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Supakul S, Yoshida M, Kosaka M, Murayama A, Tani Y, Bhandari D, Ozaki A, Tanimoto T. Characteristics of Vulnerable Foreigners in Need of Emergency Care Support in Japan: A Case Study of Thai Nationals from 2004 to 2020. J Immigr Minor Health 2024; 26:517-526. [PMID: 37982918 DOI: 10.1007/s10903-023-01566-2] [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: 10/20/2023] [Indexed: 11/21/2023]
Abstract
In Japan, a considerable number of foreigners encounter challenges in accessing appropriate healthcare services due to the lack of insurance coverage. However, the absence of a public database on these individuals makes it difficult to assess their health problems and healthcare access status. This study aims to investigate the characteristics of vulnerable Thai patients in Japan and to shed light on the specific challenges they face within Japan's healthcare system. A retrospective analysis was conducted using records of patients who required emergency healthcare support from the Royal Thai Embassy in Tokyo between 2004 and 2020. Descriptive statistical analyses were performed to examine the general characteristics, insurance status, and diseases of the patients. Additionally, patients were classified as either prolonged residents or brief residents based on their duration of stay in Japan until hospital admission (1 year or more or less than 1 year). A total of 74 patients were identified, with the majority (91.9%) lacking insurance coverage. Notably, there was an increase in the number of brief residents, including tourists, during the 2010s. Prolonged residents were more likely to experience chronic diseases, whereas brief residents were more prone to sustaining injuries. The patient records from the Thai Embassy consistently highlight the urgent requirement for emergency healthcare support within this population. However, the existing policies in Japan fall short in adequately addressing the healthcare access needs of this vulnerable population. Therefore, it is crucial to provide additional support and interventions to enhance their healthcare access.
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Affiliation(s)
- Sopak Supakul
- Graduate School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan.
| | - Makoto Yoshida
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Makoto Kosaka
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Anju Murayama
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Yuta Tani
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Divya Bhandari
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
- Navitas Clinic, Tokyo, Japan
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2
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Villagrán Castro KN, Hernández Rincón EH, García Zárate G, Jaimes Peñuela CL. [Communication with a culturally and linguistically diverse population from Primary Care]. Semergen 2024; 50:102149. [PMID: 38157756 DOI: 10.1016/j.semerg.2023.102149] [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: 06/27/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
The care of a culturally and linguistically diverse population is a challenge in primary health care due to language barriers and cultural differences. For this reason, good communication and cultural competence of health personnel is key within medical consultation. Thus, during consultations with this group of people, it is the doctor's duty to identify the patient's culture, their perception of the concept of health, in what way and to what extent they want to be informed, and the role they want to assign to the members of their family before the treatment process begins. For this reason, there are interventions that seek to optimize the care provided to these patients and mitigate the cultural barrier, including the use of multimodal digital tools, the use of translators or interpreters, and training of health personnel in communication and intercultural skills.
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Affiliation(s)
- K N Villagrán Castro
- Médica de Atención Primaria, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - E H Hernández Rincón
- Médico, Máster en Investigación en Atención Primaria, Doctor en Investigación Clínica, Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia.
