Study highlights importance of social media influencers in information dissemination during mpox outbreak

University of Florida

A recent study shows social media influencers are more important than previously thought when it comes to getting out vital information in a crisis.

The study suggested partnerships that could improve public communication between governments, non-profits and social media influencers during crises. The study, conducted by UF/IFAS assistant professor Kimberly Kay Wiley, a researcher in the family, youth and community sciences department, and Bridgewater State University associate professor Seth Meyer, shows how these groups can collaborate to effectively disseminate information and manage public health emergencies on social media.

“In this case, the informal public health authorities seem to be able to reach the at-risk audiences and build on the trust that they have in a way that the formal health authorities just weren’t able to do,” Wiley said. “There are strong partnership opportunities here.”

The study, titled “A Framework for Messy Communication: A Qualitative Study of Competing Voices of Authority on Social Media,” explores social media communication during the 2022 mpox outbreak. It was published in Administrative Sciences. By analyzing 1,392 social media posts from governments, non-profits and influencers across six platforms, the researchers identified how these groups could improve their reach and impact.

One of the central findings of the study, published in the journal Administrative Sciences, is the importance of partnerships with non-traditional allies. Governments and non-profits can significantly enhance their communication efforts by partnering with influencers who are trusted by specific communities – in this case, the LGBTQIA+ community. This approach allows for a more targeted strategy to get the word out to hard-to-reach groups, particularly to isolated or minority groups that may be more vulnerable during crises.

Non-profits can tailor messages to address specific needs and concerns, while influencers, with their broad reach, trusted relationships with their followers and engaging content, can amplify these messages to a wider audience.

During the 2022 mpox outbreak, the study found, the most successful communication strategies were those that used partnerships to manage a rocky start. Initially, there was a vacuum of information from official sources such as governments, leading to confusion and misinformation. However, as governments began to collaborate with influencers, the messaging became more organized and audience-specific. These findings highlight the need for proper planning and for groups to set up partnerships before a crisis happens.

The researchers also emphasized the importance of trust in these public-private partnerships. Influencers, in particular, must be selected based on their credibility and reliability to ensure that the information they disseminate is accurate and helpful. At the same time, influencers need the freedom to frame messaging for their audiences, even when it falls outside of a government’s branded social media approach.

“Formal health authorities can step in with resources and evidence-based action steps, but influencer partnerships can reach specific communities with the right messaging and get right into their social media feeds,” Wiley said.

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Journal

Administrative Sciences

DOI

10.3390/admsci14070145 

Article Title

A Framework for Messy Communication: A Qualitative Study of Competing Voices of Authority on Social Media

 

Dangerous airborne fungus boosted by California droughts

Valley fever cases peak from September to November; drought temporarily dampens these peaks, but leads to bigger surges once rain returns

University of California - San Diego

 

image: 

This map shows how the average incidence of Valley fever varies across different counties, with yellow and green representing higher incidence than blue and purple.

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Credit: UC San Diego Health Sciences

Valley fever is an emerging fungal disease in the western United States that most often causes flu-like symptoms, but can also cause dangerous or even deadly complications. By analyzing data on reported cases of Valley fever in California, which have increased dramatically over the last two decades, researchers from University of California San Diego and University of California, Berkeley, have identified seasonal patterns that could help individuals and public health officials better prepare for future surges in Valley fever cases. The findings also have important implications for how the changing climate can exacerbate the threat of infectious diseases. The findings are published in The Lancet Regional Health - Americas.

The researchers collaborated closely with the California Department of Health (CDPH) to analyze all reported Valley fever cases in California from 2000 to 2021. By comparing these to seasonal climate data, they discovered how the disease cycles seasonally across different California counties and identified how these cycles are influenced by drought periods. The researchers found that while most cases occur during the period from September to November, there were differences in seasonal patterns and timing between counties and years.

“Most seasonal infectious diseases show a peak in cases every year, so we were surprised to see that there were certain years during which few or no counties had a seasonal peak in Valley fever cases,” said first author Alexandra Heaney, Ph.D., assistant professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science. “This made us wonder what was driving these differences in seasonality between years, and based on the timing we observed, we hypothesized that drought might be playing a role.”

