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Sheen J, Curtin L, Finley S, Konstorum A, McGee R, Craig M. Integrating Diversity, Equity, and Inclusion into Preclinical, Clinical, and Public Health Mathematical Models. Bull Math Biol 2024; 86:56. [PMID: 38625656 PMCID: PMC11021228 DOI: 10.1007/s11538-024-01282-4] [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: 03/10/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
Mathematical modelling applied to preclinical, clinical, and public health research is critical for our understanding of a multitude of biological principles. Biology is fundamentally heterogeneous, and mathematical modelling must meet the challenge of variability head on to ensure the principles of diversity, equity, and inclusion (DEI) are integrated into quantitative analyses. Here we provide a follow-up perspective on the DEI plenary session held at the 2023 Society for Mathematical Biology Annual Meeting to discuss key issues for the increased integration of DEI in mathematical modelling in biology.
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Affiliation(s)
- Justin Sheen
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA
| | - Lee Curtin
- Mathematical Neuro-Oncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, USA
| | - Stacey Finley
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, USA.
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, USA.
- Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, USA.
| | | | - Reginald McGee
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, USA
| | - Morgan Craig
- Department of Mathematics and Statistics, Université de Montréal, Montréal, Canada.
- Sainte-Justine University Hospital Azrieli Research Centre, Montréal, Canada.
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2
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Smith PD, Keene DE, Dilday S, Blankenship KM, Groves AK. Eviction from rental housing and its links to health: A scoping review. Health Place 2024; 86:103182. [PMID: 38340495 DOI: 10.1016/j.healthplace.2024.103182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/24/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Patrick D Smith
- Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, Nesbitt Hall, 3215 Market Street 718, Philadelphia, PA, 19104, USA.
| | - Danya E Keene
- Yale University School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Sarah Dilday
- Drexel University Dornsife School of Public Health, Department Health Management and Policy, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Kim M Blankenship
- American University, Department of Sociology, 4400 Massachusetts Avenue, Washington, DC, 20016, USA
| | - Allison K Groves
- Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, Nesbitt Hall, 3215 Market Street 718, Philadelphia, PA, 19104, USA
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Graetz N, Gershenson C, Porter SR, Sandler DH, Lemmerman E, Desmond M. The impacts of rent burden and eviction on mortality in the United States, 2000-2019. Soc Sci Med 2024; 340:116398. [PMID: 38007965 PMCID: PMC10828546 DOI: 10.1016/j.socscimed.2023.116398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023]
Abstract
Investments in stable, affordable housing may be an important tool for improving population health, especially in the context of rising costs and evictions for American renters. Still, a lack of longitudinal data linking these exposures to health outcomes has limited prior research. In this study, we use linked administrative data to estimate the associations of rent burden and eviction with all-cause mortality. We constructed a novel dataset linking renters in the long-form 2000 Census (N = 6,587,000) to mortality follow-up through 2019 from the Census Numident file. To measure exposure to eviction, we further linked this dataset to 38 million eviction records between 2000 and 2016 using names and addresses. For a subsample of renters, we also measured within-individual changes in rent burden between 2000 and 2008-2012 by linking to the American Community Survey. We estimated the associations of rent burden and eviction with mortality using Cox proportional-hazards models and discrete-time hazard models adjusted for individual, household, neighborhood, and state characteristics, examining varying associations by cohort, race, gender, and eviction risk. Higher baseline rent burden, increases in rent burden during midlife, and evictions were all associated with increased mortality. Compared to a baseline rent burden of 30%, a burden of 70% was associated with 12% (95% confidence interval = 11-13%) higher mortality. A 20-point increase in rent burden between 2000 and 2008-2012 was associated with 16% (12-19%) higher mortality through 2019. An eviction filing without judgment was associated with a 19% (15-23%) increase in mortality and an eviction judgment was associated with a 40% (36-43%) increase. Associations were larger for those at lower predicted risk of eviction. These findings reveal how rising costs and evictions are shaping mortality for American renters. Policies designed to increase the supply of affordable housing and prevent eviction may lead to widespread improvements in population health.
