determinants of health,traffic exposure,and asthma exacerbations in New York State's Medicaid Population(2005–2015)

This study aims to evaluate the association between social determinants,environmental exposure metrics,and the risk of asthma emergency department(ED)visits in the New York State(NYS)Medicaid population using smallarea analysis.Traffic densities for each census tract in NYS were calculated using the length of road segments within each tract and total area of the tract to produce a measure of average number of vehicles per square meter per day.Data on social determinants of health including internal and external environments and other demographic factors were obtained from various sources.Poisson regression analyses were conducted to identify significant factors associated with asthma ED visits in Medicaid claim and encounter data for years 2005–2015.High traffic density in NYS excluding New York City(NYC)correlated with increased risk of asthma ED visits(RR 1.69;95%CI:1.42,2.00),mitigated by adjusting for environmental and social determinants(RR 1.00;95%CI:0.85,1.19).Similar trends were observed in NYC only(RR 1.19;95%CI:1.00,1.41),with the adjusted risk remaining elevated(RR 1.14;95%CI:0.98,1.33)albeit not statistically significant.Living in census tracts with high concentrated disadvantage index,high proportions of minorities,and less green space predicted higher asthma ED visits.We mapped predicted rates and model residuals to identify areas of high risk.Our results support previous findings that environmental and social risk factors in poor and urban areas contribute to asthma exacerbations in the NYS Medicaid population,even if they may not necessarily contribute to its development.

Epidemiology of coal miners’pneumoconiosis and its social determinants:An ecological study from 1949 to 2021 in China

Background:Pneumoconiosis is the most widely distributed occupational disease worldwide.China is currently the largest coal producer and consumer and the country with the most coal miners and cases of coal workers’pneumoconiosis(CWP).Despite more than 70 years of effort,the problem of CWP and silicosis remains serious.There is a lack of analysis of direct data on coal miners’pneumoconiosis from all over the country.This study aimed to describe the epidemiology of coal miners’pneumoconiosis and reveal some important clues regarding its social determinants.Methods:The annual incidence rate,20-year prevalence rate,and incidence rate of coal miners’pneumoconiosis per million tons in China from 1949 to 2021 were calculated by using the data of annual number of coal miners’pneumoconiosis diagnosed and reported from the coal mining and dressing industry,the number of coal miners,and the raw coal production,and the relationship between the incident cases of coal miners’pneumoconiosis and the death toll from coal mine safety accidents was analyzed using Pearson correlation analysis,with the aim of exploring the relationship between the incident cases of coal miners’pneumoconiosis and its social determinants with an ecological study.Results:From 1949 to 2021,there have been more than 462,000 patients with coal miners’pneumoconio-sis in China,showing double U-shaped distributions with an increasing trend,accounting for about 50.5%(462,000/915,000)of all diagnosed pneumoconiosis in China,while the incidencet rate of coal miners’pneu-moconiosis presents a large W shaped distribution with three peaks over a time span of more than 50 years.From 1949 to 1986,there was a strong correlation between the incident cases of coal miners’pneumoconiosis and raw coal production,the number of coal miners,and the number of deaths from coal mine accidents(r=0.849,P<0.001;r=0.817,P<0.001;r=0.697,P<0.001,respectively),but there was no such correlation found from 1987 to 2006.It was estimated that the annual incidence rate of coal miners’pneumoconiosis in China from 2016 to 2020 was 3.4‰(95%CI:2.6-4.3‰),and the prevalence rate across the recent 20-year observation period was 4.8%(95%CI:4.6-4.9%),both measured at the peak or around the peak over the 70 years.In particular,1963,1986,2006,and 2009 were the four important turning points in time.Conclusion:There was a sustained high level of incident cases of coal miners’pneumoconiosis with double U-shaped curve in China,which may be affected by a variety of social determinants and risk factors.

Sociodemographic determinants associated with breastfeeding in term infants with low birth weight in Latin American countries

BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.

Epidemiological characteristics of pulmonary tuberculosis in patients with pneumoconiosis based on its social determinants and risk factors in China:a cross-sectional study from 27 provinces