The researchers found that on average, counties in the San Joaquin Valley and Central Coast regions had the most pronounced seasonal peaks, though the peaks started earlier in San Joaquin Valley.

“This is valuable information to time public health messaging aimed at educating the public about the symptoms of Valley fever and how to protect themselves,” added Heaney.

Valley fever is caused by spores from the soil-dwelling Coccidioides fungus. People contract Valley fever by inhaling infectious spores that become aerosolized when the soil is disturbed by wind or human activity. Valley fever is most likely to affect people who are exposed to airborne dust frequently, including those who work outdoors. However, the disease is not contagious.

Valley fever has long been a problem in the American Southwest, but the number of cases has skyrocketed in recent years, tripling from 2014–2018 and again from 2018–2022, according to the CDPH. However, because it is still relatively rare, and because it causes similar symptoms to other respiratory infections, including COVID-19, Valley fever is often misdiagnosed. When left untreated, the fungus can cause severe damage to the respiratory system and spread to other parts of the body, such as the skin, bones and even the brain, the latter of which can be deadly.

“Knowing when the Valley fever season starts and how intense it will be can help health care practitioners know when they should be on high alert for new cases,” said corresponding author Justin Remais, Ph.D., professor at UC Berkeley School of Public Health. “This is the first study to pin down exactly when disease risk is highest in all of California’s endemic counties, as well as places where the disease is newly emerging.”

The researchers observed that during drought periods, seasonal peaks in Valley fever cases are less severe. However, when the rains return, these peaks are particularly high. One hypothesis to explain this pattern is that droughts allow heat-resistant Coccidioides spores to outlast their less-hardy competitors. When rains return, the fungus is able to proliferate widely with less competition for moisture and nutrients.

Another hypothesis suggests that the links between Valley fever and drought may be due to drought’s impact on rodents that host the Coccidioides fungus. Because rodent populations decline during droughts, and because dead rodents are thought to be an important source of nutrients for the fungus, it may be able to survive and spread more easily in drought conditions.

“This work is an important example of how infectious diseases are influenced by climate conditions,” said Heaney. “Even though droughts appear to decrease Valley fever cases in the short term, the net effect is an increase in cases over time, particularly as we experience more frequent and severe droughts due to climate change.”

Individuals can help protect themselves against Valley fever during dry and dusty periods by minimizing time outdoors and wearing face coverings that can block dust. The researchers also emphasize the need for more thorough monitoring of the Valley fever fungus, which can be difficult to detect.

The team is now expanding the range of their analyses to include other Valley fever hotspots in the United States.

“Arizona is much dustier than California and has very different climate dynamics, and about two thirds of cases in the United States occur in Arizona, so that’s where we’re looking next,” said Heaney. “Understanding where, when, and in what conditions Valley fever is most prevalent is critical for public health officials, physicians, and the public to take precautions during periods of increased risk.”

Full link to study: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(24)00191-1/fulltext

Additional co-authors on the study include Simon K. Camponuri, Phil Collender, Amanda Weaver and John Taylor at UC Berkeley; Jennifer R. Head at University of Michigan; Gail Sondermeyer-Cooksey, Alexander Yu, Duc Vugia and Seema Jain at California Department of Public Health and Abinash Bhattachan at Texas Tech University.

This study was funded by the National Institutes of Health (grant R01AI148336).

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Journal

The Lancet Regional Health - Americas

DOI

10.1016/j.lana.2024.100864 

 

Finger wrap uses sweat to provide health monitoring at your fingertips—literally

University of California - San Diego

 

image: 

This finger wrap is powered by the wearer's fingertip sweat—and also monitors levels of glucose, lactate, vitamin C and levodopa in that same sweat.

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Credit: Shichao Ding

A sweat-powered wearable has the potential to make continuous, personalized health monitoring as effortless as wearing a Band-Aid. Engineers at the University of California San Diego have developed an electronic finger wrap that monitors vital chemical levels—such as glucose, vitamins, and even drugs—present in the same fingertip sweat from which it derives its energy.

