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Azap L, Woldesenbet S, Osae H, Henn M, Bozinovski J, Whitson B, Mokadam NA, Ganapathi A, Pawlik TM. County-level food insecurity is associated with outcomes following cardiac surgery. Am J Surg 2024; 237:115907. [PMID: 39197233 DOI: 10.1016/j.amjsurg.2024.115907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/05/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND As there is limited literature evaluating food insecurity status (FI) and surgical outcomes, we sought to assess the association between county-level FI and outcomes following cardiac surgery. METHODS In a retrospective cohort, patients who underwent coronary artery bypass grafting between 2016 and 2020 were identified utilizing the Medicare Standard Analytic Files. Using County-level FI, patients were stratified into low, moderate, and high cohorts. The primary outcome was textbook outcomes, a measure of "optimal" post-operative outcomes. Adjusted multiple logistic regression and Cox regression models were utilized to evaluate outcomes and survival. RESULTS Among 267,914 patients, patients residing in high FI regions were less likely to achieve textbook outcomes (OR: 0.94, 95 % CI: 0.90-0.99). When evaluating individual post-operative outcomes of interest, patients residing in high FI regions also had a greater odd of 90-day mortality (OR: 1.24, 95 % CI: 1.12-1.36) and extended LOS (OR: 1.07, 95 % CI: 1.01-1.14) (all p < 0.0001). Moreover, this population was also at greater risk of 5-year mortality (HR: 1.11, 95 % CI: 1.06-1.17) compared with their counterparts from low food insecurity regions. Racial disparities persisted in high FI counties as Black patients had a greater risk of 5-year mortality (HR: 1.27, 95 % CI: 1.17-1.38, p < 0.0001) compared with White patients within the same FI level. CONCLUSIONS County-level FI was associated with worse outcomes following cardiac surgery.
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Affiliation(s)
- Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, United States; Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Selam Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, United States
| | - Hannah Osae
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, United States
| | - Matthew Henn
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jovan Bozinovski
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Bryan Whitson
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nahush A Mokadam
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Asvin Ganapathi
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Timothy M Pawlik
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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Nam S, Jeon S, Ash GI, Weinzimer S, Dunton GF, Parekh N, Grey M, Chen K, Lee M, Sajdlowska A, Whittemore R. Personal and Social-Built Environmental Factors of Glucose Variability Among Multiethnic Groups of Adults With Type 2 Diabetes: Research Protocol Using Ecological Momentary Assessment, Continuous Glucose Monitoring, and Actigraphy. Res Nurs Health 2024. [PMID: 39243147 DOI: 10.1002/nur.22420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/19/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
Glucose variability (GV)-the degree of fluctuation in glucose levels over a certain period of time-is emerging as an important parameter of dynamic glycemic control. Repeated glycemic oscillations have been reported to be the link to diabetes complications. This prospective observational study aims to: (1) identify multilevel risk factors (personal and social-built environmental factors) associated with high GV; (2) identify "within-person predictors" of high GV leveraging the intra-person data to inform future personalized diabetes interventions; and (3) examine which lifestyle factors either mediate or moderate the relationship between emotional well-being and GV among diverse adults with type 2 diabetes (T2D). We will recruit 200 adults with T2D from the community. All participants will complete baseline surveys assessing demographics, lifestyle, social-built environmental, and clinical factors. Real-time dynamic glucose levels will be measured using continuous glucose monitoring (CGM). Sleep, physical activity, diet/eating, and emotional well-being will be measured with an actigraphy device and a real-time self-report tool (ecological momentary assessment [EMA]) across 14 days. Two 24-h dietary recall data will be collected by online video calls. Generalized linear models, multilevel models, and structural equation models will be developed to achieve the study aims. The findings from the study will identify high-risk groups of high GV who would benefit from CGM to improve diabetes outcomes and inform the future development of personalized just-in-time interventions targeting lifestyle behaviors with an increased understanding of GV and by supporting healthcare providers' clinical decisions.
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Affiliation(s)
- Soohyun Nam
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Sangchoon Jeon
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Garrett I Ash
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Stuart Weinzimer
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Genevieve F Dunton
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, California, USA
| | - Niyati Parekh
- College of Global Public Health, and Population Health, Langone School of Medicine, New York, New York, USA
| | - Margaret Grey
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Kai Chen
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Minjung Lee
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Anna Sajdlowska
- School of Nursing, Yale University, Orange, Connecticut, USA
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Bansal R, Anderson D, Cuyegkeng A, Tran TGN, Aijaz A, Dhillon J, Carlos RC, Sadigh G. Feasibility of Screening for Financial Hardship and Health-Related Social Needs at Radiology Encounters. J Am Coll Radiol 2024; 21:1362-1370. [PMID: 38159833 DOI: 10.1016/j.jacr.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/16/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To evaluate the prevalence of financial hardship and health-related social needs (HRSNs) among outpatients undergoing advanced imaging services and assess the feasibility of screening for financial and social needs during radiology encounters. METHODS Adult patients receiving CT, MRI, or PET/CT at outpatient imaging centers of an academic tertiary center were asked to complete a 15-minute survey with adapted validated questions inquiring about their experience of financial hardship related to imaging and HRSNs, and the appropriateness of screening for financial and social needs at radiology encounters. Logistic regression analyses were performed to assess factors associated with perceived appropriateness of screening and level of interest in meeting with financial counselors. RESULTS A total of 430 patients responded (10.0% response rate; mean age: 57.1 years; 57.4% female; 54.5% White; 22.1% Hispanic; 19.1% Asian; 1% Black). A total of 35% reported experiencing financial hardship with imaging; 47.5% reported material hardship, 15.3% reported cost-related care nonadherence, and 5.3% reported cost-related imaging nonadherence. Overall, 35.9% had at least one HRSN, with food insecurity being the most common (28.3%). The majority (79.7%) felt that being screened for HRSNs at radiology encounters is appropriate, with those experiencing imaging hardship being more likely to feel that screening is appropriate (odds ratio [OR]: 2.93; 95% confidence interval [CI], 1.31-6.56). Overall, 29.5% were interested in meeting with a financial counselor, with those with imaging hardship (OR: 3.70; 95% CI, 1.96-6.97) and HRSNs (OR: 2.87; 95% CI, 1.32-6.24) and who felt uncomfortable with screening (OR: 2.83; 95% CI, 1.14-7.03) being more likely to be interested. DISCUSSION Financial hardship and HRSNs are common among outpatients undergoing advanced imaging, with the majority reporting that getting screened at radiology encounters is appropriate.
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Affiliation(s)
- Riya Bansal
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Desiree Anderson
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Andrew Cuyegkeng
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Thuan Gia-Nhat Tran
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Arham Aijaz
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Jasmine Dhillon
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and Editor-in-Chief, JACR
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California Irvine, Orange, California; Director of Health Services and Comparative Outcome Research at University of California Irvine, Orange, California; and Associate Editor, JACR.
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Garcia-Davis S, Tyagi P, Bouldin ED, Hansen J, Brintz BJ, Noel P, Rupper R, Trivedi R, Kinosian B, Intrator O, Pugh MJ, Leykum LK, Dang S. Sex differences in unmet needs between male and female older veterans. J Women Aging 2024:1-16. [PMID: 38976516 DOI: 10.1080/08952841.2024.2375480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health management, and social. We calculated weighted estimates and compared sex differences using age-adjusted prevalence ratios. On average, female Veterans were younger, more were Non-Hispanic Black and unmarried. Females and males reported a similar prevalence of problems across all domains. However, compared to males, female Veterans had a lesser prevalence of missed appointments due to transportation (aPR 0.49; 95% CI: 0.26-0.92), housework unmet needs (aPR: 0.44; 95% CI: 0.20-0.97), and medication management unmet needs (aPR: 0.33; 95% CI: 0.11-0.95) but a higher prevalence of healthcare communication unmet needs (aPR: 2.40; 95% CI: 1.13-5.05) and monitoring health conditions unmet needs (aPR: 2.13, 95% CI: 1.08-4.20). Female Veterans' common experience of unmet needs in communicating with their healthcare teams could result in care that is less aligned with their preferences or needs. As the number of older female Veterans grows, these data and additional work to understand sex-specific unmet needs and ways to address them are essential to providing high-quality care for female Veterans.
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Affiliation(s)
- Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Pranjal Tyagi
- South Florida Veterans Affairs Foundation for Research and Education (SFVAFRE), Miami, Florida, USA
| | - Erin D Bouldin
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
| | - Jared Hansen
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Polly Noel
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Randall Rupper
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Salt Lake City Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Salt Lake City, Utah, USA
| | - Ranak Trivedi
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Bruce Kinosian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Orna Intrator
- Canandaigua VA Medical Center Geriatrics and Extended Care Data Analysis Center (GECDAC), Canandaigua, New York, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luci K Leykum
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
- Harbor Health, Austin, Texas, USA
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Stuti Dang
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Miami, Florida, USA
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida, USA
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Phelan S, Tseng M, Kelleher A, Kim E, Macedo C, Charbonneau V, Gilbert I, Parro D, Rawlings L. Increasing Access to Medical Care for Hispanic Women Without Insurance: A Mobile Clinic Approach. J Immigr Minor Health 2024; 26:482-491. [PMID: 38170427 DOI: 10.1007/s10903-023-01575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
The purpose of this study was to describe the health status and barriers of people who sought care on a free mobile health clinic for women without insurance in California. Participants were 221 women who attended the Salud para Mujeres (Women's Health) mobile medical clinic between 2019 and 2021. Medical chart abstractions provided data on sociodemographic factors, medical history, barriers to care, depressive symptoms, and dietary factors. Anthropometric measure, blood pressure, and biomarkers of cardiometabolic disease risk were also abstracted. Participants were young adult (29.1 [SD 9.3] years), Hispanic (97.6%), farm-working (62.2%) women from Mexico (87.0%). Prevalent barriers to accessing (non-mobile) medical care included high cost (74.5%), language (47.6%), hours of operation (36.2%), and transportation (31.4%). The majority (89.5%) of patients had overweight (34.0%) or obesity (55.5%), and 27% had hypertension. Among those (n = 127) receiving a lipid panel, 60.3% had higher than recommended levels of low-density lipoprotein and 89% had lower than recommended levels of high-density lipoprotein. Point-of-care HbA1c tests (n = 133) indicated that 9.0% had diabetes and 24.8% had prediabetes. Over half (53.1%) of patients reported prevalent occupational exposure to pesticides and 19% had moderate to severe depressive symptoms. Weekly or more frequent consumption of sugar sweetened beverages (70.9%) and fast food (43.5%) were also prevalent. Mobile health units have potential for reaching women who face several barriers to care and experience major risk factors for cardometabolic disease. Findings suggest a compelling need to assure that Hispanic and Indigenous women and farmworkers have access to healthcare.
