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Khazanchi R, South EC, Cabrera KI, Winkelman TNA, Vasan A. Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. Am J Prev Med 2024; 66:936-947. [PMID: 38416088 DOI: 10.1016/j.amepre.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Neighborhood violence is an adverse childhood experience which impacts millions of U.S. children and is associated with poor health outcomes across the life course. These effects may be mitigated by access to care. Yet, the ways in which exposure to neighborhood violence shapes children's health care access have been understudied. METHODS This is a cross-sectional analysis of 16,083 children (weighted N=67,214,201) ages 1 to <18 years from the 2019 and 2021 National Health Interview Survey. Guardians were asked about preventive care access, unmet health needs, and health care utilization in the last year. Changes associated with exposure to neighborhood violence were estimated using marginal effects from multivariable logistic regression models adjusted for year, age, sex, race/ethnicity, parental education, family structure, rurality, income, insurance type, insurance discontinuity, and overall reported health. RESULTS Of 16,083 sample children, 863 (weighted 5.3% [95% CI 4.8-5.7]) reported exposure to neighborhood violence, representing a weighted population of ∼3.5 million. In adjusted analyses, exposure to violence was associated with forgone prescriptions (adjusted difference 1.2 percentage-points (pp) [95%CI 0.1-2.3]; weighted national population impact 42,833 children), trouble paying medical bills (7.7pp [4.4-11.0]; 271,735), delayed medical (1.5pp [0.2-2.9]; 54,063) and mental health care (2.8pp [1.1-4.6]; 98,627), and increased urgent care (4.5pp [0.9-8.1]; 158,246) and emergency department utilization (6.4pp [3.1-9.8]; 227,373). CONCLUSIONS In this nationally representative study, neighborhood violence exposure among children was associated with unmet health needs and increased acute care utilization. Evidence-based interventions to improve access to care and reduce economic precarity in communities impacted by violence are needed to mitigate downstream physical and mental health consequences.
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Affiliation(s)
- Rohan Khazanchi
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts; FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
| | - Eugenia C South
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keven I Cabrera
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Liang MH, Lew ER, Fraser PA, Flower C, Hennis EH, Bae SC, Hennis A, Tikly M, Roberts WN. Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2024; 76:823-835. [PMID: 38229482 DOI: 10.1002/art.42797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Abstract
Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.
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Affiliation(s)
- Matthew H Liang
- Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Cindy Flower
- University of the West Indies, Cave Hill campus, Barbados
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea
| | - Anselm Hennis
- University of the West Indies, Cave Hill campus, Barbados
| | - Mohammed Tikly
- The Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and Life Roseacres Hospital, Primrose, Germiston, South Africa
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Henry CM, Oseran AS, Zheng Z, Dong H, Wadhera RK. Cardiovascular hospitalizations and mortality among adults aged 25-64 years in the USA. Eur Heart J 2024; 45:1017-1026. [PMID: 37952173 PMCID: PMC10972685 DOI: 10.1093/eurheartj/ehad772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND AIMS Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25-64 years were evaluated, overall and by community-level income. METHODS Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25-64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities. RESULTS Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P < .001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P < .001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P < .001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period. CONCLUSIONS There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow.
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Affiliation(s)
- Chantal M Henry
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Meharry Medical College, Nashville,
TN, USA
| | - Andrew S Oseran
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Huaying Dong
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
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Bouchelle Z, Darwiche S, Dalembert G. Financial support policies as a mechanism to reduce child welfare involvement. Curr Probl Pediatr Adolesc Health Care 2024; 54:101554. [PMID: 38184448 DOI: 10.1016/j.cppeds.2023.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Affiliation(s)
- Zoe Bouchelle
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Denver Health, Denver, CO, United States; Guaranteed Income and Health Consortium, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Sabrina Darwiche
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - George Dalembert
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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MCCONNELL MARGARET, AGARWAL SUMIT, HANSON ERIKA, MCCRADY ERIN, PARKER MARGARETG, BONA KIRA. Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings. Milbank Q 2024; 102:64-82. [PMID: 37994263 PMCID: PMC10938935 DOI: 10.1111/1468-0009.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes.
