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Jungo KT, Choudhry NK, Chaitoff A, Lauffenburger JC. Associations between sex, race/ethnicity, and age and the initiation of chronic high-risk medication in US older adults. J Am Geriatr Soc 2024. [PMID: 39215549 DOI: 10.1111/jgs.19173] [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: 04/05/2024] [Revised: 07/18/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND High-risk medication use is associated with an increased risk of adverse events, but little is known about its chronic utilization by key demographic groups. We aimed to study the associations between age, sex, and race/ethnicity with new chronic use of high-risk medications in older adults. METHODS In this retrospective cohort study, we analyzed data from older adults aged ≥65 years enrolled in a national health insurer who started a high-risk medication between 2017 and 2022 across 16 high-risk medication classes. We used generalized estimating equations to estimate the associations between sociodemographic classifications and the onset of chronic high-risk medication use after initiation (≥90 days' supply across ≥2 fills within 180 days). We adjusted the analyses for sociodemographic and clinical patient characteristics and added three-way interaction terms for race/ethnicity, sex, and age to explore whether the outcome varied across different subgroups of race/ethnicity, age, and sex. RESULTS Across 2,751,069 patients (mean age: 74 years [SD = 7], 72% White, 60% Female), 406,075 (15%) became new chronic users of ≥1 high-risk medication. Compared to White older adults, Asian (RR = 0.81, 95% CI: 0.79-0.84), Black (RR = 0.92, 95% CI: 0.90-0.94), and Hispanic (RR = 0.85, 95% CI: 0.83-0.86) older adults had a lower risk of becoming new chronic users. Men had a higher risk compared to women (RR = 1.09, 95% CI: 1.08-1.10). Age was not significantly associated with new chronic high-risk medication use (≥75 years: RR = 1.00, 95% CI: 1.00-1.01). We observed differences across some medication classes, like benzodiazepines, first-generation antihistamines, and antimuscarinics for which non-White older adults were at a higher risk. The joint presence of specific age, sex, and race/ethnicity characteristics decreased the risk of becoming a new chronic user (e.g., Hispanic/Female/65-74 years: RR = 0.96, 95% CI: 0.94-0.99). CONCLUSIONS New chronic high-risk medication use varied across older adults by sociodemographic characteristics, suggesting the need to individualize medication optimization approaches and better understand how systematic barriers in access to health care may influence differences in high-risk medication use in older adults.
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Affiliation(s)
- Katharina Tabea Jungo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Chaitoff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Davis S, Jester M, Yoder CM, Kaylor S, Tapp J, Finn-Romero D, Morgan PD, Hinds M, Ferraro A. Introducing the "Nursing Education Integrating Social Change for Health Equity (NISCHE)" framework for nursing education. Nurs Outlook 2024; 72:102263. [PMID: 39167995 DOI: 10.1016/j.outlook.2024.102263] [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: 10/09/2023] [Revised: 06/07/2024] [Accepted: 07/28/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND A need exists for a unified curriculum framework for nurse educators, recognizing racism as a central driver of health inequities. PURPOSE This paper provides nurse educators with a unifying curriculum framework that centers racism as a root cause of health inequity shaping SSDH. METHODS A critical examination of the social and structural determinants of health (SSDH) and Yob's (2018) Framework for a Curriculum in Social Change was conducted, to develop a curriculum framework tailored to the intersection of SSDH and social change within nursing education. DISCUSSION The "Nursing Education Integrating Social Change for Health Equity (NISCHE)" framework was developed as a comprehensive curriculum framework for SSDH and social change specifically tailored for nursing education. Practical examples of curricular activities across various settings are offered, thus illustrating implementation and potential impact. CONCLUSION By centering racism in the curriculum framework and emphasizing its role in perpetuating health inequities, this paper advances a crucial agenda in nursing education.
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Affiliation(s)
- Sandra Davis
- National League for Nursing (NLN)/Walden University College of Nursing, Institute for Social Determinants of Health and Social Change, Washington, DC
| | - Megan Jester
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Sara Kaylor
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL.
| | - Jannyse Tapp
- School of Nursing, Vanderbilt University, Nashville, TN
| | | | | | - Melissa Hinds
- Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY
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Zhao J, Staton E, Soltoff A, George PE, Yabroff KR. Association of Family Member Incarceration During Childhood and Smoking and Unhealthy Drinking Behaviors, Access to Care, and Functional Status Among Adults in the United States. J Gen Intern Med 2024:10.1007/s11606-024-08959-5. [PMID: 39103604 DOI: 10.1007/s11606-024-08959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
IMPORTANCE Incarceration can result in adverse socioeconomic and health consequences for individuals who have been incarcerated; these consequences extend to their children and may have impacts into later adulthood. OBJECTIVE To examine the association of family member incarceration (FMI) during childhood and smoking and unhealthy drinking behaviors, access to care, and functional status in later adulthood. DESIGN AND PARTICIPANTS Adults aged 18-64 and ≥ 65 with and without FMI during childhood from 42 states and Washington DC from the 2019-2022 Behavioral Risk Factor Surveillance System. MAIN MEASURES Having FMI history was defined as "living with anyone during childhood who served time or was sentenced to serve time in a prison, jail, or other correctional facility." Study outcomes included 1) smoking and unhealthy drinking behaviors, 2) access to care (health insurance coverage, care affordability, having a usual source of care, and use of preventive services), and 3) functional status (e.g., having difficulty walking or climbing stairs). KEY RESULTS After adjusting for demographic characteristics and other adverse childhood experiences, compared to adults without FMI, adults aged 18-64 with FMI were more likely to report any history of smoking or unhealthy drinking (adjusted odds ratio (AOR): 1.19, 95% confidence interval (CI): 1.11-1.28), any access to care problems (AOR: 1.26, 95% CI: 1.12-1.42), and any functional limitations (AOR: 1.18, 95% CI: 1.10-1.28); adults aged ≥ 65 with FMI reported higher likelihood of reporting any smoking or unhealthy drinking behaviors (AOR: 1.23, 95% CI: 1.05-1.43) and impaired functional status (AOR: 1.30, 95% CI: 1.10-1.54). Associations were attenuated after additional adjustment for socioeconomic measures, especially educational attainment, but remained statically significant for multiple outcomes. CONCLUSIONS FMI during childhood was associated with adverse health-related outcomes for adults of all ages. Developing programs to improve access to education and economic opportunities for adults with FMI may help mitigate the disparities.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Elizabeth Staton
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Alexander Soltoff
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Paul E George
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Patel RJ, Dodo-Williams TS, Sendek G, Elsayed N, Malas MB. Non-White Patients Have a Higher Risk of Stroke Following Transcarotid Artery Revascularization. J Surg Res 2024; 300:71-78. [PMID: 38796903 DOI: 10.1016/j.jss.2024.04.062] [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: 03/13/2023] [Revised: 01/28/2024] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Carotid artery revascularization has traditionally been performed by either a carotid endarterectomy or carotid artery stent. Large data analysis has suggested there are differences in perioperative outcomes with regards to race, with non-White patients (NWP) having worse outcomes of stroke, restenosis and return to the operating room (RTOR). The introduction of transcarotid artery revascularization (TCAR) has started to shift the paradigm of carotid disease treatment. However, to date, there have been no studies assessing the difference in postoperative outcomes after TCAR between racial groups. METHODS All patients from 2016 to 2021 in the Vascular Quality Initiative who underwent TCAR were included in our analysis. Patients were split into two groups based on race: individuals who identified as White and a second group that comprised all other races. Demographic and clinical variables were compared using Student's t-Test and chi-square test of independence. Logistic regression analysis was performed to determine the impact of race on perioperative outcomes of stroke, myocardial infarction (MI), death, restenosis, RTOR, and transient ischemic attack (TIA). RESULTS The cohort consisted of 22,609 patients: 20,424 (90.3%) White patients and 2185 (9.7%) NWP. After adjusting for sex, diabetes, hypertension, coronary artery disease, history of prior stroke or TIA, symptomatic status, and high-risk criteria at time of TCAR, there was a significant difference in postoperative stroke, with 63% increased risk in NWP (odds ratio = 1.63, 95% confidence interval: 1.11-2.40, P = 0.014). However, we found no significant difference in the odds of MI, death, postoperative TIA, restenosis, or RTOR when comparing NWP to White patients. CONCLUSIONS This study demonstrates that NWP have increased risk of stroke but similar outcomes of death, MI, RTOR and restenosis following TCAR. Future studies are needed to elucidate and address the underlying causes of racial disparity in carotid revascularization.
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Affiliation(s)
- Rohini J Patel
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Taiwo S Dodo-Williams
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Gabriela Sendek
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Nadin Elsayed
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Mahmoud B Malas
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, California.
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Shete M, Kocher M, Pratt R, Lee H, Zierhut H. Genetic counseling processes and strategies for racially and ethnically diverse populations: A systematic review. J Genet Couns 2024; 33:842-861. [PMID: 37743585 DOI: 10.1002/jgc4.1773] [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: 10/14/2022] [Revised: 06/26/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023]
Abstract
Genetic counseling outcomes are influenced by the processes and strategies used by counselors, yet little is known about how these strategies directly impact patients and populations. In particular, tailoring genetic counseling consultations to best meet the needs of cultural, racial, and ethnically diverse populations has been explored. This review aims to identify genetic counseling strategies tailored for a diversity of racial and ethnic populations with the goal to find ways to improve genetic counseling outcomes. Medline, Cochrane CENTRAL, Embase, PsychInfo, and CINAHL databases were searched for original research articles published in English that employed genetic counseling processes and strategies to improve genetic counseling outcomes, specifically for participants from ethnically or racially diverse populations. A review of 5300 titles and abstracts resulted in the identification of 36 articles that met the inclusion criteria. Three themes emerged: (1) community involvement in culturally tailoring genetic counseling, (2) creation and use of culturally tailored resources, and (3) modifications to the genetic counseling process. The effectiveness of genetic counseling strategies could not be evaluated due to lack of consistent outcome measures in the articles. The involvement of diverse ethnic and racial populations in developing inclusive genetic counseling tools and practices will help the profession provide better patient care in the future. More research connecting genetic counseling processes and outcomes will help to assess how well these modified approaches meet the needs of diverse populations.