The advance was published Sept. 3 in Nature Electronics by the research group of Joseph Wang, a professor in the Aiiso Yufeng Li Family Department of Chemical and Nano Engineering at UC San Diego.

The device, which wraps snugly around the finger, draws power from an unlikely source—the fingertip’s sweat. Fingertips, despite their small size, are among the body’s most prolific sweat producers, each packed with over a thousand sweat glands. These glands can produce 100 to 1000 times more sweat than most other areas of the body, even during rest. This constant trickle of natural perspiration—without any stimuli or physical activity—offers a reliable energy source, fueling the device even during periods of inactivity or sleep.

The device is constructed from several electronic components printed onto a thin, flexible and stretchable polymer material. Its design allows it to conform to the finger while being durable enough to withstand repeated bending, stretching and movement. “It is based on a remarkable integration of energy harvesting and storage components, with multiple biosensors in a fluidic microchannel, along with the corresponding electronic controller, all at the fingertip,” said Wang.

Central to its operation are biofuel cells that are positioned where the device contacts the fingertip. These cells have been specially engineered to efficiently collect and convert chemicals in sweat into electricity. This electricity is stored in a pair of stretchable, silver chloride-zinc batteries, which power a suite of sensors—four in total—each tasked with monitoring a specific biomarker: glucose, vitamin C, lactate and levodopa, a drug used for treating Parkinson’s disease. As sweat is wicked through tiny paper microfluidic channels to these sensors, the device analyzes the biomarker levels, all while drawing energy it needs from the very sweat it’s sampling. A small chip processes signals from the sensors and wirelessly transmits the data via Bluetooth low energy to a custom-designed smartphone or laptop application.

“This is automatic health monitoring at your fingertips,” said study co-first author Shichao Ding, a postdoctoral researcher in Wang’s research group at the UC San Diego Jacobs School of Engineering. “The wearer can be resting or asleep, and the device can still harvest energy and track biomarker levels.”

In tests, a subject wore the device throughout the day to track glucose levels during meals, lactate levels during both desk work and exercise, vitamin C levels while drinking orange juice, and levodopa levels after eating fava beans, a natural source of the compound.

Ding and co-first author Tamoghna Saha say that the device can be customized to cater to individual health needs by detecting different sets of biomarkers. The researchers are working on developing a closed-loop system that not only monitors biomarkers, but also administers treatments based on the collected data. For instance, in the case of diabetes, such a device could continuously monitor glucose levels and automatically deliver insulin as needed, then assess the treatment’s effectiveness by further monitoring biomarker levels.

“Autonomous power, sensing and treatment all in one device—that’s the ultimate goal,” said Ding.

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Journal

Nature Electronics

DOI

10.1038/s41928-024-01236-7 

Article Title

A fingertip wearable microgrid system for autonomous energy management and metabolic monitoring

Article Publication Date

3-Sep-202

 

Can you identify the new threat attracting Gen Z to nicotine use?

Survey finds just 1 in 4 adults could identify nicotine pouches if they saw them, but they are skyrocketing in popularity

Ohio State University Wexner Medical Center

 

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A new national survey by The Ohio State University Comprehensive Cancer Center —Arthur G. James Cancer Hospital and Richard J. Solove Research Institute finds just one in four Americans could identify a nicotine pouch outside of its packaging. As these products skyrocket in popularity, experts worry they’re a gateway to nicotine addiction for teens and young adults.

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Credit: The Ohio State University Comprehensive Cancer Center.

COLUMBUS, Ohio – About half of adults can identify cigarettes and e-cigarettes, but just one in four would recognize oral nicotine pouches, and these easily available products are growing increasingly popular among teens and young adults, according to a recent study commissioned by The Ohio State University Comprehensive Cancer Center – Arthur G. James Hospital and Richard J. Solove Research Institute (OSUCCC – James).

Oral nicotine pouches are small packets filled with a flavored powder containing nicotine and other chemicals that are tucked between the lip and gums. Researchers at the OSUCCC – James Center for Tobacco Research are concerned that these oral nicotine pouches are so appealing and easy to use that they could be a gateway to future tobacco product addiction for Gen Z.

