Medicine and Health Sciences Commons^™

A Symphony Of Struggle: The Tender Connection Between Bad Health And Poverty, Jashkumar Choudhari

be Still

In the journey of crafting this essay, I sought to explore the profound connection between bad health and poverty, recognizing how these two facets of human existence intricately interlace, influencing and shaping one another in ways both profound and far-reaching. The process of delving into this theme was like unraveling a multi-layered tapestry, each thread revealing a new perspective on the unbreakable bond that exists between these seemingly distinct aspects of life.

Through the creative process, I aimed to capture the emotional resonance of this theme, evoking a sense of empathy and understanding in the reader. The imagery of haunting …

Transformative Learning: Changing Nurses’ Perceptions About People In Poverty, Jacqueline Debrew

Journal of Social, Behavioral, and Health Sciences

Background: Meaningful learning experiences with clients in poverty may help nursing students change their perceptions towards those experiencing poverty and, thus, provide unbiased, nonjudgmental care when they become nurses.

Purpose: The purpose of this research was to understand what learning activities and experiences nursing students found meaningful and led to a change in prior perceptions of people in poverty.

Methods: Guided by Mezirow’s Theory of Transformative Learning, accelerated BSN students enrolled in a mental health nursing course (n = 14) were assigned reflective journals throughout the semester on their assigned clinical experiences, which were analyzed for emergent themes.

Results: …

Financial Incentives For Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial, Darla Kendzor, Michael Businelle, Summer Frank-Pearce, Joseph Waring, Sixia Chen, Emily Hébert, Michael Swartz, Adam Alexander, Munjireen Sifat, Laili Kharazi Boozary, David Wetter

Kimmel Cancer Center Faculty Papers

IMPORTANCE: Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions.

OBJECTIVES: To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES.

DESIGN, SETTING, AND PARTICIPANTS: This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024.

INTERVENTIONS: Participants were randomized to usual care (UC) for smoking cessation (counseling …

Trends In Selected Heart Diseases Among Below Poverty Line Population From Karnataka State, South India, Devajana Chinnappa Nanjunda, Rajesh H. Acharya, Amit Kumar Mishra, Subramani Jyothi Lakshmi, Prasanna K Santhekadur

International Journal of Health and Allied Sciences

Objective: The study aims to reveal the most common heart diseases found among the below-the-poverty-line (BPL) population in Karnataka State (South India) using SAST data. Method: This study has been done using the data found in the Suvarna Arogya Suraksha Trust on below-the-poverty line (BPL) categories Results and

Discussion: It is found that the coronary artery disease, myocardial infarction, Bradycardia, pericarditis. Arrhythmia was found common among BPL section

Conclusion: Poverty, material deprivation, social exclusion, health disparity, and poor social cohesion throughout the life course among the BPL community are the key reasons for poor cardiac care and related outcomes.

Socioeconomic Factors Influencing Hematological Health In Latin America, Lina M. Barrios, Ms

Student Papers, Posters & Projects

Hematological malignancies, also known as blood cancers, such as leukemia, lymphomas, and myelomas, are a significant health concern globally. The incidence of these malignancies has dramatically increased over time, leukemias being the leading cause. The incidence of blood cancers in Latin America exhibits regional variability, with leukemia being the emerging cause as the most prevalent type in children and young adults. However, the overall incidences are oddly lower than in developed countries, potentially due to the underreporting of the cases and the lack of cancer registries. This situation implies a critical need for improving surveillance and data collection methods to …

Preexisting Diabetes And Breast Cancer Treatment Among Low-Income Women, Bayu Begashaw Bekele, Min Lian, Chester Schmaltz, Tracy Greever-Rice, Pratibha Shrestha, Ying Liu

2020-Current year OA Pubs

IMPORTANCE: Diabetes is associated with poorer prognosis of patients with breast cancer. The association between diabetes and adjuvant therapies for breast cancer remains uncertain.

OBJECTIVE: To comprehensively examine the associations of preexisting diabetes with radiotherapy, chemotherapy, and endocrine therapy in low-income women with breast cancer.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included women younger than 65 years diagnosed with nonmetastatic breast cancer from 2007 through 2015, followed up through 2016, continuously enrolled in Medicaid, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. Data were analyzed from January 2022 to October 2023.