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Affiliation(s)
- Suzanne Phelan
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA.
| | - Marilyn Tseng
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Anita Kelleher
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Erin Kim
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Cristina Macedo
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Vicki Charbonneau
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | - David Parro
- SLO NOOR Foundation, San Luis Obispo, CA, USA
| | - Luke Rawlings
- Marian Regional Medical Center, Santa Maria, CA, USA
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Malik FS, Liese AD, Ellyson A, Reid LA, Reboussin BA, Sauder KA, Frongillo EA, Pihoker C, Dabelea D, Reynolds K, Jensen ET, Marcovina S, Bowlby DA, Mendoza JA. Household food insecurity and associations with hemoglobin A 1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study. Diabetes Res Clin Pract 2024; 212:111608. [PMID: 38574894 PMCID: PMC11290462 DOI: 10.1016/j.diabres.2024.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
AIMS To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia. METHODS HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use. RESULTS Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI. CONCLUSIONS HFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States.
| | | | - Alice Ellyson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | | | - Beth A Reboussin
- Wake Forest University School of Medicine, Winston-Salem, United States
| | | | | | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | - Dana Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Kristi Reynolds
- Kaiser Permanente Southern California, Pasadena, United States
| | | | | | | | - Jason A Mendoza
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States; Fred Hutchinson Cancer Center, Seattle, United States
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Suarez L, Armstrong S, Fleming R, Howard J, Cholera R. Families Benefit After Utilization of a Clinic-Based Food Pantry Irrespective of Food Insecurity Experiences in a Pediatric Obesity Treatment Program. Am J Health Promot 2024; 38:661-671. [PMID: 38321414 DOI: 10.1177/08901171241229828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To evaluate the congruence between food insecurity screening outcome and clinic-based food pantry utilization and to examine caregiver reported comfort, motivation, and benefits of utilization. DESIGN Mixed-methods study. SETTING Academic pediatric obesity treatment clinic. SUBJECTS Convenience sample of caregivers. INTERVENTION Clinic-based food pantry offered irrespective of food insecurity screening outcome. MEASURES Food insecurity screening (Hunger Vital Sign) and severity, self-rated caregiver health, willingness to disclose food insecurity and receive food, and food-related stress. ANALYSIS Chi-square and t-tests were utilized to examine associations and descriptive analysis explored benefits. Rapid qualitative analysis was utilized to identify themes. RESULTS Caregivers of 120 children were included (child mean age 11.8; 56.7% female, 67.6% Non-Hispanic Black), with 47 of 59 eligible completing follow-up surveys and 14 completing in-depth interviews. Approximately half (N = 30/59, 50.8%) of families utilizing the food pantry screened negative for food insecurity. Families utilizing the food pantry were more likely to report severe food insecurity (N = 23/59; 38.9%) compared to those declining (N = 3/61; 4.9%, P < .001). Caregivers accepting food were able to meet a child health goal (N = 30/47, 63.8%). Caregivers reported feeling comfortable receiving food (N = 13/14) and felt utilizing the food pantry led to consumption of healthier foods (N = 7/14). CONCLUSIONS Families who screened both positive and negative for food insecurity utilized and benefited from a clinic-based food pantry. Clinics should consider strategies offering food resources to all families irrespective of screening outcome.
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Affiliation(s)
- Lilianna Suarez
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Janna Howard
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, NC, USA
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Azap L, Woldesenbet S, Akpunonu CC, Alaimo L, Endo Y, Lima HA, Yang J, Munir MM, Moazzam Z, Huang ES, Kalady MF, Pawlik TM. The Association of Food Insecurity and Surgical Outcomes Among Patients Undergoing Surgery for Colorectal Cancer. Dis Colon Rectum 2024; 67:577-586. [PMID: 38100574 DOI: 10.1097/dcr.0000000000003073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Food insecurity predisposes individuals to suboptimal nutrition, leading to chronic disease and poor outcomes. OBJECTIVE We sought to assess the impact of county-level food insecurity on colorectal surgical outcomes. DESIGN Retrospective cohort study. SETTING Data from the Surveillance, Epidemiology, and End Results-Medicare database was merged with county-level food insecurity obtained from the Feeding America: Mapping the Meal Gap report. Multiple logistic and Cox regression adjusted for patient-level covariates were implemented to assess outcomes. PATIENTS Medicare beneficiaries diagnosed with colorectal cancer between 2010 and 2015. MAIN OUTCOME MEASURES Surgical admission type (nonelective and elective admission), any complication, extended length of stay, discharge disposition (discharged to home and nonhome discharge), 90-day readmission, 90-day mortality, and textbook outcome. Textbook outcome was defined as no extended length of stay, postoperative complications, 90-day readmission, and 90-day mortality. RESULTS Among 72,354 patients with colorectal cancer, 46,296 underwent resection. Within the surgical cohort, 9091 (19.3%) were in low, 27,716 (59.9%) were in moderate, and 9,489 (20.5%) were in high food insecurity counties. High food insecurity patients had greater odds of nonelective surgery (OR: 1.17; 95% CI, 1.09-1.26; p < 0.001), 90-day readmission (OR: 1.11; 95% CI, 1.04-1.19; p = 0.002), extended length of stay (OR: 1.32; 95% CI, 1.21-1.44; p < 0.001), and complications (OR: 1.11; 95% CI, 1.03-1.19; p = 0.002). High food insecurity patients also had decreased odds of home discharge (OR: 0.85; 95% CI, 0.79-0.91; p < 0.001) and textbook outcomes (OR: 0.81; 95% CI, 0.75-0.87; p < 0.001). High food insecurity minority patients had increased odds of complications (OR 1.59; 95% CI, 1.43-1.78) and extended length of stay (OR 1.89; 95% CI, 1.69-2.12) compared with low food insecurity white patients (all, p < 0.001). Notably, high food insecurity minority patients had 31% lower odds of textbook outcomes (OR: 0.69; 95% CI, 0.62-0.76; p < 0.001) compared with low food insecurity White patients ( p < 0.001). LIMITATIONS This study was limited to Medicare beneficiaries aged 65 years or older; hence, it may not be generalizable to younger populations or those without insurance or with private insurance. CONCLUSIONS County-level food insecurity was associated with suboptimal outcomes, demonstrating the importance of interventions to mitigate these inequities. See Video Abstract. LA ASOCIACIN DE INSEGURIDAD ALIMENTARIA Y RESULTADOS QUIRRGICOS ENTRE PACIENTES SOMETIDOS A CIRUGA DE CNCER COLORRECTAL ANTECEDENTES:La inseguridad alimentaria predispone a las personas a una nutrición subóptima, lo que conduce a enfermedades crónicas y malos resultados.OBJETIVO:Intentamos evaluar el impacto de la inseguridad alimentaria a nivel de condado en resultados de la cirugía colorrectal.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:La base de datos SEER-Medicare fusionada con la inseguridad alimentaria a nivel de condado obtenida del informe Feeding America: Mapping the Meal Gap. Para evaluar los resultados se implementaron regresiones logísticas múltiples y de Cox ajustadas según las covariables a nivel de paciente.PACIENTES:Beneficiarios de Medicare diagnosticados con cáncer colorrectal entre 2010 y 2015.PRINCIPALES MEDIDAS DE RESULTADO:Tipo de ingreso quirúrgico (ingreso no electivo y electivo), cualquier complicación, duración prolongada de la estancia hospitalaria, disposición del alta (alta al domicilio y alta no domiciliaria), reingreso a los 90 días, mortalidad a los 90 días y resultado del libro de texto. El resultado de los libros de texto se definió como ausencia de estancia hospitalaria prolongada, complicaciones postoperatorias, reingreso a los 90 días y mortalidad a los 90 días.RESULTADOS:Entre 72.354 pacientes con cáncer colorrectal, 46.296 se sometieron a resección. Dentro de la cohorte quirúrgica, 9.091 (19,3%) tenían inseguridad alimentaria baja, 27.716 (59,9%) eran moderadas y 9.489 (20,5%) tenían inseguridad alimentaria alta. Los pacientes con alta inseguridad alimentaria tuvieron mayores probabilidades de cirugía no electiva (OR: 1,17, IC 95%: 1,09-1,26, p <0,001), reingreso a los 90 días (OR: 1,11, IC95%: 1,04-1,19, p = 0,002), duración prolongada de la estancia hospitalaria (OR: 1,32; IC95%: 1,21-1,44, p < 0,001) y complicaciones (OR: 1,11; IC95%: 1,03-1,19, p = 0,002). Los pacientes con alta inseguridad alimentaria también tuvieron menores probabilidades de ser dados de alta a domicilio (OR: 0,85, IC del 95%: 0,79-0,91, p <0,001) y resultados de los libros de texto (OR: 0,81, IC del 95%: 0,75-0,87, p <0,001). Los pacientes minoritarios con alta inseguridad alimentaria tuvieron mayores probabilidades de complicaciones (OR 1,59, IC 95%, 1,43-1,78) y duración prolongada de la estadía (OR 1,89, IC 95%, 1,69-2,12) en comparación con los individuos blancos con baja inseguridad alimentaria (todos, p < 0,001). En particular, los pacientes minoritarios con alta inseguridad alimentaria tenían un 31% menos de probabilidades de obtener resultados según los libros de texto (OR: 0,69, IC del 95%, 0,62-0,76, p <0,001) en comparación con los pacientes blancos con baja inseguridad alimentaria ( p <0,001).LIMITACIONES:Limitado a beneficiarios de Medicare mayores de 65 años, por lo tanto, puede no ser generalizable a poblaciones más jóvenes o a aquellos sin seguro o con seguro privado.CONCLUSIONES:La inseguridad alimentaria a nivel de condado se asoció con resultados subóptimos, lo que demuestra la importancia de las intervenciones para mitigar estas desigualdades. (Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Chinaemelum C Akpunonu
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Henrique Araujo Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Jason Yang
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Emily S Huang
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew F Kalady
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
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9
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Leng S, Jin Y, Vitiello MV, Zhang Y, Ren R, Lu L, Shi J, Tang X. Association of food insecurity with successful aging among older Indians: study based on LASI. Eur J Nutr 2024; 63:859-868. [PMID: 38200307 DOI: 10.1007/s00394-023-03322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Whether food insecurity (FI), a social determinant of health, is linked with successful aging (SA) in the older generation remains uncertain. This study explored the association of FI with SA among older Indians. METHODS Data were collected from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-2018). Older adults (≥ 60 years) who completed both the FI and the SA surveys were selected. FI was indicated by the lack of access to enough food in the past year. SA was determined by five components: (1) low probability of diseases; (2) low probability of disability; (3) high cognitive functionality; (4) low probability of depression; and (5) active social engagement. The association of FI and SA was assessed using multivariable logistic regression adjusted for potential covariates. Subgroup analyses were performed to evaluate interactions with age, sex, alcohol use, smoking, and place of residence. RESULTS 27,579 participants met the eligibility criteria. Overall prevalence was 7.13% for FI and 19.41% for SA. Following full adjustment, FI was inversely associated with SA (OR 0.56; 95% CI 0.49-0.65) and with each of SA's five components. No significant interactions of FI and SA were observed in subgroup analyses stratified by age, sex, alcohol use, smoking, or place of residence. CONCLUSIONS FI was inversely associated with SA among older Indians. These findings need to be validated by future studies which should also explore potential underlying mechanisms, and whether interventions decreasing FI might increase SA.