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Affiliation(s)
- Mrunmayee Shete
- Department of Genetics, Cell Biology & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Megan Kocher
- University Libraries, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Heewon Lee
- Department of Genetics, Cell Biology & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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Kent JT, Ritchie LMP, Klaiman M, Dell EM, Garnett M, Landes M, Ginocchio GF, Alsefaou A. Barriers and facilitators to the implementation of rapid HIV testing in Canadian Emergency Departments: a mixed methods study. CAN J EMERG MED 2024; 26:463-471. [PMID: 38960973 DOI: 10.1007/s43678-024-00716-1] [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] [Received: 12/17/2023] [Accepted: 04/27/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES 1 in 7 Canadians with Human Immunodeficiency Virus (HIV) do not know their status. Patients at increased risk of HIV routinely access the emergency department (ED), yet few are tested, representing a missed opportunity for diagnosis and linkage-to-care. Rapid HIV testing provides reliable results within the same ED encounter but is not routinely implemented. The objective of this study was to identify barriers and facilitators to rapid HIV testing in Ontario EDs. METHODS We employed a mixed-methods, convergent, parallel design study including online surveys and semi-structured interviews of physicians, nurses, and allied health across four hospitals in Toronto and Thunder Bay, Ontario. Data were analyzed in equal priority using descriptive statistics for quantitative data and thematic analysis for qualitative data guided by the Theoretical Domains framework and Capability, Opportunity, Motivation Behaviour change model. RESULTS Among 187 survey respondents, 150 (80%) felt implementing rapid HIV testing would be helpful in the ED. Facilitators included availability of resources to link patients to care after testing (71%), testing early in patient encounters (41%), and having dedicated staff with lived experience support testing (34%). Motivation to offer testing included opportunities to support an underserved population (66%). Challenges to implementation included limited time during ED patient encounters (51%) and a lack of knowledge around HIV testing (42%) including stigma. Interview themes confirmed education, and integration of people with lived experience being essential to provide rapid HIV testing and linkage-to-care in the ED. CONCLUSIONS Implementation of rapid HIV testing in the ED is perceived to be important irrespective of practice location or profession. Intrinsic motivations to support underserved populations and providing linkage-to-care are novel insights to facilitate testing in the ED. Streamlined implementation, including clear testing guidelines and improved access to follow-up care, is felt to be necessary for implementation.
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Affiliation(s)
- Jessica T Kent
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michelle Klaiman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Evelyn Marion Dell
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Meghan Garnett
- Emergency and Critical Care Services, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Division of Clinical Sciences, NOSM University, Thunder Bay, ON, Canada
| | - Megan Landes
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Galo Fernando Ginocchio
- Emergency Department, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
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Li J. Relationships among health-related social media use, knowledge, worry, and cervical cancer screening: A cross-sectional study of US females. PATIENT EDUCATION AND COUNSELING 2024; 124:108283. [PMID: 38593482 DOI: 10.1016/j.pec.2024.108283] [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: 01/05/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to explore the relationship between health-related social media use and HPV-related health knowledge, attitudes, and practices (KAP). METHOD Data were derived from a subset of the national cohort from the 2022 Health Information National Trends Survey (HINTS 6), including only women aged 21 to 65 years old (n = 2013). Ordinary least squares regression and structural equation modeling were used to answer the research question and test hypotheses. RESULTS Participants with a family history of cancer, higher education, and White showed more HPV knowledge. Older females were associated with lower HPV knowledge, less worry and fewer timely cervical cancer screening. Additionally, HPV knowledge positively predicted worry and cervical cancer screening. Health-related social media use positively predicted HPV knowledge, worry, and cervical cancer screening. CONCLUSION This study identified populations with HPV knowledge and hesitated cervical cancer screening and tested hypothesized models that combine social media use with the KAP survey. PRACTICE IMPLICATIONS Future health interventions should strategically leverage the role of social media to enhance public awareness of HPV knowledge and cancer concerns. By promoting HPV knowledge and awareness, such interventions can subsequently encourage timely cervical cancer screening.
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Affiliation(s)
- Jinxu Li
- Department of Communication and Journalism, Texas A&M University, USA.
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Silva JBB, Howe CJ, Jackson JW, Riester MR, Bardenheier BH, Xu L, Puckrein G, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Racial Disparities in Receipt of High-Dose Influenza Vaccine Among US Older Adults. J Racial Ethn Health Disparities 2024; 11:1520-1529. [PMID: 37184814 PMCID: PMC10184628 DOI: 10.1007/s40615-023-01628-z] [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: 02/12/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Racial disparities in receipt of high-dose influenza vaccine (HDV) have been documented nationally, but whether small-area geographic variation in such disparities exists remains unknown. We assessed the distribution of disparities in HDV receipt between Black and White traditional Medicare beneficiaries vaccinated against influenza within states and hospital referral regions (HRRs). METHODS We conducted a nationally representative retrospective cohort study of 11,768,724 community-dwelling traditional Medicare beneficiaries vaccinated against influenza during the 2015-2016 influenza season (94.3% White and 5.7% Black). Our comparison was marginalized versus privileged racial group measured as Black versus White race. Vaccination and type of vaccine were obtained from Medicare Carrier and Outpatient files. Differences in the proportions of individuals who received HDV between Black and White beneficiaries within states and HRRs were used to measure age- and sex-standardized disparities in HDV receipt. We restricted to states and HRRs with ≥ 100 beneficiaries per age-sex strata per racial group. RESULTS We detected a national disparity in HDV receipt of 12.8 percentage points (pps). At the state level, the median standardized HDV receipt disparity was 10.7 pps (minimum, maximum: 2.9, 25.6; n = 30 states). The median standardized HDV receipt disparity among HRRs was 11.6 pps (minimum, maximum: 0.4, 24.7; n = 54 HRRs). CONCLUSION Black beneficiaries were less likely to receive HDV compared to White beneficiaries in almost every state and HRR in our analysis. The magnitudes of disparities varied substantially across states and HRRs. Local interventions and policies are needed to target geographic areas with the largest disparities to address these inequities.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA.
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Westat LLC, Rockville, MD, USA
| | - Liou Xu
- National Minority Quality Forum, Washington, DC, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Tam CC, Kerr WC, Cook WK, Li L. At-Risk Drinking in US Adults with Health Conditions: Differences by Gender, Race, and Ethnicity in the National Survey of Drug Use and Health, 2015-2019. J Racial Ethn Health Disparities 2024; 11:1444-1453. [PMID: 37219733 PMCID: PMC10729902 DOI: 10.1007/s40615-023-01621-6] [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: 02/10/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023]
Abstract
Few studies in the US address alcohol consumption patterns in adults with chronic health conditions, and little is known about race and ethnicity differences. This study examined at-risk drinking prevalence rates among US adults with hypertension, diabetes, heart condition or cancer and assessed differences by gender and, among adults aged 50 and older, by race and ethnicity. We used data from the 2015-2019 National Survey on Drug Use and Health (N = 209,183) to estimate (1) prevalence rates and (2) multivariable logistic regression models predicting odds of at-risk drinking among adults with hypertension, diabetes, heart condition, or cancer, compared to adults with none of these conditions. To examine subgroup differences, analyses were stratified by gender (ages 18-49 and ages 50 +) and by gender and race and ethnicity for adults ages 50 + . Results showed that all adults with diabetes and women ages 50 + with heart conditions in the full sample had lower odds of at-risk drinking relative to their counterparts without any of the four conditions. Men ages 50 + with hypertension had greater odds. In race and ethnicity assessments among adults ages 50 + , only non-Hispanic White (NHW) men and women with diabetes and heart conditions had lower odds, and NHW men and women and Hispanic men with hypertension had greater odds of at-risk drinking. There were differential associations of at-risk drinking with demographic and lifestyle indicators across race and ethnicity groups. These findings underscore tailored efforts in community and clinical settings to reduce at-risk drinking in subgroups with health condition diagnoses.
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Affiliation(s)
- Christina C Tam
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA.
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| | - Won Kim Cook
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
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Kancherla V, Ma C, Purkey NJ, Hintz SR, Lee HC, Grant G, Carmichael SL. Factors Associated with Transfer Distance from Birth Hospital to Repair Hospital for First Surgical Repair among Infants with Myelomeningocele in California. Am J Perinatol 2024; 41:e1091-e1098. [PMID: 36646096 DOI: 10.1055/s-0042-1760431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of our study was to examine factors associated with distance to care for first surgical repair among infants with myelomeningocele in California. STUDY DESIGN A total of 677 eligible cases with complete geocoded data were identified for birth years 2006 to 2012 using data from the California Perinatal Quality Care Collaborative linked to hospital and vital records. The median distance from home to birth hospital among eligible infants was 9 miles, and from birth hospital to repair hospital was 15 miles. We limited our analysis to infants who lived close to the birth hospital, creating two study groups to examine transfer distance patterns: "lived close and had a short transfer" (i.e., lived <9 miles from birth hospital and traveled <15 miles from birth hospital to repair hospital; n = 92), and "lived close and had a long transfer" (i.e., lived <9 miles from birth hospital and traveled ≥15 miles from birth hospital to repair hospital; n = 96). Log-binomial regression was used to estimate crude and adjusted risk ratios (aRRs and 95% confidence intervals (CIs). Selected maternal, infant, and birth hospital characteristics were compared between the two groups. RESULTS We found that low birth weight (aRR = 1.44; 95% CI = 1.04, 1.99) and preterm birth (aRR = 1.41; 95% CI = 1.01, 1.97) were positively associated, whereas initiating prenatal care early in the first trimester was inversely associated (aRR = 0.64; 95% CI = 0.46, 0.89) with transferring a longer distance (≥15 miles) from birth hospital to repair hospital. No significant associations were noted by maternal race-ethnicity, socioeconomic indicators, or the level of hospital care at the birth hospital. CONCLUSION Our study identified selected infant factors associated with the distance to access surgical care for infants with myelomeningocele who had to transfer from birth hospital to repair hospital. Distance-based barriers to care should be identified and optimized when planning deliveries of at-risk infants in other populations. KEY POINTS · Low birth weight predicted long hospital transfer distance.. · Preterm birth was associated with transfer distance.. · Prenatal care was associated with transfer distance..