EXPOSURE: Preexisting …

Exploration Of Latina/Hispanic Women's Experiences Living With Non-Alcoholic Fatty Liver Disease: A Qualitative Study With Patients In Houston, Natalia I Heredia, Erika Mendoza Duque, Sylvia Ayieko, Amelia Averyt, Lorna H Mcneill, Jessica P Hwang, Maria E Fernandez

Student and Faculty Publications

OBJECTIVES: A deeper understanding of the lived experiences of Hispanic patients with non-alcoholic fatty liver disease (NAFLD) can help guide the development of behavioral programs that facilitate NAFLD management. This paper explores Hispanic women's experiences living with NAFLD.

DESIGN, SETTING, PARTICIPANTS: We collected brief sociodemographic questionnaires and conducted in-depth interviews with 12 low-income (all had household income ≤USD$55 000 per year) Hispanic women with NAFLD from the Houston area. Transcripts were audio-recorded and transcribed. We developed a coding scheme and used thematic analysis to identify emergent themes, supported by Atlas.ti.

RESULTS: Participants identified physicians as their main information source on …

County-Level Trends And Potential Disparities In The Suicide Rates In Virginia, 2020 – 2022, Sharon A. Olowoyo, Oluwatosin M. Oduneye, Glodi B. Bokanya, Ayooluwa G. Olowoyo, Coralie E. Mugenga, Yuhan Yan, Robyn L. Anderson

Montview Journal of Research & Scholarship

Abstract

Objectives

This study aims to investigate the influence of social determinants of health (SDH) on suicide patterns in the state of Virginia.

Methods

A secondary statistical analysis was conducted using publicly accessible data from the County Health Rankings & Roadmaps database for Virginia. Data from 2020 to 2022 were analyzed, focusing on age-adjusted suicide rates and SDH factors, including % rural, mental health provider rate, median household income, high school completion, and unemployment rates. Multiple regression analysis and visualizations were employed for data interpretation.

Results

The analysis revealed that SDH factors significantly predicted suicide rates across the study period. …

Enhancing Health Professions Students’ Attitudes And Self-Efficacy To Care For Unhoused Populations, Jacob T. Greenfield, Brad Phillips, Kathryn L. Hoffman, Gina M. Baugh

Journal of Occupational Therapy Education

Health professions students, including occupational therapy students, often have limited exposure to unhoused populations, which may alter their attitudes and self-efficacy to participate in their care. In turn, this could reduce access and quality of care for these marginalized groups. The purpose of this study was to evaluate the impact of a phased multimodal learning approach on interprofessional health sciences students’ attitudes and self-efficacy in providing care to unhoused individuals. A pre-posttest single group design was used to evaluate a didactic presentation, poverty simulation, and street-based experiential learning experience. Findings revealed significant differences in students’ (N=257) attitudes and self-efficacy in …

Differences In Urine Creatinine And Osmolality Between Black And White Americans After Accounting For Age, Moisture Intake, Urine Volume, And Socioeconomic Status, Patrick B. Wilson, Ian P. Winter, Josie Burdin

Exercise Science Faculty Publications

Urine osmolality is used throughout research to determine hydration levels. Prior studies have found black individuals to have elevated urine creatinine and osmolality, but it remains unclear which factors explain these findings. This cross-sectional, observational study sought to understand the relationship of self-reported race to urine creatinine and urine osmolality after accounting for age, socioeconomic status, and fluid intake. Data from 1,386 participants of the 2009–2012 National Health and Nutrition Examination Survey were utilized. Age, poverty-to-income ratio (PIR), urine flow rate (UFR), fluid intake, estimated lean body mass (LBM), urine creatinine, and urine osmolality were measured. In a sex-specific manner, …

Persistent Poverty And Incidence-Based Melanoma Mortality, Tiffaney Tran, Karla Madrigal, Lillian Morris, Kehe Zhang, Emelie Nelson, Marcita Galindez, Zhigang Duan, Adewole S. Adamson, Hui Zhao, Hung Q. Doan, Madison M. Taylor, Cici Bauer, Kelly C. Nelson