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Affiliation(s)
- Siqi Leng
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Yuming Jin
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Ye Zhang
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Rong Ren
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Lin Lu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Jie Shi
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China.
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10
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Sanjeevi N, Monsivais P. Association of Supplemental Nutrition Assistance Program participation duration with cost-related medication non-adherence and emergency department visits. Public Health Nurs 2024; 41:338-345. [PMID: 38284424 DOI: 10.1111/phn.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Administrative requirements could disrupt sustained Supplemental Nutrition Assistance Program (SNAP) participation among income-eligible individuals. To meet their food needs, low-income individuals without consistent SNAP benefits may compromise on medication use, posing a risk to their health. The objective of this study is to examine the association of SNAP participation duration in a given year with cost-related medication nonadherence (CRN) and emergency department (ED) use in income-eligible individuals. DESIGN Cross-sectional. SAMPLE Non-elderly and elderly adults who used prescription medications and participated in SNAP the previous year in 2016-2018 National Health Interview Survey. Subsamples included individuals with specific chronic conditions. MEASUREMENTS CRN and ED usage. RESULTS SNAP participation for <12 months in the previous year was related to increased CRN and ED use in nonelderly adults taking prescription medication, as well as in those with hypertension, cardiovascular disease and asthma. Further, <12-month SNAP participation was associated with greater odds of having at least one ED visit in nonelderly and elderly adults. CONCLUSIONS Sustained SNAP participation could help income-eligible individuals better adhere to their prescribed medications and reduce health complications requiring ED visits. Findings suggest the importance of addressing SNAP participation gaps among income-eligible individuals in health care settings.
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Affiliation(s)
- Namrata Sanjeevi
- Department of Nutrition and Exercise Physiology, Washington State University, Spokane, Washington, USA
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Washington State University, Spokane, Washington, USA
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11
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Dhiman K, Hall M, Crump T, Hoens AM, Lacaille D, Rankin JA, Then KL, Hazlewood G, Barnabe C, Katz S, Sutherland J, Dempsey E, Barber CEH. Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers. Health Expect 2024; 27:e13978. [PMID: 38366795 PMCID: PMC10873686 DOI: 10.1111/hex.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.
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Affiliation(s)
- Kiran Dhiman
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Marc Hall
- Faculty of NursingUniversity of CalgaryCalgaryAlbertaCanada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Alison M. Hoens
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Arthritis Patient Advisory Board, Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - Diane Lacaille
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Karen L. Then
- Faculty of NursingUniversity of CalgaryCalgaryAlbertaCanada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
| | - Steven Katz
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Jason Sutherland
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Erika Dempsey
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Claire E. H. Barber
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
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12
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Kasper G, Momen M, Sorice KA, Mayhand KN, Handorf EA, Gonzalez ET, Devlin A, Brownstein K, Esnaola N, Fisher SG, Lynch SM. Effect of neighborhood and individual-level socioeconomic factors on breast cancer screening adherence in a multi-ethnic study. BMC Public Health 2024; 24:63. [PMID: 38166942 PMCID: PMC10763410 DOI: 10.1186/s12889-023-17252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although mammography can significantly reduce breast cancer mortality, many women do not receive their annual breast cancer screening. Differences in screening adherence exist by race/ethnicity, socioeconomic status (SES), and insurance status. However, more detailed investigations into the impact of neighborhood disadvantage and access to resources on screening adherence are lacking. METHODS We comprehensively examined the effect of individual social, economic, and demographic factors (n = 34 variables), as well as neighborhood level SES (nSES) indicators (n = 10 variables) on breast cancer screening adherence across a multi-ethnic population (n = 472). In this cross-sectional study, participants were surveyed from 2017 to 2018. The data was analyzed using univariate regression and LASSO for variable reduction. Significant predictors were carried forward into final multivariable mixed-effect logistic regression models where odds ratios (OR), 95% confidence intervals and p-values were reported. RESULTS Nineteen percent of participants were non-adherent to breast screening guidelines. Race/ethnicity was not associated with adherence; however, increasing age (OR = 0.97, 95%CI = 0.95-0.99, p = 0.01), renting a home (OR = 0.53, 95%CI = 0.30-0.94, p = 0.04), food insecurity (OR 0.46, 95%CI = 0.22-0.94, p = 0.01), and overcrowding (OR = 0.58, 95% CI = 0.32-0.94, p = 0.01) were significantly associated with lower breast cancer screening adherence. CONCLUSION Socioeconomic indicators at the individual and neighborhood levels impact low breast cancer screening adherence and may help to inform future screening interventions.
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Affiliation(s)
- Gillian Kasper
- Temple University School of Medicine, Philadelphia, PA, USA.
| | - Mahsa Momen
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Kristen A Sorice
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Kiara N Mayhand
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Handorf
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Evelyn T Gonzalez
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Amie Devlin
- Temple University School of Medicine, Philadelphia, PA, USA
| | | | | | - Susan G Fisher
- Temple University School of Medicine, Philadelphia, PA, USA
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Shannon M Lynch
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Anderson E, McCurley JL, Sonnenblick R, McGovern S, Fung V, Levy DE, Clark CR, Thorndike AN. Food Insecurity and Diet Quality Among Adults on Medicaid With and Without a Mental Illness Diagnosis. J Acad Nutr Diet 2023; 123:1470-1478.e2. [PMID: 37207956 PMCID: PMC10524583 DOI: 10.1016/j.jand.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/07/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Adults with mental illnesses are more likely to have low income and diet-related chronic diseases. OBJECTIVE This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries. DESIGN This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program. PARTICIPANTS/SETTING Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system. MAIN OUTCOME MEASURES Food security was measured with the 10-item US Adult Food Security survey module (0 = high food security, 1-2 = marginal food security, 3-10 = low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls. STATISTICAL ANALYSES Multivariable regression analyses adjusted for demographics, income, and survey date. RESULTS Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P = 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P = 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P = 0.99). CONCLUSION In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.
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Hager K, Du M, Li Z, Mozaffarian D, Chui K, Shi P, Ling B, Cash SB, Folta SC, Zhang FF. Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States. Circ Cardiovasc Qual Outcomes 2023; 16:e009520. [PMID: 37641928 PMCID: PMC10529680 DOI: 10.1161/circoutcomes.122.009520] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations. METHODS This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI z-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program. RESULTS After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m2 (-0.64 to -0.09). Child BMI z-score did not change -0.01 (-0.06 to 0.04). CONCLUSIONS In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Kenneth Chui
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Jung S, Shin J, Lee M. The Health and Nutritional Status of Children (10-18 years) Belonging to Food Insecure Households: The Korea National Health and Nutrition Examination Survey (2012-2019). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6695. [PMID: 37681835 PMCID: PMC10487755 DOI: 10.3390/ijerph20176695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/05/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
To research the health and nutritional status in Korean children and adolescents belonging to food insecure households (FI), the preregistered secondary data of 18 items from the Food Security Evaluation in the Korea National Health and Nutrition Examination Survey (KNHANES; 2012-2019) were used. Comparative analyses (food security group [FS], (n = 3150) vs. FI, (n = 405) of household characteristics, health status (anthropometrics, clinics, mentality), and nutritional status (nutrient intake, diet-quality, and pattern) were performed in children (boys: 1871, girls: 1684) aged 10-18 years. The FI comprised higher proportions of participants from low-income families, basic livelihood-security recipients, and vulnerability (characteristics: female household heads, aged ≥50, single, unemployed, with low education and unmet healthcare needs). Compared to FS, boys had higher abdominal obesity and alcohol use, whereas girls had lower high-density-lipoprotein cholesterol (HDLc) and mental vulnerability (self-perceived obesity despite FS-similar anthropometry) in FI. Inadequate protein intake among boys and girls, and high carbohydrate and inadequate fat intake among girls were especially found in the FI status. From the results of a nutrition quality test, Vit-A in boys, and protein, niacin, and iron intakes in girls were insufficient, respectively. Health-nutritional policies to improve children's lifestyles should reinforce FI-based intake of deficient nutrients.