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Chen Ma
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Neha J Purkey
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Henry C Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Gerald Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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11
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Vaidya A, Chen RJ, Williamson DFK, Song AH, Jaume G, Yang Y, Hartvigsen T, Dyer EC, Lu MY, Lipkova J, Shaban M, Chen TY, Mahmood F. Demographic bias in misdiagnosis by computational pathology models. Nat Med 2024; 30:1174-1190. [PMID: 38641744 DOI: 10.1038/s41591-024-02885-z] [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: 09/03/2023] [Accepted: 02/23/2024] [Indexed: 04/21/2024]
Abstract
Despite increasing numbers of regulatory approvals, deep learning-based computational pathology systems often overlook the impact of demographic factors on performance, potentially leading to biases. This concern is all the more important as computational pathology has leveraged large public datasets that underrepresent certain demographic groups. Using publicly available data from The Cancer Genome Atlas and the EBRAINS brain tumor atlas, as well as internal patient data, we show that whole-slide image classification models display marked performance disparities across different demographic groups when used to subtype breast and lung carcinomas and to predict IDH1 mutations in gliomas. For example, when using common modeling approaches, we observed performance gaps (in area under the receiver operating characteristic curve) between white and Black patients of 3.0% for breast cancer subtyping, 10.9% for lung cancer subtyping and 16.0% for IDH1 mutation prediction in gliomas. We found that richer feature representations obtained from self-supervised vision foundation models reduce performance variations between groups. These representations provide improvements upon weaker models even when those weaker models are combined with state-of-the-art bias mitigation strategies and modeling choices. Nevertheless, self-supervised vision foundation models do not fully eliminate these discrepancies, highlighting the continuing need for bias mitigation efforts in computational pathology. Finally, we demonstrate that our results extend to other demographic factors beyond patient race. Given these findings, we encourage regulatory and policy agencies to integrate demographic-stratified evaluation into their assessment guidelines.
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Affiliation(s)
- Anurag Vaidya
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Health Sciences and Technology, Harvard-MIT, Cambridge, MA, USA
| | - Richard J Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Drew F K Williamson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew H Song
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Guillaume Jaume
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yuzhe Yang
- Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | - Thomas Hartvigsen
- School of Data Science, University of Virginia, Charlottesville, VA, USA
| | - Emma C Dyer
- T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ming Y Lu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | - Jana Lipkova
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Muhammad Shaban
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tiffany Y Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Faisal Mahmood
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Data Science Initiative, Harvard University, Cambridge, MA, USA.
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12
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Michael YL, Senerat AM, Buxbaum C, Ezeanyagu U, Hughes TM, Hayden KM, Langmuir J, Besser LM, Sánchez B, Hirsch JA. Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health. Public Health Rev 2024; 45:1606677. [PMID: 38596450 PMCID: PMC11002187 DOI: 10.3389/phrs.2024.1606677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024] Open
Abstract
Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.
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Affiliation(s)
- Yvonne L. Michael
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Araliya M. Senerat
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Channa Buxbaum
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ugonwa Ezeanyagu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Timothy M. Hughes
- Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Bowman Gray Center for Medical Education, Winston-Salem, NC, United States
| | - Julia Langmuir
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Lilah M. Besser
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brisa Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Jana A. Hirsch
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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13
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Tiruneh YM, Anwoju O, Harrison AC, Garcia MT, Elbers SK. Examining Health-Seeking Behavior among Diverse Ethnic Subgroups within Black Populations in the United States and Canada: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:368. [PMID: 38541367 PMCID: PMC10970228 DOI: 10.3390/ijerph21030368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/13/2024]
Abstract
The Black populations, often treated as ethnically homogenous, face a constant challenge in accessing and utilizing healthcare services. This study examines the intra-group differences in health-seeking behavior among diverse ethnic subgroups within Black communities. A cross-sectional analysis included 239 adults ≥18 years of age who self-identified as Black in the United States and Canada. Multiple logistic regression assessed the relationship between health-seeking behaviors and ethnic origin, controlling for selected social and health-related factors. The mean age of the participants was 38.6 years, 31% were male, and 20% were unemployed. Sixty-one percent reported a very good or excellent health status, and 59.7% were not receiving treatment for chronic conditions. Advancing age (OR = 1.05, CI: 1.01-1.09), female gender (OR = 3.09, CI: 1.47-6.47), and unemployment (OR = 3.46, CI: 1.35-8.90) were associated with favorable health-seeking behaviors. Compared with the participants with graduate degrees, individuals with high school diplomas or less (OR = 3.80, CI: 1.07-13.4) and bachelor's degrees (OR = 3.57, CI: 1.3-9.23) were more inclined to have engaged in favorable health-seeking behavior compared to those with graduate degrees. Across the Black communities in our sample, irrespective of ethnic origins or country of birth, determinants of health-seeking behavior were age, gender, employment status, and educational attainment.
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Affiliation(s)
- Yordanos M. Tiruneh
- School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Ariel C. Harrison
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Martha T. Garcia
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Shauna K. Elbers
- School of Interdisciplinary Arts and Sciences, University of Washington Bothell, Bothell, WA 98011, USA;
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14
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Hinman A, Chang R, Royse KE, Navarro R, Paxton E, Okike K. Utilization of Total Joint Arthroplasty by Rural-Urban Designation in Patients With Osteoarthritis in a Universal Coverage System. J Arthroplasty 2023; 38:2541-2548. [PMID: 37595769 DOI: 10.1016/j.arth.2023.08.030] [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: 01/26/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Utilization of total joint arthroplasty (TJA) is affected by differences linked to sex, race, and socioeconomic status; there is little information about how geographic variation contributes to these differences. We sought to determine whether discrepancies in TJA utilization exist in patients diagnosed with osteoarthritis (OA) based upon urban-rural designation in a universal coverage system. METHODS We conducted a cohort study using data from a US-integrated healthcare system (2015 to 2019). Patients aged ≥50 years who had a diagnosis of hip or knee OA were included. Total hip arthroplasty and total knee arthroplasty utilization (in respective OA cohorts) was evaluated by urban-rural designation (urban, mid, and rural). Incidence rate ratios (IRRs) for urban-rural regions were modeled using multivariable Poisson regressions. RESULTS The study cohort included 93,642 patients who have hip OA and 275,967 patients who had knee OA. In adjusted analysis, utilization of primary total hip arthroplasty was lower in patients living in urban areas (IRR = 0.87, 95% confidence interval = 0.81 to 0.94) compared to patients in rural regions. Similarly, total knee arthroplasty was used at a lower rate in urban areas (IRR = 0.88, 95% confidence interval = 0.82 to 0.95) compared with rural regions. We found no differences in the hip and knee groups within the mid-region. CONCLUSIONS In hip and knee OA patients enrolled in a universal coverage system, we found patients living in urban areas had lower TJA utilization compared to patients living in rural areas. Further research is needed to determine how patient location contributes to differences in elective TJA utilization. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adrian Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, California
| | - Richard Chang
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Kathryn E Royse
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Ronald Navarro
- Department of Orthopaedics, Southern California Permanente Medical Group, South Bay, California
| | - Elizabeth Paxton
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Kanu Okike
- Department of Orthopaedics, Hawaii Permanente Medical Group, Honolulu, Hawaii
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15
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Shahid M, Ibrahim R, Arakelyan A, Hassan K, Sainbayar E, Pham HN, Mamas MA. Alcoholic cardiomyopathy mortality and social vulnerability index: A nationwide cross-sectional analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200224. [PMID: 37964864 PMCID: PMC10641739 DOI: 10.1016/j.ijcrp.2023.200224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/17/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
Background Social vulnerability index (SVI) plays a pivotal role in the outcomes of cardiovascular diseases and prevalence of alcohol use. We evaluated the impact of the SVI on alcoholic cardiomyopathy (ACM) mortality. Methods Mortality data from 1999 to 2020 and the SVI were obtained from CDC databases. Demographics such as age, sex, race/ethnicity, and geographic residence were obtained from death certificates. The SVI was divided into quartiles, with the fourth quartile (Q4) representing the highest vulnerability. Age-adjusted mortality rates across SVI quartiles were compared, and excess deaths due to higher SVI were calculated. Risk ratios were calculated using univariable Poisson regression. Results A total of 2779 deaths were seen in Q4 compared to 1672 deaths in Q1. Higher SVI accounted for 1107 excess-deaths in the US and 0.05 excess deaths per 100,000 person-years (RR: 1.38). Similar trends were seen for both male (RR: 1.43) and female (RR: 1.67) populations. Higher SVI accounted for 0.06 excess deaths per 100,000 person-years in Hispanic populations (RR: 2.50) and 0.06 excess deaths per 100,000 person-years in non-Hispanic populations (RR: 1.46). Conclusion Counties with elevated SVI experienced higher ACM mortality rates. Recognizing the impact of SVI on ACM mortality can guide targeted interventions and public health strategies, emphasizing health equity and minimizing disparities.
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Affiliation(s)
- Mahek Shahid
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Anna Arakelyan
- Department of Anesthesiology, University of Arizona Tucson, Tucson, AZ, USA
| | - Kamal Hassan
- New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
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16
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Rencsok EM, Slopen N, Autio K, Morgans A, McSwain L, Barata P, Cheng HH, Dreicer R, Heath E, McKay RR, Pomerantz M, Rathkopf D, Tagawa S, Whang YE, Ragin C, Odedina FT, George DJ, Kantoff PW, Vinson J, Villanti P, Haneuse S, Mucci LA. Quality of life in the year after new diagnosis with advanced prostate cancer for Black and White individuals living in the US. Qual Life Res 2023; 32:3209-3221. [PMID: 37410340 PMCID: PMC10711502 DOI: 10.1007/s11136-023-03468-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To assess differences in baseline and longitudinal quality of life among Black and White individuals in the US with advanced prostate cancer. METHODS Secondary analysis of data from the International Registry for Men with Advanced Prostate Cancer (IRONMAN) including US participants newly diagnosed with advanced prostate cancer and identifying their race as Black or White from 2017 to 2023. Participants completed the EORTC QLQ-C30 Quality of Life (QoL) Survey at study enrollment and every 3 months thereafter for up to 1 year of follow-up reporting 15 scale scores ranging from 0 to 100 (higher functioning and lower symptom scores represent better quality of life). Linear mixed effects models with race and month of questionnaire completion were fit for each scale, and model coefficients were used to assess differences in baseline and longitudinal QoL by race. RESULTS Eight hundred and seventy-nine participants were included (20% identifying as Black) at 38 US sites. Compared to White participants at baseline, Black participants had worse constipation (mean 6.3 percentage points higher; 95% CI 2.9-9.8), financial insecurity (5.7 (1.4-10.0)), and pain (5.1 (0.9-9.3)). QoL decreased over time similarly by race; most notably, role functioning decreased by 0.7 percentage points (95% CI -0.8, -0.5) per month. CONCLUSION There are notable differences in quality of life at new diagnosis of advanced prostate cancer for Black and White individuals, and quality of life declines similarly in the first year for both groups. Interventions that address specific aspects of quality of life in these patients could meaningfully improve the overall survivorship experience.
