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Gangopadhyaya A, Dubay L, Johnston E, Pancini V. How structural racism, neighborhood deprivation, and maternal characteristics contribute to inequities in birth outcomes. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae092. [PMID: 39099704 PMCID: PMC11296672 DOI: 10.1093/haschl/qxae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/08/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
Decades of disparities in health between infants born to Black and White mothers have persisted in recent years, despite policy initiatives to improve maternal and reproductive health for Black mothers. Although scholars have increasingly recognized the critical role that structural racism plays in driving health outcomes for Black people, measurement of this relationship remains challenging. This study examines trends in preterm birth and low birth weight between 2007 and 2018 separately for births to Black and White mothers. Using a multivariate regression model, we evaluated potential factors, including an index of racialized disadvantage as well as community- and individual-level factors that serve as proxy measures for structural racism, that may contribute to White-Black differences in infant health. Finally, we assessed whether unequal effects of these factors may explain differences in birth outcomes. We found that differences in the effects of these factors appear to explain about half of the underlying disparity in infant health.
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Affiliation(s)
- Anuj Gangopadhyaya
- Department of Economics, Quinlan School of Business, Loyola University, Chicago, IL 60611United States
| | - Lisa Dubay
- The Urban Institute, Health Policy Center, Washington, DC 20034, United States
| | - Emily Johnston
- The Urban Institute, Health Policy Center, Washington, DC 20034, United States
| | - Vincent Pancini
- The Urban Institute, Health Policy Center, Washington, DC 20034, United States
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Hsia RY, Shen YC. Structural Inequities In The Adoption Of Percutaneous Coronary Intervention Services By US Hospitals, 2000-20. Health Aff (Millwood) 2024; 43:1011-1020. [PMID: 38950302 PMCID: PMC11293955 DOI: 10.1377/hlthaff.2023.01649] [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] [Indexed: 07/03/2024]
Abstract
Percutaneous coronary intervention (PCI) is a procedure that opens blocked arteries and restores blood flow to the heart. Timely access to hospitals offering PCI services can be a matter of life or death for patients experiencing a heart attack; however, hospitals' adoption of PCI services may vary between communities, posing potential barriers to critical care. Our cohort study of US general acute hospitals during the period 2000-20 examined PCI service adoption across communities stratified by race, ethnicity, income, and rurality and further classified as segregated or integrated. Of 5,260 hospitals, 1,621 offered PCI services in 2020 or before, 630 added PCI services between 2001 and 2010, and 225 added PCI services between 2011 and 2020. Hospitals serving Black, racially segregated communities were 48 percent less likely to adopt PCI services compared with hospitals serving non-Black, racially segregated communities, and hospitals serving Hispanic, ethnically segregated communities were 41 percent less likely to do so than those serving non-Hispanic, ethnically segregated communities. Hospitals in high-income, economically integrated communities were 1.8 times more likely to adopt PCI services than those in high-income, economically segregated communities, and rural hospitals were less likely to do so than urban hospitals. Understanding where services are expanding in relation to community need may aid in successful policy interventions.
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Affiliation(s)
- Renee Y Hsia
- Renee Y. Hsia , University of California San Francisco, San Francisco, California
| | - Yu-Chu Shen
- Yu-Chu Shen, Naval Postgraduate School, Monterey, California; and National Bureau of Economic Research, Cambridge, Massachusetts
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Kim H, Mahmood A, Kedia S, Ogunsanmi DO, Sharma S, Wyant DK. Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02018-9. [PMID: 38758399 DOI: 10.1007/s40615-024-02018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/10/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.
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Affiliation(s)
- Hyunmin Kim
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Deborah O Ogunsanmi
- Tennessee Population Health Consortium and Institute for Health Outcomes and Policy Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sadikshya Sharma
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - David K Wyant
- Jack C. Massey College of Business, Frist College of Medicine, Belmont University, Nashville, TN, USA
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Kabangu JLK, Fry L, Bhargav AG, De Stefano FA, Bah MG, Hernandez A, Rouse AG, Peterson J, Ebersole K, Camarata PJ, Eden SV. Association of geographical disparities and segregation in regional treatment facilities for Black patients with aneurysmal subarachnoid hemorrhage in the United States. Front Public Health 2024; 12:1341212. [PMID: 38799679 PMCID: PMC11121994 DOI: 10.3389/fpubh.2024.1341212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 05/29/2024] Open
Abstract
Background and objectives This study investigates geographic disparities in aneurysmal subarachnoid hemorrhage (aSAH) care for Black patients and aims to explore the association with segregation in treatment facilities. Understanding these dynamics can guide efforts to improve healthcare outcomes for marginalized populations. Methods This cohort study evaluated regional differences in segregation for Black patients with aSAH and the association with geographic variations in disparities from 2016 to 2020. The National Inpatient Sample (NIS) database was queried for admission data on aSAH. Black patients were compared to White patients. Segregation in treatment facilities was calculated using the dissimilarity (D) index. Using multivariable logistic regression models, the regional disparities in aSAH treatment, functional outcomes, mortality, and end-of-life care between Black and White patients and the association of geographical segregation in treatment facilities was assessed. Results 142,285 Black and White patients were diagnosed with aSAH from 2016 to 2020. The Pacific division (D index = 0.55) had the greatest degree of segregation in treatment facilities, while the South Atlantic (D index = 0.39) had the lowest. Compared to lower segregation, regions with higher levels of segregation (global F test p < 0.001) were associated a lower likelihood of mortality (OR 0.91, 95% CI 0.82-1.00, p = 0.044 vs. OR 0.75, 95% CI 0.68-0.83, p < 0. 001) (p = 0.049), greater likelihood of tracheostomy tube placement (OR 1.45, 95% CI 1.22-1.73, p < 0.001 vs. OR 1.87, 95% CI 1.59-2.21, p < 0.001) (p < 0. 001), and lower likelihood of receiving palliative care (OR 0.88, 95% CI 0.76-0.93, p < 0.001 vs. OR 0.67, 95% CI 0.59-0.77, p < 0.001) (p = 0.029). Conclusion This study demonstrates regional differences in disparities for Black patients with aSAH, particularly in end-of-life care, with varying levels of segregation in regional treatment facilities playing an associated role. The findings underscore the need for targeted interventions and policy changes to address systemic healthcare inequities, reduce segregation, and ensure equitable access to high-quality care for all patients.
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Affiliation(s)
- Jean-Luc K. Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Adip G. Bhargav
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Frank A. De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Momodou G. Bah
- Michigan State University College of Human Medicine, East Lansing, MI, United States
| | - Amanda Hernandez
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Adam G. Rouse
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Paul J. Camarata
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sonia V. Eden
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN, United States
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
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Sasser J, Doane LD, Su J, Grimm KJ. Stress and diurnal cortisol among Latino/a college students: A multi-risk model approach. Dev Psychopathol 2024; 36:719-735. [PMID: 36734230 DOI: 10.1017/s0954579423000019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The transition to college is a time of increased opportunity and stress spanning multiple domains. Adolescents who encounter significant stress during this transition may be vulnerable to adverse outcomes due to a "wear and tear" of the hypothalamic pituitary adrenal (HPA) axis. Latino/a students may be particularly at-risk for heightened stress exposure due to experiences of both minority-specific and general life stress. Despite this, little is known regarding the cumulative impact of multiple stressors on Latino/a students' HPA axis functioning. The present study employed a "multi-risk model" approach to examine additive, common, and cumulative effects of multiple stress forms (general, academic, social, financial, bicultural, ethnic/racial discrimination) on diurnal cortisol in a sample of first-year Latino/a college students (N = 196; 64.4% female; Mage = 18.95). Results indicated that no stress forms were additively associated with the cortisol awakening response (CAR), but general stress was associated with a flatter diurnal cortisol slope (DCS) and bicultural stress was linked with a steeper DCS. A college stress latent factor was associated with a lower CAR, whereas a latent factor of discrimination was not associated with diurnal cortisol. Cumulative risk was linked with a lower CAR. Findings highlight the physiological correlates of various stressors experienced by Latino/a college students.
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Affiliation(s)
- Jeri Sasser
- Arizona State University, Department of Psychology, Tempe, AZ, USA
| | - Leah D Doane
- Arizona State University, Department of Psychology, Tempe, AZ, USA
| | - Jinni Su
- Arizona State University, Department of Psychology, Tempe, AZ, USA
| | - Kevin J Grimm
- Arizona State University, Department of Psychology, Tempe, AZ, USA
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Bedford S, Vachuska K. Assessing interstate racial and socioeconomic disparities in newborn screening policies in the United States. Front Public Health 2024; 12:1310516. [PMID: 38741907 PMCID: PMC11089229 DOI: 10.3389/fpubh.2024.1310516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction This paper explores racial and socioeconomic disparities in newborn screening (NBS) policies across the United States. While inter-state inequality in healthcare policies is often considered a meaningful source of systemic inequity in healthcare outcomes, to the best of our knowledge, no research has explored racial and socioeconomic disparities in newborn screening policies based on state of residence. Methods We investigate these disparities by calculating weighted average exposure to specific NBS tests by racial and socioeconomic group. We additionally estimate count models of the number (and type) of NBS conditions screened for by state racial and socioeconomic composition. Results Adding to the knowledge base that social determinants of health and health disparities are linked, our analysis surprisingly reveals little evidence of substantial inter-state inequity in newborn screenings along racial and socioeconomic lines. Discussion While there is substantial nationwide racial and socioeconomic inequity in terms of infant health, the distribution of state-level policies does not appear to be structured in a manner to be a driver of these disparities. Our findings suggest that efforts to reduce inequities in outcomes related to NBS should shift focus toward the delivery of screening results and follow-up care as discussion builds on expanding NBS to include more conditions and genomic testing.