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Affiliation(s)
- Nick Graetz
- Department of Sociology, Princeton University, Princeton, NJ, USA.
| | - Carl Gershenson
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | - Sonya R Porter
- Center for Economics Studies, United States Census Bureau, Washington D.C., USA
| | - Danielle H Sandler
- Center for Economics Studies, United States Census Bureau, Washington D.C., USA
| | - Emily Lemmerman
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | - Matthew Desmond
- Department of Sociology, Princeton University, Princeton, NJ, USA
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Schwartz GL, Leifheit KM, Arcaya MC, Keene D. Eviction as a community health exposure. Soc Sci Med 2024; 340:116496. [PMID: 38091853 PMCID: PMC11249083 DOI: 10.1016/j.socscimed.2023.116496] [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: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/23/2024]
Abstract
Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.
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Affiliation(s)
- Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Urban Health Collaborative & Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Kathryn M Leifheit
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariana C Arcaya
- Department of Urban Studies & Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Danya Keene
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Brown EM, Moineddin R, Hapsari A, Gozdyra P, Durant S, Pinto AD. Eviction filings during bans on enforcement throughout the COVID-19 pandemic: an interrupted time series analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:745-754. [PMID: 37581748 PMCID: PMC10485221 DOI: 10.17269/s41997-023-00813-1] [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: 01/13/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Bans on evictions were implemented to reduce the spread of COVID-19 and to protect vulnerable populations during a public health crisis. Our objective was to examine how three bans on eviction enforcement impacted eviction filings from March 2020 through January 2022 in Ontario, Canada. METHODS Data were derived from eviction application records kept by the Ontario Landlord and Tenant Board. We used segmented regression analysis to model changes in the average weekly filing rates for evictions due to non-payment of rent (L1 filings) and reasons other than non-payment of rent (L2 filings). RESULTS The average number of weekly L1 and L2 applications dropped by 67.5 (95% CI: 55.2, 79.9) and 31.7 (95% CI: 26.7, 36.6) filings per 100,000 rental dwellings, respectively, following the first ban on eviction enforcement (p < 0.0001). Notably, they did not fall to zero. Level changes during the second and third bans were insubstantial and slope changes for L2 applications varied throughout the study period. The L1 filing rate appeared to increase towards the end of the study period (slope change: 1.3; 95% CI: 0.1, 2.6; p = 0.0387). CONCLUSION Our findings suggest that while the first ban on eviction enforcement appeared to substantially reduce filing rates, subsequent bans were less effective and none of them eliminated eviction filings altogether. Enacting upstream policies that tackle the root causes of displacement would better equip jurisdictions during future public health emergencies.
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Affiliation(s)
- Erika M Brown
- California Policy Lab, Institute for Research on Labor & Employment, University of California, Berkeley, Berkeley, CA, USA
- Social Interventions Research & Evaluation Network, University of California, San Francisco, San Francisco, CA, USA
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ayu Hapsari
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Gozdyra
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Steve Durant
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Paglino E, Lundberg DJ, Zhou Z, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Preston SH, Elo IT, Stokes AC. Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022. SCIENCE ADVANCES 2023; 9:eadf9742. [PMID: 37352359 PMCID: PMC10289647 DOI: 10.1126/sciadv.adf9742] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/18/2023] [Indexed: 06/25/2023]
Abstract
Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the COVID-19 pandemic's mortality impact. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating factors, and inform response efforts. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,179,024 excess deaths occurred during the first 2 years of the pandemic (first: 634,830; second: 544,194). Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic's rural impact grows.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Boen CE, Keister LA, Gibson-Davis CM, Luck A. The Buffering Effect of State Eviction and Foreclosure Policies for Mental Health during the COVID-19 Pandemic in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023:221465231175939. [PMID: 37334797 PMCID: PMC10288207 DOI: 10.1177/00221465231175939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The COVID-19 pandemic spurred an economic downturn that may have eroded population mental health, especially for renters and homeowners who experienced financial hardship and were at risk of housing loss. Using household-level data from the Census Bureau's Household Pulse Survey (n = 805,223; August 2020-August 2021) and state-level data on eviction/foreclosure bans, we estimated linear probability models with two-way fixed effects to (1) examine links between COVID-related financial hardship and anxiety/depression and (2) assess whether state eviction/foreclosure bans buffered the detrimental mental health impacts of financial hardship. Findings show that individuals who reported difficulty paying for household expenses and keeping up with rent or mortgage had increased anxiety and depression risks but that state eviction/foreclosure bans weakened these associations. Our findings underscore the importance of state policies in protecting mental health and suggest that heterogeneity in state responses may have contributed to mental health inequities during the pandemic.