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Affiliation(s)
- Emily M Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA.
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen Autio
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Pedro Barata
- Section of Hematology and Oncology, Tulane University School of Medicine, New Orleans, LA, USA
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Heather H Cheng
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Rana R McKay
- Department of Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Young E Whang
- Department of Medicine, Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Camille Ragin
- Fox Chase Cancer Center, Philadelphia, PA, USA
- African-Caribbean Cancer Consortium, Philadelphia, PA, USA
| | - Folakemi T Odedina
- Mayo Clinic Comprehensive Cancer Center, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
| | | | - Philip W Kantoff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Convergent Therapeutics, Cambridge, MA, USA
| | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, NY, USA
| | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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17
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Applebaum JW, McDonald SE, Widmeyer M, Fabelo HE, Cook RL. The impact of pet ownership on healthcare access and utilization among people with HIV. PLoS One 2023; 18:e0292658. [PMID: 37910449 PMCID: PMC10619778 DOI: 10.1371/journal.pone.0292658] [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] [Received: 06/08/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Though bonds with pets can be health-promoting for people with HIV (PWH), recent studies indicate that owning pets may complicate healthcare access, especially for those with fewer economic resources, poorer social support, and a strong human-animal bond. In this study, we make a case for considering pets to be an important element of the social environment that can influence healthcare access and utilization among PWH. Pet-owning PWH (n = 204) were recruited at healthcare and community sites throughout Florida as part of a larger survey study (the “Florida Cohort”). We developed a 12-item index of pet-related barriers to healthcare, which was designed to assess whether the participants experienced or anticipated any barriers to accessing and/or utilizing timely healthcare or health-related services due to pet caregiving or concerns about pet welfare. We estimated a series of regression models (negative binomial, logistic regression) to assess the effects of comfort from companion animals, human social support, healthcare needs, and sociodemographic characteristics on 1) the total number of pet-related healthcare barriers endorsed, 2) previously experienced pet-related healthcare barriers, and 3) anticipated pet-related healthcare barriers. Thirty-six percent of the sample reported at least one experienced or anticipated pet-related barrier to their healthcare; 17% reported previous healthcare barriers and 31% anticipated future healthcare barriers. Greater comfort from companion animals, greater healthcare needs, and poorer social support were associated with a greater probability of experiencing or anticipating any pet-related healthcare barriers. Those who identified racially as Black were less likely to anticipate future healthcare barriers than those who were White. Income was associated with pet-related healthcare barriers in all models. Given the importance of health maintenance for PWH and previous research suggesting pets may be an important emotional support for this population, social safety net programs and community partnerships that support multispecies families are strongly recommended.
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Affiliation(s)
- Jennifer W. Applebaum
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Shelby E. McDonald
- Community Research and Evaluation, Denver Zoological Foundation, Denver, Colorado, United States of America
| | - Maya Widmeyer
- Unconditional Love, Inc., Melbourne, Florida, United States of America
| | - Humberto E. Fabelo
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United Stated of America
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18
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Dorritie A, Faysel M, Gruessner A, Robakis D. Black and hispanic patients with movement disorders less likely to undergo deep brain stimulation. Parkinsonism Relat Disord 2023; 115:105811. [PMID: 37657299 DOI: 10.1016/j.parkreldis.2023.105811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND DBS is an effective surgical treatment for ET, PD, and dystonia. Racial disparities in DBS utilization in PD have been documented demonstrating that Black patients receive DBS at lower rates than White patients. To our knowledge, no studies have investigated if this pattern of non-use persists in other movement disorders with FDA-approval. OBJECTIVE To identify racial and ethnic disparities in DBS utilization in those hospitalized for ET, PD, and dystonia. METHODS The NIS database was queried for US hospitalizations from 2012 to 2018 with a primary diagnosis of ET, PD, or dystonia, and a total of 3,363, 21,963, and 1,835 discharges were recorded, respectively. Within that sample, treatment with DBS was identified. Sex, race, age, payment method, income quartile, year, mortality risk, hospital size, urban/rural setting, teaching status, and geographic region were extracted. A multivariate logistic regression was performed to identify predictors for use and non-use of DBS. RESULTS Between 2012 and 2018, Black patients with PD, ET, and dystonia were less likely to receive DBS than White patients. Black patients with PD were 7 times less likely to receive DBS (OR = 0.145, CI = 0.111-0.189), and Black patients with ET and dystonia were 5 times less likely to receive DBS than White patients (OR = 0.188, CI = 0.124-0.285; OR = 0.186, CI = 0.084-0.414). Compared to White patients, Hispanic patients with PD (OR = 0.631, OR = 0.539-0.740) and ET (OR = 0.438, CI = 0.277-0.695) were less likely to undergo DBS. When controlling for patient and hospital level characteristics, racial and ethnic disparities remained. CONCLUSIONS Our data suggest that Black patients with a diagnosis of ET, PD, or dystonia and Hispanic patients with a diagnosis of ET or PD were less likely to be treated with DBS than White patients between 2012 and 2018.
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Affiliation(s)
- Andrew Dorritie
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mohammad Faysel
- Health Informatics Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Angelika Gruessner
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Daphne Robakis
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
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19
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Vanjani R, Reddy N, Giron N, Bai E, Martino S, Smith M, Harrington-Steppen S, Trimbur MC. The Social Determinants of Health - Moving Beyond Screen-and-Refer to Intervention. N Engl J Med 2023; 389:569-573. [PMID: 37590456 DOI: 10.1056/nejmms2211450] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Rahul Vanjani
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Neha Reddy
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Nicole Giron
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Eric Bai
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Sarah Martino
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Megan Smith
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - Suzanne Harrington-Steppen
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
| | - M Catherine Trimbur
- From the Warren Alpert Medical School, Brown University (R.V., N.R., M.C.T.), Brown University School of Public Health (N.G.), and the Center for Health and Justice Transformation, Lifespan Health System (S.M.), Providence, the House of Hope Community Development Corporation, Warwick (R.V., M.S.), and the Roger Williams University School of Law, Bristol (S.H.-S.) - all in Rhode Island; and the Johns Hopkins University School of Medicine, Baltimore (E.B.)
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Mukhopadhyay P, Desouza S, Lolayekar AP. What does the demographic profile of convicts tell us about social equity in India? PLoS One 2023; 18:e0288127. [PMID: 37428733 DOI: 10.1371/journal.pone.0288127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/16/2023] [Indexed: 07/12/2023] Open
Abstract
Social equity is a critical component of social justice and is measured in multiple ways. Conventionally, researchers use literacy levels, workforce participation, political participation and representation, corporate presence, and demographic parity as indicators of social and economic equity. We add law enforcement outcomes to this literature by examining the demographic profiles of convicts in prisons in India for each state and compare it with that of the population of the respective state. To test whether entrenched social inequities have permeated into the law enforcement system, we use three indicators of social identity-religion, caste, and domicile-to create a social equity index (SEI). This is a composite index combining caste, religion and domicile similar in method to the Human Development Index which combines income, education and health. Our indicators are not considered in other popular development indices and is a conceptual innovation. Our paper innovates by combining prison data and census data at the state level over the two latest census rounds (2001 and 2011). We use a spatial panel analysis as well as a distributional dynamics approach to test for bias and transitions over time at the state level. We find that entrenched social hierarchies are mirrored in conviction outcomes and that social identities influence law enforcement. In contrast to earlier studies, we find that states that are conventionally considered to perform poorly in terms of economic and human development have done better in terms of social equity than economically advanced states.
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Affiliation(s)
| | - Shaila Desouza
- Manohar Parrikar School of Law, Governance and Public Policy, Goa University, Goa, India
| | - Aparna P Lolayekar
- Manohar Parrikar School of Law, Governance and Public Policy, Goa University, Goa, India
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21
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Rodriguez TM, Sheffler P, Ferguson LE, Rebok GW, Wu R. Cognitive and Functional Improvement via Novel Skill Learning for Low-Income Minoritized Middle-Aged and Older Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:926-935. [PMID: 35895188 DOI: 10.1007/s11121-022-01413-0] [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: 07/18/2022] [Indexed: 11/25/2022]
Abstract
Prior research has demonstrated beneficial outcomes for learning new skills in older adulthood, including increased cognitive and functional abilities, which help prevent age-related declines and foster healthy aging. However, these studies largely have included participants not typically considered at risk for cognitive and functional decline (i.e., White, highly educated, higher income). Cognitive and functional disparities exist among minoritized racial and ethnic individuals, particularly Black and Latinx populations, because of a lifetime of inequalities associated with low socioeconomic status, low education, and discrimination. This theoretical paper proposes a potential pathway in which such disparities could be mitigated by increasing cognitive and functional abilities via novel skill learning in these at-risk populations in middle and later life to prevent decline. We also discuss indirect barriers (e.g., financial and health issues), direct barriers (e.g., limited learning opportunities), and motivational barriers (e.g., self-beliefs, values) that these adults may encounter. We further highlight that addressing these barriers to novel skill learning by providing appropriate resources is necessary to maximize the feasibility and potential effectiveness of this pathway. Lastly, we encourage future research to test this pathway and help inform policymakers and existing learning programs to implement better ways of promoting lifelong learning in an inclusive and equitable manner to prevent decline.
