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Ibrahim R, Pham HN, Ganatra S, Javed Z, Nasir K, Al-Kindi S. Social Phenotyping for Cardiovascular Risk Stratification in Electronic Health Registries. Curr Atheroscler Rep 2024; 26:485-497. [PMID: 38976220 DOI: 10.1007/s11883-024-01222-6] [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: 06/08/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE OF REVIEW Evaluation of social influences on cardiovascular care requires a comprehensive analysis encompassing economic, societal, and environmental factors. The increased utilization of electronic health registries provides a foundation for social phenotyping, yet standardization in methodology remains lacking. This review aimed to elucidate the primary approaches to social phenotyping for cardiovascular risk stratification through electronic health registries. RECENT FINDINGS Social phenotyping in the context of cardiovascular risk stratification within electronic health registries can be separated into four principal approaches: place-based metrics, questionnaires, ICD Z-coding, and natural language processing. These methodologies vary in their complexity, advantages and limitations, and intended outcomes. Place-based metrics often rely on geospatial data to infer socioeconomic influences, while questionnaires may directly gather individual-level behavioral and social factors. Z-coding, a relatively new approach, can capture data directly related to social determinant of health domains in the clinical context. Natural language processing has been increasingly utilized to extract social influences from unstructured clinical narratives-offering nuanced insights for risk prediction models. Each method plays an important role in our understanding and approach to using social determinants data for improving population cardiovascular health. These four principal approaches to social phenotyping contribute to a more structured approach to social determinant of health research via electronic health registries, with a focus on cardiovascular risk stratification. Social phenotyping related research should prioritize refining predictive models for cardiovascular diseases and advancing health equity by integrating applied implementation science into public health strategies.
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Affiliation(s)
- Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Zulqarnain Javed
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA.
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Yoo EH, Roberts JE. Differential effects of air pollution exposure on mental health: Historical redlining in New York State. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 948:174516. [PMID: 39009165 DOI: 10.1016/j.scitotenv.2024.174516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
Growing evidence suggests that ambient air pollution has adverse effects on mental health, yet our understanding of its unequal impact remains limited, especially in areas with historical redlining practices. This study investigates whether the impact of daily fluctuations in ambient air pollutant levels on emergency room (ER) visits for mental disorders (MDs) varies across neighborhoods affected by redlining. Furthermore, we explored how demographic characteristics and ambient temperature may modify the effects of air pollution. To assess the disproportional short-term effects of PM2.5, NO2, and O3 on ER visits across redlining neighborhoods, we used a symmetric bidirectional case-crossover design with a conditional logistic regression model. We analyzed data from 2 million ER visits for MDs between 2005 and 2016 across 17 cities in New York State, where redlining policies were historically implemented. A stratified analysis was performed to examine potential effect modification by individuals' demographic characteristics (sex, age, and race/ethnicity) and ambient temperature. We found that both PM2.5 and NO2 were significantly associated with MD-related ER visits primarily in redlined neighborhoods. Per 10μgm-3 increase in daily PM2.5 and per 10 ppb increase in NO2 concentration were associated with 1.04 % (95 % Confidence Interval (CI): 0.57 %, 1.50 %) and 0.44 % (95 % CI: 0.21 %, 0.67 %) increase in MD-related ER visits in redlined neighborhoods, respectively. We also found significantly greater susceptibility among younger persons (below 18 years old) and adults aged 35-64 among residents in grade C or D, but not in A or B. Furthermore, we found that positive and statistically significant associations between increases in air pollutants (PM2.5 and NO2) and MD-related ER visits exist during medium temperatures (4.90 °C to 21.11 °C), but not in low or high temperature. Exposures to both PM2.5 and NO2 were significantly associated with MD-related ER visits, but these adverse effects were disproportionately pronounced in redlined neighborhoods.
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Affiliation(s)
- Eun-Hye Yoo
- Department of Geography, State University of New York at Buffalo, Buffalo, NY, USA.
| | - John E Roberts
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
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Mensah P, Valdez K, Gyawali A, Snell-Bergeon J. Social and Structural Determinants of Cardiovascular Complications of Diabetes. Curr Diab Rep 2024; 24:147-157. [PMID: 38696042 DOI: 10.1007/s11892-024-01541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of mortality in people who have diabetes. Racial and ethnic minorities with diabetes have suboptimal management of cardiovascular risk factors, leading to higher mortality. Social and structural determinants of health are external factors that influence an individual's ability to choose positive health behaviors. In this review, we will discuss cardiovascular complications in people who have diabetes and their relationship to social determinants of health (SDOH). RECENT FINDINGS Recent innovations in diabetes treatment, including new devices and medications, have improved care and survival. However, disparities in the availability of these treatments to racial and ethnic minorities may contribute to continued inequities in CVD outcomes. Racial/ethnic disparities in CVD relate to inequities in economic opportunity, education and health literacy, neighborhoods and social cohesion, and health care access and quality driven by structural racism.