Epidemiologist Brittney Keller-Hamilton, PhD, says these products are available in low- and high-nicotine concentrations, making them appealing to both new users and people who are already addicted to nicotine. 

“We're starting to hear from college students that they find it easier to use nicotine pouches at work or in class because they are easier to conceal. They also do not require you to spit excess saliva like older tobacco oral products (dip, snuff),” said Keller-Hamilton, who studies nicotine pouch use and regulation at the Center for Tobacco Research. “One of my biggest concerns with nicotine pouches is that as youth experiment with these products, they might not find them to be satisfying enough to continue to meet a growing nicotine craving and then might transition to more harmful products.” 

She notes that regulation of these products is minimal, and that removing flavorings, prohibiting online sales, and increasing the price could discourage youth experimentation and, therefore, reduce their risk of becoming addicted to nicotine. 

As students go back to school, Keller-Hamilton cautions parents to pay attention to what is in their teenagers’ backpacks.

“Many products are cleverly packaged to conceal the real content – vapes as highlighters or pens, oral nicotine pouches as mints. Unfortunately, due to loose industry regulation, they are very easy to obtain for underage youth, and they are far from harmless. We know that when people start using any nicotine product, including nicotine pouches, before their brain is finished developing, it primes their brain for a stronger nicotine addiction and also primes their brain for addiction to other substances,” said Keller-Hamilton. “It’s really important for parents to talk with their kids about the dangers of these products and seek help from their pediatrician if they’re concerned about nicotine addiction.”

Study results and methods
For this survey, 1,000 adults aged 18 or older were asked about their ability to recognize nicotine products with and without the visual aid of packaging, as well as their perceptions about the health effects of these products.

Ohio State’s recent survey showed that 70% of adults believe nicotine pouches are harmful to health and lead to addiction, but just 25% say they could identify a nicotine pouch out of its container or packaging. The survey also found that those between the ages of 18-29 are more likely to know someone who uses nicotine pouches, as opposed to older adults.

This study was conducted on behalf of the OSUCCC – James by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from July 19-22, 2024, among a sample of 1,008 respondents. The survey was conducted via web (n=976) and telephone (n=32) and administered in English. The margin of error for total respondents is +/- 3.5 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older. 

To learn more about research at the Center for Tobacco Research, visit cancer.osu.edu/CTR. For resources on nicotine use and cessation in youth, visit tobaccofreekids.org. Adult smoking cessation support is available at The Ohio State University Wexner Medical Center. To schedule an appointment, call 614-293-QUIT (7848) or visit medcenter.osu.edu. 

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at the Center for Tobacco Research at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute are concerned that the fruity flavors and discreet design of nicotine pouches are a gateway to addiction for Gen Z.

Credit

The Ohio State University Comprehensive Cancer Center

News Package [VIDEO] | 

If a parent found a cigarette or vape in their child’s things, they would probably know what it was. But a new national survey by The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute finds just one in four Americans could identify a nicotine pouch, which are growing in popularity and are much easier to hide.

Credit

The Ohio State University Comprehensive Cancer Center

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Method of Research

Survey

Subject of Research

People

 DARKNESS CONTAINS LIGHT   NOX vel LUX

Photosynthesis in near darkness

Research team publishes new results of the MOSAiC project

Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research

 

image: 

MOSAiC Ocean City during Leg 3.

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Credit: Alfred-Wegener-Institut / Saga Svavarsdottir (CC-BY 4.0)

Photosynthesis can take place in nature even at extremely low light levels. This is the result of an international study that investigated the development of Arctic microalgae at the end of the polar night. The measurements were carried out as part of the MOSAiC expedition at 88° northern latitude and revealed that even this far north, microalgae can build up biomass through photosynthesis as early as the end of March. At this time, the sun is barely above the horizon, so that it is still almost completely dark in the microalgae's habitat under the snow and ice cover of the Arctic Ocean. The results of the study now published in the journal Nature Communications show that photosynthesis in the ocean is possible under much lower light conditions, and can therefore take place at much greater depths, than previously assumed.

Photosynthesis converts sunlight into biologically usable energy and thus forms the basis of all life on our planet. However, previous measurements of the amount of light required for this have always been well above the theoretically possible minimum. A new study in the scientific journal Nature Communications shows that the build-up of biomass can actually take place with a quantity of light that is close to this minimum.