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Affiliation(s)
| | - Pamela Sheffler
- Department of Psychology, University of California, Riverside, USA
| | - Leah E Ferguson
- Department of Psychology, University of California, Riverside, USA
| | - George W Rebok
- Department of Mental Health, Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, USA
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, USA
| | - Rachel Wu
- Department of Psychology, University of California, Riverside, USA
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22
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Alam MS, Tabassum NJ, Tokey AI. Evaluation of accessibility and equity to hospitals by public transport: evidence from six largest cities of Ohio. BMC Health Serv Res 2023; 23:598. [PMID: 37291565 PMCID: PMC10251528 DOI: 10.1186/s12913-023-09588-0] [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: 11/25/2022] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION In the United States, health care has long been viewed as a 'right,' and residents of the state of Ohio are no exception. The Ohio Department of Health ensures that this right exists for all residents of Ohio. Socio-spatial characteristics, however, can have an impact on access to health care, particularly among vulnerable groups. This article seeks to measure the spatial accessibility to healthcare services by public transport in the six largest cities of Ohio based on population and to compare the accessibility of healthcare to vulnerable demographic groups. To the authors' knowledge, this is the first study to analyze the accessibility and equity of hospitals by public transit across different cities in Ohio, allowing the identification of common patterns, difficulties, and knowledge gaps. METHODOLOGY Using a two-step floating catchment area technique, the spatial accessibility to general medical and surgical hospitals through public transportation was estimated, considering both service-to-population ratios and travel time to these health services. The average accessibility of all census tracts and the average accessibility of the 20% of most susceptible census tracts were determined for each city. Using Spearman's rank correlation coefficient between accessibility and vulnerability, an indicator was then devised to evaluate vertical equity. FINDINGS Within cities (except Cleveland), people of vulnerable census tracts have less access to hospitals via public transportation. These cities (Columbus, Cincinnati, Toledo, Akron, and Dayton) fail in terms of vertical equity and average accessibility. According to this, vulnerable census tracts in these cities have the lowest accessibility levels. CONCLUSION This study emphasizes the issues connected with the suburbanization of poverty in Ohio's large cities and the need to provide adequate public transportation to reach hospitals on the periphery. In addition, this study shed light on the need for additional empirical research to inform the implementation of guidelines for healthcare accessibility in Ohio. Researchers, planners, and policymakers who want to make healthcare more accessible for everyone should take note of the findings in this study.
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Affiliation(s)
- M. S. Alam
- Department of Geography and Planning, The University of Toledo, Toledo, OH United States
| | - N. J. Tabassum
- Department of Geography and Planning, The University of Toledo, Toledo, OH United States
| | - A. I. Tokey
- Department of Geography, Ohio State University, Columbus, OH United States
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23
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Segura A, Siddique SM. Reducing disparities and achieving health equity in colorectal cancer screening. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2023; 25:284-296. [PMID: 37808233 PMCID: PMC10554575 DOI: 10.1016/j.tige.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Increases in colorectal cancer screening are linked to the declining incidence of the disease over the past three decades. These favorable trends, however, are not observed in marginalized racial and ethnic populations with disproportionately lower rates of screening, higher disease incidence, and increased mortality despite advances in health technology and policy. This review describes the differences in screening uptake and test selection amongst racial and ethnic groups, discusses known obstacles and facilitators that impact screening, and highlights existing frameworks developed to achieve health equity in colorectal cancer screening.
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Affiliation(s)
- Abraham Segura
- Division of Gastroenterology, University of Pennsylvania
| | - Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania
- Leonard Davis Institute for Health Economics, University of Pennsylvania
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Khidir H, Salhi R, Sabbatini AK, Franks NM, Green A, Richardson LD, Terry A, Vasquez N, Goyal P, Kocher K, Venkatesh AK, Lin MP. A Quality Framework to Address Racial and Ethnic Disparities in Emergency Department Care. Ann Emerg Med 2023; 81:47-56. [PMID: 36257864 PMCID: PMC9780164 DOI: 10.1016/j.annemergmed.2022.08.010] [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: 05/24/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 02/04/2023]
Abstract
The emergency department serves as a vital source of health care for residents in the United States, including as a safety net. However, patients from minoritized racial and ethnic groups have historically experienced disproportionate barriers to accessing health care services and lower quality of services than White patients. Quality measures and their application to quality improvement initiatives represent a critical opportunity to incentivize health care systems to advance health equity and reduce health disparities. Currently, there are no nationally recognized quality measures that track the quality of emergency care delivery by race and ethnicity and no published frameworks to guide the development and prioritization of quality measures to reduce health disparities in emergency care. To address these gaps, the American College of Emergency Physicians (ACEP) convened a working group of experts in quality measurement, health disparities, and health equity to develop guidance on establishing quality measures to address racial and ethnic disparities in the provision of emergency care. Based on iterative discussion over 3 working group meetings, we present a summary of existing emergency medicine quality measures that should be adapted to track racial and ethnic disparities, as well as a framework for developing new measures that focus on disparities in access to emergency care, care delivery, and transitions of care.
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Affiliation(s)
- Hazar Khidir
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Rama Salhi
- National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Amber K Sabbatini
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Nicole M Franks
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Andrea Green
- University Medical Center Northeast, El Paso, TX
| | - Lynne D Richardson
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Emergency Medicine and Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aisha Terry
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC; Department of Health Policy, Milken Institute of Public Health, George Washington University, Washington, DC
| | | | - Pawan Goyal
- American College of Emergency Physicians, Irving, TX
| | - Keith Kocher
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Arjun K Venkatesh
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT; Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT
| | - Michelle P Lin
- Department of Emergency Medicine at Stanford University School of Medicine, Palo Alto, CA.
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Dauria E, Skipalska H, Gopalakrishnan L, Savenko O, Sabadash L, Tolou-Shams M, Flanigan T, Navario P, Castillo TP. Exploratory qualitative study examining acceptability of strategies to improve access to substance use treatment and HIV prevention services for young adults on probation in Ukraine. BMJ Open 2022; 12:e061909. [PMID: 36418138 PMCID: PMC9685251 DOI: 10.1136/bmjopen-2022-061909] [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: 02/12/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Adults <30 years' of age experience elevated HIV-rates in Ukraine. Young adults (YA) involved in the criminal justice system (CJS) are at an increased HIV-risk given elevated rates of substance use, engagement in high-risk sexual behaviour and insufficient healthcare access. The objective of this exploratory study was to investigate the acceptability of strategies to refer and link CJS-involved YA to HIV-prevention and substance use treatment services from CJS settings. DESIGN We conducted qualitative individual interviews with CJS-involved YA (18-24 years), and CJS stakeholders. Interviews were guided by the Social Ecological Model. Interviews with YA explored substance use and sexual behaviour, and acceptability of strategies to link YA to HIV-prevention and substance use treatment services from CJS. Stakeholder interviews explored system practices addressing HIV-prevention and substance use and addiction. Data were analysed using Inductive Thematic Analysis. SETTING Data were collected in three locales, prior to the 2022 Russian-Ukrainian conflict. PARTICIPANTS Thirty YA and 20 stakeholders. RESULTS Most YA were men, reported recent injection drug use and were M age=23 years. YA were receptive to linkage to HIV-prevention services from CJS; this was shaped by self-perceived HIV-risk and lack of access to HIV-prevention services. YA were less receptive to being referred to substance use treatment services, citing a lack of self-perceived need and mistrust in treatment efficacy. Stakeholders identified multilevel contextual factors shaping acceptability of HIV-prevention and substance use treatment from CJS (eg, stigma). CONCLUSIONS Findings should be reviewed as a historical record of the pre-conflict context. In that context, we identified strategies that may have been used to help curtail the transmission of HIV in a population most-at-risk, including CJS-involved YA. This study demonstrates that improving access to substance use treatment and HIV-prevention services via CJS linkage were acceptable if provided in the right conditions (eg, low or no-cost, confidential).
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Affiliation(s)
- Emily Dauria
- Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Lakshmi Gopalakrishnan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | | | | | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Peter Navario
- School of Public Health, New York University, New York, New York, USA
- HealthRight International, New York, New York, USA
| | - Theresa P Castillo
- School of Public Health, New York University, New York, New York, USA
- HealthRight International, New York, New York, USA
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Jason LA, Torres C. Differences in Symptoms among Black and White Patients with ME/CFS. J Clin Med 2022; 11:jcm11226708. [PMID: 36431185 PMCID: PMC9696897 DOI: 10.3390/jcm11226708] [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: 10/27/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Study samples of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have primarily involved White subjects, so the literature on ethnic differences is sparse. The current study identified a sample of 19 Black patients diagnosed with ME/CFS and compared them with White patients with ME/CFS, as well as with healthy controls. The studies used a similar psychometrically sound assessment tool to assess symptoms in all subjects. Findings indicated there were significant differences between patients with ME/CFS versus controls, but few differences between patients who identified as Black or White. The results suggest there might be few symptom differences between patients with ME/CFS in these two ethnic groups. The implications of these findings are discussed.
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Lin SC, Maddox KEJ, Ryan AM, Moloci N, Shay A, Hollingsworth JM. Exit Rates of Accountable Care Organizations That Serve High Proportions of Beneficiaries of Racial and Ethnic Minority Groups. JAMA HEALTH FORUM 2022; 3:e223398. [PMID: 36218951 PMCID: PMC9526083 DOI: 10.1001/jamahealthforum.2022.3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Importance The Medicare Shared Savings Program provides financial incentives for accountable care organizations (ACOs) to reduce costs of care. The structure of the shared savings program may not adequately adjust for challenges associated with caring for patients with high medical complexity and social needs, a population disproportionately made up of racial and ethnic minority groups. If so, ACOs serving racial and ethnic minority groups may be more likely to exit the program, raising concerns about the equitable distribution of potential benefits from health care delivery reform efforts. Objective To evaluate whether ACOs with a high proportion of beneficaries of racial and ethnic minority groups are more likely to exit the Medicare Shared Savings Program and identify characteristics associated with this disparity. Design, Setting, and Participants This retrospective observational cohort study used secondary data on Medicare Shared Savings Program ACOs from January 2012 through December 2018. Bivariate and multivariate cross-sectional regression analyses were used to understand whether ACO racial and ethnic composition was associated with program exit, and how ACOs with a high proportion of beneficaries of racial and ethnic minority groups differed in characteristics associated with program exit. Exposures Racial and ethnic composition of an ACO's beneficiaries. Main Outcomes and Measures Shared savings program exit before 2018. Results The study included 589 Medicare Shared Savings Program ACOs. The ACOs in the highest quartile of proportion of beneficaries of racial and ethnic minority groups were designated high-proportion ACOs (145 [25%]), and those in the lowest 3 quartiles were designated low-proportion ACOs (444 [75%]). In unadjusted analysis, a 10-percentage point increase in the proportion of beneficiaries of racial and ethnic minority groups was associated with a 1.12-fold increase in the odds of an ACO exit (95% CI, 1.00-1.25; P = .04). In adjusted analysis, there were significant associations among high-proportion ACOs between characteristics such as patient comorbidities, disability, and clinician composition and a higher likelihood of exit. Conclusions and Relevance The study results suggest that ACOs that served a higher proportion of beneficaries of racial and ethnic minority groups were more likely to exit the Medicare Shared Savings Program, partially because of serving patients with greater disease severity and complexity. These findings raise concerns about how current payment reform efforts may differentially affect racial and ethnic minority groups.