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Nandonik AJ, Das Pooja S, Ahmed T, Parvez A, Kabir ZN. Experiences of aftermath of COVID-19 in relation to social, financial and health related aspects among previously hospitalized patients: a qualitative exploration. Front Public Health 2023; 11:1196810. [PMID: 37397755 PMCID: PMC10311015 DOI: 10.3389/fpubh.2023.1196810] [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: 03/30/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background There is increasing evidence of long-term consequences of COVID-19. The world has seen multidimensional impact of the pandemic and Bangladesh is no exception to that. Policymakers in Bangladesh laid out strategies to curb the initial spread of COVID-19. However, long-term consequences of COVID-19 received little or no attention in the country. Evidence suggests that people presumed to be recovered face multidimensional post-covid consequences. This study aimed to describe the aftermath of COVID-19 in relation to social, financial and health related aspects among previously hospitalized patients. Methods This descriptive qualitative study includes participants (n = 14) who were previously hospitalized for COVID-19 and returned home after recovery. The participants were part of a mixed method study from which they were purposively selected. Semi-structured in-depth interviews were conducted over telephone. Inductive content analysis was used to analyze the data. Results Twelve sub-categories emerged from the data analysis which converged into five main categories. The main categories included perspective on physical health, financial struggle, life adjustment, interplay between different domains, and spontaneous support. Conclusion The lived experiences of COVID-19 recovered patients highlighted multidimensional impact on their daily lives. Physical and psychological wellbeing found to be related to the effort of restoring financial status. People's perception about life altered due to pandemic, for few the pandemic was an opportunity to grow while others found it difficult to accept the hardship. Such multidimensional post COVID-19 impact on people's lives and wellbeing holds considerable implication for response and mitigation plan for future related pandemics.
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Lundberg DJ, Wrigley-Field E, Cho A, Raquib R, Nsoesie EO, Paglino E, Chen R, Kiang MV, Riley AR, Chen YH, Charpignon ML, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open 2023; 6:e2311098. [PMID: 37129894 PMCID: PMC10155069 DOI: 10.1001/jamanetworkopen.2023.11098] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.
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Affiliation(s)
- Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Elizabeth Wrigley-Field
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University, Boston, Massachusetts
- Department of Political Science, Boston University, Boston, Massachusetts
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center for Antiracist Research, Boston University, Boston, Massachusetts
| | - Eugenio Paglino
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | | | - Samuel H. Preston
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Irma T. Elo
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Goldenberg SM, Buglioni N, Krüsi A, Frost E, Moreheart S, Braschel M, Shannon K. Housing Instability and Evictions Linked to Elevated Intimate Partner and Workplace Violence Among Women Sex Workers in Vancouver, Canada: Findings of a Prospective, Community-Based Cohort, 2010-2019. Am J Public Health 2023; 113:442-452. [PMID: 36888950 PMCID: PMC10003487 DOI: 10.2105/ajph.2022.307207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings. Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions with intimate partner violence (IPV) and workplace violence among a community-based longitudinal cohort of cisgender and transgender women sex workers in Vancouver, Canada, from 2010 through 2019. Results. Of 946 women, 85.9% experienced unstable housing, 11.1% eviction, 26.2% IPV, and 31.8% workplace violence. In multivariable generalized estimating equation models, recent exposure to unstable housing (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI] = 1.45, 2.87) and evictions (AOR = 2.45; 95% CI = 0.99, 6.07) were associated with IPV, and exposure to unstable housing was associated with workplace violence (AOR = 1.46; 95% CI = 1.06, 2.00). Conclusions. Women sex workers face a high burden of unstable housing and evictions, which are linked to increased odds of intimate partner and workplace violence. Increased access to safe, women-centered, and nondiscriminatory housing is urgently needed. (Am J Public Health. 2023;113(4):442-452. https://doi.org/10.2105/AJPH.2022.307207).