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Affiliation(s)
- Sowon Jung
- Department of Food & Nutrition, Sungshin Women’s University, Seoul 01133, Republic of Korea;
| | - Jieun Shin
- Healthcare Data Science Center, Bio-Medical Informatics, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea;
| | - Myoungsook Lee
- Department of Food & Nutrition, Sungshin Women’s University, Seoul 01133, Republic of Korea;
- Research Institute of Obesity Science, Sungshin Women’s University, Seoul 01133, Republic of Korea
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Seligman HK, Levi R, Adebiyi VO, Coleman-Jensen A, Guthrie JF, Frongillo EA. Assessing and Monitoring Nutrition Security to Promote Healthy Dietary Intake and Outcomes in the United States. Annu Rev Nutr 2023; 43:409-429. [PMID: 37257420 DOI: 10.1146/annurev-nutr-062222-023359] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The US Department of Agriculture's Economic Research Service leads the federal government in data development and research on food security in US households. Nutrition security is an emerging concept that, although closely related, is distinct from food security. No standard conceptualization or measure of nutrition security currently exists. We review the existing research on nutrition security and how it is informed by the more robust literature on food security and diet quality. Based on this review, we propose a conceptual framework for understanding nutrition security and its relationship to food security. We identify two constructs (healthy diets and nutritional status) and multiple subconstructs that form the basis of nutrition security. The proposed framework and corresponding constructs are intended to provide (a) understanding of how nutrition security arises and how it differs from food security, (b) background on why assessment and monitoring of nutrition security is important, and (c) guidance for a research agenda that will further clarify the meaning of nutrition security and its measurement.
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Affiliation(s)
- Hilary K Seligman
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California, San Francisco, California, USA;
| | - Ronli Levi
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California, San Francisco, California, USA;
| | - Victoria O Adebiyi
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Alisha Coleman-Jensen
- United States Department of Agriculture, Economic Research Service, Washington, DC, USA
| | - Joanne F Guthrie
- United States Department of Agriculture, Economic Research Service, Washington, DC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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Ojinnaka CO, Arteaga I, Hodges L, Heflin C. SNAP Participation and Medication Adherence Among Older Black Medicaid-Insured Individuals Living With Hypertension. Am J Hypertens 2023; 36:485-490. [PMID: 37225664 DOI: 10.1093/ajh/hpad052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/03/2022] [Accepted: 05/23/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Black people are more likely to be diagnosed with hypertension and to experience food insecurity and antihypertensive medication non-adherence compared to White people in the U.S. The Supplemental Nutrition Assistance Program (SNAP)-a means-tested program that targets food insecurity has been shown to affect health outcomes. This study analyzed the relationship between SNAP participation and antihypertensive medication adherence among older Black Medicaid-insured individuals. METHODS This is a retrospective cohort study using linked 2006-2014 state of Missouri Medicaid and SNAP administrative claims data. Analyses were restricted to older (≥60 years) Black individuals who were continuously enrolled in Medicaid for 12 months following their first observed claim for hypertension at or after age 60 years with at least one pharmacy claim (n = 10,693). Our outcome measure is a dichotomous measure of antihypertensive medication adherence defined using the Proportion of Days Covered (≥80% PDC = 1). The exposure variables are four measures of SNAP participation. RESULTS A higher proportion of SNAP participants were adherent to their antihypertensive medications compared to non-SNAP participants (43.5% vs. 32.0%). On multivariable analyses, compared to non-SNAP participants there was an increased likelihood of antihypertensive medication adherence among SNAP participants (prevalence ratio [PR] = 1.25; 95% confidence interval [CI] = 1.16-1.35). Compared to those who participated in SNAP for 1-3 months during the 12-month continuous enrollment, there was an increased likelihood of antihypertensive medication adherence among those who were enrolled for 10-12 months (PR = 1.41; 95% CI = 1.08-1.85). CONCLUSIONS Medicaid-insured older Black adults who were SNAP participants had a higher likelihood of antihypertensive medication adherence compared to non-SNAP participants.
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Affiliation(s)
- Chinedum O Ojinnaka
- College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, Arizona 85004
| | - Irma Arteaga
- Harry S Truman School of Public Affairs, University of Missouri, 239 Middlebush Hall, Columbia, Missouri 65211
| | - Leslie Hodges
- Economic Research Service, United States Department of Agriculture, PO Box 419205, MS 9999, Kansas City, Missouri 64141-6205
| | - Colleen Heflin
- Maxwell School of Citizenship and Public Affairs, Syracuse University, 426 Eggers Hall, Syracuse, New York 13244-1020
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Choe H, Pak TY. Food Insecurity, Healthcare Utilization, and Healthcare Expenditures: A Longitudinal Cohort Study. Int J Public Health 2023; 68:1605360. [PMID: 37564696 PMCID: PMC10409992 DOI: 10.3389/ijph.2023.1605360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
Objective: This study examines the longitudinal association between household food insecurity and healthcare utilization and expenditure. Methods: A multi-wave longitudinal cohort study was conducted using the 2008-2019 and 2021 waves of the Korean Welfare Panel Study. The baseline data included participants aged ≥19 years with valid responses to the food insecurity and healthcare questionnaires in the 2008 wave (n = 12,166). Healthcare outcomes encompassed outpatient visits, inpatient admissions, days hospitalized, and personal healthcare expenditure. Random effects Poisson and linear regressions were estimated. Results: Severe food insecurity was associated with a higher incidence rate of outpatient visits (IRR, 1.14; 95% CI, 1.12-1.17), days of hospitalization (IRR, 1.18; 95% CI, 1.13-1.22), and inpatient admissions (IRR, 1.40; 95% CI, 1.18-1.65). Moderate food insecurity was associated with 10.4% (β = -0.11; 95% CI, -0.14 to -0.07) or 238,276 KRW reductions in personal healthcare expenditures in the subsequent year. Conclusion: Household food insecurity was linked to increased healthcare utilization and reduced personal healthcare expenditure among Korean adults. Our findings present opportunities to identify target populations for healthcare policies and interventions.
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Affiliation(s)
| | - Tae-Young Pak
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, Republic of Korea
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Baig-Ward KM, Jha MK, Trivedi MH. The Individual and Societal Burden of Treatment-Resistant Depression: An Overview. Psychiatr Clin North Am 2023; 46:211-226. [PMID: 37149341 PMCID: PMC11008705 DOI: 10.1016/j.psc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Major depressive disorder is characterized by depressed mood and/or anhedonia with neurovegetative symptoms and neurocognitive changes affecting an individual's functioning in multiple aspects of life. Treatment outcomes with commonly used antidepressants remain suboptimal. Treatment-resistant depression (TRD) should be considered after inadequate improvement with two or more antidepressant treatments of adequate dose and duration. TRD has been associated with increased disease burden including higher associated costs (both socially and financially) affecting both the individual and society. Additional research is needed to better understand the long-term burden of TRD to both the individual and society.
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Affiliation(s)
- Kimberlyn Maravet Baig-Ward
- Department of Psychiatry, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Manish Kumar Jha
- Department of Psychiatry, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA; O'Donnell Brain Institute, UT Southwestern Medical Center, 6363 Forest Park Road, Dallas, TX 75235, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA; O'Donnell Brain Institute, UT Southwestern Medical Center, 6363 Forest Park Road, Dallas, TX 75235, USA.
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20
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Ojinnaka CO, Arteaga I, Hodges L, Heflin C. Supplemental Nutrition Assistance Program Participation and Medication Adherence Among Medicaid-Insured Older Adults Living with Hypertension. J Gen Intern Med 2023; 38:1349-1356. [PMID: 36707458 PMCID: PMC10160273 DOI: 10.1007/s11606-022-07994-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/23/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Food insecurity has been associated with medication non-adherence among individuals living with chronic diseases like hypertension. The relationship between Supplemental Nutrition Assistance Program (SNAP)-a public program that addresses food insecurity-and Medication adherence among older Medicaid-insured adults living with hypertension is not clear. OBJECTIVE To analyze the association between patterns of SNAP participation and adherence to antihypertensive medications among older Medicaid-insured individuals. DESIGN Retrospective study using linked 2006-2014 state of Missouri's Medicaid claims and Supplemental Nutrition Assistance Program data. PARTICIPANTS Older adults (≥ 60 years) who were continuously enrolled in Medicaid for 12 months following their first observed claim for hypertension at or after age 60. MAIN MEASURES The outcome measure was medication adherence assessed using the proportion of days covered (PDC). The exposure measures were as follows: (1) receipt of SNAP benefits (no [0], yes [1]); (2) SNAP benefits receipt during the 12-month Medicaid continuous enrollment (no [0], yes [1]); (3) duration of SNAP participation during the 12-month continuous Medicaid enrollment; and (4) SNAP participation pattern. KEY RESULTS On multivariable analyses, there was a statistically significant association between ever participating in SNAP and medication adherence (β = 0.32; S.E. = 0.011). Compared to those who participated in SNAP for 1-3 months during the 12-month continuous enrollment, there was an increased likelihood of medication adherence among those who were enrolled for 10-12 months (β = 0.44, S.E. = 0.041). CONCLUSIONS Medicaid-insured older adults who are SNAP participants or enrolled in SNAP for 10-12 months of a 12-month Medicaid continuous enrollment period are more likely to be adherent to antihypertensive medication compared to non-SNAP participants or those enrolled for 1-3 months, respectively.
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Affiliation(s)
| | - Irma Arteaga
- Harry S Truman School of Government and Public Affairs, University of Missouri, Columbia, MO, USA
| | - Leslie Hodges
- Economic Research Service, United States Department of Agriculture, Kansas City, MO, USA
| | - Colleen Heflin
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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21
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Abstract
PURPOSE OF REVIEW In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes. RECENT FINDINGS Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards - the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) - improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs. SUMMARY After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.