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Affiliation(s)
- Portia Mensah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly Valdez
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ankita Gyawali
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Mail Stop F547, Aurora, CO, 80045, USA.
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Blaustein JR, Moon H, Long C, Bonanni LJ, Gordon T, Thorpe LE, Newman JD, Wittkopp S. Residences in Historically Redlined Districts in New York City Area Have More Indoor Particulate Air Pollution Potentially Reducible by Portable Air Cleaners. Circ Res 2024; 135:e1-e3. [PMID: 38759106 PMCID: PMC11232086 DOI: 10.1161/circresaha.124.324486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Jacob R. Blaustein
- New York University Grossman School of Medicine, Department of Medicine, Division of Cardiology, New York, USA
| | - Heewon Moon
- New York University Grossman School of Medicine, Department of Medicine, Division of Cardiology, New York, USA
| | - Clarine Long
- New York University Grossman School of Medicine, Department of Medicine, New York, USA
| | - Luke J. Bonanni
- New York University Grossman School of Medicine, New York, USA
| | - Terry Gordon
- New York University Grossman School of Medicine, Department of Environmental Medicine, New York, USA
| | - Lorna E. Thorpe
- New York University Grossman School of Medicine, Department of Population Health, New York, USA
| | - Jonathan D. Newman
- New York University Grossman School of Medicine, Department of Medicine, Division of Cardiology, New York, USA
| | - Sharine Wittkopp
- New York University Grossman School of Medicine, Department of Medicine, Division of Cardiology, New York, USA
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Motairek I, Rvo Salerno P, Chen Z, Deo S, Makhlouf MHE, Al-Araji R, Rajagopalan S, Nasir K, Al-Kindi S. Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest. Resuscitation 2024; 201:110264. [PMID: 38851447 DOI: 10.1016/j.resuscitation.2024.110264] [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: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with low survival rates. Bystander cardiopulmonary resuscitation (CPR) is essential for improving outcomes, but its utilization remains limited, particularly among racial and ethnic minorities. Historical redlining, a practice that classified neighborhoods for mortgage risk in 1930s, may have lasting implications for social and health outcomes. This study sought to investigate the influence of redlining on the provision of bystander CPR during witnessed OHCA. METHODS We conducted an analysis using data from the comprehensive Cardiac Arrest Registry to Enhance Survival (CARES), encompassing 736,066 non-traumatic OHCA cases across the United States. The Home Owners' Loan Corporation (HOLC) map shapefiles were utilized to categorize census tracts of arrests into four grades (A signifying "best", B "still desirable", C "declining", and D "hazardous"). Multivariable hierarchical logistic regression models were employed to predict the likelihood of CPR provision, adjusting for various factors including age, sex, race/ethnicity, arrest location, calendar year, and state of occurrence. Additionally, we accounted for the percentage of Black residents and residents below poverty levels at the census tract level. RESULTS Among the 43,186 witnessed cases of OHCA in graded HOLC census tracts, 37.2% received bystander CPR. The rates of bystander CPR exhibited a gradual decline across HOLC grades, ranging from 41.8% in HOLC grade A to 35.8% in HOLC grade D. In fully adjusted model, we observed significantly lower odds of receiving bystander CPR in HOLC grades C (OR 0.89, 95% CI 0.81-0.98, p = 0.016) and D (OR 0.86, 95% CI 0.78-0.95, p = 0.002) compared to HOLC grade A. CONCLUSION Redlining, a historical segregation practice, is associated with reduced contemporary rates of bystander CPR during OHCA. Targeted CPR training in redlined neighborhoods may be imperative to enhance survival outcomes.