| | - G García Zárate
- Médica de Atención Primaria, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - C L Jaimes Peñuela
- Médica, especialista en Medicina Familiar y Comunitaria, Máster en Educación Médica, Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
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Folk A, Mouhaffel R, Grewal H, Noh S, Le Cam E, Liu F, Ho S, Loveland M, Sainbayar E, Pham HN, Ferreira JP, Ibrahim R. United States-Mexico Border Disparities in Alcoholic Liver Disease Mortality: A Cross-Sectional Analysis 1999-2020. J Clin Gastroenterol 2024:00004836-990000000-00283. [PMID: 38597414 DOI: 10.1097/mcg.0000000000002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND US-Mexico (US-MX) border regions are impacted by socioeconomic disadvantages. Alcohol use disorder remains widely prevalent in US-MX border regions, which may increase the risk of alcoholic liver disease (ALD). GOALS We aimed to characterize ALD mortality trends in border regions compared to non-border regions from 1999 to 2020 in the United States (US). METHODS We performed a cross-sectional analysis using the CDC repository. We queried death certificates to find ALD-related deaths from 1999 to 2020, which included demographic information such as gender, race/ethnicity, and area of residence. We estimated age-adjusted mortality rates (AAMR) per 100,000 population and compared the AAMRs across border and non-border regions. We also explored yearly mortality shifts using log-linear regression models and calculated the average annual percentage change (AAPC) using the Monte Carlo permutation test. RESULTS In all, 11,779 ALD-related deaths were identified in border regions (AAMR 7.29) compared with 361,523 in non-border regions (AAMR 5.03). Border male (AAMR 11.21) and female (AAMR 3.77) populations were higher compared with non-border male (AAMR 7.42) and female (2.85) populations, respectively. Border non-Hispanic populations (AAMR 7.53) had higher mortality compared with non-border non-Hispanic populations (4.79), while both populations experienced increasing mortality shifts (AAPC +1.7, P<0.001 and +3.1, P<0.001, respectively). Border metropolitan (AAMR 7.35) and non-metropolitan (AAMR 6.76) regions had higher mortality rates compared with non-border metropolitan (AAMR 4.96) and non-metropolitan (AAMR 5.44) regions. CONCLUSIONS Mortality related to ALD was higher in border regions compared with non-border regions. Border regions face significant health disparities when comparing ALD-related mortality.
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Affiliation(s)
- Akira Folk
- Department of Medicine, University of Arizona-Tucson, Tucson
| | - Rama Mouhaffel
- Department of Medicine, University of Arizona-Tucson, Tucson
| | - Harneet Grewal
- Department of Medicine, Abrazo Health Network, Glendale, AZ
| | - Sangkyu Noh
- Department of Medicine, University of Arizona-Tucson, Tucson
| | - Elise Le Cam
- Department of Medicine, University of Arizona-Tucson, Tucson
| | - Franklin Liu
- Department of Medicine, University of Arizona-Tucson, Tucson
| | - Sabrina Ho
- Department of Medicine, University of Arizona-Tucson, Tucson
| | | | | | - Hoang Nhat Pham
- Department of Medicine, University of Arizona-Tucson, Tucson
| | | | - Ramzi Ibrahim
- Department of Medicine, University of Arizona-Tucson, Tucson
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GIRTAIN KATELYN, SHAH SURAL, MONTERREY ANAC, GUTIERREZ JRAUL, KUCZEWSKI MARK, LINTON JULIEM. Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children. Milbank Q 2023; 101:1009-1032. [PMID: 37494705 PMCID: PMC10726766 DOI: 10.1111/1468-0009.12665] [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: 02/13/2023] [Revised: 05/31/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Policy Points Models for access to care for uninsured immigrant children that mitigate structural and sociopolitical barriers to inclusive health care include funding structures (e.g., state-sponsored coverage) and care delivery systems (e.g., federally qualified health centers,). Although the quintessential model of access to care necessitates health coverage for all children regardless of immigration status or date of United States entry, incremental policy change may more realistically and efficiently advance equitable access to high-quality health care. Intentional advocacy efforts should prioritize achievable goals that are grounded in data, are attentive to the sociopolitical milieu, are inclusive of diverse perspectives, and would meaningfully impact health care access and outcomes.