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Affiliation(s)
- Shira M Goldenberg
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Natalie Buglioni
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Andrea Krüsi
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Elizabeth Frost
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Sarah Moreheart
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Melissa Braschel
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
| | - Kate Shannon
- Shira M. Goldenberg is with the School of Public Health, San Diego State University, CA. Natalie Buglioni recently graduated from the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC. Andrea Krüsi and Kate Shannon are with the Department of Medicine, University of British Columbia (UBC), Vancouver. Elizabeth Frost is a doctoral student in the Joint Doctoral Program in Public Health (Epidemiology), San Diego State University-University of California, San Diego. Sarah Moreheart is a doctoral student in the Faculty of Health Sciences, Simon Fraser University. Melissa Braschel is with the Centre for Gender & Sexual Health Equity, UBC
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PONCE NINEZA, SHIMKHADA RITI, ADKINS‐JACKSON PARISB. Making Communities More Visible: Equity-Centered Data to Achieve Health Equity. Milbank Q 2023; 101:302-332. [PMID: 37096622 PMCID: PMC10126976 DOI: 10.1111/1468-0009.12605] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Despite decades of research exposing health disparities between populations and communities in the US, health equity goals remain largely unfulfilled. We argue these failures call for applying an equity lens in the way we approach data systems, from collection and analysis to interpretation and distribution. Hence, health equity requires data equity. There is notable federal interest in policy changes and federal investments to improve health equity. With this, we outline the opportunities to align these health equity goals with data equity by improving the way communities are engaged and how population data are collected, analyzed, interpreted, made accessible, and distributed. Policy priority areas for data equity include increasing the use of disaggregated data, increasing the use of currently underused federal data, building capacity for equity assessments, developing partnerships between government and community, and increasing data accountability to the public.
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Affiliation(s)
- NINEZ A. PONCE
- Center for Health Policy ResearchUniversity of CaliforniaLos Angeles
- Los Angeles Fielding School of Public HealthUniversity of California
| | - RITI SHIMKHADA
- Center for Health Policy ResearchUniversity of CaliforniaLos Angeles
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Tan W. The association of demographic and socioeconomic factors with COVID-19 during pre- and post-vaccination periods: A cross-sectional study of Virginia. Medicine (Baltimore) 2023; 102:e32607. [PMID: 36607863 PMCID: PMC9828584 DOI: 10.1097/md.0000000000032607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Sociodemographic factors have been found to be associated with the transmission of coronavirus disease 2019 (COVID-19), yet most studies focused on the period before the proliferation of vaccination and obtained inconclusive results. In this cross-sectional study, the infections, deaths, incidence rates, case fatalities, and mortalities of Virginia's 133 jurisdictions during the pre-vaccination and post-vaccination periods were compared, and their associations with demographic and socioeconomic factors were studied. The cumulative infections and deaths and medians of incidence rates, case fatalities, and mortalities of COVID-19 in 133 Virginia jurisdictions were significantly higher during the post-vaccination period than during the pre-vaccination period. A variety of demographic and socioeconomic risk factors were significantly associated with COVID-19 prevalence in Virginia. Multiple linear regression analysis suggested that demographic and socioeconomic factors contributed up to 80% of the variation in the infections, deaths, and incidence rates and up to 53% of the variation in the case fatalities and mortalities of COVID-19 in Virginia. The demographic and socioeconomic determinants differed during the pre- and post-vaccination periods. The developed multiple linear regression models could be used to effectively characterize the impact of demographic and socioeconomic factors on the infections, deaths, and incidence rates of COVID-19 in Virginia.
