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Abstract BackgroundPrevious social determinants of health (SDoH) studies on laryngeal cancer (LC) have assessed individual factors of socioeconomic status and race/ethnicity but seldom investigate a wider breadth of SDoH-factors for their effects in the real-world. This study aims to delineate how a wider array of SDoH-vulnerabilities interactively associates with LC-disparities. MethodsThis retrospective cohort study assessed 74,495 LC-patients between 1975 and 2017 from the Surveillance-Epidemiology-End Results (SEER) database using the Social Vulnerability Index (SVI) from the CDC, total SDoH-vulnerability from 15 SDoH variables across specific vulnerabilities of socioeconomic status, minority-language status, household composition, and infrastructure/housing and transportation, which were measured across US counties. Univariate linear and logistic regressions were performed on length of care/follow-up and survival, staging, and treatment across SVI scores. ResultsSurvival time dropped significantly by 34.37% (from 72.83 to 47.80 months), and surveillance time decreased by 28.09% (from 80.99 to 58.24 months) with increasing overall social vulnerability, alongside advanced staging (OR 1.15; 95%CI 1.13–1.16), increased chemotherapy (OR 1.13; 95%CI 1.11–1.14), decreased surgical resection (OR 0.91; 95%CI 0.90–0.92), and decreased radiotherapy (OR 0.97; 95%CI 0.96–0.99). DiscussionIn this SDoH-study of LCs, detrimental care and prognostic trends were observed with increasing overall SDoH-vulnerability.
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Demonstrating a systems approach for integrating disparate data streams to inform decisions on children’s environmental health
Abstract BackgroundThe use of systems science methodologies to understand complex environmental and human health relationships is increasing. Requirements for advanced datasets, models, and expertise limit current application of these approaches by many environmental and public health practitioners. MethodsA conceptual system-of-systems model was applied for children in North Carolina counties that includes example indicators of children’s physical environment (home age, Brownfield sites, Superfund sites), social environment (caregiver’s income, education, insurance), and health (low birthweight, asthma, blood lead levels). The web-based Toxicological Prioritization Index (ToxPi) tool was used to normalize the data, rank the resulting vulnerability index, and visualize impacts from each indicator in a county. Hierarchical clustering was used to sort the 100 North Carolina counties into groups based on similar ToxPi model results. The ToxPi charts for each county were also superimposed over a map of percentage county population under age 5 to visualize spatial distribution of vulnerability clusters across the state. ResultsData driven clustering for this systems model suggests 5 groups of counties. One group includes 6 counties with the highest vulnerability scores showing strong influences from all three categories of indicators (social environment, physical environment, and health). A second group contains 15 counties with high vulnerability scores driven by strong influences from home age in the physical environment and poverty in the social environment. A third group is driven by data on Superfund sites in the physical environment. ConclusionsThis analysis demonstrated how systems science principles can be used to synthesize holistic insights for decision making using publicly available data and computational tools, focusing on a children’s environmental health example. Where more traditional reductionist approaches can elucidate individual relationships between environmental variables and health, the study of collective, system-wide interactions can enable insights into the factors that contribute to regional vulnerabilities and interventions that better address complex real-world conditions.
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- Award ID(s):
- 1937012
- PAR ID:
- 10362986
- Publisher / Repository:
- Springer Science + Business Media
- Date Published:
- Journal Name:
- BMC Public Health
- Volume:
- 22
- Issue:
- 1
- ISSN:
- 1471-2458
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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