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22
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Turner K, Brownstein NC, Whiting J, Arevalo M, Islam JY, Vadaparampil ST, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 Pandemic on Women's Health Care Access: A Cross-Sectional Study. J Womens Health (Larchmt) 2022; 31:1690-1702. [PMID: 36318766 PMCID: PMC9805885 DOI: 10.1089/jwh.2022.0128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women. Materials and Methods: We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits. Results: The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19-2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25-3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35-4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care. Conclusions: The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.
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Affiliation(s)
- Kea Turner
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T. Vadaparampil
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cathy D. Meade
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Clement K. Gwede
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Shannon M. Christy
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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23
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Siegel KR, Ali MK, Ackermann RT, Black B, Huguet N, Kho A, Mangione CM, Nauman E, Ross-Degnan D, Schillinger D, Shi L, Wharam JF, Duru OK. Evaluating Natural Experiments that Impact the Diabetes Epidemic: an Introduction to the NEXT-D3 Network. Curr Diab Rep 2022; 22:393-403. [PMID: 35864324 PMCID: PMC9303841 DOI: 10.1007/s11892-022-01480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Diabetes is an ongoing public health issue in the USA, and, despite progress, recent reports suggest acute and chronic diabetes complications are increasing. RECENT FINDINGS The Natural Experiments for Translation in Diabetes 3.0 (NEXT-D3) Network is a 5-year research collaboration involving six academic centers (Harvard University, Northwestern University, Oregon Health & Science University, Tulane University, University of California Los Angeles, and University of California San Francisco) and two funding agencies (Centers for Disease Control and Prevention and National Institutes of Health) to address the gaps leading to persisting diabetes burdens. The network builds on previously funded networks, expanding to include type 2 diabetes (T2D) prevention and an emphasis on health equity. NEXT-D3 researchers use rigorous natural experiment study designs to evaluate impacts of naturally occurring programs and policies, with a focus on diabetes-related outcomes. NEXT-D3 projects address whether and to what extent federal or state legislative policies and health plan innovations affect T2D risk and diabetes treatment and outcomes in the USA; real-world effects of increased access to health insurance under the Affordable Care Act; and the effectiveness of interventions that reduce barriers to medication access (e.g., decreased or eliminated cost sharing for cardiometabolic medications and new medications such as SGLT-2 inhibitors for Medicaid patients). Overarching goals include (1) expanding generalizable knowledge about policies and programs to manage or prevent T2D and educate decision-makers and organizations and (2) generating evidence to guide the development of health equity goals to reduce disparities in T2D-related risk factors, treatment, and complications.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Ronald T Ackermann
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard Black
- Pritzker School of Law, Institute for Policy Research, and Kellogg School of Management, Northwestern University, Evanston, IL, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Abel Kho
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carol M Mangione
- David Geffen School of Medicine at UCLA and Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | | | - Dennis Ross-Degnan
- Duke University Department of Medicine and Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Dean Schillinger
- Division of General Internal Medicine and Center for Vulnerable Populations, San Francisco General Hospital and University of California San Francisco, San Francisco, CA, USA
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - J Frank Wharam
- Duke University Department of Medicine and Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - O Kenrik Duru
- David Geffen School of Medicine at UCLA and Fielding School of Public Health, UCLA, Los Angeles, CA, USA
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Bertoldo J, Wolfson JA, Sundermeir SM, Edwards J, Gibson D, Agarwal S, Labrique A. Food Insecurity and Delayed or Forgone Medical Care During the COVID-19 Pandemic. Am J Public Health 2022; 112:776-785. [PMID: 35417213 PMCID: PMC9010899 DOI: 10.2105/ajph.2022.306724] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To describe food insecurity in the United States in December 2020 and examine associations with underuse of medical care during the COVID-19 pandemic. Methods. We fielded a nationally representative Web-based survey in December 2020 (n = 8318). Multivariable logistic regression models and predicted probabilities were used to evaluate factors associated with food insecurity and compare the likelihood of delaying or forgoing medical care because of cost concerns by food security status. Results. In December 2020, 18.8% of US adults surveyed reported experiencing food insecurity. Elevated odds of food insecurity were observed among non-Hispanic Black, Hispanic, and low-income respondents. Experiencing food insecurity was significantly associated with a greater likelihood of forgoing any type of medical care as a result of cost concerns. Conclusions. Food insecurity during the COVID-19 pandemic disproportionately affected non-White and low-income individuals. Experiencing food insecurity was a significant risk factor for delaying or forgoing medical care, an association that could have cumulative short- and long-term health effects. Public Health Implications. Comprehensive policies that target the most at-risk groups are needed to address the high rates of food insecurity in the United States and mitigate its adverse health effects. (Am J Public Health. 2022;112(5):776-785. https://doi.org/10.2105/AJPH.2022.306724).
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Affiliation(s)
- Jaclyn Bertoldo
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
| | - Julia A Wolfson
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
| | - Samantha M Sundermeir
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
| | - Jeffrey Edwards
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
| | - Dustin Gibson
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
| | - Smisha Agarwal
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
| | - Alain Labrique
- The authors are with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Julia A. Wolfson is also with the School of Public Health, University of Michigan, Ann Arbor
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26
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Clancy HA, Zhu Z, Gordon NP, Kipnis P, Liu VX, Escobar GJ. Prospective evaluation of social risks, physical function, and cognitive function in prediction of non-elective rehospitalization and post-discharge mortality. BMC Health Serv Res 2022; 22:574. [PMID: 35484624 PMCID: PMC9052530 DOI: 10.1186/s12913-022-07910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/31/2022] [Indexed: 01/04/2023] Open
Abstract
Background Increasing evidence suggests that social factors and problems with physical and cognitive function may contribute to patients’ rehospitalization risk. Understanding a patient’s readmission risk may help healthcare providers develop tailored treatment and post-discharge care plans to reduce readmission and mortality. This study aimed to evaluate whether including patient-reported data on social factors; cognitive status; and physical function improves on a predictive model based on electronic health record (EHR) data alone. Methods We conducted a prospective study of 1,547 hospitalized adult patients in 3 Kaiser Permanente Northern California hospitals. The main outcomes were non-elective rehospitalization or death within 30 days post-discharge. Exposures included patient-reported social factors and cognitive and physical function (obtained in a pre-discharge interview) and EHR–derived data for comorbidity burden, acute physiology, care directives, prior utilization, and hospital length of stay. We performed bivariate comparisons using Chi-square, t-tests, and Wilcoxon rank-sum tests and assessed correlations between continuous variables using Spearman’s rho statistic. For all models, the results reported were obtained after fivefold cross validation. Results The 1,547 adult patients interviewed were younger (age, p = 0.03) and sicker (COPS2, p < 0.0001) than the rest of the hospitalized population. Of the 6 patient-reported social factors measured, 3 (not living with a spouse/partner, transportation difficulties, health or disability-related limitations in daily activities) were significantly associated (p < 0.05) with the main outcomes, while 3 (living situation concerns, problems with food availability, financial problems) were not. Patient-reported cognitive (p = 0.027) and physical function (p = 0.01) were significantly lower in patients with the main outcomes. None of the patient-reported variables, singly or in combination, improved predictive performance of a model that included acute physiology and longitudinal comorbidity burden (area under the receiver operator characteristic curve was 0.716 for both the EHR model and maximal performance of a random forest model including all predictors). Conclusions In this insured population, incorporating patient-reported social factors and measures of cognitive and physical function did not improve performance of an EHR-based model predicting 30-day non-elective rehospitalization or mortality. While incorporating patient-reported social and functional status data did not improve ability to predict these outcomes, such data may still be important for improving patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07910-w.
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Affiliation(s)
- Heather A Clancy
- Systems Research Initiative, Kaiser Permanente Division of Research, 2000 Broadway Avenue, Oakland, CA, 94612, USA
| | - Zheng Zhu
- Systems Research Initiative, Kaiser Permanente Division of Research, 2000 Broadway Avenue, Oakland, CA, 94612, USA
| | - Nancy P Gordon
- Systems Research Initiative, Kaiser Permanente Division of Research, 2000 Broadway Avenue, Oakland, CA, 94612, USA
| | - Patricia Kipnis
- Systems Research Initiative, Kaiser Permanente Division of Research, 2000 Broadway Avenue, Oakland, CA, 94612, USA.
| | - Vincent X Liu
- Systems Research Initiative, Kaiser Permanente Division of Research, 2000 Broadway Avenue, Oakland, CA, 94612, USA.,Intensive Care Unit, Kaiser Permanente Medical Center, 700 Lawrence Expressway, Santa Clara, CA, 95051, USA
| | - Gabriel J Escobar
- Systems Research Initiative, Kaiser Permanente Division of Research, 2000 Broadway Avenue, Oakland, CA, 94612, USA
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Na M, Dou N, Liao Y, Rincon SJ, Francis LA, Graham-Engeland JE, Murray-Kolb LE, Li R. Daily Food Insecurity Predicts Lower Positive and Higher Negative Affect: An Ecological Momentary Assessment Study. Front Nutr 2022; 9:790519. [PMID: 35399670 PMCID: PMC8990300 DOI: 10.3389/fnut.2022.790519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/10/2022] [Indexed: 12/28/2022] Open
Abstract
Food insecurity (FI) is a dynamic phenomenon, and its association with daily affect is unknown. We explored the association between daily FI and affect among low-income adults during a 2-seasonal-month period that covered days both pre- and during the COVID-19 pandemic. A total of 29 healthy low-income adults were recruited during fall in 2019 or 2020, 25 of whom were followed in winter in 2020 or 2021. Daily FI (measured once daily) and affect (measured 5 times daily) were collected over the 2nd−4th week in each month. Time-Varying-Effect-Models were used to estimate the association between daily FI and positive/negative affect (PA/NA). Overall, 902 person-days of daily-level data were collected. Daily FI was associated with lower PA in the 3rd and 4th week of fall and winter and with higher NA in the second half of winter months. Similar patterns of FI-affect relations were found pre- and during COVID-19 in the second half of a given month, while unique patterns of positive affect scores in the 2nd week and negative scores in the 1st week were only observed during COVID days. Our study supports a time-varying association between FI and affect in low-income adults. Future large studies are needed to verify the findings; ultimately, better understanding such associations may help identify, target, and intervene in food insecure adults to prevent adverse mental health outcomes.