Background:Patients with pneumoconiosis have an elevated risk of contracting pulmonary tuberculosis(PTB)and need particular attention.However,extensive population-based studies on the prevalence of PTB in patients with pneumoconiosis have not been reported in China since 1992.This study aimed to investigate the epidemiological characteristics of PTB in patients with pneumoconiosis based on its social determinants and risk factors in China.Methods:Based on the Commission on Social Determinants of Health(CSDH)framework,data were obtained from a questionnaire survey of patients with pneumoconiosis from China’s 27 provinces(autonomous regions,municipalities)from December 2017 to June 2021.By chi-square and multivariate logistic regression analyses,the epidemiological characteristics of PTB in the patients were identified based on its prevalence and odds ratio(OR)and associated social determinants and risk factors.The population attributable fractions(PAFs)of significant risk factors were also calculated.Results:The prevalence of PTB in patients with pneumoconiosis(n=10,137)was 7.5%(95%confidence interval[CI]:7.0-8.0%).Multivariate logistic regression analysis showed that risk factors included in-hospital exposure to patients with PTB(OR=3.30,95%CI:2.77-3.93),clinically diagnosed cases(OR=3.25,95%CI:2.42-4.34),and northeastern regions(OR=2.41,95%CI:1.76-3.31).In addition,lack of work-related injury insurance(WRII),being born in a rural area,being unemployed,living in western regions,household exposure to patients with PTB,smoking,being underweight,complications of pulmonary bullae or pneumothorax,hospitalization history,and former drinkers among the rural patients were also statistically significant risk factors.Being born in a rural area,lack of WRII and in-hospital exposure to patients with PTB had higher PAFs,which were 13.2%(95%CI:7.9-18.5%),12.5%(95%CI:8.3-16.7%),and 11.6%(95%CI:8.8-14.3%),respectively.Conclusion:The prevalence of PTB in pneumoconiosis remains high in China;it is basically in line with the CSDH models and has its characteristics.

Social determinants that lead to poor knowledge about, and inappropriate precautionary practices towards, avian influenza among butchers in Kathmandu, Nepal

Background:Avian influenza(AI)is a global public health threat.Understanding the knowledge that butchers have about it and the precautionary practices they take against it is crucial for designing future preparedness programs.This study aimed to identify the social determinants of knowledge and precautionary measures of AI among butchers in the Kathmandu district in Nepal.Methods:The study was based on a cross-sectional study design using structured interview questionnaires and checklists to observe social determinants and the precautionary measures of 120 butchers aged 15 years and above from the Kathmandu district.Results:The majority of the respondents were male(69.2%)and more than half(53.3%)were from the age group of 25-39 years(mean:31.08,SD:±9.82).Nearly two-thirds(61.3%)of the respondents had a‘poor knowledge’,and the remaining had‘some knowledge’,about AI.More than half(55.4%)of the respondents were in the category of displaying‘poor practice’towards AI and the remaining half were in the‘satisfactory practice’category.None of the respondents had‘adequate knowledge’or displayed‘good practice’.The respondents in the>25 years of age group were less likely[OR 0.169;95%CI(0.056-0.512)]compared to those in the<25 years age group to have a poor knowledge about AI;and the respondents with‘primary education’were more likely[OR 3.265;95%CI(1.326-8.189)]to have a poor knowledge about AI as compared to those who had a secondary or above level of education.Respondents who did not know the correct definition of AI were more likely to follow poor practices[OR 4.265;95%CI(1.193-15.242)];and the respondents who did not know the risk groups associated with AI were also more likely to follow poor practices[OR 3.103;95%CI(1.191-8.083)].Conclusion:This study points out the need to address butchers to improve their knowledge of,and more importantly their compliance with,the precautionary measures to prevent avian influenza.

Clustering of Risk Behaviors and their Social Determinants among Primary School Learners in Beijing, China：A Cross-sectional Study

Background：Studies in developed countries reveal that poor lifestyle choices triggering diseases typically cluster among children.However,there is insufficient evidence on the clustering of risk behaviors among children in developing countries.This study aimed to determine the clustering of risk behaviors and their social determinants among 4th-and 5th-grade learners in Beijing,China.Methods：The sample comprised of 967 learners from six primary schools enrolled migrant and resident learners by two-stage stratified cluster sampling.Prevalence denoted the risk behaviors and their clustering.A log-linear model was used to explore the clustering patterns.Ordinal logistic regression determined the influence of demographic characteristics,school environment,and family context on behavioral clustering.Results：The prevalence of none,one,two,and three or more risk factors was 61.2%,20.0%,10.8%,and 8.1% for infectious diseases and 46.0%,30.6%,15.4%,and 8.0% for chronic diseases,respectively.Some behaviors appeared dependent and were more likely to be observed together.The three most influential factors for infectious diseases were school type （odds ratio [OR] =4.47,95% confidence interval [CI] 3.00-6.66）,school located in an inner suburb （OR =0.27,95% CI 0.18-0.38）,and gender （OR =0.56,95% CI 0.42-0.74）.Regarding risk behaviors for chronic diseases,clustering was not associated with household registration status and number of appliances,but was significantly associated with school type （OR =5.36,95% CI 3.72-7.73）,school located in an inner suburb （OR =0.59,95% CI 0.43-0.81）,and gender （OR =0.61,95% CI 0.47-0.78）.School environment variables were the most significant contributor to the number of risk behaviors.Conclusions：The characteristics of schools enrolling migrants and residents influenced the number of risk behaviors.Therefore,improved school conditions and integrated behavioral interventions are particularly recommended for health promotion.