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Affiliation(s)
| | | | - ERIKA HANSON
- Center for Health Law and Policy Innovation, Harvard Law School
| | - ERIN MCCRADY
- Center for Health Law and Policy Innovation, Harvard Law School
| | - MARGARET G. PARKER
- Child Health Equity CenterUniversity of Massachusetts Chan Medical School
| | - KIRA BONA
- Harvard Medical School
- Dana‐Farber Cancer Institute
- Boston Children's Hospital
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Albert MA, Churchwell K, Desai N, Johnson JC, Johnson MN, Khera A, Mieres JH, Rodriguez F, Velarde G, Williams DR, Wu JC. Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association. Circulation 2024; 149:e312-e329. [PMID: 38226471 DOI: 10.1161/cir.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.
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Alosi B, Curtis DS. Racial and Ethnic Disparities in Blood Pressure and Glycemic Control in the US Community Health Center Patient Population. J Prim Care Community Health 2024; 15:21501319241226766. [PMID: 38270076 PMCID: PMC10812092 DOI: 10.1177/21501319241226766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE To describe blood pressure and glycemic control by racial/ethnic group in the US Community Health Center (CHC) patient population, and whether center characteristics, proxying for higher resource levels and better quality of care, were associated with greater rates of controlled cardiometabolic conditions. METHODS Data came from the Uniform Data System, representing aggregate patient clinical data for individual health centers in 2019. Descriptive analyses were conducted weighting by health center patient populations to produce race-specific national rates of blood pressure and glycemic control, and linear regression is used to test whether cardiometabolic control rates varied by center characteristics. RESULTS Hypertension was controlled for 67.2% of non-Hispanic White, 66.9% of Hispanic, and 56.7% of non-Hispanic Black patients. Diabetes was controlled for 70.7% of non-Hispanic White, 65.7% of Hispanic, and 66.1% of non-Hispanic Black patients. The rate of blood pressure control was 2.54 to 3.99 percentage points higher across racial/ethnic groups in health centers that adopted a patient-centered medical home (PCMH) model of care relative to non-PCMH centers, while glycemic control was 1.08 to 2.27 pp. higher as a function of PCMH certification. Results for other center characteristics did not show consistent patterns across racial groups or outcomes. CONCLUSION This study documented racial and ethnic health disparities in the CHC patient population after major expansion of the CHC program. CHCs with PCMH certification have improved clinical outcomes among patients with hypertension and diabetes across racial/ethnic groups relative to centers without this certification.
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Birkenmaier J, Maynard B, Shanks H, Blumhagen H. PROTOCOL: Medical-financial partnerships for improving financial and health outcomes for lower-income Americans: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1364. [PMID: 37818253 PMCID: PMC10561025 DOI: 10.1002/cl2.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
This is the protocol for a Campbell systematic review. The primary objectives of this review is to answer the following research questions using formal research studies: What is the extent and quality of MFP intervention research? What are the effects on financial outcomes of financial services embedded within healthcare settings? What are the effects on health-related outcomes of financial services embedded within healthcare settings?