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Affiliation(s)
- Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Nan Dou
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Yujie Liao
- Department of Statistics, The Pennsylvania State University, University Park, PA, United States
| | - Sara Jimenez Rincon
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States.,Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Lori A Francis
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Laura E Murray-Kolb
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Runze Li
- Department of Statistics, The Pennsylvania State University, University Park, PA, United States
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Heflin C, Hodges L, Ojinnaka CO, Arteaga I. Hypertension, Diabetes and Medication Adherence among the Older Supplemental Nutritional Assistance Program Population. J Appl Gerontol 2022; 41:780-787. [PMID: 34137290 PMCID: PMC8678375 DOI: 10.1177/07334648211022493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The burdens of chronic diseases such as hypertension and diabetes for older Americans are profound. Yet, data on the population-level prevalence of hypertension and diabetes among the older adult Supplemental Nutritional Assistance Program (SNAP) population and the associated level of medication adherence is lacking despite evidence of the "treat or eat" trade-off in the general population. We used linked administrative data from SNAP and Medicaid between 2006 and 2014 in the state of Missouri to document rates of hypertension or diabetes diagnoses and medication adherence. About 69% of the study sample were found to be diagnosed with a hypertension and 40% with diabetes. Approximately 1 in 4 of those living with hypertension and 1 and 3 of those living with diabetes were nonadherent to antihypertensive or antidiabetic medications each year, on average. Furthermore, medication non-adherence increases with age and is more common among non-White and urban residents.
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Affiliation(s)
- Colleen Heflin
- Maxwell School of Citizenship and Public Affairs, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244-1020.,Corresponding author Phone: (315) 443-9042.
| | - Leslie Hodges
- Economic Research Service, United States Department of Agriculture, PO Box 419205, MS 9999, Kansas City, MO 64141-6205
| | - Chinedum O. Ojinnaka
- College of Health Solutions, Arizona State University, 326 Mercado Building C, Phoenix, AZ 85004
| | - Irma Arteaga
- Harry S Truman School of Public Affairs, University of Missouri, 239 Middlebush Hall, Columbia, MO 65211
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29
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A Call for Action to Address the Root Causes of Racial/Ethnic Health Disparities. J Acad Nutr Diet 2022; 122:661-669. [DOI: 10.1016/j.jand.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022]
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Ding A, Dixon SW, Ferries EA, Shrank WH. The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence. J Manag Care Spec Pharm 2022; 28:379-386. [PMID: 35199574 PMCID: PMC10372970 DOI: 10.18553/jmcp.2022.28.3.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medication nonadherence in the United States contributes to 125,000 deaths and 10% of hospitalizations annually. The pain of preventable deaths and the personal costs of nonadherence are borne disproportionately by Black, Latino, and other minority groups because nonadherence is higher in these groups due to a variety of factors. These factors include socioeconomic challenges, issues with prescription affordability and convenience of filling and refilling them, lack of access to pharmacies and primary care services, difficulty taking advantage of patient engagement opportunities, health literacy limitations, and lack of trust due to historical and structural discrimination outside of and within the medical system. Solutions to address the drivers of lower medication adherence, specifically in minority populations, are needed to improve population outcomes and reduce inequities. While various solutions have shown some traction, these solutions have tended to be challenging to scale for wider impact. We propose that integrated medical and pharmacy plans are well positioned to address racial and ethnic health disparities related to medication adherence. DISCLOSURES: This study was not supported by any funding sources other than employment of all authors by Humana Inc. Humana products and programs are referred to in this article.
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Bernhardt C, King C. Telehealth and food insecurity screenings: challenges and lessons learned. Mhealth 2022; 8:10. [PMID: 35178441 PMCID: PMC8800207 DOI: 10.21037/mhealth-21-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022] Open
Abstract
Food insecurity remains a persistent problem in the United States and affected 35.2 million Americans in 2019. In the wake of COVID-19, food insecurity has increased in many communities. Given that food insecurity exacerbates poor health or health conditions, screening of food insecurity within medical settings is frequently identified within the literature as an important first step in effectively addressing this social concern and improving the health outcomes of patients. However, health care providers often do not screen for food insecurity for a variety of reasons. In this article review, we discuss the challenges associated with incorporating food insecurity screenings within the medical model and how the COVID-19 pandemic has exacerbated these challenges. Specifically, the COVID-19 pandemic has substantially increased the delivery of health care services via telehealth, making screening for food insecurity even more difficult via remote videoconferencing. We examine the strengths and weaknesses of telehealth and their implications for food insecurity screenings. We discuss how these implications might inform future research regarding the use of telehealth as a means of screening patients for social determinants of health in the COVID-19 era. Given that the use of telehealth is not expected to back to pre-pandemic levels, it is important to understand how to best screen for social determinants of health via videoconferencing.
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Affiliation(s)
| | - Christian King
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
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Alefan Q, Cheekireddy VM, Blackburn D. Cost-Related Nonadherence Can be Explained by A General Non-Adherence Framework. J Am Pharm Assoc (2003) 2022; 62:658-673. [DOI: 10.1016/j.japh.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
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Mahajan S, Grandhi GR, Valero-Elizondo J, Mszar R, Khera R, Acquah I, Yahya T, Virani SS, Blankstein R, Blaha MJ, Cainzos-Achirica M, Nasir K. Scope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States. J Am Heart Assoc 2021; 10:e020028. [PMID: 34387089 PMCID: PMC8475063 DOI: 10.1161/jaha.120.020028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) results in high out‐of‐pocket healthcare expenditures predisposing to food insecurity. However, the burden and determinants of food insecurity in this population are unknown. Methods and Results Using 2013 to 2018 National Health Interview Survey data, we evaluated the prevalence and sociodemographic determinants of food insecurity among adults with ASCVD in the United States. ASCVD was defined as self‐reported diagnosis of coronary heart disease or stroke. Food security was measured using the 10‐item US Adult Food Security Survey Module. Of the 190 113 study participants aged 18 years or older, 18 442 (adjusted prevalence 8.2%) had ASCVD, representing ≈20 million US adults annually. Among adults with ASCVD, 2968 or 14.6% (weighted ≈2.9 million US adults annually) reported food insecurity compared with 9.1% among those without ASCVD (P<0.001). Individuals with ASCVD who were younger (odds ratio [OR], 4.0 [95% CI, 2.8–5.8]), women (OR, 1.2 [1.0–1.3]), non‐Hispanic Black (OR, 2.3 [1.9–2.8]), or Hispanic (OR, 1.6 [1.2–2.0]), had private (OR, 1.8 [1.4–2.3]) or no insurance (OR, 2.3 [1.7–3.1]), were divorced/widowed/separated (OR, 1.2 [1.0–1.4]), and had low family income (OR, 4.7 [4.0–5.6]) were more likely to be food insecure. Among those with ASCVD and 6 of these high‐risk characteristics, 53.7% reported food insecurity and they had 36‐times (OR, 36.2 [22.6–57.9]) higher odds of being food insecure compared with those with ≤1 high‐risk characteristic. Conclusion About 1 in 7 US adults with ASCVD experience food insecurity, with more than 1 in 2 adults reporting food insecurity among the most vulnerable sociodemographic subgroups. There is an urgent need to address the barriers related to food security in this population.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | | | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Reed Mszar
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Rohan Khera
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Isaac Acquah
- Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center & Section of Cardiology Baylor College of Medicine Houston TX
| | - Ron Blankstein
- Cardiovascular Imaging Program Cardiovascular Division and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
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Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC: CARDIOONCOLOGY 2021; 3:236-246. [PMID: 34396329 PMCID: PMC8352280 DOI: 10.1016/j.jaccao.2021.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Background Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. Objectives This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. Methods From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. Results The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. Conclusions Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
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Affiliation(s)
- Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Fouad Chouairi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida, USA
| | - Haider J Warraich
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Department of Industrial and Systems Engineering, Texas A&M College of Engineering, Texas A&M University, College Station, Texas, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nestor F Esnaola
- Cancer Center, Houston Methodist Research Institute, Houston, Texas, USA.,Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
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Tamargo JA, Hernandez-Boyer J, Teeman C, Martin HR, Huang Y, Johnson A, Campa A, Martinez SS, Li T, Rouster SD, Meeds HL, Sherman KE, Baum MK. Immune activation: A link between food insecurity and chronic disease in people living with HIV. J Infect Dis 2021; 224:2043-2052. [PMID: 33993311 DOI: 10.1093/infdis/jiab257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
Persistent immune activation is a hallmark of HIV infection and thought to play a role on chronic diseases in people with HIV (PWH). Food insecurity is disproportionately prevalent in PWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with increased plasma levels of sCD14, sCD27, and sCD163 in 323 antiretroviral -treated PWH from the Miami Adult Studies on HIV (MASH) Cohort. Nearly half (42.7%) of participants were food insecure and 85.5% were virally suppressed (<200 copies/mL). Food insecurity was independently associated with higher levels of sCD14 and sCD27. Very low food security was associated with increased sCD163 levels among those with lower CD4+ cell counts. Food insecurity may promote immune activation in PWH, suggesting a biological link between food insecurity and chronic disease among PWH. Improving financial security and access to high-quality diets could reduce the burden of disease in this highly vulnerable population.
