Benjamin Amick

This paper describes the development of the Arkansas Health Survey (AHS) and AR-COMPASS Explorer as an integrated surveillance-to-action infrastructure that uses representative statewide survey data to produce publicly accessible estimates at the state, county, and census tract levels. The AHS is an annual, statewide, population-based survey of adult Arkansans. Year 1 used address-based sampling to improve representation of lower-income, racially and ethnically diverse, and rural census tracts. Responses were geocoded, imputed as needed, weighted to represent Arkansas adults, and prepared for small-area estimation and public dissemination. A total of 9932 respondents met eligibility and completion criteria. Weighted baseline estimates identified substantial disease and behavioral health need, including hypertension, obesity, clinically relevant depressive symptoms, past-30-day tobacco or nicotine use, and hazardous alcohol use. Baseline estimates provide the empirical foundation for AR-COMPASS, which disseminates AHS indicators through interactive maps, local profiles, comparison tools, and downloadable outputs. The AHS and AR-COMPASS illustrate an approach to designing population health surveillance with a localized dissemination component. This model offers a replicable framework for states seeking geographically granular, publicly useful data infrastructure.

Supplementary Table S2 shows the baseline demographic and clinical characteristics of individuals with type 2 diabetes, categorized by their baseline income status including Medical Aid beneficiaries and income quartiles.

Supplementary Table S4 provides the results of a 5-year landmark analysis assessing the hazard ratios for hepatocellular carcinoma according to cumulative income consistency and baseline income status.

Supplementary Table S3 displays the association between income parameters (cumulative years in income groups and baseline status) and the risk of hepatocellular carcinoma, adjusted for additional potential mediators in Models 4 and 5.

Background:This study aimed to examine the cumulative effect of income on hepatocellular carcinoma (HCC) risk in individuals with type 2 diabetes (T2D).Methods:A nationwide cohort of 1,516,897 adults with T2D and no history of cancer (2015–2016 baseline) from the Korean National Health Insurance Service was analyzed. Annual income was categorized into quartiles based on health insurance premiums, designating the highest quartile and lowest quartile as high- and low-income groups, respectively. Cumulative income status was assessed over 5 years, including the 4 years preceding and the baseline year. Incident HCC was identified via International Classification of Diseases, Tenth Revision (ICD-10) code.Results:The hazard ratio (HR) for 5-year consistent high-income status was 0.68 [95% confidence interval (CI), 0.65–0.72] compared with those never classified as the high-income group, whereas the HR for 5-year consistent low-income status was 1.34 (95% CI, 1.26–1.43) compared with those never classified as the low-income group. The HCC risk showed a significant duration-dependent trend in relation to cumulative exposure to low or high income, respectively (Ptrend < 0.0001). The association was stronger in those without chronic liver disease or major cancer risk factors and remained robust after adjusting for diabetes-related factors.Conclusions:Prolonged low- or high-income status was independently associated with HCC risk among individuals with T2D, with a clear duration-dependent pattern.Impact:These findings emphasize how income stability independently affects the incidence risk of HCC in individuals with T2D.

Supplementary Table S1 presents the baseline characteristics of study participants stratified by the cumulative number of years in low- or high-income groups over a 5-year period.

Background: This study aimed to examine the cumulative effect of income on hepatocellular carcinoma (HCC) risk in individuals with type 2 diabetes (T2D). Methods: A nationwide cohort of 1,516,897 adults with T2D and no history of cancer (2015–2016 baseline) from the Korean National Health Insurance Service was analyzed. Annual income was categorized into quartiles based on health insurance premiums, designating the highest quartile and lowest quartile as high- and low-income groups, respectively. Cumulative income status was assessed over 5 years, including the 4 years preceding and the baseline year. Incident HCC was identified via International Classification of Diseases, Tenth Revision (ICD-10) code. Results: The hazard ratio (HR) for 5-year consistent high-income status was 0.68 [95% confidence interval (CI), 0.65–0.72] compared with those never classified as the high-income group, whereas the HR for 5-year consistent low-income status was 1.34 (95% CI, 1.26–1.43) compared with those never classified as the low-income group. The HCC risk showed a significant duration-dependent trend in relation to cumulative exposure to low or high income, respectively (Ptrend < 0.0001). The association was stronger in those without chronic liver disease or major cancer risk factors and remained robust after adjusting for diabetes-related factors. Conclusions: Prolonged low- or high-income status was independently associated with HCC risk among individuals with T2D, with a clear duration-dependent pattern. Impact: These findings emphasize how income stability independently affects the incidence risk of HCC in individuals with T2D.

Associations between household dysfunction in childhood and school-to-work trajectories throughout young adulthood were examined along with the mediating role of adolescent mental health problems. Data from 1134 participants in the Dutch prospective cohort TRacking Adolescents’ Individual Lives Survey (TRAILS) with 18-year follow-up were used. Factors of household dysfunction were assessed at age 11; (1) parental socio-economic status (SES), (2) parental mental health, and (3) parental divorce. Mental health was assessed at age 16. School-to-work trajectories from ages 20 to 28 were identified using sequence and hierarchical clustering analysis. Structural equation modelling was used to examine direct effects of household dysfunction on school-to-work trajectories, and the mediating role of mental health. Young adults with low parental SES backgrounds were more likely to follow trajectories of Neither in Education, Employment, nor Training or early work (adjusted odds ratio [aOR] 3.83, 95% confidence interval [CI] 2.24–6.54 and aOR 5.15, 95% CI 3.13–8.49, respectively) compared to a study to work trajectory. Young adults whose parents divorced in childhood were less likely to follow an early work trajectory, compared to a study to work trajectory (aOR 0.63, 95% CI 0.40–0.92). Parental mental health problems were not associated with school-to-work trajectories. Adolescent mental health did not mediate the associations between household dysfunction and school-to-work trajectories. Our study showed the importance of childhood parental SES, relative to other parental factors, for young adults’ school-to-work trajectories. More research in larger samples is needed to unravel the underlying mechanisms to better inform policy and practice.

Supplementary Methods shows the search strategy for each database (e.g., query terms, results).

There is a growing understanding of the influence of long-term place-based poverty, termed persistent poverty, on cancer outcomes. The goal of this scoping review was to characterize the rapidly growing body of literature on the relationship between persistent poverty and outcomes across the cancer care continuum while identifying gaps and opportunities for future research. We searched the CINAHL, Embase, PubMed MEDLINE, and Web of Science databases. Inclusion criteria were peer-reviewed journal articles in English with empirical data from studies conducted in the United States that described cancer outcomes in persistent poverty area(s) and/or compared cancer outcomes in persistent poverty area(s) to other areas. The search yielded 35 articles that were retained for data extraction. Cancer mortality was the most frequently studied outcome; other outcomes assessed were development (including incidence and stage at diagnosis), risk reduction, early detection, treatment, and survivorship (including palliative end-of-life care). Overwhelmingly, persistent poverty residence was associated with worse outcomes across the cancer continuum. Rurality and race intersected with persistent poverty to influence cancer outcomes. Interventions are urgently needed to address the factors contributing to the high cancer burden in persistent poverty areas.