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Affiliation(s)
| | - Brandy Maynard
- Saint Louis University School of Social WorkSt LouisMissouriUSA
| | - Hannah Shanks
- Saint Louis University School of Social WorkSt LouisMissouriUSA
| | - Harly Blumhagen
- Saint Louis University School of Social WorkSt LouisMissouriUSA
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Roy AM, George A, Attwood K, Alaklabi S, Patel A, Omilian AR, Yao S, Gandhi S. Effect of neighborhood deprivation index on breast cancer survival in the United States. Breast Cancer Res Treat 2023; 202:139-153. [PMID: 37542631 PMCID: PMC10504126 DOI: 10.1007/s10549-023-07053-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/14/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To analyze the association between the Neighborhood Deprivation Index (NDI) and clinical outcomes of locoregional breast cancer (BC). METHODS Surveillance, Epidemiology and End Results (SEER) database is queried to evaluate overall survival (OS) and disease-specific survival (DSS) of early- stage BC patients diagnosed between 2010 and 2016. Cox multivariate regression was performed to measure the association between NDI (Quintiles corresponding to most deprivation (Q1), above average deprivation (Q2), average deprivation (Q3), below average deprivation (Q4), least deprivation (Q5)) and OS/DSS. RESULTS Of the 88,572 locoregional BC patients, 27.4% (n = 24,307) were in the Q1 quintile, 26.5% (n = 23,447) were in the Q3 quintile, 17% (n = 15,035) were in the Q2 quintile, 13.5% (n = 11,945) were in the Q4 quintile, and 15.6% (n = 13,838) were in the Q5 quintile. There was a predominance of racial minorities in the Q1 and Q2 quintiles with Black women being 13-15% and Hispanic women being 15% compared to only 8% Black women and 6% Hispanic women in the Q5 quintile (p < 0.001). In multivariate analysis, in the overall cohort, those who live in Q2 and Q1 quintile have inferior OS and DSS compared to those who live in Q5 quintile (OS:- Q2: Hazard Ratio (HR) 1.28, Q1: HR 1.2; DSS:- Q2: HR 1.33, Q1: HR 1.25, all p < 0.001). CONCLUSION Locoregional BC patients from areas with worse NDI have poor OS and DSS. Investments to improve the socioeconomic status of areas with high deprivation may help to reduce healthcare disparities and improve breast cancer outcomes.
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Affiliation(s)
- Arya Mariam Roy
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
| | - Anthony George
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Sabah Alaklabi
- Division of Oncology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Archit Patel
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
| | - Angela R. Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14228 USA
| | - Shipra Gandhi
- Division of Hematology and Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263 USA
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Loehrer AP. High-deductible Health Plans, Surgical Conditions, and a Different Moral Hazard. Ann Surg 2023; 278:e675-e676. [PMID: 37450695 DOI: 10.1097/sla.0000000000006010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Andrew P Loehrer
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Dartmouth Cancer Center, Lebanon, NH
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Venkataramani AS. Moving Beyond Intent and Realizing Health Equity. JAMA HEALTH FORUM 2023; 4:e232525. [PMID: 37656474 DOI: 10.1001/jamahealthforum.2023.2525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Abstract
The current approach for the management of pulmonary arterial hypertension (PAH) relies on data gathered from clinical trials and large registries. However, there is concern that minorities including Black, Indigenous, and People of Color are underrepresented in these trials and registries, making current data not generalizable to these groups of patients. Hence, it is important to discuss the significance of race/ethnicity and socioeconomic factors in patients with PAH. Here, we review the current knowledge on health care disparities in PAH. We also propose future steps in the global task of assuring justice and equality in access to pulmonary hypertension health care.
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Affiliation(s)
- Roberto J Bernardo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Boulevard, Suite 8400, Oklahoma City, OK 73104, USA
| | - Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Grant S140B, Stanford, CA 94305, USA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA, USA.
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FISCELLA KEVIN, EPSTEIN RONALDM. The Profound Implications of the Meaning of Health for Health Care and Health Equity. Milbank Q 2023; 101:675-699. [PMID: 37343061 PMCID: PMC10509522 DOI: 10.1111/1468-0009.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high-quality primary care. The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.