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Affiliation(s)
- Issam Motairek
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Salil Deo
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Surgical Services, Louis Stokes VA Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mohamed H E Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Rabab Al-Araji
- Department of Global Health, Emory University, Atlanta, GA, United States
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Khurram Nasir
- Houston Methodist Hospital, Houston, TX, United States
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Kabangu JLK, Dugan JE, Joseph B, Hernandez A, Newsome-Cuby T, Fowler D, Bah MG, Fry L, Eden SV. The impact of historical redlining on neurosurgeon distribution and reimbursement in modern neighborhoods. Front Public Health 2024; 12:1364323. [PMID: 38774047 PMCID: PMC11106381 DOI: 10.3389/fpubh.2024.1364323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Background This study examines the lasting impact of historical redlining on contemporary neurosurgical care access, highlighting the need for equitable healthcare in historically marginalized communities. Objective To investigate how redlining affects neurosurgeon distribution and reimbursement in U.S. neighborhoods, analyzing implications for healthcare access. Methods An observational study was conducted using data from the Center for Medicare and Medicaid Services (CMS) National File, Home Owner's Loan Corporation (HOLC) neighborhood grades, and demographic data to evaluate neurosurgical representation across 91 U.S. cities, categorized by HOLC Grades (A, B, C, D) and gentrification status. Results Of the 257 neighborhoods, Grade A, B, C, and D neighborhoods comprised 5.40%, 18.80%, 45.8%, and 30.0% of the sample, respectively. Grade A, B, and C neighborhoods had more White and Asian residents and less Black residents compared to Grade D neighborhoods (p < 0.001). HOLC Grade A (OR = 4.37, 95%CI: 2.08, 9.16, p < 0.001), B (OR = 1.99, 95%CI: 1.18, 3.38, p = 0.011), and C (OR = 2.37, 95%CI: 1.57, 3.59, p < 0.001) neighborhoods were associated with a higher representation of neurosurgeons compared to Grade D neighborhoods. Reimbursement disparities were also apparent: neurosurgeons practicing in HOLC Grade D neighborhoods received significantly lower reimbursements than those in Grade A neighborhoods ($109,163.77 vs. $142,999.88, p < 0.001), Grade B neighborhoods ($109,163.77 vs. $131,459.02, p < 0.001), and Grade C neighborhoods ($109,163.77 vs. $129,070.733, p < 0.001). Conclusion Historical redlining continues to shape access to highly specialized healthcare such as neurosurgery. Efforts to address these disparities must consider historical context and strive to achieve more equitable access to specialized care.
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Affiliation(s)
- Jean-Luc K. Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - John E. Dugan
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Benson Joseph
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Amanda Hernandez
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Takara Newsome-Cuby
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, United States
| | - Danny Fowler
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, United States
| | - Momodou G. Bah
- Michigan State University College of Human Medicine, East Lansing, MI, United States
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Sonia V. Eden
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
- Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, United States
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Blaustein JR, Quisel MJ, Hamburg NM, Wittkopp S. Environmental Impacts on Cardiovascular Health and Biology: An Overview. Circ Res 2024; 134:1048-1060. [PMID: 38662864 PMCID: PMC11058466 DOI: 10.1161/circresaha.123.323613] [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: 05/02/2024]
Abstract
Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.
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Affiliation(s)
- Jacob R. Blaustein
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
| | - Matthew J. Quisel
- Department of Medicine, Boston University Chobanian and Avedision School of Medicine
| | - Naomi M. Hamburg
- Section of Vascular Biology, Whitaker Cardiovascular Institute, Chobanian and Avedisian School of Medicine, Boston University, Boston, USA
| | - Sharine Wittkopp
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
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Fields ND, Tristan Urrutia A, Morris AA, Kramer MR, Lewis TT, Patel SA. Historical Redlining and Heart Failure Outcomes Following Hospitalization in the Southeastern United States. J Am Heart Assoc 2024; 13:e032019. [PMID: 38563370 PMCID: PMC11262499 DOI: 10.1161/jaha.123.032019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Historical redlining, a discriminatory lending practice, is an understudied component of the patient risk environment following hospital discharge. We investigated associations between redlining, patient race, and outcomes following heart failure hospitalization. METHODS AND RESULTS We followed a hospital-based cohort of Black and White patients using electronic medical records for acute heart failure hospitalizations between 2010 and 2018 (n=6800). Patient residential census tracts were geocoded according to the 1930s Home Owners' Loan Corporation map grades (A/B: best/still desirable, C: declining, D: redlined). We used Poisson regression to analyze associations between Home Owners' Loan Corporation grade and 30-day outcomes (readmissions, mortality, and their composite). One-third of patients resided in historically redlined tracts (n=2034). In race-stratified analyses, there was a positive association between historically declining neighborhoods and composite readmissions and mortality for Black patients (risk ratio [RR], 1.24 [95% CI, 1.003-1.54]) and an inverse association between redlined neighborhoods and 30-day readmissions among White patients (RR, 0.58 [95% CI, 0.39-0.86]). Examining racial disparities across Home Owners' Loan Corporation grades, Black patients had higher 30-day readmissions (RR, 1.86 [95% CI, 1.31-2.65]) and composite readmissions and mortality (RR, 1.32 [95% CI, 1.04-1.65]) only in historically redlined neighborhoods. CONCLUSIONS Historical redlining had potentially mixed impacts on outcomes by race, such that residing in less desirable neighborhoods was associated with an elevated risk of an adverse outcome following heart failure hospitalization in Black patients and a reduced risk in White patients. Moreover, racial disparities in patient outcomes were present only in historically redlined neighborhoods. Additional research is needed to explore observed heterogeneity in outcomes.