The researchers used data from the international MOSAiC research project for their work. As part of the expedition, they froze the German research icebreaker Polarstern in the icepack of the central Arctic for a year in 2019, in order to investigate the annual cycle of the Arctic climate and ecosystem. The team led by Dr Clara Hoppe from the Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI) focused on studying phytoplankton and ice algae. These are responsible for the majority of photosynthesis in the central Arctic. Unexpectedly, the measurements showed that just a few days after the end of the month-long polar night, plant biomass was built up again, for which photosynthesis is absolutely essential. Extremely sensitive light sensors in the ice and water made it possible to measure the amount of light available.

The results were particularly surprising because photosynthesis in the Arctic Ocean took place under snow-covered sea ice, which only allows a few photons of incident sunlight to pass through: The microalgae only had about one hundred thousandth of the amount of light of a sunny day on the Earth's surface available for their growth. "It is very impressive to see how efficiently the algae can utilise such low amounts of light. This shows once again how well organisms are adapted to their environment" says Clara Hoppe.

The study was made possible by the close collaboration of researchers from various disciplines. Sea ice researchers Dr Niels Fuchs and Prof Dirk Notz from the Institute of Marine Research at the University of Hamburg were responsible for combining measurements of the light field with the biological measurements. "To measure such low light levels under the harsh conditions of the Arctic winter, we had to freeze special, newly developed instruments into the ice in the middle of the polar night," explains Niels Fuchs. His colleague Dirk Notz adds that it was particularly difficult to take into account irregularities in the light field under the ice due to variations in ice thickness and snow: "But in the end we could be sure: There was just not more light."

The results of the now published study are important for the entire planet. "Even though our results are specific to the Arctic Ocean, they show what photosynthesis is capable of. If it is so efficient under the challenging conditions of the Arctic, we can assume that organisms in other regions of the oceans have also adapted so well," says Clara Hoppe, contextualising the results. This means that there could also be enough light to produce usable energy and oxygen through photosynthesis in deeper areas of the oceans, which would then be available for fish, for example. The corresponding photosynthetic habitat in the global ocean could therefore be significantly larger than previously assumed.

Original publication:

Clara J.M. Hoppe, Niels Fuchs, Dirk Notz, Philip Anderson, Philipp Assmy, Jørgen Berge, Gunnar Bratbak, Gaël Guillou, Alexandra Kraberg, Aud Larsen, Benoit Lebreton, Eva Leu, Magnus Lucassen, Oliver Müller, Laurent Oziel, Björn Rost, Bernhard Schartmüller, Anders Torstensson, Jonas Wloka: Photosynthetic light requirement near the theoretical minimum detected in Arctic microalgae, Nature Communications (2024). DOI: https://doi.org/10.1038/s41467-024-51636-8

Notes for editors:

Please note the publisher’s embargo: 11:00 CEST (10:00 am London Time) on Wednesday, 4 September 2024

 

Printable images are available until the embargo here: https://multimedia.awi.de/pincollection.jspx?collectionName=%7Bd5138955-7fcd-4792-a8db-bbeed9ffdfe9%7D, and afterwards in the online version of this press release at: https://www.awi.de/ueber-uns/service/presse.html

Follow the Alfred Wegener Institute on Instagram: @awiexpedition, LinkedIn: @Alfred Wegener Institute, Mastodon: @awi@helmholtz.social.de, Facebook: @AlfredWegenerInstitute and Youtube: @AWIresearch.

 

The Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI) conducts research in the Arctic, Antarctic and the oceans of the temperate and high latitudes. It coordinates polar research in Germany and provides important infrastructure such as the research icebreaker Polarstern and stations in the Arctic and Antarctic for international science. The Alfred Wegener Institute is one of the 18 research centres of the Helmholtz Association, Germany's largest scientific organisation.