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Family Structure, Family Transitions, And Child Overweight And Obesity: Comparing Australia, The United Kingdom, And The United States, Sadie A. Slighting, Kirsten Rasmussen, Mikaela J. Dufur, Jonathan A. Jarvis, Shana Pribesh, Alyssa J. Alexander, Carolina Otero

STEMPS Faculty Publications

Growing rates of childhood obesity globally create concern for individuals' health outcomes and demands on health systems. While many policy approaches focus on macro-level interventions, we examine how the type of stability of a family structure might provide opportunities for policy interventions at the micro level. We examine the association between family structure trajectories and childhood overweight and obesity across three Anglophone countries using an expanded set of eight family structure categories that capture biological relationships and instability, along with potential explanatory variables that might vary across family trajectories and provide opportunities for intervention, including access to resources, family stressors, …

Empowering And Educating Parents To Implement A Home Intervention: Effects On Preschool Children's Engagement In Hands-On Constructive Play, Michelle Boulanger Thompson, Yaoying Xu, Chin-Chih Chen, Kathleen Rudasill

Rehabilitation Sciences Faculty Publications

Constructive play is a creative process-oriented activity that promotes children’s engaged learning through building and designing with materials. This study investigated a parent-implemented intervention to promote active engagement in constructive play for preschool-aged children at risk for developmental delay. This study utilized a single-subject multiple-baseline across-participants design with four participants. Visual analysis of the data identified a functional relation between the temporal, physical, and social–emotional environmental support provided by the parents and the children’s active engagement in constructive play. Parents reported the intervention as meaningful to their lives, indicating strong social validity. These findings highlight the importance of centering and …

Association Between Lack Of Access To A Neighborhood Park And High Blood Pressure In The Philadelphia Metropolitan Area, Stephanie Kjelstrom, Richard W. Hass, Russell K. Mcintire

College of Population Health Faculty Papers

INTRODUCTION: Studies have shown a lower risk of high blood pressure (HBP) among people who live near parks; however, little information exists on how feeling safe and comfortable visiting the park affects blood pressure. We identified associations between neighborhood park access, comfort visiting a park, and HBP to understand how these factors may contribute to disparities in HBP prevalence.

METHODS: The 2018 Southeastern Pennsylvania Household Health Survey of 3,600 residents in the Philadelphia metropolitan area asked if respondents had ever been told they had HBP and whether they had a neighborhood park or outdoor space that they were comfortable visiting …

Determining Call-To-Entry Rate And Recruitment Barriers In Clinical Studies For Community Clinics Serving Low-Income Populations: A Cohort Study, Elizabeth M Vaughan, Salim Virani, Mahmoud Al Rifai, Victor J Cardenas, Craig A Johnston, Laura Porterfield, Zuleica Santiago Delgado, Susan L Samson, Vanessa Schick, Aanand D Naik

Student and Faculty Publications

BACKGROUND: Recruitment for clinical studies is challenging. to overcome barriers, investigators have previously established call-to-entry rates to assist in planning. However, rates specific to low-income minority populations are needed to account for additional barriers to enrolment these individuals face.

OBJECTIVE: to obtain a call-to-entry rate in a low-income uninsured Hispanic population with chronic disease.

METHODS: We used data from four of our randomised clinical studies to determine the call-to-entry rate for individuals (n=1075) with or at risk for type 2 diabetes: participants needed/potential participants contacted=recruitment rate (yield). Research staff contacted potential participants to enrol in a study that evaluated 6 …

Program Penanganan Fakir Miskin Di Desa Mulyasari Kota Banjar Provinsi Jawa Barat, Aep Rusmana, Eri Susanto, Muhammad Rai Jemadila, Nabila Aulia Putri