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Affiliation(s)
- Nicole D. Fields
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | | | - Michael R. Kramer
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Tené T. Lewis
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Shivani A. Patel
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
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Thompson DR, Ski CF, Clark AM. Advancing health equity in cardiovascular care. Eur J Cardiovasc Nurs 2024; 23:e23-e25. [PMID: 38079193 DOI: 10.1093/eurjcn/zvad131] [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] [Indexed: 04/13/2024]
Affiliation(s)
- David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Alexander M Clark
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
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Khalil M, Munir MM, Woldesenbet S, Katayama E, Diaz A, Chen JC, Obeng-Gyasi S, Pawlik TM. Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California. Ann Surg Oncol 2024; 31:1477-1487. [PMID: 38082168 DOI: 10.1245/s10434-023-14679-7] [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: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND We sought to determine the impact of historical redlining on travel patterns and utilization of high-volume hospitals (HVHs) among patients undergoing complex cancer operations. METHODS The California Department of Health Care Access and Information database was utilized to identify patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PA), or proctectomy (PR) for cancer between 2010 and 2020. Patient ZIP codes were assigned Home Owners' Loan Corporation grades (A: 'Best'; B: 'Still Desirable'; C: 'Definitely Declining'; and D: 'Hazardous/Redlined'). A clustered multivariable regression was used to assess the likelihood of patients undergoing surgery at an HVH, bypassing the nearest HVH, and total real driving time and travel distance. RESULTS Among 14,944 patients undergoing high-risk cancer surgery (ES: 4.7%, n = 1216; PN: 57.8%, n = 8643; PD: 14.4%, n = 2154; PR: 23.1%, n = 3452), 782 (5.2%) individuals resided in the 'Best', whereas 3393 (22.7%) individuals resided in redlined areas. Median travel distance was 7.8 miles (interquartile range [IQR] 4.1-14.4) and travel time was 16.1 min (IQR 10.7-25.8). Overall, 10,763 (ES: 17.4%; PN: 76.0%; PA: 63.5%; PR: 78.4%) patients underwent surgery at an HVH. On multivariable regression, patients residing in redlined areas were less likely to undergo surgery at an HVH (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.54-0.82) and were more likely to bypass the nearest hospital (OR 1.80, 95% CI 1.44-2.46). Notably, Medicaid insurance, minority status, limited English-language proficiency, and educational level mediated the disparities in access to HVH. CONCLUSION Surgical disparities in access to HVH among patients from historically redlined areas are largely mediated by social determinants such as insurance and minority status.
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Affiliation(s)
- Mujtaba Khalil
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J C Chen
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Kraus NT, Connor S, Shoda K, Moore SE, Irani E. Historic redlining and health outcomes: A systematic review. Public Health Nurs 2024; 41:287-296. [PMID: 38148621 DOI: 10.1111/phn.13276] [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: 05/31/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to synthesize the existing literature on the associations between historic redlining and modern-day health outcomes across the lifespan. METHOD This review searched PubMed and CINAHL for peer-reviewed, data-based articles examining the relationship between historic redlining and any health outcome. Articles were appraised using the JBI critical appraisal checklist. The results were synthesized using a narrative summary approach. RESULTS Thirty-six articles were included and focused on various health outcomes, including cardiovascular outcomes, breast cancer incidence and mortality, firearm injury or death, birth-related outcomes, and asthma outcomes. Most of the included articles (n = 31; 86%) found significant associations between historic redlining and adverse health outcomes such as increased cardiovascular disease, higher rates of preterm births, increased cancer incidence, reduced survival time after breast cancer diagnosis, and increased firearm injury incidence. DISCUSSION This review demonstrates the persistent effect of historic redlining on individuals' health. Public health nurses should recognize redlining as a form of structural racism when caring for affected communities and should advocate for policies and programs that advance health equity. Nurse researchers should develop and test multilevel interventions to address systemic racism and improve health outcomes in communities affected by redlining.
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Affiliation(s)
- Noa T Kraus
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarah Connor
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krista Shoda
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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