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Affiliation(s)
| | - Karl Vachuska
- School of Medicine and Public Health and Department of Sociology, University of Wisconsin-Madison, Madison, WI, United States
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Daniel EV, Wiese LAK, Holt JK. Assessing Alzheimer's Disease Knowledge and Cognitive Risk Among a Rural Older Afro-Caribbean Cohort. J Community Health Nurs 2024; 41:1-10. [PMID: 37705286 PMCID: PMC10841183 DOI: 10.1080/07370016.2023.2257199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE Older, rural Afro-Caribbeans are a growing subset of the Black population who face increased risk for Alzheimer's disease and related dementias (ADRD), but research targeting ADRD is scarce in this group. The purpose of this study was to investigate dementia risk among older Afro-Caribbeans living in a rural area. We also examined age, sex, and years of education, and knowledge about Alzheimer's disease as potential predictors of dementia risk. DESIGN A pre-post, correlational design was employed. METHODS Cognitive screenings were conducted using Nasreddine's Mini-MoCA, with tests of language fluency/orientation/recall, and linear regression analysis. A basic knowledge of Alzheimer's disease survey (BKAD) was also administered. FINDINGS A total of 55 Afro-Caribbean participants (67.0 +10.8y (M ± SD), 65.5% with 10y or less of education residing in a rural area within the last 20 years were included.Over 50% of the convenience sample scored in the cognitive risk range. Significant associations were found between Mini-MoCA Total and Language scores and education (p < 0.01). Further, there was a significant change from pretest to posttest in BKAD scores. BKAD pretest and posttest scores were also significantly higher for those without dementia risk based on the Mini-MoCA Total. CONCLUSION While the Mini-MoCA showed good reliability in less-educated older Afro-Caribbeans, scores were strongly dependent on years of education. Offering a limited intervention resulted in increased BKAD scores in this Afro-Caribbean sample, and a low BKAD score was associated with a higher dementia risk category. CLINICAL EVIDENCE This study contributes to the limited but growing body of research about Alzheimer's disease knowledge, cognitive risk, and dementia detection among Afro-Caribbeans. The use of language-neutral cognitive assessments is recommended among rural older immigrants.
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Affiliation(s)
- E Valerie Daniel
- Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, Florida, USA
| | - Lisa Ann Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Janet K Holt
- Academic Researcher, Southern Illinois University Edwardsville, C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Baxter SLK, Zare H, Thorpe RJ. Race Disparities in Hypertension Prevalence Among Older Men. Int J Aging Hum Dev 2024; 98:10-26. [PMID: 37150878 DOI: 10.1177/00914150231172119] [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] [Indexed: 05/09/2023]
Abstract
This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR = 1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.
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Affiliation(s)
- Samuel L K Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Business, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD, USA
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Anderson KF, Wolski C. Racial/Ethnic Residential Segregation, Neighborhood Health Care Provision, and Choice of Pediatric Health Care Provider Across the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01766-4. [PMID: 37624536 DOI: 10.1007/s40615-023-01766-4] [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: 06/12/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Much research has been conducted that demonstrates a link between racial/ethnic residential segregation and health care outcomes. We suggest that minority segregated neighborhoods may have diminished access to organizations and that this differential access may contribute to differences in health care outcomes across communities. We analyze this specifically using the case of pediatric health care provider choice. To examine this association, we estimate a series of multinomial logistic regression models using restricted data with ZIP code level geoidentifiers from the 2011-2012 National Survey of Children's Health (NSCH). We find that racial/ethnic residential segregation is related to a greater reliance on non-ideal forms of health care, such as clinics, and hospital outpatient departments, instead of pediatric physician's offices. This association is at least partially attenuated by the distribution of health care facilities in the local area, physician's offices, and health care practitioners in particular. Additionally, families express greater dissatisfaction with these other forms of care compared to physician's offices, demonstrating that the lack of adequate health care provision is meaningful for health care outcomes. This study expands the literature by examining how the siting of health organizations has consequences for individuals residing within these areas.
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Affiliation(s)
- Kathryn Freeman Anderson
- Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA.
| | - Caroline Wolski
- Department of Sociology, University of Houston, 3551 Cullen Blvd, PGH Building, Room 450, Houston, TX, 77204-3012, USA
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Hicks PM, Niziol LM, Newman-Casey PA, Salami K, Singh K, Woodward MA. Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis. JAMA Ophthalmol 2023; 141:727-734. [PMID: 37318786 PMCID: PMC10273131 DOI: 10.1001/jamaophthalmol.2023.2415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Importance Neighborhood-level social risk factors may contribute to health disparities in microbial keratitis (MK) disease presentation. Understanding neighborhood-level factors may identify areas for revised health policies to address inequities that impact eye health. Objective To investigate if social risk factors were associated with presenting best-corrected visual acuity (BCVA) for patients with MK. Design, Setting, and Participants This was a cross-sectional study of patients with a diagnosis of MK. Patients presenting to the University of Michigan with a diagnosis of MK between August 1, 2012, and February 28, 2021, were included in the study. Patient data were obtained from the University of Michigan electronic health record. Main Outcomes and Measures Individual-level characteristics (age, self-reported sex, self-reported race and ethnicity), presenting log of the minimum angle of resolution (logMAR) BCVA, and neighborhood-level factors, including measures on deprivation, inequity, housing burden, and transportation at the census block group, were obtained. Univariate associations of presenting BCVA (< 20/40 vs ≥20/40) with individual-level characteristics were assessed with 2-sample t, Wilcoxon, and χ2 tests. Logistic regression was used to test associations of neighborhood-level characteristics with the probability of presenting BCVA worse than 20/40 after adjustment for patient demographics. Results A total of 2990 patients with MK were identified and included in the study. Patients had a mean (SD) age of 48.6 (21.3) years, and 1723 were female (57.6%). Patients self-identified with the following race and ethnicity categories: 132 Asian (4.5%), 228 Black (7.8%), 99 Hispanic (3.5%), 2763 non-Hispanic (96.5%), 2463 White (84.4%), and 95 other (3.3%; included any race not previously listed). Presenting BCVA had a median (IQR) value of 0.40 (0.10-1.48) logMAR units (Snellen equivalent, 20/50 [20/25-20/600]), and 1508 of 2798 patients (53.9%) presented with BCVA worse than 20/40. Patients presenting with logMAR BCVA less than 20/40 were older than those who presented with 20/40 or higher (mean difference, 14.7 years; 95% CI, 13.3-16.1; P < .001). Furthermore, a larger percentage of male vs female sex patients presented with logMAR BCVA less than 20/40 (difference, 5.2%; 95% CI, 1.5-8.9; P = .04), as well as Black race (difference, 25.7%; 95% CI, 15.0%-36.5%;P < .001) and White race (difference, 22.6%; 95% CI, 13.9%-31.3%; P < .001) vs Asian race, and non-Hispanic vs Hispanic ethnicity (difference, 14.6%; 95% CI, 4.5%-24.8%; P = .04). After adjusting for age, self-reported sex, and self-reported race and ethnicity, worse Area Deprivation Index (odds ratio [OR], 1.30 per 10-unit increase; 95% CI, 1.25-1.35; P < .001), increased segregation (OR, 1.44 per 0.1-unit increase in Theil H index; 95% CI, 1.30-1.61; P < .001), higher percentage of households with no car (OR, 1.25 per 1 percentage point increase; 95% CI, 1.12-1.40; P = .001), and lower average number of cars per household (OR, 1.56 per 1 less car; 95% CI, 1.21-2.02; P = .003) were associated with increased odds of presenting BCVA worse than 20/40. Conclusion and Relevance Findings of this cross-sectional study suggest that in a sample of patients with MK, patient characteristics and where they live were associated with disease severity at presentation. These findings may inform future research on social risk factors and patients with MK.
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Affiliation(s)
- Patrice M. Hicks
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Leslie M. Niziol
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Kassim Salami
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Karandeep Singh
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Maria A. Woodward
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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MacKinnon NJ, Emery V, Waller J, Ange B, Ambade P, Gunja M, Watson E. Mapping Health Disparities in 11 High-Income Nations. JAMA Netw Open 2023; 6:e2322310. [PMID: 37418259 PMCID: PMC10329207 DOI: 10.1001/jamanetworkopen.2023.22310] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/21/2023] [Indexed: 07/08/2023] Open
Abstract
Importance Health care delivery faces a myriad of challenges globally with well-documented health inequities based on geographic location. Yet, researchers and policy makers have a limited understanding of the frequency of geographic health disparities. Objective To describe geographic health disparities in 11 high-income countries. Design, Setting, and Participants In this survey study, we analyzed results from the 2020 Commonwealth Fund International Health Policy (IHP) Survey-a nationally representative, self-reported, and cross-sectional survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US. Eligible adults older than age 18 years were included by random sampling. Survey data were compared for the association of area type (rural or urban) with 10 health indicators across 3 domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individuals' age and sex. Main Outcomes and Measures The main outcomes were geographic health disparities as measured by differences in respondents living in urban and rural settings in 10 health indicators across 3 domains. Results There were 22 402 survey respondents (12 804 female [57.2%]), with a 14% to 49% response rate depending on the country. Across the 11 countries and 10 health indicators and 3 domains (health status and socioeconomic risk factors, affordability of care, access to care), there were 21 occurrences of geographic health disparities; 13 of those in which rural residence was a protective factor and 8 of those where rural residence was a risk factor. The mean (SD) number of geographic health disparities in the countries was 1.9 (1.7). The US had statistically significant geographic health disparities in 5 of 10 indicators, the most of any country, while Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. The indicators with the most occurrences of geographic health disparities were in the access to care domain. Conclusions and Relevance In this survey study of 11 high-income nations, health disparities across 10 indicators were identified. Differences in number of disparities reported by country suggest that health policy and decision makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.