Jurnal Ilmu Kesejahteraan Sosial

Poverty is a condition where a person cannot fulfill their basic needs to achieve a more dignified life. This research aims to explain the program for handling the poor in Mulyasari Village which is directed at three things, namely: 1) managing social problems, 2) mechanisms for meeting needs, and 3) providing opportunities for advancement for the poor. The method used in this research is a descriptive qualitative method with a phenomenological tradition. Determining the research sample used purposive sampling technique. There were 6 research informants consisting of Mulyasari Village officials, poor families who received social welfare services, and Community Social …

Multiple Rsv Strains Infecting Hep-2 And A549 Cells Reveal Cell Line-Dependent Differences In Resistance To Rsv Infection, Anubama Rajan, Felipe-Andres Piedra, Letisha Aideyan, Trevor Mcbride, Matthew Robertson, Hannah L. Johnson, Gina Marie Aloisio, David Henke, Cristian Coarfa, Fabio Stossi, Vipin Kumar Menon, Harshavardhan Doddapaneni, Donna Marie Muzny, Sara Joan Javornik Cregeen, Kristi Louise Hoffman, Joseph Petrosino, Richard A. Gibbs, Vasanthi Avadhanula, Pedro A. Piedra

Research Symposium

Background: Respiratory syncytial virus (RSV) is the major viral driver of a global pediatric respiratory disease burden disproportionately borne by the poor¹. Thus, RSV, like SARS-CoV-2, combines with congenital and environmental and host-history-dependent factors to create a spectrum of disease with greatest severity most frequently occurring in those least able to procure treatment.

Methods: Here we apply whole genome sequencing and a suite of other molecular biological techniques to survey host-virus dynamics in infections of two distinct cell lines (HEp2 and A549) with four strains representative of known RSV genetic diversity.

Results: We observed non-gradient patterns of RSV …

Understanding The Resources, Barriers, Facilitators And Interests About Aging And Dementia Research Of Community Members From The Rio Grande Valley, Karla Daniela Lopez Lorenzo, Rosa V. Pirela Mavarez, Gabriela Osuna, Kendra Stine, Nahalie Chacon De Alvarez, Noe Garza, Gladys E. Maestre

Research Symposium

Background: One of ten people aged 65 develops Alzheimer’s Disease and it is one of the sixth-leading cause of death in the United States. The Rio Grande Valley (RGV) is mostly constituted by Hispanic/Latinos (93%), a population that has a 1.5X increased risk of AD onset. Nevertheless, there are not enough resources to support people living with dementia and their care partners. This study will leverage research efforts deployed by the RGV Alzheimer’s Disease Resource Center for Minority Aging Research to understand the social representations about the resources, barriers, facilitators, and interests of the RGV community about dementia and Alzheimer’s …

Equity And Inclusion In Pediatric Gastroenterology Telehealth: A Study Of Demographic, Socioeconomic, And Digital Disparities., Edward B. Mougey, Wesley C. Judy, Rajitha D. Venkatesh, Elizabeth Berg, Jennifer A. Lee, John Rosen, B U K Li, Alex Koster, Kristin Maiden, Zhongcui Gao, James P. Franciosi

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: The purpose of our study is to compare in-person and telehealth pediatric care ambulatory visits for gastroenterology (GI) at the Nemours Children's Health System in the Delaware Valley (NCH-DV) based on geospatial, demographic, socioeconomic, and digital disparities.

METHODS: Characteristics of 26,565 patient encounters from January 2019 to December 2020 were analyzed. U.S. Census Bureau geographic identifiers were assigned to each participant and aligned with the American Community Survey (2015-2019) socioeconomic and digital outcomes. Reported odds ratios (OR) are telehealth encounter/in-person encounter.