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Affiliation(s)
- Sunny C. Lin
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri,Institute for Informatics, Washington University in St. Louis, St Louis, Missouri,Institute for Public Health, Washington University in St. Louis, St Louis, Missouri
| | - Karen E. Joynt Maddox
- Institute for Public Health, Washington University in St. Louis, St Louis, Missouri,Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Andrew M. Ryan
- Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Nicholas Moloci
- Department of Health Policy and Management, University of North Carolina, Chapel Hill
| | - Addison Shay
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
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Freytag J, Touchett HN, Bryan JL, Lindsay JA, Gould CE. Advances in Psychotherapy for Older Adults Using Video-to-Home Treatment. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2022; 2:71-78. [PMID: 38013747 PMCID: PMC9458515 DOI: 10.1016/j.ypsc.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Providing telemental health services to older adults has become especially important during the COVID-19 pandemic. Video-to-home (VTH) treatment is an effective treatment modality; research shows that older adults are open to using VTH. However, there are unique barriers to using VTH with older adults. Barriers include access to technology, acceptance of technology, and physical and cognitive limitations. Additional concerns include establishing rapport with older patients and the policy and ethical concerns surrounding the use of VTH. Methods of addressing these barriers have been developed, and more research is needed to develop evidence-based VTH practice.
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Affiliation(s)
- Jennifer Freytag
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
| | - Hilary N Touchett
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
| | - Jennifer L Bryan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Lee and Joe Jamail Specialty Care Center, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Christine E Gould
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304-1207, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101, USA
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Health Care Disparities Among Latina Patients Presenting With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2022; 28:608-615. [PMID: 35759777 DOI: 10.1097/spv.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE This study identifies barriers, including language and insurance status, Latina patients may face in accessing urogynecology care. OBJECTIVE The aim of the study was to determine differences in objective prolapse severity at the time of presentation between Latina and non-Latina patients and the effect socioeconomic disparities may have on these differences. STUDY DESIGN This is a retrospective cohort study of patients visiting urogynecology clinics at 2 academic institutions (1 private, 1 public). Patients with symptomatic > stage II prolapse were included. Initial Pelvic Organ Prolapse Quantification examinations, leading edge of prolapse, and demographic data were extracted. We evaluated several socioeconomic factors for associations with prolapse severity in a multivariable analysis. RESULTS Three hundred forty-two patients were included (36% Latina). Twenty-eight percent were non-English speaking and 54% had public or no insurance. Using leading edge as the outcome, there was no objective difference in prolapse severity between the Latina and non-Latina patients. A higher proportion of patients with public insurance had more advanced prolapse compared with those with private insurance (odds ratio, 2.78; 95% confidence interval, 1.40-5.55; P < 0.01) and a higher proportion of non-English speaking had more advanced prolapse compared with English speakers (odds ratio, 2.44; 95% confidence interval, 1.12-5.34; P = 0.03). CONCLUSIONS Latina ethnicity was not a risk factor for more advanced prolapse at the time of initial evaluation in a urogynecology clinic. Rather, patients who were non-English speaking and had public insurance were more likely to present with more advanced prolapse. Our data suggest that language barriers and lower socioeconomic status are health care disparities for patients seeking care for prolapse.
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Thompson TV, Crocker KC. Study the forest, not only the trees: Environmental exposures, not genomes, generate most health disparities. Front Genet 2022; 13:817899. [PMID: 36061175 PMCID: PMC9437270 DOI: 10.3389/fgene.2022.817899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
As sequencing and analysis techniques provide increasingly detailed data at a plummeting cost, it is increasingly popular to seek the answers to medical and public health challenges in the DNA sequences of affected populations. This is methodologically attractive in its simplicity, but a genomics-only approach ignores environmentally mediated health disparities, which are well-documented at multiple national and global scales. While genetic differences exist among populations, it is unlikely that these differences overcome social and environmental factors in driving the gap in health outcomes between privileged and oppressed communities. We advocate for following the lead of communities in addressing their self-identified interests, rather than treating widespread suffering as a convenient natural experiment.
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Affiliation(s)
- Taylor V. Thompson
- Genetics Department, Albert Einstein College of Medicine, New York, NY, United States
| | - Katherine C. Crocker
- Biology Department, University of Puget Sound, Tacoma, WA, United States
- *Correspondence: Katherine C. Crocker,
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Lyon-Scott K, Cohen-Cline H. Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10149. [PMID: 36011783 PMCID: PMC9408230 DOI: 10.3390/ijerph191610149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Adverse childhood experiences (ACEs) are widely prevalent but unevenly distributed in the United States, with disadvantaged groups, especially those with low socioeconomic status, being more likely to experience them. ACEs have been linked to poor health outcomes in adulthood. In this study, we examined the association between ACEs and emergency department (ED) utilization using a cross-sectional life-course survey of low-income adults matched to Medicaid enrollment and claims data. Surveys were obtained from 2348 Medicaid-enrolled adults in the Portland, OR metropolitan area; 1133 were used in this analysis. We used a two-part regression model to estimate the association between ACE score and both ever using the ED and frequency of ED use in the year after survey completion. We also evaluated a set of potentially protective factors to see if they impacted the relationship between ED use and ACE score. We found that participants with a higher ACE score were more likely to obtain any emergency services care (odds ratio (OR) = 1.11, p = 0.011), but ACE score did not predict how frequently they would utilize those services. Close social relationships were found to be protective against high ED utilization for those with high ACE scores. Upstream prevention efforts that identify places to intervene in childhood and incorporate trauma-informed strategies into ED care in adulthood have the potential to decrease ED use.
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Affiliation(s)
| | - Hannah Cohen-Cline
- Providence Center for Outcomes Research and Education, Portland, OR 97213, USA
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Camerota M, Wylie AC, Goldblum J, Wideman L, Cheatham CL, Propper CB. Testing a cascade model linking prenatal inflammation to child executive function. Behav Brain Res 2022; 431:113959. [PMID: 35690156 PMCID: PMC10652221 DOI: 10.1016/j.bbr.2022.113959] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023]
Abstract
Inflammation during pregnancy is beginning to be understood as a risk factor predicting poor infant health and neurodevelopmental outcomes. The long-term sequelae associated with exposure to prenatal inflammation are less well established. The current study examined associations between maternal inflammation during pregnancy, markers of infant neurodevelopment (general cognitive ability, negative affect, and sleep quality), and preschool executive function (EF) in a longitudinal sample of 40 African American mother-infant dyads. Mothers completed a blood draw in the third trimester of pregnancy to measure plasma levels of C-reactive protein (CRP) and pro-inflammatory cytokines (e.g., interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α]). When infants were 6 months of age, we assessed general cognitive ability via the Bayley-III, negative affect via the Still-Face Paradigm, and sleep quality via actigraphy monitoring. When children were 4 years of age, we assessed their EF ability using four tasks from the EF Touch battery. Elevated levels of maternal CRP, IL-6, and TNF-α were associated with poorer infant general cognitive ability. Although there were no direct effects of prenatal inflammation on preschool EF, we observed an indirect relationship between IL-6 and preschool EF ability via infant general cognitive ability. Our findings suggest that prenatal inflammation may have long-lasting, cascading implications for child neurodevelopment. Implications of these findings for health disparities in women and children of color are discussed.
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Affiliation(s)
- Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States
| | - Amanda C Wylie
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jessica Goldblum
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, United States
| | - Carol L Cheatham
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States; Nutrition Research Institute, University of North Carolina at Chapel Hill, United States
| | - Cathi B Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
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Linnander EL, Ayedun A, Boatright D, Ackerman-Barger K, Morgenthaler TI, Ray N, Roy B, Simpson S, Curry LA. Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study. BMC Health Serv Res 2022; 22:975. [PMID: 35907839 PMCID: PMC9338573 DOI: 10.1186/s12913-022-08331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention. METHODS Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis. DISCUSSION This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.
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Affiliation(s)
- Erika L Linnander
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA.
- Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA.
| | - Adeola Ayedun
- Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Kupiri Ackerman-Barger
- Betty Irene Moore School of Nursing, University of California Davis Health, Sacramento, USA
| | | | | | - Brita Roy
- Department of Medicine, Yale School of Medicine, New Haven, USA
| | - Steven Simpson
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of Kansas, Kansas City, USA
| | - Leslie A Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA
- Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA
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Characteristics associated with disease prevalence, SCORTEN, length of stay, and mortality in hospitalized SJS/TEN patients: A single-center, eleven-year experience. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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O’Shea DM, Maynard T, Tremont G. DNA Methylation "GrimAge" Acceleration Mediates Sex/Gender Differences in Verbal Memory and Processing Speed: Findings From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2022; 77:2402-2412. [PMID: 35715888 PMCID: PMC9799212 DOI: 10.1093/gerona/glac133] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Indexed: 01/20/2023] Open
Abstract
Whether sex/gender differences in rates of biological aging mediate sex/gender differences in cognition in older adults has not been fully examined. The aim of the current study was to investigate this association. Data from up to 1 928 participants (mean age = 75, standard deviation = 7.04, female = 57%) who took part in the 2016 Harmonized Cognitive Assessment Protocol and Venous Blood Study; substudies of the Health and Retirement Study were included in the current study. The residuals from 4 age-adjusted epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge) were used to measure biological age acceleration. Sex/gender differences in cognition were tested using a series of analyses of covariance. Mediation analyses tested whether the measures of age acceleration accounted for these sex/gender differences, controlling for age, education, smoking status, and white blood cell count. Women outperformed men on measures of verbal learning, verbal memory, visual scanning, and processing speed. No other significant sex/gender differences were identified. Results from mediation analyses revealed that women's slower rates of GrimAge fully accounted for their faster processing speeds and partially accounted for their better performances on verbal learning, verbal memory, and visual scanning measures. None of the other measures of age acceleration were significant mediators. Accounting for sex/gender differences in biological aging may differentiate between cognitive sex/gender differences that are driven by universal (ie, age-related) versus sex-specific mechanisms. More broadly, these findings support the growing evidence that the GrimAge clock outperforms other clocks in predicting cognitive outcomes.