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Sandhu AT, Heidenreich PA, Borden W, Farmer SA, Ho PM, Hammond G, Johnson JC, Wadhera RK, Wasfy JH, Biga C, Takahashi E, Misra KD, Joynt Maddox KE. Value-Based Payment for Clinicians Treating Cardiovascular Disease: A Policy Statement From the American Heart Association. Circulation 2023; 148:543-563. [PMID: 37427456 DOI: 10.1161/cir.0000000000001143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Clinician payment is transitioning from fee-for-service to value-based payment, with reimbursement tied to health care quality and cost. However, the overarching goals of value-based payment-to improve health care quality, lower costs, or both-have been largely unmet. This policy statement reviews the current state of value-based payment and provides recommended best practices for future design and implementation. The policy statement is divided into sections that detail different aspects of value-based payment: (1) key program design features (patient population, quality measurement, cost measurement, and risk adjustment), (2) the role of equity during design and evaluation, (3) adjustment of payment, and (4) program implementation and evaluation. Each section introduces the topic, describes important considerations, and lists examples from existing programs. Each section includes recommended best practices for future program design. The policy statement highlights 4 key themes for successful value-based payment. First, programs should carefully weigh the incentives between lowering cost and improving quality of care and ensure that there is adequate focus on quality of care. Second, the expansion of value-based payment should be a tool for improving equity, which is central to quality of care and should be a focal point of program design and evaluation. Third, value-based payment should continue to move away from fee for service toward more flexible funding that allows clinicians to focus resources on the interventions that best help patients. Last, successful programs should find ways to channel clinicians' intrinsic motivation to improve their performance and the care for their patients. These principles should guide the future development of clinician value-based payment models.
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Nouri S, Quinn M, Doyle BN, McKissack M, Johnson N, Wertz M, Tan C, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "We've Got to Bring Information to Where People Are Comfortable": Community-Based Advance Care Planning with the Black Community. J Gen Intern Med 2023; 38:2478-2485. [PMID: 36894819 PMCID: PMC9998020 DOI: 10.1007/s11606-023-08134-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND People identifying as Black/African American are less likely to engage in advance care planning (ACP) compared to their White peers, despite the association of ACP with improved patient and caregiver outcomes. OBJECTIVES Assess facilitators/barriers to ACP in the San Francisco (SF) Black community and co-design/implement/test community-based ACP pilot events. DESIGN Community-based participatory research, including qualitative research, intervention development, and implementation. PARTICIPANTS In partnership with the SF Palliative Care Workgroup (which includes health system, city, and community-based organizations), we formed an African American Advisory Committee (n = 13). We conducted 6 focus groups with Black older adults (age ≥ 55), caregivers, and community leaders (n = 29). The Advisory Committee then selected 5 community-based organizations through a widespread request for proposal. These community-based organizations designed and implemented community-based pilot events to support ACP engagement. MAIN MEASURES Two authors analyzed recorded focus group transcripts using thematic analysis. We assessed pre- vs post-event readiness to engage in ACP (validated ACP Engagement Survey; 1-4 scale, 4 = most ready) using Wilcoxon signed rank tests and assessed event acceptability with open-ended questions. KEY RESULTS Themes included the importance of ACP to the Black community (sub-themes: strengthens families; preserves dignity, particularly for sexual/gender minorities; is tied to financial planning) and facilitators for increasing ACP engagement (sub-themes: culturally relevant materials; events in trusted community spaces including Black-owned businesses). A total of 114 participants attended 5 events; 74% identified as Black, and 16% as sexual/gender minorities. Readiness to engage in ACP was similar pre- vs post-events; 98% would recommend the events to others. CONCLUSIONS Community-based ACP events designed and led by and for the Black community are highly acceptable. Novel insights underscored the importance of financial planning as part of ACP and the role of Black-owned businesses as trusted spaces for ACP-related discussions.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Natalya Johnson
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Molly Wertz
- Molly Wertz Consulting, San Francisco, CA, USA
| | - Charissa Tan
- John A. Burns School of Medicine, University of Hawai'I at Mānoa, Honolulu, HI, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, USA
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16
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Khraishah H, Daher R, Garelnabi M, Karere G, Welty FK. Sex, Racial, and Ethnic Disparities in Acute Coronary Syndrome: Novel Risk Factors and Recommendations for Earlier Diagnosis to Improve Outcomes. Arterioscler Thromb Vasc Biol 2023; 43:1369-1383. [PMID: 37381984 PMCID: PMC10664176 DOI: 10.1161/atvbaha.123.319370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
In this review, sex, racial, and ethnic differences in acute coronary syndromes on a global scale are summarized. The relationship between disparities in presentation and management of acute coronary syndromes and effect on worse clinical outcomes in acute coronary syndromes are discussed. The effect of demographic, geographic, racial, and ethnic factors on acute coronary syndrome care disparities are reviewed. Differences in risk factors including systemic inflammatory disorders and pregnancy-related factors and the pathophysiology underlying them are discussed. Finally, breast arterial calcification and coronary calcium scoring are discussed as methods to detect subclinical atherosclerosis and start early treatment in an attempt to prevent clinical disease.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore (H.K.)