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Affiliation(s)
- Javier A Tamargo
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | | | - Colby Teeman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Haley R Martin
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Yongjun Huang
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Angelique Johnson
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Sabrina S Martinez
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Susan D Rouster
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi L Meeds
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Marianna K Baum
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
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Brady PJ, Askelson NM, Wright B, Daly E, Momany E, McInroy B, Damiano P. Food Insecurity Is Prevalent in Iowa's Medicaid Expansion Population. J Acad Nutr Diet 2021; 122:394-402. [PMID: 33994143 DOI: 10.1016/j.jand.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Food insecurity has been identified as an important social determinant of health and is associated with many health issues prevalent in Medicaid members. Despite this, little research has been done around food insecurity within Medicaid populations. OBJECTIVE Our objective was to estimate the prevalence of household food insecurity and identify factors associated with experiencing food insecurity in Iowa's Medicaid expansion population. DESIGN We conducted a cross-sectional telephone survey between March and May of 2019. PARTICIPANTS Our sample was drawn from Medicaid members enrolled in Iowa's expansion program at least 14 months, stratified by Federal Poverty Level (FPL) category. Members who did not have valid contact information were excluded. We selected one individual per household to reduce the interrelatedness of responses. We sampled 6,000 individuals and had 1,349 respondents in the analytic sample. MAIN OUTCOME MEASURE Our main outcome was whether a respondent's household experienced food insecurity in the previous year, using the Hunger Vital Sign screening tool. STATISTICAL ANALYSES PERFORMED We weighted responses to account for the sampling design and differential nonresponse between strata. We estimated the prevalence of food insecurity and used logistic regression to model food insecurity as a function of demographic (age, FPL category, gender, employment, education, race, rurality, and Supplemental Nutrition Assistance Program [SNAP] participation) and health-related (self-rated health, self-rated oral health, health literacy) factors. RESULTS The estimated prevalence of experiencing food insecurity was 51.3%. Race, gender, education, employment, health literacy, and self-rated health were all significantly associated with food insecurity. CONCLUSIONS Our findings show that food insecurity is prevalent in Iowa's Medicaid expansion population. Food insecurity should be more widely measured as a critical social determinant of health in Medicaid populations. Policymakers and clinicians should consider interventions that connect households experiencing food insecurity to food resources (eg, produce prescriptions and food pantry referrals) and policies that increase food access. ABBREVIATIONS Iowa Wellness Plan (IWP); Federal Poverty Level (FPL); Healthy Behavior Program (HBP); Supplemental Nutrition Assistance Program (SNAP).
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Affiliation(s)
- Melissa Hawkins
- Department of Health Studies, College of Arts & Sciences, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016, United States of America.
| | - Anthony Panzera
- Department of Health Studies, College of Arts & Sciences, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016, United States of America.
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Tamargo JA, Sherman KE, Campa A, Martinez SS, Li T, Hernandez J, Teeman C, Mandler RN, Chen J, Ehman RL, Baum MK. Food insecurity is associated with magnetic resonance-determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV. Am J Clin Nutr 2021; 113:593-601. [PMID: 33515016 PMCID: PMC7948863 DOI: 10.1093/ajcn/nqaa362] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD. OBJECTIVES To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults. METHODS We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals. RESULTS Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants. CONCLUSIONS Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.
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Affiliation(s)
| | | | | | | | - Tan Li
- Florida International University, Miami, FL, USA
| | | | - Colby Teeman
- Florida International University, Miami, FL, USA
| | | | - Jun Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, Thornton PL, Haire-Joshu D. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care 2020; 44:dci200053. [PMID: 33139407 PMCID: PMC7783927 DOI: 10.2337/dci20-0053] [Citation(s) in RCA: 652] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nancy E Adler
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Tiffany L Gary-Webb
- Departments of Epidemiology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Pamela L Thornton
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, St. Louis, MO
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Abstract
The COVID-19 pandemic and the social unrest pervading U.S. cities in response to the killings of George Floyd and other Black citizens at the hands of police are historically significant. These events exemplify dismaying truths about race and equality in the United States. Racial health disparities are an inexcusable lesion on the U.S. health care system. Many health disparities involve medications, including antidepressants, anticoagulants, diabetes medications, drugs for dementia, and statins, to name a few. Managed care pharmacy has a role in perpetuating racial disparities in medication use. For example, pharmacy benefit designs are increasingly shifting costs of expensive medications to patients, creating affordability crises for lower income workers, who are disproportionally persons of color. In addition, the quest to maximize rebates serves to inflate list prices paid by the uninsured, among which Black and Hispanic people are overrepresented. While medication cost is a foremost barrier for many patients, other factors also propagate racial disparities in medication use. Even when cost sharing is minimal or zero, medication adherence rates have been documented to be lower among Blacks as compared with Whites. Deeper understandings are needed about how racial disparities in medication use are influenced by factors such as culture, provider bias, and patient trust in medical advice. Managed care pharmacy can address racial disparities in medication use in several ways. First, it should be acknowledged that racial disparities in medication use are pervasive and must be resolved urgently. We must not believe that entrenched health system, societal, and political structures are impermeable to change. Second, the voices of community members and their advocates must be amplified. Coverage policies, program designs, and quality initiatives should be developed in consultation with those directly affected by racial disparities. Third, the industry should commit to dramatically reducing patient cost sharing for essential medication therapies. Federal and state efforts to limit annual out-of-pocket pharmacy spending should be supported, even though increased premiums may be an undesirable (yet more equitable) consequence. Finally, information about race should be incorporated into all internal and external reporting and quality improvement activities. DISCLOSURES: No funding was received for the development of this manuscript. Kogut is partially supported by Institutional Development Award Numbers U54GM115677 and P20GM125507 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR), and the RI Lifespan Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, respectively. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Stephen J Kogut
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
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Heflin CM, Ingram SJ, Ziliak JP. The Effect Of The Supplemental Nutrition Assistance Program On Mortality. Health Aff (Millwood) 2020; 38:1807-1815. [PMID: 31682512 DOI: 10.1377/hlthaff.2019.00405] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States. Although participation in it has been shown to reduce food insecurity, there is comparatively less clear causal evidence of positive health effects of participation, particularly among adults. We examined the relationship between SNAP participation and premature mortality using data for 1997-2009 from the National Health Interview Survey, linked to data for 1999-2011 from the National Death Index. Results from bivariate probit models found that participation in SNAP led to a populationwide reduction of 1-2 percentage points in mortality from all causes and a reduction in specific causes of death among people ages 40-64.
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Affiliation(s)
- Colleen M Heflin
- Colleen M. Heflin ( cmheflin@syr. edu ) is a professor of public administration and international affairs and a senior research associate at the Center for Policy Research, Syracuse University, in New York
| | - Samuel J Ingram
- Samuel J. Ingram is a doctoral candidate in economics at the University of Kentucky, in Lexington
| | - James P Ziliak
- James P. Ziliak is the Carol Martin Gatton Endowed Chair in Microeconomics in the Department of Economics, University of Kentucky
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Donneyong MM, Chang TJ, Jackson JW, Langston MA, Juarez PD, Sealy-Jefferson S, Lu B, Im W, Valdez RB, Way BM, Colen C, Fischer MA, Salsberry P, Bridges JF, Hood DB. Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186684. [PMID: 32937852 PMCID: PMC7557537 DOI: 10.3390/ijerph17186684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022]
Abstract
Background: Non-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors. Methods: Two cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries’ claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models. Results: Among 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31, P-value < 0.001) and weak social supports (β = 0.27, P-value < 0.001), but inversely with healthy built environment (β = −0.10, P-value = 0.02). These three constructs explained one-third (R2 = 30.0%) of the variation in county-level AHM non-adherence. Conclusion: AHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments.
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Affiliation(s)
- Macarius M. Donneyong
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
- Correspondence: ; Tel.: +1-614-292-0075
| | - Teng-Jen Chang
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
| | - John W. Jackson
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA;
| | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - Shawnita Sealy-Jefferson
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Bo Lu
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - R. Burciaga Valdez
- Family & Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Baldwin M. Way
- Department of Psychology, Ohio State University, Columbus, OH 43210, USA;
| | - Cynthia Colen
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Michael A. Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women’s Hospital, Boston, MA 02115, USA;
| | - Pamela Salsberry
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - John F.P. Bridges
- Department of Biomedical Informatics, Ohio State University, Columbus, OH 43210, USA;
| | - Darryl B. Hood
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
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Malnutrition and Food Insecurity Might Pose a Double Burden for Older Adults. Nutrients 2020; 12:nu12082407. [PMID: 32796746 PMCID: PMC7468760 DOI: 10.3390/nu12082407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022] Open
Abstract
Although food insecurity has been associated with a disadvantageous socioeconomic status, especially in older adults, its association with comorbidities is less clear. The scope of the present cross-sectional study was to assess the prevalence of food insecurity among older adults and evaluate the association between food insecurity, malnutrition, chronic disease, multimorbidity and healthcare utilization. A total of 121 older adults (mean (standard deviation) age: 72.6 (8.1)) were recruited from a Primary Care Health Center from 10 August 2019 to 10 September 2019. Food insecurity and malnutrition status were assessed by the Household Food Insecurity Access Scale and Mini Nutritional Assessment tool, respectively. Recorded variables included financial, family data and comorbidities. The prevalence of food insecurity in the sample reached 50.4%, with men and older adults malnourished or at risk for malnutrition, exhibiting high risk for food insecurity. Multimorbidity, frequency of health care utilization and medication adherence were not associated with food insecurity, possibly due to the free health services and remunerated medications offered by the Greek government. However, male gender and malnutrition risk were significant predictors of food insecurity in the multiple logistic analyses. This study highlights the need for mainstreaming food insecurity assessment among older adults with comorbidities, especially those at risk for malnutrition.
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Original Research: The Relationship Between Food Insecurity and Cost-Related Medication Nonadherence in Older Adults: A Systematic Review. Am J Nurs 2020; 120:24-36. [PMID: 32443122 DOI: 10.1097/01.naj.0000668732.28490.c1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food insecurity, which can be defined as having limited access to nutritional and safe foods as a result of a lack of financial resources, is believed to adversely influence health outcomes. Older adults, in particular, face rising health care costs and may be forced to choose between purchasing prescribed medications or using their limited financial resources for basic needs, such as food. PURPOSE The purpose of this systematic review was to examine the relationship between food insecurity and cost-related medication nonadherence (CRN) in older adults living in a community setting. METHODS A comprehensive electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, written in English, involving community-dwelling U.S. adults 60 years of age and older. RESULTS Six studies met all criteria and were included for analysis. Two studies reported a significant dose-response relationship between food insecurity and CRN, and a third reported an increased risk of CRN in subjects with persistent food insecurity. Three key predictors of food insecurity and CRN in older adults were identified: low income, health insurance gaps, and higher out-of-pocket prescription costs. Most studies reported that subjects with higher food insecurity and CRN were more likely to be young-old (ages 60 to 84), have lower income, and have relatively more chronic conditions. CONCLUSION Overall, the findings indicate that older adults who have multiple chronic conditions and only receive Medicare are at increased risk for food insecurity and CRN. Finding ways for health care providers and organizations to help manage these risks is critical to improving health outcomes and reducing use of health care services. Nurses can be pivotal in taking the lead to develop appropriate interventions and programs for patients, and to advocate better government-funded health care and policy reform in order to improve outcomes in this vulnerable population.