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Affiliation(s)
- Deirdre M O’Shea
- Address correspondence to: Deirdre M. O’Shea, PhD, Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, 593 Eddy Street Building, 7th Floor, Providence, RI 02903, USA. E-mail:
| | | | - Geoffrey Tremont
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island,USA,Rhode Island Hospital, Providence, Rhode Island, USA
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Ashktorab H, Pizuorno A, Adeleye F, Laiyemo A, Dalivand MM, Aduli F, Sherif ZA, Oskrochi G, Angesom K, Oppong-Twene P, Challa SR, Okorie N, Moon ES, Romos E, Jones-Wonni B, Kone AM, Rankine S, Thrift C, Scholes D, Ekwunazu C, Banson A, Mitchell B, Maskalo G, Ross J, Curtis J, Kim R, Gilliard C, Ahuja G, Mathew J, Gavin W, Kara A, Hache-Marliere M, Palaiodimos L, Mani VR, Kalabin A, Gayam VR, Garlapati PR, Miller J, Chirumamilla LG, Jackson F, Carethers JM, Kamangar F, Brim H. Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans. BMC Infect Dis 2022; 22:552. [PMID: 35715729 PMCID: PMC9204073 DOI: 10.1186/s12879-022-07520-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. METHODS We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected. RESULTS The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort. CONCLUSION Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC, USA.
| | - Antonio Pizuorno
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Folake Adeleye
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Adeyinka Laiyemo
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Maryam Mehdipour Dalivand
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Farshad Aduli
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Zaki A. Sherif
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
| | - Gholamreza Oskrochi
- grid.472279.d0000 0004 0418 1945College of Engineering and Technology, American University of the Middle East, Salmiya, Kuwait
| | - Kibreab Angesom
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Philip Oppong-Twene
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Suryanarayana Reddy Challa
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Nnaemeka Okorie
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Esther S. Moon
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Edward Romos
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Boubini Jones-Wonni
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Abdoul Madjid Kone
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Sheldon Rankine
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Camelita Thrift
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Derek Scholes
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Chiamaka Ekwunazu
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Abigail Banson
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Brianna Mitchell
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Guttu Maskalo
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Jillian Ross
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Julencia Curtis
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Rachel Kim
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Chandler Gilliard
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Geetha Ahuja
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Joseph Mathew
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Warren Gavin
- grid.257413.60000 0001 2287 3919Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Areeba Kara
- grid.257413.60000 0001 2287 3919Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Manuel Hache-Marliere
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Leonidas Palaiodimos
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Vishnu R. Mani
- grid.189509.c0000000100241216Department of Trauma, Acute and Critical Care Surgery, Duke University Medical Center, Durham, NC USA
| | - Aleksandr Kalabin
- grid.21729.3f0000000419368729Dartment of Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, NY USA
| | - Vijay Reddy Gayam
- grid.414783.d0000 0004 0427 3735Department of Medicine, Interfaith Medical Center, New York, NY USA
| | - Pavani Reddy Garlapati
- grid.414783.d0000 0004 0427 3735Department of Medicine, Interfaith Medical Center, New York, NY USA
| | - Joseph Miller
- grid.413103.40000 0001 2160 8953Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI USA
| | - Lakshmi Gayathri Chirumamilla
- grid.411399.70000 0004 0427 2775Department of Medicine, GI Division, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC USA
| | - Fatimah Jackson
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
| | - John M. Carethers
- grid.214458.e0000000086837370Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI USA
| | - Farin Kamangar
- grid.260238.d0000 0001 2224 4258Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD USA
| | - Hassan Brim
- grid.257127.40000 0001 0547 4545Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC USA
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Abstract
PURPOSE OF REVIEW Causes of health disparities in Alzheimer disease and related dementias (ADRD) in the United States are multifactorial. This article contextualizes health disparities as they relate to the neurodegenerative processes of ADRD. RECENT FINDINGS Older adults' life expectancy has increased such that a 65-year-old is expected to live 19 or more years and an 85-year-old can expect to live, on average, 6 to 7 years longer. Individuals of certain ethnoracial groups (Black, Hispanic/Latino, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) may be at a higher risk of incident ADRD compared to non-Hispanic/Latino White people. These differences in a higher risk of ADRD across ethnoracial groups persist despite no statistically significant differences in the rate of cognitive decline over time. The intersectionality of social determinants of health, experiences with discrimination and oppression, and access to care are related to the issue of justice and the risk for and expression of ADRD. The theoretical frameworks of various health disparities provide organized approaches to tracking the progression of health disparities for diverse patients. SUMMARY ADRD health disparities are complex. Neurologists and their care teams must consider the main reasons for clinical ADRD evaluations of members of ethnoracial groups and the factors that may impact patient adherence and compliance with diagnostic and management recommendations.
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Sawyer KN, Cofield SS, Selph JP. Race as a Predictor of Recurrence and Complications After Urethroplasty in Men With Urethral Stricture Disease. Urology 2022; 163:69-75. [PMID: 34852248 PMCID: PMC9142758 DOI: 10.1016/j.urology.2021.10.038] [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: 03/03/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the role of race in surgical outcomes of and complications after urethroplasty. METHODS A single institution, retrospective review was conducted from 2011 to 2019 on male patients ≥18 years of age who underwent urethroplasty. Exclusion criteria included previous urethral cancer, lack of follow up, or revision urethroplasty. Failure of urethroplasty was defined as requiring revision surgery or recurrence on imaging or cystoscopy. Risk factors for recurrence were determined using descriptive statistics, Wilcoxon comparisons, and multivariate logistic regression. RESULTS Three hundred and seven patients were identified with 234 patients meeting inclusion criteria. 63.2% identified as White/Caucasian (CA), 32.5% Black/African American (AA), and 4.3% other race. Mean age was 49.4 years. Between CA and AA patients, there was no difference in mean age, body mass index, smoking status, prior urethroplasty, or prior dilation/DVIU. CAs were more likely to have a fossa navicularis stricture compared to AAs (P = .0094), but there were no significant differences in bulbar, penile, or posterior stricture rates (all P >.05) or length (P = .32). The overall stricture recurrence rate was 15.8% with a median of 242 days to recurrence and no significant difference by race for either outcome (P = .83, P = .64). The only predictor of stricture recurrence was prior dilation/DVIU (P = .0404, OR 2.3, 95% CI 1.0, 5.6). Overall complication rate was 17.5%, with no difference between CA and AAs rates (P = .83) or complication type (P = .62). CONCLUSION There was no significant difference in the rate of surgical failure for urethral stricture repair based on race. The only predictor of surgical failure was having a prior urethral dilation/DVIU.
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Affiliation(s)
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - John P Selph
- Department of Urology, University of Alabama School of Medicine, Birmingham, AL.
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Yang TC, Shoff C, Kim S, Shaw BA. County social isolation and opioid use disorder among older adults: A longitudinal analysis of Medicare data, 2013-2018. Soc Sci Med 2022; 301:114971. [PMID: 35430465 DOI: 10.1016/j.socscimed.2022.114971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/12/2022] [Accepted: 04/07/2022] [Indexed: 01/03/2023]
Abstract
This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults' risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults' risk of OUD using longitudinal data analysis. We merged the 2013-2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and used conditional logit fixed-effects modeling to test whether changes in individual- and county-level covariates alter older adults' risk of OUD. Moreover, we conducted race/ethnicity-specific models to compare how these associations vary across racial/ethnic groups. At the county-level, a one-unit increase in social isolation (mean = -0.197, SD = 0.511) increased the risk of OUD by 5.5 percent (OR = 1.055; 95% CI = [1.018, 1.094]) and a one-percentage-point increase in the working population employed in primary industry decreases the risk of OUD by 1 percent (OR = 0.990; 95% CI = [0.985, 0.996]). At the individual-level, increases in the Medicare Hierarchical Condition Categories risk score, physical comorbidity, and mental comorbidity all elevate the risk of OUD. The relationship between county-level social isolation and OUD is driven by non-Hispanic whites, while Hispanic beneficiaries are less sensitive to the changes in county-level factors than any other racial ethnic groups. Between 2013 and 2018, US older adults' risk of OUD was associated with both ecological and individual factors, which carries implications for intervention. Further research is needed to understand why associations of individual factors with OUD are comparable across racial/ethnic groups, but county-level social isolation is only associated with OUD among non-Hispanic white beneficiaries.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Seulki Kim
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
| | - Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Cummings E, Martinez S, Mourad M. Primary care gap: factors associated with persistent lack of primary care after hospitalisation. BMJ Open Qual 2022; 11:bmjoq-2021-001666. [PMID: 35354598 PMCID: PMC8968534 DOI: 10.1136/bmjoq-2021-001666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Access to primary care in the USA is associated with decreased acute care utilisation and better health outcomes, yet millions of Americans lack a primary care provider (PCP). In our study, we report the risk factors for having no assigned PCP for hospitalised patients both at the time of discharge and over the course of the following year. Methods We conducted a retrospective cohort study of 12 663 adult patients discharged from the medicine service at our academic inpatient hospital from 2017 to 2018. We compared the characteristics of patients with and without a PCP listed in the electronic health record at time of discharge. In a second analysis, for those patients without a PCP, we used subsequent encounters with our health system to compare characteristics of those who had a PCP assigned within 1 year after discharge with those who did not. Results At time of discharge, patients without a PCP were more likely to be younger, male, non-Asian and non-Black, to have Medicaid insurance or to be self-pay, to be experiencing homelessness and to have a substance use disorder diagnosis. During the year after discharge, the most significant risk factors for persistently lacking a PCP were non-private insurance status (Medicaid, Medicare, self-pay), experiencing homelessness and having a substance use disorder diagnosis. Discussion Our study demonstrates important risk factors for persistently lacking an assigned PCP in our urban patient population, including health insurance status, homelessness and substance use disorders. Targeted interventions are indicated to connect these high-risk individuals to primary care.
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Seefeld L, Mojahed A, Thiel F, Schellong J, Garthus-Niegel S. Preferences and Barriers to Counseling for and Treatment of Intimate Partner Violence, Depression, Anxiety, and Posttraumatic Stress Disorder Among Postpartum Women: Study Protocol of the Cross-Sectional Study INVITE. Front Psychiatry 2022; 13:836350. [PMID: 35422719 PMCID: PMC9001846 DOI: 10.3389/fpsyt.2022.836350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
The cross-sectional study INVITE (INtimate partner VIolence care and Treatment prEferences in postpartum women) aims to examine treatment and counseling preferences and barriers in relation to the experience of intimate partner violence (IPV), depression and anxiety, and (childbirth-related) posttraumatic stress disorder (PTSD) among postpartum women in Dresden, Germany. Currently, the INVITE study consists of an interim sample of N = 1,787 participants with n = 891 completed interviews. Recruitment is ongoing, targeting a community sample of at least N = 4,000 women who complete various quantitative questionnaires via telephone interviews at 3-4 months postpartum. The differences in rates of IPV, postpartum depression and anxiety, and/or (childbirth-related) PTSD as well as treatment and counseling preferences and barriers between affected and non-affected women will be assessed. Further, predisposing variables, past and present stress exposure, enabling resources, as well as past and present health will be examined as predictors of service preferences and barriers. In this study protocol, the theoretical background, methods, as well as preliminary results regarding sociodemographic characteristics and birth-related factors of the interim sample are presented and discussed in terms of their socio-political relevance. Simultaneously assessing IPV, postpartum depression and anxiety, and (childbirth-related) PTSD will facilitate exploring comorbidities and concomitant special needs of affected women. Results of the INVITE study will therefore set the ground for well-aimed development and improvement of treatment and counseling services for the respective target groups by informing health care professionals and policy makers about specific preferences and barriers to treatment. This will yield the possibility to tailor services to the needs of postpartum women.