RESULTS: GI telehealth usage increased 145-fold in 2020 compared to 2019 for NCH-DV. Comparing telehealth to in-person usage …

Poverty And Commercial Surrogacy In India: An Intersectional Analytical Approach, Sheela Suryanarayanan

Dignity: A Journal of Analysis of Exploitation and Violence

The destination and source countries for commercial surrogacy match world patterns of inequality. India, Nepal, Thailand, Mexico, and Cambodia banned commercial surrogacy, moving the market to other less-developed countries in South Africa and South America. India had a commercial surrogacy boom until exploitative factors led to the passage of the Surrogacy (Regulation) Bill in 2019, which banned the practice. This paper examines surrogacy's monetary, health, and emotional effects on 45 surrogate mothers in Gujarat State, India. The study revealed that a majority (63%) of the very poor women remained very poor post-surgery. Surrogate mothers in poor households had to do …

The Impact Of Vaccinations And Chronic Disease On Covid Death Rates, James L. Doti

Economics Faculty Articles and Research

This study presents a theoretical and empirical regression model to measure the efficacy of vaccinations in reducing COVID death rates across states over the 3/10/21 to 12/28/22 period. During that period, it was estimated that the availability of vaccinations resulted in a reduction of 427,000 COVID deaths in the nation. To arrive at that estimate, other covariants were held constant. In particular, it was found that chronic disease should be included as an explanatory variable to arrive at unbiased measures of the efficacy of vaccinations in reducing deaths. In addition, the percentage of people over the age of 65 was …

An Introduction To The Sustainable Developmental Goals Through The Lens Of Dewroze, Obidimma Ezezika, Kishif Fatima, Umayangga Yogalingam, Mona Jarrah, Suzanne Sicchia

Health Studies Publications

The following interactive discussion questions are based on a fictional animated storyline by Chapter 1 of the third edition of An Introduction to Global Health. The animated storyline and questions are intended to provide students with the opportunity to understand global health, the Sustainable Development Goals (SDGs), and barriers related to the social determinants of health, in the context of a developing country.

Students will be introduced to the fictional village of Dewroze where they will learn how poverty shapes vulnerabilities that lead to health inequities. In this village, students will meet Ada, Ada’s father, Ada’s mother who is pregnant, …

The Design And Rationale Of A Multicenter Real-World Trial: The Southeastern Collaboration To Improve Blood Pressure Control In The Us Black Belt – Addressing The Triple Threat, Monika M Safford, Doyle M Cummings, Jacqueline Halladay, James M Shikany, Joshua Richman, Suzanne Oparil, James Hollenberg, Alyssa Adams, Muna Anabtawi, Lynn Andreae, Elizabeth Baquero, Joanna Bryan, Debra Clark, Ethel Johnson, Erica Richman, Orysya Soroka, James Tillman, Andrea L Cherrington

Student and Faculty Publications

BACKGROUND: Impoverished African Americans (AA) with hypertension face poor health outcomes.

PURPOSE: To conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension.

METHODS: We engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + …

Developmental Boxes, Karina Ryabinina, Lauren Kelly, Marissa Bankey, Kaila Medeiros, Sammy Schultz

Nursing Leadership in Community Engagement Projects

Developmental Boxes

The assigned facility is a resource center that operates to assist families in need. Services offered include housing placement, homelessness prevention, securement of affordable childcare, after-school programs, and health education. The center has served the Mount Baker community for nearly three years and intends to continue partnering with public services to end the cycle of poverty and create brighter futures for those who need it most (Mercy Housing, 2021).

Our team conducted a windshield survey of the community served by the facility and determined there to be limited access to childcare in the area as well as minimal …

Neurodevelopment, Vision And Auditory Outcomes At Age 2 Years In Offspring Of Participants In The ‘Women First’ Maternal Preconception Nutrition Randomised Controlled Trial, Michelle Fernandes, Nancy F. Krebs, Jamie Westcott, Antoinette Tshefu, Adrien Lokangaka, Melissa Bauserman, Ana L. Garcés, Lester Figueroa, Sarah Saleem, Sumera A. Aziz, Robert L. Goldenberg, Shivaprasad S. Goudar, Sangappa M. Dhaded, Richard J. Derman, Jennifer F. Kemp, Marion Koso-Thomas, Amaanti Sridhar, Elizabeth M. Mcclure, K. Michael Hambidge

Global Health Articles

BACKGROUND: Maternal nutrition in preconception and early pregnancy influences fetal growth. Evidence for effects of prenatal maternal nutrition on early child development (ECD) in low-income and middle-income countries is limited.

OBJECTIVES: To examine impact of maternal nutrition supplementation initiated prior to or during pregnancy on ECD, and to examine potential association of postnatal growth with ECD domains.