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Affiliation(s)
- Wanli Tan
- College of Life Sciences, The University of California, Los Angeles, CA
- * Correspondence: Wanli Tan, College of Life Sciences, The University of California, Class of 2026, Los Angeles, CA 90095 (e-mail: )
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Paglino E, Lundberg DJ, Zhou Z, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Preston SH, Elo IT, Stokes AC. Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.04.23.22274192. [PMID: 35547848 PMCID: PMC9094106 DOI: 10.1101/2022.04.23.22274192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the overall impact of the Covid-19 pandemic that is not biased by differences in testing or cause-of-death assignment. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating and mitigating factors, and inform response efforts, including allocating resources to affected communities. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,159,580 excess deaths occurred during the first two years of the pandemic (first: 620,872; second: 538,708). Overall, excess mortality decreased in large metropolitan counties, but increased in nonmetro counties, between the first and second years of the pandemic. Despite the initial concentration of mortality in large metropolitan Northeast counties, beginning in February 2021, nonmetro South counties had the highest cumulative relative excess mortality. These results highlight the need for investments in rural health as the pandemic's disproportionate impact on rural areas continues to grow.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA
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Chen KL, Miake-Lye IM, Begashaw MM, Zimmerman FJ, Larkin J, McGrath EL, Shekelle PG. Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review. JAMA Netw Open 2022; 5:e2239860. [PMID: 36322083 PMCID: PMC9631101 DOI: 10.1001/jamanetworkopen.2022.39860] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Housing insecurity-that is, difficulty with housing affordability and stability-is prevalent and results in increased risk for both homelessness and poor health. However, whether interventions that prevent housing insecurity upstream of homelessness improve health remains uncertain. OBJECTIVE To review evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access. EVIDENCE REVIEW Pairs of independent reviewers systematically searched PubMed, Web of Science, EconLit, and the Social Interventions Research and Evaluation Network for quantitative studies published from 2005 to 2021 that evaluated interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households (targeted primary prevention) or by enhancing community-level housing supply and affordability in partnership with the health sector (structural primary prevention). Risk of bias was appraised using validated tools, and the evidence was synthesized using modified Grading of Recommendations Assessment, Development, and Evaluation criteria. FINDINGS A total of 26 articles describing 3 randomized trials and 20 observational studies (16 longitudinal designs and 4 cross-sectional quasi-waiting list control designs) were included. Existing interventions have focused primarily on mitigating housing insecurity for the most vulnerable individuals rather than preventing housing insecurity outright. Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance. No studies evaluated health system-partnered structural primary prevention strategies. CONCLUSIONS AND RELEVANCE This systematic review found mixed and mostly low-certainty evidence that interventions that promote housing affordability and stability were associated with improved adult health outcomes. Existing interventions may need to be paired with other efforts to address the structural determinants of health. As health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway interventions should focus for the most effective and equitable health impact.
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Affiliation(s)
- Katherine L. Chen
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Fielding School of Public Health, University of California, Los Angeles
| | - Isomi M. Miake-Lye
- Fielding School of Public Health, University of California, Los Angeles
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | - Meron M. Begashaw
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | | | - Jody Larkin
- RAND Corporation, Southern California Evidence-Based Practice Center, Santa Monica, California
| | - Emily L. McGrath
- Health Equity and Population Health, Humana Inc, Louisville, Kentucky
| | - Paul G. Shekelle
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
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Ali AK, Wehby GL. State Eviction Moratoriums During The COVID-19 Pandemic Were Associated With Improved Mental Health Among People Who Rent. Health Aff (Millwood) 2022; 41:1583-1589. [DOI: 10.1377/hlthaff.2022.00750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - George L. Wehby
- George L. Wehby , University of Iowa; and National Bureau of Economic Research, Cambridge, Massachusetts
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Lundberg DJ, Cho A, Raquib R, Nsoesie EO, Wrigley-Field E, Stokes AC. Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.07.20.22277872. [PMID: 35898347 PMCID: PMC9327633 DOI: 10.1101/2022.07.20.22277872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Prior research has established that American Indian, Alaska Native, Black, Hispanic, and Pacific Islander populations in the United States have experienced substantially higher mortality rates from Covid-19 compared to non-Hispanic white residents during the first year of the pandemic. What remains less clear is how mortality rates have changed for each of these racial/ethnic groups during 2021, given the increasing prevalence of vaccination. In particular, it is unknown how these changes in mortality have varied geographically. In this study, we used provisional data from the National Center for Health Statistics (NCHS) to produce age-standardized estimates of Covid-19 mortality by race/ethnicity in the United States from March 2020 to February 2022 in each metro-nonmetro category, Census region, and Census division. We calculated changes in mortality rates between the first and second years of the pandemic and examined mortality changes by month. We found that when Covid-19 first affected a geographic area, non-Hispanic Black and Hispanic populations experienced extremely high levels of Covid-19 mortality and racial/ethnic inequity that were not repeated at any other time during the pandemic. Between the first and second year of the pandemic, racial/ethnic inequities in Covid-19 mortality decreased-but were not eliminated-for Hispanic, non-Hispanic Black, and non-Hispanic AIAN residents. These inequities decreased due to reductions in mortality for these populations alongside increases in non-Hispanic white mortality. Though racial/ethnic inequities in Covid-19 mortality decreased, substantial inequities still existed in most geographic areas during the pandemic's second year: Non-Hispanic Black, non-Hispanic AIAN, and Hispanic residents reported higher Covid-19 death rates in rural areas than in urban areas, indicating that these communities are facing serious public health challenges. At the same time, the non-Hispanic white mortality rate worsened in rural areas during the second year of the pandemic, suggesting there may be unique factors driving mortality in this population. Finally, vaccination rates were associated with reductions in Covid-19 mortality for Hispanic, non-Hispanic Black, and non-Hispanic white residents, and increased vaccination may have contributed to the decreases in racial/ethnic inequities in Covid-19 mortality observed during the second year of the pandemic. Despite reductions in mortality, Covid-19 mortality remained elevated in nonmetro areas and increased for some racial/ethnic groups, highlighting the need for increased vaccination delivery and equitable public health measures especially in rural communities. Taken together, these findings highlight the continued need to prioritize health equity in the pandemic response and to modify the structures and policies through which systemic racism operates and has generated racial health inequities.