Cardiovascular diseases in European ethnic minorities: Beyond the traditional cardiovascular risk factors

This editorial is intended to be a reflection on cardiovascular disease(CVD)burden in European ethnic minorities.In some European countries,ethnic minority realities,due to their recent appearance,are still to be studied in depth.The experience of several European countries,where the migration processes started earlier,even more than a century ago,can help by being an example.Many studies have shown that major differences in CVD burden exist not only between countries,but also within the same country when considering different social strata and ethnic groups.The CV risk factors underlying heart disease have been well established.Important epidemiological studies have helped us understand that the underlying causes of heart disease as well as the behaviors that can help prevent them are the same.We are now well aware that CVD should be treated by considering a holistic approach.This is why the social determinants(SDs)of health that may worsen the disease burden or that,vice versa,may improve the treatment,and even more significantly,the prognosis of a patient’s illness should be taken into consideration.For ethnic minority patients,this holistic,hermeneutic approach is of importance.Several SDs of health that influence CVDs have been identified but their relevance for the health of ethnic minorities has not yet been clearly defined.In some European countries,most ethnic minorities are largely also religious minorities.Only a few studies have evaluated the role of religion,which is an important SD that affects the probability of having CV risk factors and diseases.Adolescents,particularly those belonging to the second generation,seem to be the weak link.If we believe that these young people are really citizens of their country of birth,then a way of recognizing their belonging to the community starts from a will to better understand their condition,in order to assist them while they grow physically and mentally.Thinking about safeguarding the health of this population should be more than a health task,rather a goal of social justice.

Challenges with non-descriptive compliance labeling of end-stage renal disease patients in accessibility for renal transplantation

Non-descriptive and convenient labels are uninformative and unfairly project blame onto patients.The language clinicians use in the Electronic Medical Record,research,and clinical settings shapes biases and subsequent behaviors of all providers involved in the enterprise of transplantation.Terminology such as noncompliant and nonadherent serve as a reason for waitlist inactivation and limit access to life-saving transplantation.These labels fail to capture all the circum-stances surrounding a patient’s inability to follow their care regimen,trivialize social determinants of health variables,and bring unsubstantiated subjectivity into decisions regarding organ allocation.Furthermore,insufficient Medicare coverage has forced patients to ration or stop taking medication,leading to allograft failure and their subsequent diagnosis of noncompliant.We argue that perpetuating non-descriptive language adds little substantive information,in-creases subjectivity to the organ allocation process,and plays a major role in reduced access to transplantation.For patients with existing barriers to care,such as racial/ethnic minorities,these effects may be even more drastic.Transplant committees must ensure thorough documentation to correctly encapsulate the entirety of a patient’s position and give voice to an already vulnerable population.

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.

Assessing intersectional gender analysis in Nepal’s health management information system:a case study on tuberculosis for inclusive health systems

Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individuals based on their characteristics and contexts,thereby increasing risks,vulnerabilities and marganilisation associated with TB.This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System(HMIS)of National Tuberculosis Programme(NTP)by conducting an intersectional analysis of TB cases recorded via HMIS.Methods A desk review of key policies and the NTP’s HMIS was conducted.Retrospective intersectional analysis utilized two secondary data sources:annual NTP report(2017-2021)and records of 628 TB cases via HMIS 6.5 from two TB centres(2017/18-2018/19).Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB,registration category and treatment outcome.Results Gender,social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation.NTP has initiated the collection of age,sex,ethnicity and location data since 2014/15 through the HMIS.However,only age and sex disaggregated data are routinely reported,leaving recorded social stratifiers of TB patients static without analysis and dissemination.Furthermore,findings from the intersectional analysis using TB secondary data,showed that male more than 25 years exhibited higher odds[adjusted odds ratio(a OR)=4.95,95%confidence interval(CI):1.60-19.06,P=0.01]of successful outcome compared to male TB patients less than 25 years.Similarly,sex was significantly associated with types of TB(P<0.05)whereas both age(P<0.05)and sex(P<0.05)were significantly associated with patient registration category(old/new cases).Conclusions The results highlight inadequacy in the availability of social stratifiers in the routine HMIS.This limitation hampers the NTP’s ability to conduct intersectional analyses,crucial for unveiling the roles of other social determinants of TB.Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.