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Affiliation(s)
- Neil J. MacKinnon
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Vanessa Emery
- Office of the Provost and Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Jennifer Waller
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Brittany Ange
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Preshit Ambade
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Munira Gunja
- International Program in Health Policy and Practice Innovations, Commonwealth Fund, New York, New York
| | - Emma Watson
- National Health Service Education for Scotland, Edinburgh, Scotland
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Sevilla-Cazes J, Almarzooq ZI, Kyalwazi AN, Wang Y, Song Y, Batchelor WB, Keller VA, Strom J, Wadhera RK, Yeh RW. Residential Racial Segregation in Aortic Stenosis Diagnosis and Transcatheter Aortic Valve Implantation Among Medicare Patients. JACC. ADVANCES 2023; 2:100415. [PMID: 38939010 PMCID: PMC11198501 DOI: 10.1016/j.jacadv.2023.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/10/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2024]
Abstract
Background Transcatheter aortic valve implantation (TAVI) rates are lower among Black compared with White individuals. However, it is unclear whether racial residential segregation, which remains common in the United States, contributes to observed disparities in TAVI rates. Objectives The purpose of this study was to evaluate the association between county-level racial segregation, and aortic stenosis (AS) diagnosis, management, and outcomes. Methods We identified Black and White Medicare fee-for-service beneficiaries age ≥65 years living in metropolitan areas of the United States (2016-2019). Using the American Community Survey's Black-White residential segregation index, a measure of geographic racial distribution, we determined segregation in each beneficiary's county of residence. Using hierarchical modeling, we determined the association between racial segregation and rates of AS diagnosis, TAVI receipt, and 30-day clinical outcomes (mortality, readmission, stroke). Results There were 29,264,075 beneficiaries, of whom 22% lived in a high-segregation county. Among Black beneficiaries, high-segregation county residence was associated with decreased rates of AS diagnosis (OR: 0.97; 95% CI: 0.96-0.98) and TAVI (OR: 0.89; 95% CI: 0.86-0.93) compared with low-segregation county residence. In contrast, among White beneficiaries, high-segregation county residence was associated with higher rates of AS diagnosis (OR: 1.02; 95% CI: 1.02-1.03) and no differences in TAVI (OR: 1.00; 95% CI: 0.99-1.00). Segregation and race were not independently associated with 30-day mortality. Conclusions Among Black Medicare fee-for-service beneficiaries, living in a high-segregation county was independently associated with decreased rates of AS diagnosis and TAVI, an association not seen among White beneficiaries. Residential racial segregation may contribute to racial disparities seen in AS care.
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Affiliation(s)
- Jonathan Sevilla-Cazes
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Zaid I. Almarzooq
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Yun Wang
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Boston Deep Data, Boston, Massachusetts, USA
| | - Yang Song
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wayne B. Batchelor
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
- Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - V. Antoine Keller
- Heart and Vascular Center at Ochsner Lafayette General Hospital, Lafayette, Louisiana, USA
| | - Jordan Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rishi K. Wadhera
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W. Yeh
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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13
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Cross RI, Huỳnh J, Bradford NJ, Francis B. Racialized Housing Discrimination and Population Health: a Scoping Review and Research Agenda. J Urban Health 2023; 100:355-388. [PMID: 37058240 PMCID: PMC10103672 DOI: 10.1007/s11524-023-00725-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/15/2023]
Abstract
Racial residential segregation is considered a fundamental cause of racial health disparities, with housing discrimination as a critical driver of residential segregation. Despite this link, racial discrimination in housing is far less studied than segregation in the population health literature. As a result, we know little about how discrimination in housing is linked to health beyond its connection to segregation. Furthermore, we need to understand how health impacts differ across different types of housing discrimination. This review aims to assess the state of the population health literature on the conceptualization, measurement, and health implications of housing discrimination. We used PRISMA guidelines for scoping reviews and presented the data on 32 articles that met our inclusion criteria published before January 1, 2022. Nearly half of the articles do not define housing discrimination explicitly. Additionally, there is considerable variation in how housing discrimination is operationalized across studies. Compared to studies using administrative data for housing discrimination exposures, studies using survey data were more likely to report a detrimental association with health outcomes. Synthesizing and comparing the results of these studies helps bridge methodological approaches to this research. Our review helps inform the debate on how racism impacts population health. Given the changing nature of racial discrimination over time and place, we discuss how population health researchers can approach studying various forms of housing discrimination.
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Affiliation(s)
- Rebekah Israel Cross
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health Chapel Hill, Chapel Hill, NC, USA.
- Center for the Study of Racism, Social Justice, UCLA Fielding School of Public Health, & Health, Los Angeles, CA, USA.
| | - James Huỳnh
- Center for the Study of Racism, Social Justice, UCLA Fielding School of Public Health, & Health, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Natalie J Bradford
- Center for the Study of Racism, Social Justice, UCLA Fielding School of Public Health, & Health, Los Angeles, CA, USA
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Brittney Francis
- Center for the Study of Racism, Social Justice, UCLA Fielding School of Public Health, & Health, Los Angeles, CA, USA
- FXB Center for Health and Human Rights, Harvard University T.H. Chan School of Public Health, Cambridge, MA, USA
- Center for Population and Development Studies, Harvard University T.H. Chan School of Public Health, Cambridge, MA, USA
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14
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Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Racial and ethnic disparities in chronic disease risk in adolescence after prenatal polydrug exposure: Examination of the Hispanic paradox. J Ethn Subst Abuse 2023:1-18. [PMID: 36840527 DOI: 10.1080/15332640.2023.2181257] [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: 02/26/2023]
Abstract
Racial disparities exist in fetal development which in turn can influence growth and development of chronic disease later in life. The purpose of this study was to explore potential racial and ethnic differences in chronic disease risk factors throughout the pediatric years given prenatal exposure to substance use. Data from the Maternal Lifestyle Study cohort was used for this analysis. Urine toxicology confirmed maternal substance use (y/n) and offspring height, weight, and systolic blood pressure (SBP) data at 16 years was analyzed. Linear mixed effects modeling with an interaction term for adolescent race/ethnicity and maternal drug use assessed growth trajectories (body mass index (BMI) percentile) and cardiovascular disease risk factors (elevated SBP). Of the sample (n = 1,388 mother/infant dyads), 23% (n = 319) of mothers used three substances during pregnancy and 14% (n = 200) used four or five. Controlling for BMI, Hispanic adolescents prenatally exposed to any singular substance had 13 mmHg higher SBP at age 16 than their unexposed counterparts (95% Confidence Interval [CI]: 12.24, 14.01). Prenatal exposure to >1 substance significantly lowered SBP in Hispanic adolescents only. Results here showed that Hispanic adolescents exposed to singular substance are at higher risk of elevated SBP in adolescence, but SBP decreased when exposed to >1 substance. The Hispanic paradox may play a role; future studies should continue to explore this. Additionally, barriers to prenatal care for Hispanic women should be addressed in order to prevent substance use during pregnancy which can reduce chronic disease risk in offspring adolescence.
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Affiliation(s)
- Sitara M Weerakoon
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
| | | | | | - Denise C Vidot
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
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15
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Ardekani A, Fereidooni R, Heydari ST, Ghahramani S, Shahabi S, Bagheri Lankarani K. The association of patient-reported social determinants of health and hospitalization rate: A scoping review. Health Sci Rep 2023; 6:e1124. [PMID: 36846535 PMCID: PMC9944244 DOI: 10.1002/hsr2.1124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The interplay between social determinants of health (SDOH) and hospitalization is significant as targeted interventions can improve the social status of the individuals. This interrelation has been historically overlooked in health care. In the present study, we reviewed studies in which the association between patient-reported social risks and hospitalization rate was assessed. Method We performed a scoping literature review of articles published until September 1, 2022 without time limit. We searched PubMed, Embase, Web of Science, Scopus, and Google Scholar to find relevant studies using terms representing "social determinants of health" and "hospitalization." Forward and backward reference checking was done for the included studies. All studies that used patient-reported data as a proxy of social risks to determine the association between social risks and hospitalization rates were included. The screening and data extraction processes were done independently by two authors. In case of disagreement, senior authors were consulted. Results Our search process retrieved a total of 14,852 records. After the duplicate removal and screening process, eight studies met the eligibility criteria, all of which were published from 2020 to 2022. The sample size of the studies ranged from 226 to 56,155 participants. All eight studies investigated the impact of food security on hospitalization, and six investigated economic status. In three studies, latent class analysis was applied to divide participants based on their social risks. Seven studies found a statistically significant association between social risks and hospitalization rates. Conclusion Individuals with social risk factors are more susceptible to hospitalization. There is a need for a paradigm shift to meet these needs and reduce the number of preventable hospitalizations.
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Affiliation(s)
- Ali Ardekani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
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Racial/ethnic residential segregation and the availability of opioid and substance use treatment facilities in US counties, 2009–2019. SSM Popul Health 2022; 20:101289. [DOI: 10.1016/j.ssmph.2022.101289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022] Open
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17
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Harrison SE, Paton M, Muessig KE, Vecchio AC, Hanson LA, Hightow-Weidman LB. "Do I want PrEP or do I want a roof?": Social determinants of health and HIV prevention in the southern United States. AIDS Care 2022; 34:1435-1442. [PMID: 35109734 PMCID: PMC9343473 DOI: 10.1080/09540121.2022.2029816] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022]
Abstract
Scaling up use of Pre-Exposure Prophylaxis (PrEP) among young men who have sex with men and transgender women (YMSM/TGW) is a critical part of the Ending the HIV Epidemic plan. This qualitative study contextualized the social determinants of health (SDOH) that can impede HIV prevention in rural North and South Carolina with 14 key informant interviews with stakeholders and 3 focus groups with YMSM/TGW (N = 23). A deductive-inductive approach with multiple coders was employed to identify themes related to SDOH in rural areas, including economic challenges (e.g., housing and food insecurity), neighborhood characteristics (e.g., lack of transportation), healthcare-related issues (e.g., provider shortages) and educational barriers (e.g., lack of comprehensive and inclusive sexual education). The socio-environmental context of the rural South and prioritization of local, community-based partnerships are necessary to reduce the burden of HIV.