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Keith-Jennings B, Llobrera J, Dean S. Links of the Supplemental Nutrition Assistance Program With Food Insecurity, Poverty, and Health: Evidence and Potential. Am J Public Health 2020; 109:1636-1640. [PMID: 31693420 DOI: 10.2105/ajph.2019.305325] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is a highly effective program, vital to our nation's health and well-being. SNAP's entitlement funding structure allows it to provide benefits to anyone who meets the program's eligibility requirements, and this structure also enables SNAP to respond quickly when need increases. Research shows that SNAP reduces poverty for millions, improves food security, and is linked with improved health.Despite SNAP's successes, there is room to build on its considerable accomplishments. Evidence suggests that current benefit levels are not adequate for many households. Some vulnerable groups have limited SNAP eligibility, and some eligible individuals face barriers to SNAP participation.Policymakers should address these shortcomings by increasing SNAP benefits and expanding SNAP eligibility to underserved groups. The federal government and states should also continue improving policies and procedures to improve access for eligible individuals.
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Affiliation(s)
- Brynne Keith-Jennings
- Brynne Keith-Jennings, Joseph Llobrera, and Stacy Dean are with the food assistance team at the Center on Budget and Policy Priorities, Washington, DC
| | - Joseph Llobrera
- Brynne Keith-Jennings, Joseph Llobrera, and Stacy Dean are with the food assistance team at the Center on Budget and Policy Priorities, Washington, DC
| | - Stacy Dean
- Brynne Keith-Jennings, Joseph Llobrera, and Stacy Dean are with the food assistance team at the Center on Budget and Policy Priorities, Washington, DC
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Cohen AJ, Rudolph JL, Thomas KS, Archambault E, Bowman MM, Going C, Heisler M, O'Toole TP, Dosa DM. Food Insecurity Among Veterans: Resources to Screen and Intervene. Fed Pract 2020; 37:16-23. [PMID: 32047351 PMCID: PMC7010340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A screener was created in the VA electronic health record clinical reminder system to facilitate an interdisciplinary approach to identifying and addressing food insecurity.
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Affiliation(s)
- Alicia J Cohen
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - James L Rudolph
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - Kali S Thomas
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - Elizabeth Archambault
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - Megan M Bowman
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - Christine Going
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - Michele Heisler
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - Thomas P O'Toole
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
| | - David M Dosa
- is a Research Scientist; is Director; is a Research Health Science Specialist; is a Social Worker; is Associate Director; all at the VA Health Services Research & Development Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center in Rhode Island; is Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration in Washington, DC. is Assistant Chief, Nutrition and Food Services at VA Salt Lake City Health Care System in Utah. is Executive Assistant, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations, Veterans Health Administration. is a Research Scientist at the Center for Clinical Management Research, Ann Arbor VA Medical Center in Michigan. Alicia Cohen is an Assistant Professor of Family Medicine and Health Services, Policy and Practice; James Rudolph is Professor of Medicine and Health Services, Policy and Practice; Kali Thomas is an Associate Professor of Health Services, Policy, and Practice; David Dosa is an Associate Professor of Medicine and Health Services, Policy and Practice; Thomas O'Toole is a Professor of Medicine; all at the Warren Alpert Medical School of Brown University and Brown University School of Public Health in Providence, Rhode Island. Michele Heisler is a Professor of Internal Medicine and Health Behavior and Health Education at the University of Michigan Medical School and School of Public Health. Megan Bowman and Christine Going are Co- Chairs, and Alicia Cohen, Kali Thomas, and Thomas O'Toole are members of the Ensuring Veteran Food Security Work-group
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Penumarthy NL, Goldsby RE, Shiboski SC, Wustrack R, Murphy P, Winestone LE. Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas. Cancer Med 2019; 9:951-958. [PMID: 31838786 PMCID: PMC6997066 DOI: 10.1002/cam4.2739] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas. Methods The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Low‐income patients were defined as those with no insurance or Medicaid, a means‐tested form of public insurance. Survival curves were computed using the Kaplan‐Meier method and compared using log‐rank tests and Cox models. Causal mediation was used to assess whether the association between public insurance and mortality is mediated by metastatic disease. Results Of 1106 patients, 39% patients were classified as low‐income. Low‐income patients were more likely to be racial/ethnic minorities and to present with metastatic disease (OR 1.96, 95% CI 1.35‐2.86). Low‐income patients had significantly worse OS (61% vs 71%). Age at diagnosis and extent of disease at diagnosis were also independent predictors of OS. When stratified by extent of disease, low‐income patients consistently had significantly worse OS (localized: 78% vs 84%, regional: 64% vs 73%, metastatic: 23% vs 30%, respectively). Mediation analysis indicated that metastatic disease at diagnosis mediated 15% of the effect of public insurance on OS. Conclusions Low‐income patients with bone and soft tissue sarcomas had decreased OS regardless of disease stage at presentation. The mechanism by which insurance status impacts survival requires additional investigation, but may be through reduced access to care.
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Affiliation(s)
- Neela L Penumarthy
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Robert E Goldsby
- Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Stephen C Shiboski
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | | | - Patricia Murphy
- Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Lena E Winestone
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.,Division of Allergy, Immunology, and BMT, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
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Combined effects of disease management and food insecurity on physical and mental health in Korean adults. Public Health Nutr 2019; 23:112-122. [PMID: 31744589 DOI: 10.1017/s1368980019003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present study aimed to examine the combined effects of disease management and food insecurity on physical and mental health in a representative Korean population. DESIGN A cross-sectional study. SETTING Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012-2015. PARTICIPANTS Adults aged ≥30 years (n 17 934) who participated in the KNHANES. RESULTS Among health-care factors, unmet health-care needs and mental health counselling were different by food insecurity status, with a higher prevalence in adults with food insecurity. The prevalence of underweight was higher in men with food insecurity (5·9 %), whereas the prevalence of obesity was higher in women with food insecurity (37·4 %), than that in men and women with food security. Food insecurity was associated with a high risk of all mental health outcomes. For the combined effects of disease management and food insecurity, unmet health-care needs was related to increased risk of obesity for food-insecure men (Pinteraction = 0·029) and lack of participation in nutrition education or counselling was related to increased risk of obesity for food-insecure women (Pinteraction = 0·010). In addition, higher unmet health-care needs in adults with food insecurity was related to higher risk of mental health outcomes. CONCLUSIONS Unmet health-care needs may exacerbate obesity for food-insecure men and mental health problems for both food-insecure men and women. In addition, lack of participation in nutrition education or counselling may exacerbate the obesity for food-insecure women.
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Heflin C, Hodges L, Ojinnaka C. Administrative Churn in SNAP and Health Care Utilization Patterns. Med Care 2019; 58:33-37. [PMID: 31688555 DOI: 10.1097/mlr.0000000000001235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Administrative churn occurs when a household exits the Supplemental Nutrition Assistance Program (SNAP) and then returns to the program within 4 months. Although a number of studies have examined health care utilization patterns related to Medicaid administrative churn less is known about health care utilization patterns among Medicaid-insured SNAP enrollees. OBJECTIVES To investigate the characteristics and health care utilization patterns of Medicaid insured SNAP participants who experience SNAP administrative churn. RESEARCH DESIGN Retrospective cohort study using 2010-2013 SNAP benefit data from the state of Missouri linked to Medicaid claims data for the same time period. Individual fixed effect regression analysis was used to investigate differences in health care claims for churners and nonchurners across various health care settings. SUBJECTS Missouri residents ages 18-64 who were Medicaid-insured SNAP enrollees. MEASURES Inpatient, outpatient, emergency department (ED), and pharmacy claims, and churn status. RESULTS Half of our sample (49.63%) experienced administrative churn. In the descriptive analyses, churners had fewer claims for prescription drugs than nonchurners (25.42% vs. 30.47%), but more claims for ED visits (3.79% vs. 2.74%). Adjusting for individual fixed characteristics, inpatient claims occurred with more frequency during periods of churn than while on SNAP, whereas ED, outpatient, and pharmacy claims occurred with less frequency during periods of churn than while on SNAP. CONCLUSIONS SNAP administrative churn was very common among our study sample. Given that health care utilization patterns varied for churners compared with nonchurners, it is important that researchers and public health professionals not assume stable SNAP receipt among participants.
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Affiliation(s)
- Colleen Heflin
- Maxwell School of Public Affairs and Citizenship, Syracuse University, Syracuse, NY
| | - Leslie Hodges
- Institute for Research on Poverty, University of Wisconsin, Madison, WI
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McGarry ME, Williams WA, McColley SA. The demographics of adverse outcomes in cystic fibrosis. Pediatr Pulmonol 2019; 54 Suppl 3:S74-S83. [PMID: 31715087 PMCID: PMC6857719 DOI: 10.1002/ppul.24434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/16/2019] [Indexed: 01/08/2023]
Abstract
Understanding variability in cystic fibrosis (CF) health outcomes requires an understanding of factors that go far beyond Cystic Fibrosis Transmembrane Receptor (CFTR) function caused by different gene mutations. Social and environmental factors that influence health have a significant influence on the trajectory of health in CF and in other chronic diseases. In this article, we review demographic factors associated with poorer health outcomes in CF, known and postulated biological mechanisms of these outcomes, and interventions that healthcare teams can implement that may reduce outcome disparities.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Wadsworth A Williams
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois
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