Janin Schaffer (right) lowering the CTD-rosette with 12 big waterbottles into the ocean

Credit

Alfred-Wegener-Institut / Michael Gutsche (CC-BY 4.0)

Journal

Nature Communications

DOI

10.1038/s41467-024-51636-8 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Photosynthetic light requirement near the theoretical minimum detected in Arctic microalgae

Article Publication Date

4-Sep-2024

 

Ability to cope well with adversity in older age linked to lower death risk

Findings underscore importance of efforts to bolster mental resilience, say researchers

BMJ Group

The ability to cope well with, and adapt to, challenging life circumstances and events in older age is linked to a lower risk of death, suggests a large nationally representative study, published in the open access journal BMJ Mental Health.

The findings underscore the importance of efforts to bolster mental resilience, conclude the researchers.

The available evidence suggests that mental resilience is a dynamic and active process influenced by various factors, including sex, hormones, and the genes regulating the body’s stress response. This capacity is believed to evolve and vary across different periods of the life cycle, say the researchers.

In older age, good coping skills can help offset the negative impact of long term conditions and subsequent disability. And while the ability to bounce back physically after illness and trauma is associated with slower ageing and the risk of death, it’s not clear if mental resilience might have similar effects, they explain.

To explore this further, the researchers mined the US Health and Retirement Study (HRS), a long term nationally representative study of US adults aged at least 50. This study began in 1992 and includes information on the economic, health, marital and family status of participants who are monitored every 2 years. 

The researchers drew on two waves (2006–08) of HRS data, when questions on mental resilience were collected for the first time, and included a total of 10,569 participants with complete data in the final analysis. Their average age was 66; 59% of them were women.

Mental resilience was assessed using a validated scale encompassing qualities, such as perseverance, calmness, a sense of purpose, self-reliance and the recognition that certain experiences have to be faced alone. The average score of the entire sample was 9.18 (range 0-12). 

Participants were followed up until death or the end of May 2021, whichever came first. During an average tracking period of 12 years, 3489 people died. 

An almost linear association emerged between mental resilience score and death from any cause: the higher the score, the lower was the risk of death, with this association stronger in women than in men.  

Resilience scores were divided into quartiles (25%) and linked to 10-year survival probabilities. These were 61% for those in the bottom quartile (1), rising to 72% and 79% for the middle quartiles (2 and 3), and 84% for those in the top quartile (4). 

Survival analysis showed that those in the highest quartile were 53% less likely to die in the next 10 years than those in the lowest. 

This association remained statistically significant after adjusting for marital status, sex, race, and weight (BMI), but fell to 46% after factoring in ill health (diabetes, cancer, and cardiovascular disease) and to 38% after factoring in an unhealthy lifestyle. 

In all, the risk of death was 20% lower (2nd quartile), 27% lower (3rd), and 38% lower (4th) in those with higher mental resilience scores than it was in those with the lowest scores (Ist quartile), once potentially influential factors had been accounted for.

This is an observational study, and as such, no firm conclusions can be drawn about causality. And the researchers acknowledge that the potential influence of genetic and hormonal factors and childhood adversity weren’t considered. The analysis also relied on baseline data, overlooking potentially influential changes during the monitoring period. 

“Various factors, including but not limited to, meaning in life, positive emotions, self-rated health and satisfaction with social support, have been identified as potential influences on psychological resilience,” they explain. 

“Triggering these positive emotions may enhance the protective effects of psychological resilience and mitigate the negative impact of accumulated adversity on mental health in adults.”

They conclude: “The findings underscore the potential effectiveness of interventions aimed at promoting psychological resilience in order to mitigate mortality risks.”

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Journal

BMJ Mental Health

DOI

10.1136/bmjment-2024-301064 

Method of Research

Observational study

Subject of Research

People

Article Title

Association between psychological resilience and all cause mortality in the Health and Retirement Study

Article Publication Date

3-Sep-2024

MISOGYNIST, RACIST, ABLIST

Women, Black people, and disadvantaged less likely to get heart surgery in England

And when they are offered these procedures, they are more likely to die within a year

 News Release 3-Sep-2024

BMJ Group

Women, people of Black ethnicity, and those from low income households in England are less likely to be offered heart surgery than men, White people, and those who are affluent, finds research published online in the journal Heart.

And when they do have these procedures, they are more likely to die within a year, prompting the researchers to call for prompt action to tackle these health inequalities.