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Affiliation(s)
- Sayward E. Harrison
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, South Carolina
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina
| | - Mariajosé Paton
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, South Carolina
| | - Kathryn E. Muessig
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Alyssa C. Vecchio
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Lyd A. Hanson
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Lisa B. Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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18
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Mary McDaniel B, Daly P, Pacheco CL, Crist JD. Experiences With Suicide Loss: A Qualitative Study. Clin Nurs Res 2022; 31:1491-1499. [PMID: 36082419 DOI: 10.1177/10547738221119344] [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: 01/27/2023]
Abstract
To better understand suicide loss survivors' experiences and barriers to accessing support and mental health care, 28 (21 women and 7 men) suicide loss survivors were interviewed. Using qualitative analysis of 28 in-depth, semi-structured phone interviews data, three categories emerged: Life before Suicide, Life after Suicide, and Meaning of Life. This deeper understanding of suicide loss survivors along with inclusion of experiences of male and rural participants' suicide loss, fill previously identified research gaps. Our findings suggest importance in providing emotional support and mental health resources to those with suicide intent or experiences with suicide loss. Most importantly, the recognition of suicide loss survivors extends beyond the immediate family and includes cousins, friends, and work associates. Recognition of extended suicide loss survivors' bereavement will provide additional opportunities for healthcare providers to effectively intervene with this vulnerable population.
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19
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Emergency Contraception: Access and Challenges at Times of Uncertainty. Am J Ther 2022; 29:e553-e567. [PMID: 35998109 DOI: 10.1097/mjt.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. AREAS OF UNCERTAINTY Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. DATA SOURCES PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. THERAPEUTIC ADVANCES A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. CONCLUSIONS EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
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20
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Kamath CC, O’Byrne TJ, Lewallen DG, Berry DJ, Maradit Kremers H. Association of Rurality and Neighborhood Level Socioeconomic Deprivation with Perioperative Health Status in Total Joint Arthroplasty Patients: Analysis from a Large, Tertiary Care Hospital. J Arthroplasty 2022; 37:1505-1513. [PMID: 35337946 PMCID: PMC9356998 DOI: 10.1016/j.arth.2022.03.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Individual socioeconomic status (SES) is associated with disparities in access to care and worse outcomes in total joint arthroplasty (TJA). Neighborhood-level SES measures are sometimes used as a proxy for individual-level SES, but the validity of this approach is unknown. We examined neighborhood level SES and rurality on perioperative health status in TJA. METHODS The study population comprised 46,828 TJA surgeries performed at a tertiary care hospital. Community area deprivation index (ADI) was derived from the 2015 American Census Survey. Logistic regression was used to examine perioperative characteristics by ADI and rurality. RESULTS Compared to patients from the least deprived neighborhoods, patients from the most deprived neighborhoods were likely to be female (odds ratioOR 1.46, 95% confidence interval CI: 1.33-1.61), non-white (OR 1.36, 95% CI: 1.13-1.64), with education high school or less (OR 4.85, 95% CI: 4.35-5.41), be current smokers (OR 2.20, 95% CI: 1.61-2.49), have BMI>30 kg/m2 (OR 1.43, 95% CI: 1.30-1.57), more limitation on instrumental activities of daily living (OR 1.75, 95% CI: 1.55-1.97) and American Society of Anesthesiologists (ASA) score > II (OR 2.0, 95% CI: 1.11-1.37). There was a progressive association between the degree of area level deprivation with preexisting comorbidities. Patients from rural communities were more likely to be male, white, have body mass index (BMI)>30 kg/m2 and lower education levels. However, rurality was either not associated or negatively associated with comorbidities. CONCLUSION TJA patients from lower SES neighborhoods have worse behavioral risk factors and higher comorbidity burden than patients from higher SES neighborhoods. Patients from rural communities have worse behavioral risk factors but not comorbidities.
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Affiliation(s)
- Celia C. Kamath
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Thomas J. O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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21
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Brinkworth JF, Shaw JG. On race, human variation, and who gets and dies of sepsis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9544695 DOI: 10.1002/ajpa.24527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica F. Brinkworth
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
- Department of Evolution, Ecology and Behavior University of Illinois Urbana‐Champaign Urbana Illinois USA
| | - J. Grace Shaw
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
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22
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Estrada LV, Levasseur JL, Maxim A, Benavidez GA, Pollack Porter KM. Structural Racism, Place, and COVID-19: A Narrative Review Describing How We Prepare for an Endemic COVID-19 Future. Health Equity 2022; 6:356-366. [PMID: 35651360 PMCID: PMC9148659 DOI: 10.1089/heq.2021.0190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/17/2022] Open
Abstract
Background: Place is a social determinant of health, as recently evidenced by COVID-19. Previous literature surrounding health disparities in the United States often fails to acknowledge the role of structural racism on place-based health disparities for historically marginalized communities (i.e., Black and African American communities, Hispanic/Latinx communities, Indigenous communities [i.e., First Nations, Native American, Alaskan Native, and Native Hawaiian], and Pacific Islanders). This narrative review summarizes the intersection between structural racism and place as contributors to COVID-19 health disparities. Methods: This narrative review accounts for the unique place-based health care experiences influenced by structural racism, including health systems and services and physical environment. We searched online databases for peer-reviewed and governmental sources, published in English between 2000 and 2021, related to place-based U.S. health inequities in historically marginalized communities. We then narrate the link between the historical trajectory of structural racism and current COVID-19 health outcomes for historically marginalized communities. Results: Structural racism has infrequently been named as a contributor to place as a social determinant of health. This narrative review details how place is intricately intertwined with the results of structural racism, focusing on one's access to health systems and services and physical environment, including the outdoor air and drinking water. The role of place, health disparities, and structural racism has been starkly displayed during the COVID-19 pandemic, where historically marginalized communities have been subject to greater rates of COVID-19 incidence and mortality. Conclusion: As COVID-19 becomes endemic, it is crucial to understand how place-based inequities and structural racism contributed to the COVID-19 racial disparities in incidence and mortality. Addressing structurally racist place-based health inequities through anti-racist policy strategies is one way to move the United States toward achieving health equity.
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Affiliation(s)
- Leah V. Estrada
- Center for Health Policy, Columbia University School of Nursing, New York, New York, USA
| | - Jessica L. Levasseur
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Alexandra Maxim
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Gabriel A. Benavidez
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Keshia M. Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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23
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Harawa NT, Amani B, Abotsi-Kowu C, Nwankwo E, Ford CL. Using COVID-19 Surveillance Systems to Identify and Monitor Disparities: Best Practices and Recommendations. Ethn Dis 2022; 32:151-164. [PMID: 35497401 PMCID: PMC9037655 DOI: 10.18865/ed.32.2.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Inadequate attention to racial health equity is a common challenge to effective, reliable monitoring and mitigation of COVID-19 disparities. Efforts to monitor and mitigate COVID-19 disparities continue to be hampered by inadequacies in how surveillance systems collect, tabulate, and report COVID-19-related outcomes. We conducted environmental scans of existing public health surveillance systems and reporting standards, literature reviews, focus groups with surveillance experts, and consultations with the Centers for Disease Control and Prevention (CDC) and an expert panel on surveillance to identify and explore strengths, weaknesses, and gaps in how existing systems monitor COVID-19 and their implications for addressing disparities in related outcomes. We present recommendations based on these reviews and propose a core minimum set of health indicators and best-practice standards for reporting these indicators by COVID-19 surveillance systems to monitor racial/ethnic and other disparities in the pandemic. These recommendations are relevant to monitoring disparities in the ongoing COVID-19 pandemic and may inform monitoring of future epidemics. This discussion is part of an effort by Project REFOCUS to develop syndemic surveillance systems for monitoring the intersecting pandemics of COVID-19 and racism.
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Affiliation(s)
- Nina T. Harawa
- David Geffen School of Medicine, UCLA, Los Angeles, CA
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Bita Amani
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA
| | - Consuela Abotsi-Kowu
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA
| | - Ezinne Nwankwo
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA
- Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA
| | - Chandra L. Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA
- Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA
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Khanijahani A, Tomassoni L. Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA. J Racial Ethn Health Disparities 2022; 9:367-375. [PMID: 33469872 PMCID: PMC7815201 DOI: 10.1007/s40615-021-00965-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study's objective was to examine the association of the percentage of county population residing in concentrated disadvantage and Black-concentrated census tracts with county-level confirmed COVID-19 deaths in the USA, concentrated disadvantage and Black concentration at census tract-level measure socioeconomic segregation and racial segregation, respectively. METHODS We performed secondary data analysis using tract (N = 73,056) and county (N = 3142) level data from the US Census Bureau and other sources for the USA. Confirmed COVID-19 deaths per 100,000 population was our outcome measure. We performed mixed-effect negative binomial regression to examine the association of county population's percentage residing in concentrated disadvantage and Black-concentrated tracts with COVID-19 deaths while controlling for several other characteristics. RESULTS For every 10% increase in the percentage of county population residing in concentrated disadvantage and Black-concentrated tracts, the rate for confirmed COVID-19 deaths per 100,000 population increases by a factor of 1.14 (mortality rate ratio [MMR] = 1.14; 95% confidence interval [CI]:1.11, 1.18) and 1.11 (MMR = 1.11; 95% CI:1.08, 1.14), respectively. These relations stayed significant in all models in further sensitivity analyses. Moreover, a joint increase in the percentage of county population residing in racial and socioeconomic segregation was associated with a much greater increase in COVID-19 deaths. CONCLUSIONS It appears that people living in socioeconomically and racially segregated neighborhoods may be disproportionately impacted by COVID-19 deaths. Future multilevel and longitudinal studies with data at both individual and aggregated tract level can help isolate the potential impacts of the individual-level characteristics and neighborhood-level socioeconomic and racial segregation with more precision and confidence.