| | - Ralph Daher
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos (R.D.)
| | - Mahdi Garelnabi
- Department of Biomedical and Nutritional Sciences and the UMass Lowell Center for Population Health, University of Massachusetts Lowell (M.G.)
| | - Genesio Karere
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (G.K.)
| | - Francine K Welty
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (F.K.W.)
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17
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Mentias A, Mujahid MS, Sumarsono A, Nelson RK, Madron JM, Powell-Wiley TM, Essien UR, Keshvani N, Girotra S, Morris A, Sims M, Capers Q, Yancy C, Desai MY, Menon V, Rao S, Pandey A. Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries. Circulation 2023; 148:210-219. [PMID: 37459409 PMCID: PMC10797918 DOI: 10.1161/circulationaha.123.064351] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P<0.001). This association remained significant after further adjustment for area-level Social Deprivation Index (risk ratio, 1.04 [95% CI, 1.002-1.08]; P=0.04). A significant interaction was observed between redlining proportion and Social Deprivation Index (Pinteraction<0.01) such that higher redlining proportion was significantly associated with HF risk only among socioeconomically distressed regions (above the median Social Deprivation Index). Among White beneficiaries, redlining was associated with a lower risk of HF after adjustment for age, sex, and comorbidities (risk ratio, 0.94 [95% CI, 0.89-0.99]; P=0.02). CONCLUSIONS Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.
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Affiliation(s)
- Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Mahasin S Mujahid
- Division of Epidemiology, UC Berkeley, School of Public Health, Berkeley CA
| | - Andrew Sumarsono
- Division of Hospital Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Utibe R. Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles, CA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Alanna Morris
- Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Quinn Capers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Milind Y. Desai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Venu Menon
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Shreya Rao
- Division of Cardiology, Department of Internal Medicine, UTHSC San Antonio, San Antonio, TX
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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18
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Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, Betz M, Hargarten S, Williams A, Horwitz JM, Nehra D, Burstin H, Sheehan K, Dreier FL, James T, Sathya C, Armstrong JH, Rowhani-Rahbar A, Charles S, Goldberg A, Lee LK, Stewart RM, Kerby JD, Turner PL, Bulger EM. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg 2023; 236:1242-1260. [PMID: 36877809 DOI: 10.1097/xcs.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Joseph V Sakran
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD (Sakran)
| | - Sue S Bornstein
- American College of Physicians, Philadelphia, PA (Bornstein)
| | - Rochelle Dicker
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of California Los Angeles, Los Angeles, CA (Dicker)
| | - Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle, WA (Rivara)
| | - Brendan T Campbell
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT (Campbell)
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Cunningham)
| | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Aurora, CO (Betz)
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (Hargarten)
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL (Williams)
| | - Joshua M Horwitz
- Johns Hopkins Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Horwitz)
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
| | - Helen Burstin
- Council of Medical Specialty Societies, Washington, DC (Burstin)
| | - Karen Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Sheehan)
| | - Fatimah L Dreier
- The Health Alliance for Violence Intervention, Jersey City, NJ (Dreier)
| | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA (James)
| | - Chethan Sathya
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Cohen Children's Medical Center, Northwell Health, Queens, NY (Sathya)
| | - John H Armstrong
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Armstrong)
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (Rowhani-Rahbar)
| | - Scott Charles
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Amy Goldberg
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Lois K Lee
- Department of Emergency Medicine, Boston Children's Hospital, Boston, MA (Lee)
| | - Ronald M Stewart
- Department of Surgery, University of Texas San Antonio, San Antonio, TX (Stewart)
| | - Jeffrey D Kerby
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL (Kerby)
| | - Patricia L Turner
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
| | - Eileen M Bulger
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
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19
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Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Issa J Dahabreh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- CAUSALab, Departments of Epidemiology, and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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20
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Luke MJ, Vasan A. Understanding and Addressing Racial and Ethnic Inequities in Pediatric Length of Stay. Hosp Pediatr 2023; 13:e92-e94. [PMID: 36911918 PMCID: PMC10087104 DOI: 10.1542/hpeds.2023-007146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Michael J Luke
