Medicine and Health Sciences Commons^™

Health Care Use Experiences Of Ethnoculturally Diverse Immigrant Older Adults: A Meta-Ethnography, Lorna De Witt, Kathryn A. Pfaff, Roger Reka, Noeman Ahmad Mirza

Nursing Publications

Purpose

Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health care services?

Design/methodology/approach

The authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, …

Effects Of Socioeconomic Status On Colon Cancer Treatment Accessibility And Survival In Toronto, Ontario, And San Francisco, California, 1996-2006, Kevin M. Gorey, Isaac N. Luginaah, Emma Bartfay, Karen Y. Fung, Eric J. Holowaty, Frances C. Wright, Caroline Hamm, Sindu M. Kanjeekal

Social Work Publications

OBJECTIVES: We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California.

METHODS: We analyzed registry data for colon cancer patients from Ontario (n = 930) and California (n = 1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses.

RESULTS: Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After …

Breast Cancer Care In Canada And The United States: Ecological Comparisons Of Extremely Impoverished And Affluent Urban Neighborhoods, Kevin M. Gorey

Social Work Publications

This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, non-receipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian …

Income And Long-Term Breast Cancer Survival: Comparisons Of Vulnerable Urban Places In Ontario And California, Kevin M. Gorey

Social Work Publications

Effects of socioeconomic status on the long-term survival of 808 women with node-negative breast cancer in Canada and the United States were observed. Ontario and California samples diagnosed between 1988 and 1990 were followed until 2006. Socioeconomic data were taken from population censuses. Compared with their California counterparts, residents of low-income urban areas in Ontario experienced a significant 15-year survival advantage (RR = 1.66 [95% CI: 1.00, 2.76]). In these and other vulnerable, lower-middle- to working-class neighborhoods, significantly more Ontario residents gained access to adjuvant radiation therapy (RR = 1.75 [1.21, 2.53]) which seemed associated with better long-term survival (RR …

Physician Supply And Breast Cancer Survival, Kevin M. Gorey

Social Work Publications

BACKGROUND: This study tested the hypothesis that physician supply thresholds are associated with breast cancer survival in Ontario.

METHODS: The 5-year survival of 17,820 female breast cancer patients diagnosed between 1995 and 1997 was surveilled until 2003 for all-cause mortality. Physician supply densities in 1991 and 2001 were computed for 49 Ontario regions.

RESULTS: There were independent threshold effects for general practitioners (GP; 7.25 per 10,000) and obstetrician/gynecologists (OB/GYN; 6 per 100,000) at or above which women with breast cancer were more likely to survive for 5 years. The respective risk of living in areas undersupplied with OB/GYN and GP …

Increased Racial Differences On Breast Cancer Care And Survival In America: Historical Evidence Consistent With A Health Insurance Hypothesis, 1975-2001, Kevin M. Gorey

Social Work Publications

PURPOSE: This study examined whether race/ethnicity had differential effects on breast cancer care and survival across age strata and cohorts within stages of disease.

METHODS: The Detroit Cancer Registry provided 25,997 breast cancer cases. African American and non-Hispanic white, older Medicare-eligible and younger non-eligible women were compared. Successive historical cohorts (1975-1980 and 1990-1995) were, respectively, followed until 1986 and 2001.

RESULTS: African American disadvantages on survival and treatments increased significantly, particularly among younger women who were much more likely to be uninsured. Within node positive disease all treatment disadvantages among younger African American women disappeared with socioeconomic adjustment.

CONCLUSIONS: Growth …

Lower Adherence To Screening Mammography Guidelines Among Ethnic Minority Women In America: A Meta-Analytic Review, Rebecca J. Purc-Stephenson, Kevin M. Gorey

Social Work Publications

OBJECTIVE: This study investigates the association between ethnic minority status and receiving a screening mammogram within the past 2 years among American women over 50.

METHOD: The findings from 33 studies identified from interdisciplinary research databases (1980 to 2006) were synthesized. Separate pooled analyses compared white non-Hispanics to African Americans (28 outcomes), Hispanics (18 outcomes), and Asian/Pacific Islanders (10 outcomes).

RESULTS: Using the random effects model, results showed that African Americans were screened less than white non-Hispanics at a marginal level (OR 0.87, 95% CI 0.75, 1.00). Larger and significant discrepancies were observed for Hispanics (OR 0.65, 95% CI 0.50, …

An International Comparison Of Cancer Survival: Metropolitan Toronto, Ontario, And Honolulu, Hawaii, Kevin M. Gorey

Social Work Publications

OBJECTIVES: Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii.

METHODS: Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses.

RESULTS: Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in …

Gorey, K. Association Between Socioeconomic Status And Cancer Incidence In Toronto, Ontario: Possible Confounding Of Cancer Mortality By Incidence And Survival, Kevin M. Gorey

Social Work Publications

OBJECTIVE: To observe the association between socioeconomic status (SES) and cancer incidence in a cohort of Canadians.

DESIGN: Cases of primary malignant cancer (83,666) that arose in metropolitan Toronto, Ont., from 1986 to 1993 were ascertained by the Ontario Cancer Registry and linked by residence at the time of diagnosis to a census-based measure of SES. Socioeconomic quintile areas were then compared by cancer incidence.

RESULTS: Significant associations between SES and cancer incidence in the hypothesized direction--greater incidence in low-income areas--were observed for 15 of 23 cancer sites.

CONCLUSIONS: These findings, together with the recently observed consistent pattern of significant …

Group Work As Interventive Modality With The Older Depressed Client: A Meta-Analytic Review, Kevin M. Gorey, Arthur G. Cryns

Social Work Publications

This review analyzes a total of 19 empirical studies dealing with the effectiveness of group work intervention with depressed older clients (65 years and older). Multiple analyses of all outcome data reported allowed for the following summative, empirically derived inferences: (1) overall, group work was found to account for 42% positive change in client affective states; however, most of this improvement (87%) appears to be attributable to nonspecific interventive variables, i.e., factors outside the control and intent of the group worker; (2) group work is optimally effective for clients who live alone and are moderately to severely depressed; (3) client …

Effects Of Surgery On The Mental Status Of Older Persons. A Meta-Analytic Review, Arthur G. Cryns, Kevin M. Gorey, Marion Z. Goldstein

Social Work Publications

The data bases of 18 empirical studies were combined into one comprehensive data set and subjected to meta-analysis. The following trends were observed: (1) surgery has a significantly decompensating impact on the mental status of older persons, and the average effect size observed is modest (r = .37); (2) for all mental status measures included in the review (cognition, delirium and affect), effect size appears to be significantly moderated by patient age; (3) patient sex may be predictive of the kind of mental impairment that is most likely to occur within an older surgery population, with women manifesting a greater …