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Affiliation(s)
| | - SURAL SHAH
- Olive ViewUCLA Medical Center
- Division of Internal Medicine‐PediatricsDavid Geffen School of MedicineUCLA
| | | | | | | | - JULIE M. LINTON
- University of South Carolina School of Medicine Greenville
- Prisma Health Children's Hospital Upstate
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Sanchez MC, Nyarko D, Mulji J, Džunić A, Surti M, Mangat A, Mainali D, Spitzer DL. Health Care for All: Undocumented Migrants and the COVID-19 Pandemic in Alberta, Canada-A Scoping Review. J Migr Health 2023; 7:100192. [PMID: 37317684 PMCID: PMC10249367 DOI: 10.1016/j.jmh.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Marian C Sanchez
- School of Public Health, University of Alberta, ECHA 3-300, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada
| | | | - Jenna Mulji
- School of Public Health, University of Alberta
| | - Anja Džunić
- School of Public Health, University of Alberta
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Marfo EA, Fernandez-Sanchez H, Annor BOH. Challenges of undocumented immigrants in Canada and the USA during the COVID-19 pandemic: a review. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2022. [DOI: 10.1108/ijmhsc-07-2020-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Purpose
Pandemics pose challenges to all groups of people and all aspects of human lives. Undocumented migrants are likely to face more challenges during global pandemics. The purpose of this paper is to explore the possible challenges of undocumented immigrants in Canada and the USA in the ongoing COVID-19 pandemic.
Design/methodology/approach
From existing literature, the authors examined the challenges of undocumented migrants in Canada and the USA and suggested recommendations to address those challenges at both policy and national levels.
Findings
The undocumented status of some international immigrants makes them vulnerable in their host nations. They face myriad challenges in their host countries, spanning from economic, health, social isolation and employment challenges, and these are further exacerbated during pandemics such as the ongoing COVID-19. The provision of culturally sensitive and safe policies may support this particular population, especially in times of crisis like the COVID-19 pandemic.
Originality/value
This paper provides critical insights into the possible intersections that worsen the vulnerability of undocumented migrants in pandemic crises like COVID-19. Further, this review serves to initiate the discourse on policy and interventions for undocumented immigrants during pandemics or disease outbreaks.
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7
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Madimenos FC, Gildner TE, Eick GN, Sugiyama LS, Snodgrass JJ. Bringing the lab bench to the field: Point-of-care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource-limited contexts. Am J Hum Biol 2022; 34:e23808. [PMID: 36166487 DOI: 10.1002/ajhb.23808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Point-of-care testing (POCT) allows researchers and health-care providers to bring the lab bench to the field, providing essential health information that can be leveraged to improve health care, accessibility, and understanding across clinical and research settings. Gaps in health service access are most pronounced in what we term RIR settings-rural/remote regions, involving Indigenous peoples, and/or within resource-limited settings. In these contexts, morbidity and mortality from infectious and non-communicable diseases are disproportionately higher due to numerous geographic, economic, political, and sociohistorical factors. Human biologists and global health scholars are well-positioned to contribute on-the-ground-level insights that can serve to minimize global health inequities and POCT has the potential to augment such approaches. While the clinical benefits of POCT include increasing health service access by bringing testing, rapid diagnosis, and treatment to underserved communities with limited pathways to centralized laboratory testing, POCT also provides added benefits to both health-focused researchers and their participants. Through portable, minimally invasive devices, researchers can provide actionable health data to participants by coupling POCT with population-specific health education, discussing results and their implications, creating space for participants to voice concerns, and facilitating linkages to treatment. POCT can also strengthen human biology research by shedding light on questions of evolutionary and biocultural importance. Here, we expand on the epidemiological and research value, as well as practical and ethical challenges of POCT across stakeholders (i.e., participant, community, health researcher, and trainee). Finally, we emphasize the immense opportunities of POCT for fostering collaborative research and enhancing access to health delivery and information and, by extension, helping to mitigate persistent global health inequities.