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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ALBERTI PHILIPM, PIERCE HEATHERH. A Population Health Impact Pyramid for Health Care. Milbank Q 2023; 101:770-794. [PMID: 37096611 PMCID: PMC10126965 DOI: 10.1111/1468-0009.12610] [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: 04/15/2022] [Revised: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points To meaningfully impact population health and health equity, health care organizations must take a multipronged approach that ranges from education to advocacy, recognizing that more impactful efforts are often more complex or resource intensive. Given that population health is advanced in communities and not doctors' offices, health care organizations must use their advocacy voices in service of population health policy, not just health care policy. Foundational to all population health and health equity efforts are authentic community partnerships and a commitment to demonstrating health care organizations are worthy of their communities' trust.
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Affiliation(s)
- PHILIP M. ALBERTI
- AAMC Center for Health Justice, Association of American Medical Colleges
| | - HEATHER H. PIERCE
- AAMC Center for Health Justice, Association of American Medical Colleges
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22
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Baptist AP, Apter AJ, Gergen PJ, Jones BL. Reducing Health Disparities in Asthma: How Can Progress Be Made. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:737-745. [PMID: 36693539 PMCID: PMC10640900 DOI: 10.1016/j.jaip.2022.12.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
Health disparities (recently defined as a health difference closely linked with social, economic, and/or environmental disadvantage) in asthma continue despite the presence of safe and effective treatment. For example, in the United States, Black individuals have a hospitalization rate that is 6× higher than that for White individuals, and an asthma mortality rate nearly 3× higher. This article will discuss the current state of health disparities in asthma in the United States. Factors involved in the creation of these disparities (including unconscious bias and structural racism) will be examined. The types of asthma interventions (including case workers, technological advances, mobile asthma clinics, and environmental remediation) that have and have not been successful to decrease disparities will be reviewed. Finally, current resources and future actions are summarized in a table and in text, providing information that the allergist can use to make an impact on asthma health disparities in 2023.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Bridgette L Jones
- Section of Allergy Asthma Immunology, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Mo; Children's Mercy, Kansas City, Mo
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23
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Hitchens BK. The cumulative effect of gun homicide-related loss on neighborhood perceptions among street-identified black women and girls: A mixed-methods study. Soc Sci Med 2023; 320:115675. [PMID: 36702029 PMCID: PMC10035432 DOI: 10.1016/j.socscimed.2023.115675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
Racial disparities in death indicate that Black women and girls are disproportionately bereaved by violent loss across their lifetime. Yet the context and consequences of this loss remain largely understudied. This study examines the effect of gun homicide-related loss of relative/friends on subjective neighborhood perceptions among street-identified Black women and girls (ages 16 to 54). The study used a convergent mixed-methods design, with simultaneous quantitative and qualitative components. Data were collected from two low-income, high-crime neighborhoods in Wilmington, Delaware. Quantitative data (n = 277) included a community-based survey on health, opportunity and violence. Qualitative data (n = 50) included semi-structured interviews primarily from a sub-group of the survey population. This study used a street participatory action research (Street PAR) methodology, which included members of the target population onto the research project. OLS regression analyses predicted the effect of exposure to gun homicide on perceptions of neighborhood social environment (i.e., safety, aesthetic quality, walkability, social cohesion, and availability of healthy foods). Interviews were analyzed using grounded theory. Approximately 87% of those surveyed were exposed to a relative/friend gun homicide. All interviewees were exposed to a relative/friend gun homicide. Exposure to the gun homicide of either a relative or friend alone was nonsignificant. But the combination of exposure to gun homicides of both a relative and friend was significantly related to poorer neighborhood perceptions, even when controlling for co-occurring factors. Mixed-method findings indicate that the cumulative impact of gun homicide-related loss matters most in shaping negative neighborhood perceptions. Qualitative data suggest that losing multiple members of one's familial and peer networks to homicide is a powerful form of co-victimization that alters how participants conceptualize and navigate public space. Interventions to decrease gun violence should consider how traumatic loss has unintended consequences on the quality of life of co-victims and those in close proximity to street life.