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Affiliation(s)
- Lara Seefeld
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Amera Mojahed
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Freya Thiel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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May D, Fullilove R. Depression, HIV, and COVID-19: A Deadly Trifecta. Public Health Rep 2022; 137:420-424. [PMID: 35137644 PMCID: PMC9109531 DOI: 10.1177/00333549221074389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- David May
- Department of Counseling and
Clinical Psychology, Teachers College, Columbia University, New York, NY,
USA,David May, MA, Columbia University,
Teachers College, Department of Counseling and Clinical Psychology,
525 West 120th St, New York, NY 10027, USA.
| | - Robert Fullilove
- Department of Sociomedical
Sciences, Columbia University Mailman School of Public Health, New York, NY,
USA
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Nugus P, Travaglia J, MacGinley M, Colliver D, Mazaniello-Chezol M, Claudio F, Lewis LD. Conceptual foundations of organizational structure: re-structuring of women's health services. J Health Organ Manag 2021; ahead-of-print. [PMID: 34894117 DOI: 10.1108/jhom-09-2021-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.
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Affiliation(s)
| | - Joanne Travaglia
- Faculty of Health, University of Technology Sydney, Haymarket, Australia
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Body dissatisfaction and ethnic identity are associated with loss of control eating among young adult African American men. Eat Behav 2021; 43:101578. [PMID: 34768130 DOI: 10.1016/j.eatbeh.2021.101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
African American men are rarely the focus of attention in investigations of loss of control (LOC) eating. Theory and extant data support a robust link between body dissatisfaction and LOC eating behaviors in women. Ethnic identity may buffer this association, as the degree to which racially and ethnically diverse women identify with their ethnic group has been shown to decrease the relevancy of the Western culture body ideal, thereby decreasing disordered eating pathology. These associations have not been evaluated in African American men. The current study examined the link between body dissatisfaction and LOC eating frequency in 261 young African American men (1830 years old). Ethnic identity was evaluated as an independent variable and as a putative moderator. After adjusting for income, education, and body mass index, body dissatisfaction was significantly and positively associated with LOC eating frequency (p < .001). Ethnic identity did not function as a significant moderator (p = .84) but was significantly and inversely associated with LOC eating frequency (p < .001). Although longitudinal studies are needed, these data suggest that there may be multiple pathways through which young African American men engage in LOC eating. Similar to extant research with women and other ethnic groups, body dissatisfaction appears to play a role in the LOC eating of African American men. Additional research is needed to clarify the nature of the association between ethnic identity and LOC eating in this population.
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Daher M, Al Rifai M, Kherallah RY, Rodriguez F, Mahtta D, Michos ED, Khan SU, Petersen LA, Virani SS. Gender disparities in difficulty accessing healthcare and cost-related medication non-adherence: The CDC behavioral risk factor surveillance system (BRFSS) survey. Prev Med 2021; 153:106779. [PMID: 34487748 PMCID: PMC9291436 DOI: 10.1016/j.ypmed.2021.106779] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Ensuring healthcare access is critical to maintain health and prevent illness. Studies demonstrate gender disparities in healthcare access. Less is known about how these vary with age, race/ethnicity, and atherosclerotic cardiovascular disease. We utilized cross-sectional data from 2016 to 2019 CDC Behavioral Risk Factor Surveillance System (BRFSS), a U.S. telephone-based survey of adults (≥18 years). Measures of difficulty accessing healthcare included absence of healthcare coverage, delay in healthcare access, absence of primary care physician, >1-year since last checkup, inability to see doctor due to cost, and cost-related medication non-adherence. We studied the association between gender and these variables using multivariable-adjusted logistic regression models, stratifying by age, race/ethnicity, and atherosclerotic cardiovascular disease status. Our population consisted of 1,737,397 individuals; 54% were older (≥45 years), 51% women, 63% non-Hispanic White, 12% non-Hispanic Black,17% Hispanic, 9% reported atherosclerotic cardiovascular disease. In multivariable-adjusted models, women were more likely to report delay in healthcare access: odds ratio (OR) and (95% confidence interval): 1.26 (1.11, 1.43) [p < 0.001], inability to see doctor due to cost: 1.29 (1.22, 1.36) [p < 0.001], cost-related medication non-adherence: 1.24 (1.01, 1.50) [p = 0.04]. Women were less likely to report lack of healthcare coverage: 0.71 (0.66, 0.75) [p < 0.001] and not having a primary care physician: 0.50 (0.48, 0.52) [p < 0.001]. Disparities were pronounced in younger (<45 years) and Black women. Identifying these barriers, particularly among younger women and Black women, is crucial to ensure equitable healthcare access to all individuals.
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Affiliation(s)
- Marilyne Daher
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Riyad Y Kherallah
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Research Institute, Stanford University, Stanford, CA, United States of America
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States of America
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America.
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Bellerose M, Yilin D, Rowell-Cunsolo TL. Assessing the Relationship Between History of Arrest and Self-reported Cardiovascular Conditions. Am J Hypertens 2021; 34:1189-1195. [PMID: 34240119 DOI: 10.1093/ajh/hpab107] [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: 04/02/2021] [Revised: 06/11/2021] [Accepted: 07/07/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Formerly incarcerated Americans are believed to have increased risk of hypertension and cardiovascular disease, yet the impact of lower-level criminal legal system exposures, such as arrests, on cardiovascular health are less clear. METHODS We explored the relationship between lifetime history of arrest and self-report of ever having been diagnosed with hypertension or a heart condition using data from the 2018 National Survey on Drug Use and Health (NSDUH). Survey-weighted Poisson regression models with robust variance, adjusted for age group, sex, race/ethnicity, education, past year mental illness, smoking history, and past year substance use disorder, were used to estimate adjusted prevalence ratios (PRs). RESULTS Among the 13,583 respondents, 17.0% reported a history of arrest, among whom 45.2% also reported a hypertension diagnosis and 24.4% reported a heart condition. Among those without a history of arrest, 46.7% reported a hypertension diagnosis and 25.2% reported a heart condition diagnosis. The adjusted models did not show evidence that history of arrest is associated with self-reported hypertension (adjusted PR 1.0; 95% confidence interval [CI] 0.93, 1.07, P = 0.937) or self-reported heart condition (1.0; 95% CI 0.91, 1.11, P = 0.915). CONCLUSIONS We did not find evidence that history of arrest, a lower-level criminal legal system exposure, is associated with self-reported hypertension or heart conditions.
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Affiliation(s)
- Meghan Bellerose
- Department of Population and Family Health, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Diandian Yilin
- Department of Consumer Science, University of Wisconsin-Madison, School of Human Ecology, Madison, Wisconsin, USA
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Reeves TJ, Mathis TJ, Bauer HE, Hudson MM, Robison LL, Wang Z, Baker JN, Huang IC. Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review. Front Public Health 2021; 9:741334. [PMID: 34778176 PMCID: PMC8586515 DOI: 10.3389/fpubh.2021.741334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.
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Affiliation(s)
- Tegan J Reeves
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Taylor J Mathis
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hailey E Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
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48
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Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender. Appetite 2021; 168:105778. [PMID: 34715245 DOI: 10.1016/j.appet.2021.105778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/22/2022]
Abstract
Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.
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Spencer RA, Livingston MD, Komro KA, Sroczynski N, Rentmeester ST, Woods-Jaeger B. Association between Temporary Assistance for Needy Families (TANF) and child maltreatment among a cohort of fragile families. CHILD ABUSE & NEGLECT 2021; 120:105186. [PMID: 34229993 DOI: 10.1016/j.chiabu.2021.105186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 06/11/2023]
Abstract
BACKGROUND Child maltreatment disproportionately affects families experiencing poverty and structural discrimination, including African American (AA) families. The generosity of Temporary Assistance for Needy Families (TANF) may reduce child maltreatment disparities. OBJECTIVE Our aim is to understand TANF's impact on the mother's perpetration of child maltreatment and whether the effect differs across AA and White mothers. PARTICIPANTS AND SETTING Participants are 2457 primary caregiving mothers participating in waves 3 (2001-2003), 4 (2003-2006), and 5 (2007-2010) of the U.S.-based Fragile Families and Child Wellbeing birth cohort study. METHODS We use a difference-in-differences study design to estimate overall and race-specific effects of TANF policies on caregivers' self-report of child neglect and physical and psychological maltreatment measured by the Child-Parent Conflict Tactics Scale. State-level TANF policy exposures include the TANF-to-Poverty Ratio (TPR), maximum cash benefits, time limits, sanctions, diversion payments, and family caps. RESULTS A $100 increase in TANF benefits was associated with a reduction of 1.8 reported physical abuse events (Beta = -1.80, 95% CI (-3.29, -0.31)). Imposing a time limit on TANF receipt was associated with an increase of 2.3 reported physical abuse events (Beta = 2.27, 95% CI (0.04, 4.50)). No significant differences were found for AA mothers versus White mothers. CONCLUSIONS AND RELEVANCE Increasing TANF cash benefits should be prioritized to reduce poverty-related child maltreatment disparities. TANF time limits should be reconsidered.
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Affiliation(s)
- Rachael A Spencer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA.
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA
| | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA
| | | | - Shelby T Rentmeester
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA
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50
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Buikema AR, Buzinec P, Paudel ML, Andrade K, Johnson JC, Edmonds YM, Jhamb SK, Chastek B, Raja H, Cao F, Hulbert EM, Korrer S, Mazumder D, Seare J, Solow BK, Currie UM. Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database. EClinicalMedicine 2021; 39:101075. [PMID: 34493997 PMCID: PMC8413267 DOI: 10.1016/j.eclinm.2021.101075] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. METHODS This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. FINDINGS Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452). INTERPRETATION Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.
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Affiliation(s)
- Ami R. Buikema
- Optum, Eden Prairie, MN, USA
- Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.
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