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Affiliation(s)
- Felicia C Madimenos
- Department of Anthropology, Queens College (CUNY), New York, USA.,New York Consortium of Evolutionary Primatology (NYCEP), CUNY Graduate Center, New York, USA
| | - Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | | | - James J Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA.,Global Station for Indigenous Studies and Cultural Diversity, Hokkaido University, Sapporo, Japan
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8
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Venturi C, Guízar-Sánchez D, Ramos-Tovar ME, Torres M, Avellaneda FD, Torres-Hostos LR, Matuk-Villazon O. Health Through a Human Right Lens at the US-Mexico Border: Increasing Access to Healthcare for Central American Immigrants. Front Public Health 2022; 10:858402. [PMID: 35903375 PMCID: PMC9315280 DOI: 10.3389/fpubh.2022.858402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
The number of immigrants seeking entry into the U.S. through asylum requests or through irregular means is increasing, and most come from the Northern Triangle of El Salvador, Guatemala, and Honduras. Immigrants come fleeing extreme poverty, violence, health and social inequities, and drastic climate changes. Most had limited access to healthcare at home, and even more limited care along the journey. Those that are allowed entry into the U.S., are confronted with feeling unwelcome in many communities, having to navigate an array of local, state, and federal laws that regulate access to healthcare. We need immigration policies that preserve the health, dignity with a multinational policy for provision of healthcare through a human rights lens from point of origin to point of destination.
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Affiliation(s)
- Carolina Venturi
- College of Medicine, University of Houston, Houston, OH, United States
| | - Diana Guízar-Sánchez
- Physiology Department, Faculty of Medicine, Universidad Nacional Autónoma de México, México City, Mexico
| | - María Elena Ramos-Tovar
- Sistema Nacional de Investigadores, Nivel SNI II, Facultad de Trabajo Social y Desarrollo Humano, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | | | | | - Luis R. Torres-Hostos
- School of Social Work, The University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Omar Matuk-Villazon
- College of Medicine, University of Houston, Houston, OH, United States
- *Correspondence: Omar Matuk-Villazon
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Hassanin S, Kshirsagar RS, Steele TO, Liang J. A Geospatial Analysis of the Rhinologist Workforce in the United States. Am J Rhinol Allergy 2022; 36:459-464. [PMID: 35098735 DOI: 10.1177/19458924221075887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Six percent of practicing otolaryngologists identified by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) are rhinologists. This is the first study to investigate both the distribution of rhinologists in the United States and the sociodemographic characteristics that may predict their practice locations. OBJECTIVE We aim to describe the geospatial distribution of the rhinology workforce and analyze sociodemographic characteristics associated with practice distribution. METHODS We conducted a cross-sectional study of 662 rhinologists queried from the 2020 American Rhinologic Society (ARS) database. Rhinologist practice addresses were compared with ZIP code tabulation area (ZCTA) sociodemographic data from the 2010 US Census Bureau and from the 2014 to 2018 American Community Surveys. Geospatial mapping and multivariate statistics were employed to visualize rhinologist practice locations and analyze which community characteristics were associated with greater densities of rhinologists in ZCTAs. RESULTS The largest and smallest densities of rhinologists were in coastal areas and in the Central and Midwestern US, respectively. Population characteristics that significantly predicted a higher number of practicing rhinologists included: greater percentage of non-citizens and greater educational attainment (p < 0.001). Population characteristics that significantly predicted a lower number of practicing rhinologists included: greater percentage of self-identified white/Caucasians, median household income, and greater percentage of population aged 65 or older (p < 0.001). CONCLUSION Disparities in healthcare access in the US is evident and applies to rhinologic subspecialty care. Through visual geospatial analysis, we demonstrate the distribution of rhinologists and the population characteristics that may be predictive of whether patients have access to rhinological care.