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Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282 USA
| | - Larisa Tomassoni
- Rollins School of Public Health, Emory University, Atlanta, GA USA
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25
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Essien UR, Youmans QR. Burning in "Other Suns": The Effects of Residential Segregation on Cardiovascular Health. Circ Cardiovasc Qual Outcomes 2022; 15:e008694. [PMID: 35105175 DOI: 10.1161/circoutcomes.121.008694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Utibe R Essien
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA (U.R.E.).,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA (U.R.E.)
| | - Quentin R Youmans
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Q.R.Y.)
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26
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Zhang Q, Metcalf SS, Palmer HD, Northridge ME. Spatial Analysis of Chinese American Ethnic Enclaves and Community Health Indicators in New York City. Front Public Health 2022; 10:815169. [PMID: 35155326 PMCID: PMC8831844 DOI: 10.3389/fpubh.2022.815169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
In New York City, the population of Chinese Americans has grown faster than that of any other minority racial/ethnic group, and now this community constitutes almost half of all Chinese Americans living in the northeastern United States. Nonetheless, scant research attention has been given to Chinese American ethnic enclaves and little is known about the health status of their residents. This study aims to help address this gap in the literature by: (1) improving our understanding of the spatial settlement of Chinese Americans living in New York City from 2000 to 2016; and (2) assessing associations between a New York City resident's likelihood of living in a Chinese American enclave and their access to health care and perceived health status, two measures of community health. In support of this aim, this study establishes a robust criterion for defining ethnic enclaves at the Census tract level in New York City as the communities of interest in this paper. An ethnic enclave is defined as an area at the Census tract level with high dissimilarity and a spatial cluster of Chinese Americans. The spatial findings were that Chinese Americans in New York City were least segregated from other Asian American residents, somewhat segregated from White residents, and most segregated from Black residents. Also, the population density of Chinese Americans increased since 2000, as reflected by their declining exposure index with other Asian Americans. Results from logistic regression indicated that the probability of living in a Chinese American enclave was negatively associated with positive self-perception of general health and positively associated with delays in receiving health care. For Chinese American residents of New York City, living in an ethnic enclave was also associated with both lower socioeconomic status and poorer community health.
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Affiliation(s)
- Qiuyi Zhang
- College of Architecture and Urban Planning, Fujian University of Technology, Fuzhou, China
- *Correspondence: Qiuyi Zhang
| | - Sara S. Metcalf
- Department of Geography, University at Buffalo, Buffalo, NY, United States
| | - Harvey D. Palmer
- Department of Political Science, University at Buffalo, Buffalo, NY, United States
| | - Mary E. Northridge
- Hansjorg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, United States
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Assessing Trauma Center Accessibility for Healthcare Equity Using an Anti-Covering Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031459. [PMID: 35162486 PMCID: PMC8835095 DOI: 10.3390/ijerph19031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
Motor vehicle accidents are one of the most prevalent causes of traumatic injury in patients needing transport to a trauma center. Arrival at a trauma center within an hour of the accident increases a patient's chances of survival and recovery. However, not all vehicle accidents in Tennessee are accessible to a trauma center within an hour by ground transportation. This study uses the anti-covering location problem (ACLP) to assess the current placement of trauma centers and explore optimal placements based on the population distribution and spatial pattern of motor vehicle accidents in 2015 through 2019 in Tennessee. The ACLP models seek to offer a method of exploring feasible scenarios for locating trauma centers that intend to provide accessibility to patients in underserved areas who suffer trauma as a result of vehicle accidents. The proposed ACLP approach also seeks to adjust the locations of trauma centers to reduce areas with excessive service coverage while improving coverage for less accessible areas of demand. In this study, three models are prescribed for finding optimal locations for trauma centers: (a) TraCt: ACLP model with a geometric approach and weighted models of population, fatalities, and spatial fatality clusters of vehicle accidents; (b) TraCt-ESC: an extended ACLP model mitigating excessive service supply among trauma center candidates, while expanding services to less served areas for more beneficiaries using fewer facilities; and (c) TraCt-ESCr: another extended ACLP model exploring the optimal location of additional trauma centers.
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28
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Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma. AIDS Behav 2022; 26:90-99. [PMID: 34436713 PMCID: PMC8390058 DOI: 10.1007/s10461-021-03416-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
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Affiliation(s)
- Jo A Valentine
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA.
| | - Lyana F Delgado
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Matthew Hogben
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
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29
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Rhubart D, Sun Y, Pendergrast C, Monnat S. Sociospatial Disparities in "Third Place" Availability in the United States. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2022; 8:10.1177/23780231221090301. [PMID: 37946734 PMCID: PMC10634631 DOI: 10.1177/23780231221090301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Tertiary to home and work, "third places" serve as opportunity structures that transmit information and facilitate social capital and upward mobility. However, third places may be inequitably distributed, thereby exacerbating disparities in social capital and mobility. The authors use tract-level data from the National Neighborhood Data Archive to examine the distribution of third places across the United States. There were significant disparities in the availability of third places. Higher poverty rates were associated with fewer third places. Tracts with the smallest shares of Black and Hispanic populations had comparatively more third places. However, this racial disadvantage was not linear, suggesting potential buffering effects in places with the largest shares of Black and Hispanic populations. There was also a rural disadvantage, except in the most isolated rural tracts. This study demonstrates the value of conceptualizing and measuring third places to understand sociospatial disparities in the availability of these understudied opportunity structures.
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Affiliation(s)
| | - Yue Sun
- Syracuse University, Syracuse, NY, USA
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30
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Road and Transportation Lead to Better Health and Sustainable Destination Development in Host Community: A Case of China Pakistan Economic Corridor (CPEC). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312832. [PMID: 34886559 PMCID: PMC8657269 DOI: 10.3390/ijerph182312832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/21/2022]
Abstract
Road and transportation plays a vital role in the sustainable development and prosperity of the area. This study investigates the impact of road and transportation on the health of the host community and its sustainable destination development. Data were collected from the host community and were analyzed through factor analysis and structure equation modeling to evaluate the in-hand data of the structural relationship. It is revealed that road and transportation has a significant role in the improvement of health. Moreover, income mediates the effects of accessibility and employment on health. This study will help the authorities and policy maker to formulate policy regarding road and transportation that will improve health of the host community and its sustainable development. The study is limited to the seven districts of Hazara division and explores the societal aspect of CPEC on the host community, future researcher may investigate other regions and may select some other variables such as effect on GDP, per capita income, etc.
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31
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Moss JL, Wang M, Liang M, Kameni A, Stoltzfus KC, Onega T. County-level characteristics associated with incidence, late-stage incidence, and mortality from screenable cancers. Cancer Epidemiol 2021; 75:102033. [PMID: 34560364 PMCID: PMC8627446 DOI: 10.1016/j.canep.2021.102033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cancer screening differs by rurality and racial residential segregation, but the relationship between these county-level characteristics is understudied. Understanding this relationship and its implications for cancer outcomes could inform interventions to decrease cancer disparities. METHODS We linked county-level information from national data sources: 2008-2012 cancer incidence, late-stage incidence, and mortality rates (for breast, cervical, and colorectal cancer) from U.S. Cancer Statistics and the National Death Index; metropolitan status from U.S. Department of Agriculture; residential segregation derived from American Community Survey; and prevalence of cancer screening from National Cancer Institute's Small Area Estimates. We used multivariable, sparse Poisson generalized linear mixed models to assess cancer incidence, late-stage incidence, and mortality rates by county-level characteristics, controlling for density of physicians and median household income. RESULTS Cancer incidence, late-stage incidence, and mortality rates were 6-18% lower in metropolitan counties for breast and colorectal cancer, and 2-4% lower in more segregated counties for breast and colorectal cancer. Generally, reductions in cancer associated with residential segregation were limited to non-metropolitan counties. Cancer incidence, late-stage incidence, and mortality rates were associated with screening, with rates for corresponding cancers that were 2-9% higher in areas with more breast and colorectal screening, but 2-15% lower in areas with more cervical screening. DISCUSSION Lower cancer burden was observed in counties that were metropolitan and more segregated. Effect modification was observed by metropolitan status and county-level residential segregation, indicating that residential segregation may impact healthcare access differently in different county types. Additional studies are needed to inform interventions to reduce county-level disparities in cancer incidence, late-stage incidence, and mortality.