DESIGN: Secondary analysis regarding the offspring of participants of a maternal multicountry, individually randomised trial.

SETTING: Rural Democratic Republic of the Congo, Guatemala, India and Pakistan.

PARTICIPANTS: 667 offspring of Women First trial participants, aged 24 months.

INTERVENTION: Maternal lipid-based nutrient supplement initiated …

State-Level Macro-Economic Factors Moderate The Association Of Low Income With Brain Structure And Mental Health In U.S. Children, David G Weissman, Mark L Hatzenbuehler, Mina Cikara, Deanna M Barch, Katie A Mclaughlin

2020-Current year OA Pubs

Macrostructural characteristics, such as cost of living and state-level anti-poverty programs relate to the magnitude of socioeconomic disparities in brain development and mental health. In this study we leveraged data from the Adolescent Brain and Cognitive Development (ABCD) study from 10,633 9-11 year old youth (5115 female) across 17 states. Lower income was associated with smaller hippocampal volume and higher internalizing psychopathology. These associations were stronger in states with higher cost of living. However, in high cost of living states that provide more generous cash benefits for low-income families, socioeconomic disparities in hippocampal volume were reduced by 34%, such that …

Does Family Size Moderate The Relation Between Resource Transfers And Intimate Partner Violence Rates?, Paul Gramling

Psychological Science Undergraduate Honors Theses

Intimate partner violence (IPV) refers to physical, sexual, or psychological abuse within an intimate relationship. It is a global issue, particularly for women in developing countries where data show higher rates of IPV for these women than in developed countries. IPV can lead to physical harm, chronic health problems, and even death. It also has negative effects on mental health, economic stability, and the overall well-being of the woman and their children. Family size has been shown to be a predictor of IPV risk; women from larger families face a higher risk. Cash transfer programs in developing countries have been …

Family-Based Interventions Impact On Pediatric Obesity, Renee Camins

Nursing | Student Research Posters

Background: Obesity rates among children in the United States have been on the rise, with 19.7% of children aged 2-19 classified as obese (CDC, 2022). Low socioeconomic status is a risk factor for pediatric obesity,Children from low-income households are more likely to be overweight or obese than their peers from higher economic backgrounds. Obesity can lead to serious and chronic health problems such as diabetes, high blood pressure, and breathing difficulties, and is also a risk factor for leading causes of death in adults including stroke, cardiovascular disease, and cancer (CDC, 2022). Educational interventions and access to exercise resources may …

A Process Evaluation Of The Green Period Pantry Project, Gabi Wiggill

Honors College Theses

Introduction: The Green Period Pantry (GPP) was a health promotion initiative that was implemented in collaboration with the Office of Student Wellness and Health Promotion. It was created using $48,000 in grant money applied for and received from Sustain Southern as part of the Sustainability Fee Grants at Georgia Southern University. The purpose of the project was to supply students who experienced menstruation with reusable menstrual hygiene products. Another purpose was to describe the process from idea inception to implementation through collaboration with the Office of Student Wellness and Health Promotion. Results: A total of 3,506 units of reusable Menstrual …

Disparity In Checkpoint Inhibitor Utilization Among Commercially Insured Adult Patients With Metastatic Lung Cancer, Meng Li, Kaiping Liao, Alice J Chen, Tina Cascone, Yu Shen, Qian Lu, Ya-Chen Tina Shih

Student and Faculty Publications

BACKGROUND: There is a lack of evidence from nationwide samples on the disparity of initiating immune checkpoint inhibitors (ICIs) after metastatic lung cancer diagnosis.

METHODS: We identified metastatic lung cancer patients diagnosed between 2015 and 2020 from a large, nationwide commercial claims database. We analyzed the time from metastatic lung cancer diagnosis to ICI therapy using Cox proportional hazard models. Independent variables included county-level measures (quintiles of percentage of racialized population, quintiles of percentage of population below poverty, urbanity, and density of medical oncologists) and patient characteristics (age, sex, Charlson comorbidity index, Medicare Advantage, and year of diagnosis). All tests …