Cardiac surgery is one of the costliest ways of treating cardiovascular disease, with around 28,000 adults a year in the UK undergoing the procedure, note the researchers. While previously published research shows that gender, ethnicity, and social/economic deprivation can affect the short term outcomes of cardiac surgery, it’s not clear what impact they might have on longer term outcomes.

To find out, the researchers used Hospital Episode Statistics (HES) and Office for National Statistics (ONS) data to explore differences in access to and outcomes of cardiac surgery (coronary artery bypass grafting (CABG) and heart valve procedures) in England among people admitted with heart disease by sex, ethnicity, and deprivation between 2010 and 2019.

They calculated the rates of death in hospital and at 1, 3, and 5 years after surgery as well as readmission for cardiovascular causes, heart failure, and stroke/transient ischaemic attack (‘mini stroke’). 

Between 2010-19, 292,140 people had cardiac surgery: 49% CABG; 38% valve surgery; and 13% combined surgery. In all, 28% of all these patients were women, 11% were from an ethnic minority, and 17% lived in areas of greatest deprivation.

Rates of both CABG and valve surgery fell between 2010 and 2019, from 30 to 25 per 1000 people with ischaemic heart disease, and from 88 to 70/1000 people with heart valve disease. 

The age, sex, ethnicity, and levels of deprivation of those having surgery were similar across the entire period, although the proportions of those with multiple conditions and frailty and those admitted as an emergency increased between 2010 and 2019.

Women were 59% less likely to have CABG and 31% less likely to have valve surgery than men. And Black people were less likely to have surgery than White people: 32% less likely for CABG and 33% less likely for valve surgery. While people of South Asian ethnicity were 49% more likely to have CABG, they were 28% less likely to have valve surgery than White people. 

And there was almost a linear association between increasing levels of deprivation and decreasing likelihood of getting  cardiac surgery, with the most socially disadvantaged 35% and 39% less likely to have CABG and valve surgery, respectively, than the least disadvantaged.

As to outcomes, hospital deaths fell for all types of cardiac surgery between 2010 and 2019 by around 20% (from 3.4% to 2.7%). But women were more likely to die than men, and people of South Asian ethnicity were more likely to die than White people. Black people were more likely to die than their White counterparts, but only after CABG. 

Around 7 in every 100 people died within 1 year of all types of cardiac surgery, and 1 in 5 people were readmitted to hospital, rising to almost 1 in 4 for those having valve surgery. Unlike hospital deaths, which fell over time, deaths after 1 year and hospital readmissions didn’t.

Women, Black people, and those living in the most deprived areas were also more likely to die within 1 year of surgery: 24%, 85%, and 18% more likely, respectively, for CABG; 19% (women) and 10% (people from areas of greatest deprivation) more likely for valve surgery.

The researchers acknowledge that HES coding varies among hospitals and that ethnicity wasn’t coded for 10% of the data entries. And people with ischaemic heart or valve disease don’t necessarily represent the full gamut of those in need of cardiac surgery.

The decline in the use of cardiac surgery for treatment over time reflects trends in both Europe and the USA, they note. But the differences in access to surgery and outcomes by demographic and socioeconomic characteristics need to be tackled as a matter of priority, they insist.

“There is an urgent need to address inequalities through enhanced data linkage and improved transparency and publication of data from benchmarking exercises on inequality characteristics and ensuring equity of the workforce and pathways people use to access care,” they conclude.

In a linked editorial, Dominique Vervoort of the University of Toronto, Canada, comments that access to cardiac surgery in high income countries with universal health coverage is generally assumed to be equal. 

However, “Across the continuum of cardiovascular care for patients living with cardiac surgical conditions, there are potential gaps in access to care because of social determinants of health,” he writes.

“Identifying inequalities and inequities in access to cardiac surgical care is essential for health systems to understand which patients might be left behind. Health services research with a focus on healthcare utilisation, health equity, and patient centredness must, therefore, be supported,” he adds.

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Journal

Heart

DOI

10.1136/heartjnl-2024-324292 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010–2019)

Article Publication Date

3-Sep-2024