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Affiliation(s)
| | - Ming Wang
- Penn State College of Medicine, Hershey, PA, USA
| | - Menglu Liang
- Penn State College of Medicine, Hershey, PA, USA
| | - Alain Kameni
- Penn State College of Medicine, Hershey, PA, USA
| | | | - Tracy Onega
- Huntsman Cancer Institute, Salt Lake City, UT, USA; University of Utah, Salt Lake City, UT, USA
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32
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Mayfield CA, Geraci M, Dulin M, Eberth JM, Merchant AT. Social and demographic characteristics of frequent or high-charge emergency department users: A quantile regression application. J Eval Clin Pract 2021; 27:1271-1280. [PMID: 33511747 DOI: 10.1111/jep.13537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Heavy users of the emergency department (ED) are a heterogeneous population. Few studies have captured the social and demographic complexity of patients with the largest burden of ED use. Our objective was to model associations between social and demographic patient characteristics and quantiles of the distributions of ED use, defined as frequent and high-charge. METHODS We conducted a cross-sectional analysis of electronic health and billing records of 99 637 adults residing in an urban North Carolina county who visited an ED within Atrium Health, a large integrated health care system, in 2017. Mid-quantile and standard quantile regression models were used for count and continuous responses, respectively. Frequent and high-charge use outcomes were defined as the median (0.50) and upper quantiles (0.75, 0.95, 0.99) of the outcome distributions for total billed ED visits and associated charges during the study period. Patient characteristic predictors were: insurance coverage (Medicaid, Medicare, private, uninsured), total visits to ambulatory care during the study period (0, 1, >1), and patient demographics: age, gender, race, ethnicity, and living in an underprivileged community called a public health priority area (PHPA). RESULTS Results showed heterogeneous relationships that were stronger at higher quantiles. Having Medicaid or Medicare insurance was positively associated with ED visits and ED charges at most quantiles. Racial and geographic disparities were observed. Black patients had more ED visits and lower ED charges than their White counterparts at most quantiles of the outcome distributions. Patients living in PHPAs, had lower charges than their counterparts at the median but higher charges at the 0.95 and 0.99 quantiles. CONCLUSIONS The relationships between patient characteristics and frequent and high-charge use of the ED vary based on the level of use. These findings can be used to inform targeted interventions, tailored policy, and population health management initiatives.
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Affiliation(s)
- Carlene A Mayfield
- Department of Community Health, Atrium Health, Charlotte, North Carolina, USA
| | - Marco Geraci
- MEMOTEF Department, School of Economics, Sapienza, University of Rome, Rome, Italy.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Michael Dulin
- Academy for Population Health Innovation, University of North Carolina Charlotte and Mecklenburg County Health Department, Charlotte, North Carolina, USA
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Rural and Minority Health Research Center, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Fortney S, Tassé MJ. Urbanicity, Health, and Access to Services for People With Intellectual Disability and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:492-504. [PMID: 34700348 DOI: 10.1352/1944-7558-126.6.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
Previous research suggests that residence in non-metropolitan areas is associated with lower access to preventive care and poorer health. However, this research has been largely restricted to the general population, despite data demonstrating disparities in health status and access to healthcare services for people with intellectual and developmental disabilities (IDD). The current study examined several hypotheses involving the effects of rurality on access to preventive healthcare and services and health status: (1) individuals in non-metropolitan areas will have lower preventive healthcare utilization, (2) individuals in non-metropolitan areas will have poorer health outcomes, and (3) individuals in non-metropolitan areas will have poorer access to services. The current study uses data from the National Core Indicators (NCI) Adult Consumer Survey 2015-2016: Final Report which included Rural-Urban Commuting Area (RUCA) Codes for the first time. Results of logistic regression suggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas have decreased access to healthcare services, preventive healthcare utilization, and health status. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts.
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Affiliation(s)
- Stoni Fortney
- Stoni Fortney and Marc J. Tassé, The Ohio State University
| | - Marc J Tassé
- Stoni Fortney and Marc J. Tassé, The Ohio State University
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34
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Suk R, Hong YR, Wasserman RM, Swint JM, Azenui NB, Sonawane KB, Tsai AC, Deshmukh AA. Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016. JAMA Netw Open 2021; 4:e2129913. [PMID: 34665238 PMCID: PMC8527360 DOI: 10.1001/jamanetworkopen.2021.29913] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Studies suggest the risk of suicide among people with cancer diagnosis is higher compared with the general population. However, little is known about how suicide risk among people diagnosed with cancer might vary according to area-level income and rurality. OBJECTIVE To examine whether the risks and patterns of suicide mortality among people with a cancer diagnosis differ by US county-level median income and rural or urban status. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study following up individuals who were diagnosed with cancer between January 1, 2000, and December 31, 2016, was conducted. The Surveillance, Epidemiology, and End Results Program 18 registries (SEER 18) database was used to obtain data on persons diagnosed with a first primary malignant tumor. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were conducted from February 22 to October 14, 2020. EXPOSURES County-level median household income and urban or rural status. MAIN OUTCOMES AND MEASURES Standardized mortality ratios (SMRs) of suicide deaths and annual percentage changes (APCs) of SMRs. RESULTS The SEER 18 database included 5 362 782 persons with cancer diagnoses living in 635 counties. Most study participants were men (51.2%), White (72.2%), and older than 65 years (49.7%). Among them, 6357 persons died of suicide (SMR, 1.41; 95% CI, 1.38-1.44). People with cancer living in the lowest-income counties had a significantly higher risk (SMR, 1.94; 95% CI, 1.76-2.13) than those in the highest-income counties (SMR, 1.30; 95% CI, 1.26-1.34). Those living in rural counties also had significantly higher SMR than those in urban counties (SMR, 1.81; 95% CI, 1.70-1.92 vs SMR, 1.35; 95% CI, 1.32-1.39). For all county groups, the SMRs were the highest within the first year following cancer diagnosis. However, among people living in the lowest-income counties, the risk remained significantly high even after 10 or more years following cancer diagnosis (SMR, 1.83; 95% CI, 1.31-2.48). The comparative risk of suicide mortality within 1 year following cancer diagnosis significantly decreased over the years but then plateaued in the highest-income (2005-2015: APC, 2.03%; 95% CI, -0.97% to 5.13%), lowest-income (2010-2015: APC, 4.80%; 95% CI, -19.97% to 37.24%), and rural (2004-2015: APC, 1.83; 95% CI, -1.98% to 5.79%) counties. CONCLUSIONS AND RELEVANCE This cohort study showed disparities in suicide risks and their patterns among people diagnosed with cancer by county-level income and rural or urban status. The findings suggest that additional research and effort to provide psychological services addressing these disparities among people with cancer may be beneficial.
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Affiliation(s)
- Ryan Suk
- Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Health Promotion and Preventive Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UF Health Cancer Center, Gainesville, Florida
| | - Rachel M. Wasserman
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Orlando, Florida
| | - J. Michael Swint
- Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston McGovern School of Medicine
| | | | - Kalyani B. Sonawane
- Center for Health Services Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Healthcare Data, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
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35
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Moss JL, Popalis M, Ramirez SI, Reedy-Cooper A, Ruffin MT. Disparities in Cancer Screening: The Role of County-Level Metropolitan Status and Racial Residential Segregation. J Community Health 2021; 47:168-178. [PMID: 34550504 DOI: 10.1007/s10900-021-01035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 12/21/2022]
Abstract
Mortality from cervical and colorectal cancers can be reduced through routine screening, which can often be accessed through primary care. However, uptake of screening in the US remains suboptimal, with disparities observed across geographic characteristics, such as metropolitan status or level of racial residential segregation. Little is known about the interaction of metropolitan status and segregation in their relationship with cancer screening. We conducted a quantitative survey of 474 women aged 45-65 in central Pennsylvania. The survey collected county-level characteristics and participant-level demographics, beliefs, cancer screening barriers, and cervical and colorectal cancer screening. We used bivariate and multivariable logistic regression to analyze relationships between metropolitan status and segregation with screening. For cervical cancer screening, 82.8% of participants were up-to-date, which did not differ by county type in the final analysis. Higher healthcare trust, higher cancer fatalism, and reporting cost as a barrier were associated with cervical cancer screening. For colorectal cancer screening, 55.4% of participants were up-to-date, which differed by county type. In metropolitan counties, segregation was not associated with colorectal cancer screening, but in non-metropolitan counties, segregation was associated with greater colorectal cancer screening. The relationship between metropolitan status and being up-to-date with colorectal, but not cervical, cancer screening varied by segregation. Other important beliefs and barriers to screening varied by county type. This research can guide future cancer screening interventions in primary care settings in underserved communities.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 134 Sipe Ave., #205, MC HS72, P.O. Box 850, Hershey, PA, 17033, USA.
| | - Madyson Popalis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Sarah I Ramirez
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Alexis Reedy-Cooper
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Mack T Ruffin
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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36
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Merkt PT, Kramer MR, Goodman DA, Brantley MD, Barrera CM, Eckhaus L, Petersen EE. Urban-rural differences in pregnancy-related deaths, United States, 2011-2016. Am J Obstet Gynecol 2021; 225:183.e1-183.e16. [PMID: 33640361 DOI: 10.1016/j.ajog.2021.02.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The US pregnancy-related mortality ratio has not improved over the past decade and includes striking disparities by race and ethnicity and by state. Understanding differences in pregnancy-related mortality across and within urban and rural areas can guide the development of interventions for preventing future pregnancy-related deaths. OBJECTIVE We sought to compare pregnancy-related mortality across and within urban and rural counties by race and ethnicity and age. STUDY DESIGN We conducted a descriptive analysis of 3747 pregnancy-related deaths during 2011-2016 (the most recent available data) with available zone improvement plan code or county data in the Pregnancy Mortality Surveillance System, among Hispanic and non-Hispanic White, Black, American Indian or Alaska Native, and Asian or Pacific Islander women aged 15 to 44 years. We aggregated data by US county and grouped counties per the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. We used R statistical software, epitools, to calculate the pregnancy-related mortality ratio (number of pregnancy-related deaths per 100,000 live births) for each urban-rural grouping, obtain 95% confidence intervals, and perform exact tests of ratio comparisons using the Poisson distribution. RESULTS Of the total 3747 pregnancy-related deaths analyzed, 52% occurred in large metro counties, and 7% occurred in noncore (rural) counties. Large metro counties had the lowest pregnancy-related mortality ratio (14.8; 95% confidence interval, 14.2-15.5), whereas noncore counties had the highest (24.1; 95% confidence interval, 21.4-27.1), including race and ethnicity and age groups. Pregnancy-related mortality ratio age disparities increased with rurality. Women aged 25 to 34 years and 35 to 44 years living in noncore counties had pregnancy-related mortality ratios 1.5 and 3 times higher, respectively, than women of the same age groups in large metro counties. Within each urban-rural category, pregnancy-related mortality ratios were higher among non-Hispanic Black women than non-Hispanic White women. Non-Hispanic American Indian or Alaska Native pregnancy-related mortality ratios in small metro, micropolitan, and noncore counties were 2 to 3 times that of non-Hispanic White women in the same areas. CONCLUSION Although more than half of pregnancy-related deaths occurred in large metro counties, the pregnancy-related mortality ratio rose with increasing rurality. Disparities existed in urban-rural categories, including by age group and race and ethnicity. Geographic location is an important context for initiatives to prevent future deaths and eliminate disparities. Further research is needed to better understand reasons for the observed urban-rural differences and to guide a multifactorial response to reduce pregnancy-related deaths.