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Affiliation(s)
- Samir Hassanin
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Rijul S Kshirsagar
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Jonathan Liang
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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10
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Morrone A, Buonomini AR, Sannella A, Pimpinelli F, Rotulo A. Unequal Access to Testing and Vaccination Services for the Homeless and Undocumented Population During COVID-19 Pandemic. Int J Public Health 2022; 67:1604851. [PMID: 35774355 PMCID: PMC9237209 DOI: 10.3389/ijph.2022.1604851] [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: 02/18/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: To furnish a model to ensure access and use of healthcare services to the undocumented and homeless population. Methods: Between March 2020 and October 2021, public and third sector actors in Rome implemented an accessible COVID-19 screening service and vaccination program targeting the homeless and undocumented population. Results: 95.6% of the patients tested negative to both rapid and molecular tests. 0.9% tested positive to both. 0.7% were false negatives, while 2.8% were false positives. None of the participants refused the diagnostic treatment. From July to October 2021, 1384 people received a complete cycle of the COVID-19 vaccine through the program. 632 (45.6%) also agreed to perform the antibodies testing before inoculation. 318 (50.31%) of these were positive at the time of vaccination. Conclusion: We present a cost-effective model for reducing structural barriers to access diagnostic and preventive services for the homeless and undocumented population that can be applied to different public health settings.
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Affiliation(s)
- Aldo Morrone
- San Gallicano Dermatological Institute, Hospital Physiotherapy Institutes (IRCCS), Rome, Italy
| | - Anna Rita Buonomini
- San Gallicano Dermatological Institute, Hospital Physiotherapy Institutes (IRCCS), Rome, Italy
| | - Alessandra Sannella
- Human, Social, and Health Sciences Department, University of Cassino, Cassino, Italy
| | - Fulvia Pimpinelli
- San Gallicano Dermatological Institute, Hospital Physiotherapy Institutes (IRCCS), Rome, Italy
| | - Arianna Rotulo
- Wolfson Institute of Population Health, School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Department of Sustainable Health, Campus Fryslan, University of Groningen, Groningen, Netherlands
- *Correspondence: Arianna Rotulo,
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11
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Modeste-James A, Huggins C. Barriers to healthcare for Venezuelan migrants: physicians' perspective. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2022. [DOI: 10.1108/ijhg-08-2021-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeIncreased migration to small island developing states poses major challenges on receiving countries' healthcare systems. Due to public health policy on treating migrants in Trinidad and Tobago, Venezuelan migrants are experiencing less than optimal care. This paper examines the retrospective accounts of physicians treating Venezuelan migrants with limited access to healthcare.Design/methodology/approachTen in depth, semi-structured interviews were conducted with physicians working in primary healthcare and emergency departments about their clinical decision-making process in providing care for Venezuelan migrants. A narrative approach was used to highlight the personal experiences of participants. Participants were recruited by their response to an online advertisement on social media (i.e. Facebook and Instagram) and via email invitations. Interviews were transcribed verbatim and coded using NVIVO-12 software.FindingsFindings revealed language barriers between Venezuelan migrants and Trinidad and Tobago-based physicians hindered providing optimal care coordination. Physicians indicated the use of a translator app to bridge the service gap but questioned their ethics. Participants noted tensions between junior and senior physicians regarding referrals of Venezuelan migrants to outpatient care. The data suggests physicians' felt constrained providing additional services such as primary care due to the Provision of Public Healthcare Services Policy which forbids primary care services to migrants.Originality/valueSparse research on the barriers to accessing healthcare for Venezuelan migrants residing in the small island states.
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12
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Li J, Wells J, Yang C, Wang X, Lin Y, Lyu Y, Li Y. A Novel Application of Non-Negative Matrix Factorization to the Prediction of the Health Status of Undocumented Immigrants. Health Equity 2022; 5:834-839. [PMID: 35018316 PMCID: PMC8742291 DOI: 10.1089/heq.2021.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Undocumented immigrants (UIs) in the United States are less likely to be able to afford health insurance. As a result, UIs often lack family doctors and are rarely involved in annual screening programs, which makes estimating their health status remarkably challenging. This is especially true if the laboratory results from limited screening programs fail to provide sufficient clinical information. Methods: To address this issue, we have developed a machine learning model based on the non-negative matrix factorization technique. The data set we used for model training and testing was obtained from the 2004 cost-free hepatitis B screening program at the Omni Health Center located in Plano, Texas. Total 300 people were involved, with 199 identified as UIs. Results: People in the UIs group have higher cholesterol (219.6 mg/dL, p=0.038) and triglycerides (173.2 mg/dL, p=0.03) level. They also have a lower hepatitis B vaccination rate (38%, p=0.0247). No significant difference in hepatitis B(+) was found (p=0.8823). Using 16 individual clinical measurements as training features, our newly developed model has a 67.56% accuracy in predicting the ratio of cholesterol to high-density lipoprotein; in addition, this newly developed model performs 9.1% better than a comparable multiclass logistic regression model. Conclusions: Elderly UIs have poorer health status compared with permanent residents and citizens in the United States. Our newly developed machine learning model demonstrates a powerful support tool for designing health intervention programs that target UIs in the United States.