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Affiliation(s)
- Brooklynn K Hitchens
- Department of Criminology & Criminal Justice, University of Maryland, College Park, USA.
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24
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Ansell DA, Fruin K, Holman R, Jaco A, Pham BH, Zuckerman D. The Anchor Strategy - A Place-Based Business Approach for Health Equity. N Engl J Med 2023; 388:97-99. [PMID: 36617374 DOI: 10.1056/nejmp2213465] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- David A Ansell
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Kaitlyn Fruin
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Redia Holman
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Ayesha Jaco
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Bich Ha Pham
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - David Zuckerman
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
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25
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Abstract
IMPORTANCE Prior research has identified associations between housing insecurity and poor health outcomes. OBJECTIVE To evaluate the association between US state Medicaid expansions and reductions in eviction; to examine the persistence of these associations and how they vary across US states and counties. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 25 398 county-year observations (across 40 states) used US eviction and census data for the years 2002 through 2018 (ie, 17 years). County-level associations were estimated using interactive fixed effects counterfactual estimators, and models were selected using cross validation. Across-county treatment association heterogeneities were assessed using multivariable regression methods. Analyses were performed in July of 2022. EXPOSURE State-level Medicaid expansion under the Patient Protection and Affordable Care Act. MAIN OUTCOMES AND MEASURES Eviction judgments; eviction judgments per 100 renter-occupied households. RESULTS Among a total of 774 treated counties (with Medicaid expansion) and 720 control counties (untreated, without Medicaid expansion), mean (SD) eviction judgments for treated counties were 534.78 (1945.84) eviction judgments in the pre-2014 period (mean [SD] eviction rate, 2.25 [2.18] per 100 households), which decreased to 463.67 (1499.39) eviction judgments in the post-2014 period (mean [SD] eviction judgment rate, 2.02 [1.81] per 100 households). Control group mean (SD) county eviction judgments were 477.22 (1592.18) eviction judgments (mean [SD] eviction judgment rate, 1.91 per 100 households) pre-2014, and 490.22 (1575.19) eviction judgments (mean [SD] eviction judgment rate, 1.89 per 100 households) post-2014. Model estimates indicate that Medicaid expansion was associated with reductions in county eviction judgments by -66.49 (95% CI, -132.50 to -0.48; P = .047) and reductions of the eviction judgment rate by -0.25 (95% CI, -0.35 to -0.14; P < .001). Associations remained broadly consistent between 2014 and 2018, although some diminishment of associations occurred in 2018. Approximately 29% of the across-county treatment association variation was explained by across-state differences, while 9% was explained by county-level demographic and uninsurance differences. CONCLUSIONS AND RELEVANCE In this cohort study, Medicaid expansion was associated with reductions in eviction judgments and eviction judgment rates; however, these associations were found to vary considerably both across as well as within states (across counties). These findings suggest that the channel between Medicaid expansion and evictions is sensitive to state environments as well as county specific population demographics and uninsurance levels.
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Affiliation(s)
- Sebastian Linde
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee
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