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Affiliation(s)
- Peter T Merkt
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - David A Goodman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary D Brantley
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chloe M Barrera
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lindsay Eckhaus
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Emily E Petersen
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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37
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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Hospital Location and Socioeconomic Disadvantage of Emergency General Surgery Patients. J Surg Res 2021; 261:376-384. [PMID: 33493890 DOI: 10.1016/j.jss.2020.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 11/01/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emergency general surgery (EGS) patients are more socioeconomically vulnerable than elective counterparts. We hypothesized that a hospital's neighborhood disadvantage is associated with vulnerability of its EGS patients. MATERIALS AND METHODS Area deprivation index (ADI), a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patient-level data in State Inpatient Databases. Hospital and EGS patient characteristics were compared across hospital ADI quartiles (least disadvantaged [ADI 1-25] "affluent," minimally disadvantaged [ADI 26-50] "min-da", moderately disadvantaged [ADI 51-75] "mod-da", and most disadvantaged [ADI 76-100] "impoverished") using chi2 tests and multivariable regression. RESULTS Higher disadvantage hospitals are more often nonteaching (affluent = 38.9%, min-da = 53.5%, mod-da = 72.1%, and impoverished = 67.6%), nonaffiliated with medical schools (50%, 72.4%, 81.8%, and 78.8%), and in rural areas (3.3%, 9.2%, 31.2%, and 27.9%). EGS patients at higher disadvantage hospitals are more likely to be older (43.9%, 48.6%, 49.1%, and 46.6%), have >3 comorbidities (17.0%, 19.0%, 18.4%, and 19.3%), live in low-income areas (21.4%, 23.6%, 32.2%, and 42.5%), and experience complications (23.2%, 23.7%, 24.0%, and 25.2%). Rates of uninsurance/underinsurance were highest at affluent and impoverished hospitals (18.0, 16.4%, 17.7%, and 19.2%). Higher disadvantage hospitals serve fewer minorities (32.6%, 21.3%, 20.7%, and 24.0%), except in rural areas (2.9%, 6.7%, 6.5%, and 15.5%). In multivariable analyses, the impoverished hospital ADI quartile did not predict odds of serving as a safety-net or predominantly minority-serving hospital. CONCLUSIONS Hospitals in impoverished areas disproportionately serve underserved EGS patient populations but are less likely to have robust resources for EGS care or train future EGS surgeons. These findings have implications for measures to improve equity in EGS outcomes.
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Yang TC, Emily Choi SW, Sun F. COVID-19 cases in US counties: roles of racial/ethnic density and residential segregation. ETHNICITY & HEALTH 2021; 26:11-21. [PMID: 33059471 DOI: 10.1080/13557858.2020.1830036] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To investigate how racial/ethnic density and residential segregation shape the uneven burden of COVID-19 in US counties and whether (if yes, how) residential segregation moderates the association between racial/ethnic density and infections. DESIGN We first merge various risk factors from federal agencies (e.g. Census Bureau and Centers for Disease Control and Prevention) with COVID-19 cases as of June 13th in contiguous US counties (N = 3,042). We then apply negative binomial regression to the county-level dataset to test three interrelated research hypotheses and the moderating role of residential segregation is presented with a figure. RESULTS Several key results are obtained. (1) Counties with high racial/ethnic density of minority groups experience more confirmed cases than those with low levels of density. (2) High levels of residential segregation between whites and non-whites increase the number of COVID-19 infections in a county, net of other risk factors. (3) The relationship between racial/ethnic density and COVID-19 infections is enhanced with the increase in residential segregation between whites and non-whites in a county. CONCLUSIONS The pre-existing social structure like residential segregation may facilitate the spread of COVID-19 and aggravate racial/ethnic health disparities in infections. Minorities are disproportionately affected by the novel coronavirus and focusing on pre-existing social structures and discrimination in housing market may narrow the uneven burden across racial/ethnic groups.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, TX, USA
| | - Feinuo Sun
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
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Henderson LM, O'Meara ES, Haas JS, Lee CI, Kerlikowske K, Sprague BL, Alford-Teaster J, Onega T. The Role of Social Determinants of Health in Self-Reported Access to Health Care Among Women Undergoing Screening Mammography. J Womens Health (Larchmt) 2020; 29:1437-1446. [PMID: 32366199 PMCID: PMC7703148 DOI: 10.1089/jwh.2019.8267] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Social determinants of health (SDOH) contribute to health care disparities, with social and economic barriers often leading to difficulties in obtaining necessary care. We evaluated barriers to receiving health care, focusing on caretaker responsibilities, health insurance and cost, and transportation. Materials and Methods: We included women ages ≥40 years receiving screening mammography across three Breast Cancer Surveillance Consortium registries from 2012 to 2017. Women self-reported social and financial barriers to receiving health care in the 12 months before their screening mammogram. We evaluated woman- and census-based community-level factors associated with reporting a barrier using multivariate logistic regression. We assessed interaction with urban versus nonurban residence using Wald tests. Results: Among 393,430 women, 3.6% reported a barrier with a higher proportion in urban versus nonurban settings (3.9% [n = 11,977] vs. 2.2% [n = 1,655], respectively; p < 0.001). Among women reporting a barrier, health care cost and/or no insurance was the most common (49.3%), and no transportation was the least common (7.8%). Compared with white women, odds of reporting barriers were higher among black (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI]: 1.16-1.44), Hispanic (aOR = 1.66, 95% CI: 1.53-1.80), and other race (aOR = 1.84, 95% CI: 1.65-2.04) women. Barriers were less likely in women with higher median household income (aOR = 0.69, 95% CI: 0.61-0.79) or higher average health insurance costs (aOR = 0.85, 95% CI: 0.74-0.98), but were more likely in high diversity index areas (aOR = 1.28, 95% CI: 1.11-1.48). Conclusions: Social and financial barriers exist based on race/ethnicity and SDOH related to income, insurance costs, and place of residence among women undergoing screening mammography. Breast imaging facilities could utilize information on these barriers to improve biennial screening adherence or ensure that women with abnormal findings obtain appropriate follow-up care through targeted interventions.
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Affiliation(s)
- Louise M. Henderson
- Epidemiology Research, Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen S. O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer S. Haas
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Brian L. Sprague
- Department of Surgery, University of Vermont, Burlington, Vermont, USA
- Department of Radiology, University of Vermont, Burlington, Vermont, USA
| | - Jennifer Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Birenbaum-Carmeli D, Chassida J. Covid-19 in Israel: socio-demographic characteristics of first wave morbidity in Jewish and Arab communities. Int J Equity Health 2020; 19:153. [PMID: 32907584 PMCID: PMC7480661 DOI: 10.1186/s12939-020-01269-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The first wave of the Covid-19 pandemic hit Israel in late February 2020. The present study examines patterns of the first wave of Covid-19 morbidity in Israel at the macro level, during the period of late February to early June 2020, when the first wave has faded out. The analysis focuses on the significance of four sociodemographic variables: socioeconomic status, population density, rate of elderly population and minority status (Jewish / Arab identity) of the population in cities with 5000 residents or more. Additionally, we take a closer look into the association between morbidity rates and one SES component - home Internet access. METHODS The article is a cross sectional study of morbidity rates, investigated on a residential community basis. Following the descriptive statistics, we move on to present multivariate analysis to explore associations between these variables and Covid-19 morbidity in Israel. RESULTS Both the descriptive statistics and regressions show morbidity rates to be positively associated with population density. Socioeconomic status as well as the size of elderly population were both significantly related to morbidity, but only in Jewish communities. Interestingly, the association was inverse in both cases. i.e., the higher the SES the lower the morbidity and the larger the elderly population, the lower the community's morbidity. Another interesting result is that overall, morbidity rates in Jewish cities were consistently higher than in Arab communities. CONCLUSIONS We attribute the low morbidity rates in communities with relatively small elderly populations to the exceptionally high fertility rates in ultra-orthodox communities that sustained increased rates of morbidity; the lower morbidity in Arab communities is attributed to several factors, including the spatial Jewish-Arab segregation.