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Affiliation(s)
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University
- Department of Political Science, Boston University
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health
- Center for Antiracist Research, Boston University
| | | | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health
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Paglino E, Lundberg DJ, Cho A, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Elo IT, Preston SH, Stokes AC. Excess all-cause mortality across counties in the United States, March 2020 to December 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022. [PMID: 35547848 DOI: 10.1101/2022.06.29.222770652022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Official Covid-19 death counts have underestimated the mortality impact of the Covid-19 pandemic in the United States. Excess mortality, which compares observed deaths to deaths expected in the absence of the pandemic, is a useful measure for assessing the total effect of the pandemic on mortality levels. In the present study, we produce county-level estimates of excess mortality for 3,127 counties between March 2020 and December 2021. We fit two hierarchical linear models to county-level death rates from January 2015 to December 2019 and predict expected deaths for each month during the pandemic. We compare observed deaths to these estimates to obtain excess deaths for each county-month. An estimated 936,911 excess deaths occurred during 2020 and 2021, of which 171,168 (18.3%) were not assigned to Covid-19 on death certificates as an underlying cause of death. Urban counties in the Far West, Great Lakes, Mideast, and New England experienced a substantial mortality disadvantage in 2020, whereas rural counties in these regions had higher mortality in 2021. In the Southeast, Southwest, Rocky Mountain, and Plains regions, there was a rural mortality disadvantage in 2020, which was exacerbated in 2021. The proportion of excess deaths assigned to Covid-19 was lower in 2020 (76.3%) than in 2021 (87.0%), suggesting that a larger fraction of excess deaths was assigned to Covid-19 later in the pandemic. However, in rural areas and in the Southeast and Southwest a large share of excess deaths was still not assigned to Covid-19 during 2021. SIGNIFICANCE Deaths during the Covid-19 pandemic have been primarily monitored through death certificates containing reference to Covid-19. This approach has missed more than 170,000 deaths related to the pandemic between 2020 and 2021. While the ascertainment of Covid-19 deaths improved during 2021, the full effects of the pandemic still remained obscured in some regions. County-level estimates of excess mortality are useful for studying geographic inequities in the mortality burden associated with the pandemic and identifying specific regions where the full mortality burden was significantly underreported (i.e. Southeast). They can also be used to inform resource allocation decisions at the federal and state levels and encourage uptake of preventive measures in communities with low vaccine uptake.
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Liu CH, Tsai AC. Helpline data used to monitor population distress in a pandemic. Nature 2021; 600:46-47. [PMID: 34789884 DOI: 10.1038/d41586-021-03038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Orcutt TJ, Pruitt BA. Chemical injuries of the upper extremity. JMIR Public Health Surveill 1976; 19:84-95. [PMID: 3697 PMCID: PMC10132827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/21/2022] [Accepted: 03/23/2023] [Indexed: 12/12/2022] Open
Abstract
The prompt recognition and management (Tables 8-1 and 8-2) of chemical burns of the upper extremity may prevent injury to the deep structures of the hand and may make the difference between satisfactory rehabilitation and crippling deformities. Immediate irrigation with water is the single most important treatment that can be carried out, and should be continued for at least an hour and often for several hours, depending on the severity of the injury. Precious time should not be wasted hunting for a specific neutralizing agent. Hydrofluoric acid injuries and phosphorus injuries are the two exceptions to this principle. After copious irrigation and débridement, small superficial burns may be treated without dressings or topical therapy. Large partial-thickness burns are best treated with Sulfamylon burn cream and then with with biologic dressings until healing is achieved. Full-thickness injuries of limited extent should be excised and skin-grafted to regain maximum function, and more extensive burns treated in a nonexicisional regimen.
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