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Affiliation(s)
- Jason Li
- Austin College, Sherman, Texas, USA
| | - James Wells
- Department of Physiology, Tulane University, New Orleans, Louisiana, USA
| | - Chenli Yang
- Kunming Children's Hospital, Kunming, Yunnan, China
| | - Xiaodan Wang
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Yihan Lin
- HKU-Pasteur Research Pole, Hong Kong, China
| | - You Lyu
- Omni Medical Center, Plano, Texas, USA
| | - Yan Li
- Omni Medical Center, Plano, Texas, USA
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13
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Kronenfeld JP, Goel N. An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1209-1219. [PMID: 34611524 PMCID: PMC8487287 DOI: 10.2147/jhc.s284430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and affects patients of all genders, races, ethnicities, and socioeconomic status. While the causes of HCC are numerous, the primary etiology is cirrhosis from alcohol and non-alcoholic fatty liver disease in the United States and from infectious agents such as Hepatitis B and Hepatitis C in the developing world. In patients at-risk for developing HCC, screening is recommended with ultrasound imaging and alpha fetoprotein laboratory tests. In socioeconomically vulnerable patients, however, individual-level barriers (eg, insurance status) and contextual-level disparities (eg, health facilities) may not be readily available, thus limiting screening. Additional challenges faced by racial/ethnic minorities can further challenge the spectrum of HCC care and lead to inadequate screening, delayed diagnosis, and unequal access to treatment. Efforts to improve these multilevel factors that lead to screening and treatment disparities are critical to overcoming challenges. Providing health insurance to those without access, improving societal challenges that confine patients to a lower socioeconomic status, and reducing challenges to seeking healthcare can decrease the morbidity and mortality of these patients. Additionally, engaging with communities and allowing them to collaborate in their own healthcare can also help to attenuate these inequities. Through collaborative multidisciplinary change, we can make progress in tackling disparities in vulnerable populations to achieve health equity
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Affiliation(s)
- Joshua P Kronenfeld
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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14
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021; 26:443-452. [PMID: 33594785 DOI: 10.1002/onco.13729] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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15
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021. [PMID: 33594785 DOI: 10.1002/onco.13729.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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Kostareva U, Albright CL, Berens EM, Levin-Zamir D, Aringazina A, Lopatina M, Ivanov LL, Sentell TL. International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2155. [PMID: 32213891 PMCID: PMC7142703 DOI: 10.3390/ijerph17062155] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022]
Abstract
Among the world's 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants' health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants' health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants' health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants' health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.
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Affiliation(s)
- Uliana Kostareva
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA;
| | - Cheryl L. Albright
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA;
| | - Eva-Maria Berens
- Interdisciplinary Center for Health Literacy Research, Bielefeld University, 33699 Bielefeld, Germany;
| | - Diane Levin-Zamir
- Department of Health Education and Promotion, Clalit Health Services, School of Public Health, University of Haifa, Haifa 31000, Israel;
| | - Altyn Aringazina
- Kazakhstan School of Public Health, Medical University, Almaty 050000, Kazakhstan;
| | - Maria Lopatina
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, 101000 Moscow, Russia;
| | - Luba L. Ivanov
- Chamberlain College of Nursing, Chamberlain University, Downers Grove, 60515 IL, USA;
| | - Tetine L. Sentell
- Office of Public Health Studies, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA;
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