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Affiliation(s)
| | - Judith Chassida
- Department of Sociology and Anthropology, Tel Aviv University, Tel Aviv, Israel
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Yang TC, Park K, Matthews SA. Racial/ethnic segregation and health disparities: Future directions and opportunities. SOCIOLOGY COMPASS 2020; 14:e12794. [PMID: 32655686 PMCID: PMC7351362 DOI: 10.1111/soc4.12794] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/08/2020] [Indexed: 05/10/2023]
Abstract
Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we identified and systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non-black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non-black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long-term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, 315 AS, 1400 Washington Avenue, Albany, NY 12222
| | - Kiwoong Park
- Department of Sociology & Criminology, University of Arkansas, 211 Old Main, University of Arkansas Fayetteville, AR 72701
| | - Stephen A Matthews
- Department of Sociology & Criminology, Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802
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Melix BL, Uejio CK, Kintziger KW, Reid K, Duclos C, Jordan MM, Holmes T, Joiner J. Florida neighborhood analysis of social determinants and their relationship to life expectancy. BMC Public Health 2020; 20:632. [PMID: 32375737 PMCID: PMC7204051 DOI: 10.1186/s12889-020-08754-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social determinants of health (SDOH) contribute to unequal life expectancy (LE). Only a handful of papers have analyzed these relationships at the neighborhood level as opposed to the county level. This study draws on both the SDOH and social vulnerability literature to identify relevant factors affecting LE. METHODS LE was calculated from mortality records for Florida from 2009 to 2013 for 3640 census tracts with reliable estimates. A spatial Durbin error model (SDEM) quantified the direction and magnitude of the factors to LE. The SDEM contains a spatial error term and jointly estimates both local and neighborhood associations. This methodology controls for non-independence between census tracts to provide unbiased statistical estimates. RESULTS Factors significantly related to an increase in LE, include percentage (%) of the population who identify as Hispanic (beta coefficient [β]: 0.06, p-value [P] < 0.001) and % of age dependent populations (% population < 5 years old and % population > 65) (β: 0.13, P < 0.001). Conversely, the following factors exhibited significant negative LE associations, % of households with no automobile (β: -0.05, P < 0.001), % of mobile homes (β: -0.02, P < 0.001), and % of female headed households (β: -0.11, P < 0.001). CONCLUSIONS Results from the SDEM demonstrate social vulnerability indicators account for additional geographic LE variability beyond commonly studied SDOH. Empirical findings from this analysis can help local health departments identify drivers of spatial health disparities at the local level.
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Affiliation(s)
- Bertram L Melix
- Department of Geography, Florida State University, Tallahassee, FL, USA.
| | | | | | - Keshia Reid
- Division of Community Health Promotion, Tallahassee, FL, USA
| | - Chris Duclos
- Division of Disease Control and Health Protection, Tallahassee, FL, USA
| | - Melissa M Jordan
- Public Health Research Unit, Florida Department of Health, Tallahassee, FL, USA
| | - Tisha Holmes
- Department of Urban and Regional Planning, Florida State University, Tallahassee, FL, USA
| | - Jessica Joiner
- Public Health Research Unit, Florida Department of Health, Tallahassee, FL, USA
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Zhang X, Warner ME, Wethington E. Can Age-Friendly Planning Promote Equity in Community Health Across the Rural-Urban Divide in the US? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1275. [PMID: 32079197 PMCID: PMC7068446 DOI: 10.3390/ijerph17041275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/13/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
In the US, rural communities face challenges to meet the community health needs of older adults and children. Meanwhile, rural areas lag in age-friendly built environment and services. AARP, a US based organization promoting livability for all ages, has developed a Livability Index based on the World Health Organization's (WHO) domains of age-friendly communities: health, housing, neighborhood, transportation, environment, engagement, and opportunity. This study links the 2018 AARP Livability Index categories with demographic structure and socio-economic factors from the American Community Survey at the county level in the US to examine if the physical, built and social environment differentiate communities with better community health across the rural-urban divide. Results show that the neighborhood built environment has the largest impact on community health for all county types. Although rural areas lag in community health, those which give more attention to engagement and opportunity rank higher. Rural communities with more African Americans, children, and poor Whites, rank lower on community health. While neighborhood characteristics have the strongest link to community health, a broader approach with attention to age, race, poverty and engagement and opportunity is needed for rural areas.
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Affiliation(s)
- Xue Zhang
- Department of City and Regional Planning, Cornell University, Ithaca, NY 14853, USA;
| | - Mildred E. Warner
- Department of City and Regional Planning, Cornell University, Ithaca, NY 14853, USA;
| | - Elaine Wethington
- Department of Human Development, Roybal Center, Cornell University, Ithaca, NY 14853, USA;
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Key CD, Wheat JR. An Exploratory Study of Occupational Safety and Health with Limited Resource African-American Farmers. J Agromedicine 2020; 26:140-150. [PMID: 32052702 DOI: 10.1080/1059924x.2020.1724842] [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: 10/25/2022]
Abstract
Objectives: Limited resource African-American farmers exist at the nexus of several correlates of disparities (e.g., minority, poor, rural, and agricultural) and beyond the reach of most health promotion programs. Minimal research addresses their occupational safety and health. We proposed to explore such concerns with them.Methods: We conducted phenomenological interviews with nine farmers about work practices, farm operations, safety practices, health, and sources of information and assistance. We audio-recorded, transcribed, and analyzed interviews to code topics and identify themes.Results: The farmers varied in background, land ownership, farm products, and degree of resource limitation. We identified six themes: limited capital and sources of information, old unsafe machinery and equipment, a pragmatic resilient attitude, distrust of public institutions and agencies, lack of safety training useful on their farms, and personal health conditions.Conclusion: These themes raise hypotheses about limited resource African-American farmers' experience with agricultural safety and health compounded by various economic, environmental, behavioral, social, and institutional determinants. We recommend that these hypotheses be pursued with effective community engagement and partnership to collect and interpret needed data from samples representative of the population of these farmers, including comparison with other limited resource farmer populations.
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Affiliation(s)
- Corey D Key
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - John R Wheat
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
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Rural-Urban Differences in Access to Primary Care: Beyond the Usual Source of Care Provider. Am J Prev Med 2020; 58:89-96. [PMID: 31862103 DOI: 10.1016/j.amepre.2019.08.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In the U.S., rural residents have poorer health than urban residents and this disadvantage is growing. Therefore, it is important to understand rural-urban differences in access to medical care. This study compared the percentage of individuals with a usual source of care and characteristics of usual source of care providers across 3 urban-rural categories. METHODS This study identified 51,920 adults from the 2014-2016 Medical Expenditure Panel Survey and estimated the percentage with a usual source of care across the rural-urban categories. Then, differences in a variety of provider characteristics were examined. Estimates were weighted to be representative of the U.S. non-institutionalized population and adjusted for age, race/ethnicity, self-rated health, and presence of chronic conditions. Analysis was conducted in 2018 and 2019. RESULTS Compared with metropolitan county residents, residents of the most rural counties were 7 percentage points more likely to have a usual source of care (81% vs 74%), but their providers were 13 percentage points less likely to be physicians (22% vs 35%). Despite having to travel longer to reach their usual source of care providers, residents of the most rural counties were 18 percentage points less likely than metropolitan residents to have usual source of care providers with office hours on nights and weekends (27% vs 39%). CONCLUSIONS Rural-urban differences in access to care are complex; there is a rural disadvantage on some dimensions of access but not others. To understand rural-urban disparities in healthcare access, research should move beyond the usual source of care provider as an overall indicator and instead investigate disparities using multiple indicators of access based on theoretically distinct domains.
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Zahnd WE, McLafferty SL, Eberth JM. Multilevel analysis in rural cancer control: A conceptual framework and methodological implications. Prev Med 2019; 129S:105835. [PMID: 31520673 PMCID: PMC7136953 DOI: 10.1016/j.ypmed.2019.105835] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that address the cancer control continuum, population-level disparities, access to health care services, and social inequities. Micro-level factors comprised individual-level characteristics that either predispose or enable individuals to utilize health care services or that may affect their cancer risk. Macro-level factors included social context (e.g. domains of social inequity) and physical context (e.g. access to care). Rural-urban status was considered a macro-level construct spanning both social and physical context, as "rural" is often characterized by sociodemographic characteristics and distance to health care services. Supra-macro-level factors included policies and systems (e.g. public health policies) that may affect cancer disparities. Our conceptual framework can guide researchers in conceptualizing multilevel statistical models to evaluate the independent contributions of rural-urban status on cancer while accounting for important micro, macro, and supra-macro factors. Statistically, potential collinearity of multilevel model predictive variables, model structure, and spatial dependence should also be considered.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America.
| | - Sara L McLafferty
- Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, 1301 W. Green Street Urbana, IL 61801, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Lorch SA, Lee HC, Phibbs CS, Rogowski J, Gould JB, Firebaugh G. Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants. JAMA Pediatr 2019; 173:455-461. [PMID: 30907924 PMCID: PMC6503514 DOI: 10.1001/jamapediatrics.2019.0241] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear. OBJECTIVE To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks' gestation from January 2014 to December 2016. Analysis began January 2018. MAIN OUTCOMES AND MEASURES The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index. RESULTS Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46-0.53], Hispanic: 0.58 [95% CI, 0.54-0.61], and Asian: 0.45 [95% CI, 0.40-0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02-0.13], Hispanic: -0.10 [95% CI, -0.17 to -0.04], and Asian: -0.26 [95% CI, -0.32 to -0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: -0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants. CONCLUSIONS AND RELEVANCE Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.
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Affiliation(s)
- Jeffrey D. Horbar
- Vermont Oxford Network, Burlington,Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington,Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington,Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington
| | | | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,California Perinatal Quality Care Collaborative, Palo Alto
| | - David Draper
- Department of Statistics, Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz
| | - Daniel Helkey
- Department of Statistics, Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
| | - Henry C. Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,California Perinatal Quality Care Collaborative, Palo Alto
| | - Ciaran S. Phibbs
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California
| | - Jeannette Rogowski
- Department of Health Policy and Administration, Pennsylvania State University, State College
| | - Jeffrey B. Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,California Perinatal Quality Care Collaborative, Palo Alto
| | - Glenn Firebaugh
- Department of Sociology and Criminology, Pennsylvania State University, State College
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Fitts JJ, Aber MS, Allen NE. Individual, Family, and Site Predictors of Youth Receipt of Therapy in Systems of Care. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09504-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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